The Link Between Endometriosis and SIBO: Unveiling a Hidden Connection
Why is bloating one of the most common symptoms associated with endometriosis?
In my clinical practice I have found that SIBO (Small Intestinal Bacterial Overgrowth) contributes on some level to all of my endometriosis clients’ bloating and digestive discomfort.
Research is backing up this clinical finding, and has shed light on a strong connection between endometriosis and SIBO. In this blog post, we will explore the link between endometriosis and SIBO, understanding how these two conditions intertwine and affect women's health.
Understanding Endometriosis:
Endometriosis occurs when endometrial tissue, which usually lines the uterus, starts growing outside of it. This tissue can implant itself on various organs within the pelvic cavity, such as the fallopian tubes, ovaries, bladder, and intestines. The condition causes chronic inflammation, severe pain during menstruation, infertility, and gastrointestinal symptoms, among others.
SIBO Explained:
Small Intestinal Bacterial Overgrowth is a disorder characterised by an excessive growth of bacteria in the small intestine (not necessarily ‘bad’ bacteria, just bacteria).
Normally, the small intestine contains fewer bacteria compared to the large intestine. However, in SIBO, an overgrowth of bacteria occurs, leading to symptoms like bloating, abdominal pain, diarrohea or constipation. Other common symptoms of SIBO could be reflux, burping, rosacea, joint pain and brain fog.
The Link between Endometriosis and SIBO:
The theory suggests that the chronic inflammation caused by endometriosis may disrupt the normal functioning of the gastrointestinal tract, leading to an imbalance in gut bacteria and promoting the development of SIBO. Conversely, the overgrowth of bacteria in the small intestine could trigger inflammation and worsen the symptoms of endometriosis.
In more detail:
Simply put: SIBO worsens endometriosis and endometriosis exacerbates SIBO.
For instance, women with endometriosis often experience pelvic adhesions, which can cause intestinal dysmotility and slow down the movement of food through the gut. This ‘slow down’ (or dysmotility) causes bacteria to get ‘trapped’ in the small intestine – promoting the development of SIBO. This also damages the gut lining leading to intestinal permeability (leaky gut).
Conversely, the overgrowth of bacteria in the small intestine and the accompanying inflammation in the gut leads to the leakage of toxic substances into the pelvic cavity - where all of your reproductive organs, intestines and bladder lie. This can trigger massive inflammation and an immune response which can further flare pain and discomfort of endo lesions.
On top of this, hormonal imbalances, particularly oestrogen metabolism issues, play a crucial role in endometriosis development and digestive issues, as oestrogen affects gut motility and peristalsis and can therefore promote bacterial overgrowth. There are also certain gut bacterial that contribute to oestrogen metabolism in either a detrimental o beneficial way (more on this another day!)
Thus, cyclical hormonal fluctuations associated with endometriosis can easily also contribute to SIBO.
The Clinical Implications:
Recognising the link between endometriosis and SIBO is crucial for accurate diagnosis and treatment. A comprehensive endo management plan in my clinic will always involve a SIBO test. Luckily- this is cheaper than a comprehensive stool analysis ($190) and can be done in the comfort of your own home.
Clinical Management:
Managing both endometriosis and SIBO simultaneously is vital to improve symptoms and quality of life for Endowarriors.
Treatment options include:
Targeting Inflammation: Anti-inflammatory herbs and nutraceuticals such as zinc, turmeric and glutamine as well as dietary change can help reduce inflammation associated with both endometriosis and SIBO, and help to heal the gut.
Antimicrobial & Anti-fungal Herbal Medicine: In cases of confirmed SIBO, a course of antimicrobial herbs may be prescribed to eradicate the bacterial overgrowth.
Promote small intestine motility with prokinetics - to keep the small intestine moving correctly.
Hormonal Detox and Support: Supporting thorough Oestrogen metabolism via liver and gut.
