Endometriosis can be linked with bowel symptoms. These symptoms may happen around a period, throughout the month, during flare-ups, or alongside pelvic pain.

Bowel symptoms can be confusing because they may be mistaken for digestive problems, food intolerance, stress or irritable bowel syndrome. Some people may have endometriosis and a separate bowel condition at the same time.

This article explains bowel symptoms that may be worth tracking and discussing with a healthcare professional.

How endometriosis may affect bowel symptoms

Bowel symptoms may be linked with endometriosis on or near the bowel, deep endometriosis involving bowel tissue, inflammation, adhesions or scar tissue, pelvic floor muscle tension, pain sensitivity, bowel conditions that overlap with endometriosis, or changes in how the gut responds during the menstrual cycle.

Users do not need to know the cause before asking for help. What matters is explaining what happens, when it happens and how it affects life.

Symptoms to look out for

Bowel symptoms linked with endometriosis may include:

  • pain when opening the bowels
  • constipation
  • diarrhoea
  • bloating
  • nausea
  • rectal pain
  • pressure or heaviness in the bowel area
  • pain before, during or after a bowel movement
  • feeling like the bowel has not fully emptied
  • needing to strain
  • mucus or bleeding from the bowel
  • bowel symptoms that flare before or during a period
  • bowel symptoms that happen with pelvic pain
  • pain that feels deep, sharp, dragging or cramping

If bleeding from the bowel happens, especially if it follows a cyclical pattern, it should be discussed with a healthcare professional.

Cyclical bowel symptoms

A symptom is cyclical when it follows a repeated pattern linked with the menstrual cycle. Bowel symptoms may become worse before a period, during a period, around ovulation, during a flare, or at the same point each month.

Cyclical bowel symptoms are important to mention in appointments because they may help guide further assessment.

Bowel symptoms are not always bowel disease

Bowel symptoms can happen even if endometriosis is not directly growing into the bowel. Inflammation, adhesions, pelvic floor tension or pain sensitisation may affect bowel function.

It is also possible to have both endometriosis and another bowel condition. If symptoms are severe, persistent or changing, they should not be dismissed.

What bowel endometriosis can involve

Bowel endometriosis may involve the surface of the bowel or deeper layers of bowel tissue.

If bowel involvement is suspected, care may need input from specialists with experience in endometriosis and, in some cases, colorectal surgery.

This does not mean everyone with bowel symptoms needs surgery. It means the assessment and care plan should match symptoms, findings and individual goals.

What to track before an appointment

Users should use the Prepare for Appointment Tool to organise bowel symptoms before speaking with a healthcare professional.

The tool can help record symptoms, timing, cycle link, bowel movement link, bleeding, whether symptoms are worsening, daily impact, whether bowel symptoms happen with bladder/pelvic/fatigue symptoms, and whether symptoms affect eating, sleep, school, work or social life.

Useful wording might include: "My bowel pain is worse before my period, and I get sharp rectal pain when opening my bowels."

Questions to ask

Users may want to ask:

  • Could my bowel symptoms be linked with endometriosis?
  • Could I have bowel endometriosis or adhesions?
  • Would specialist ultrasound or MRI help?
  • Should I be referred to an endometriosis specialist?
  • Should a colorectal specialist be involved?
  • What symptoms should make me seek urgent help?
  • How can I manage symptoms while waiting for assessment?
  • Could pelvic physiotherapy help if pelvic floor tension is involved?

When to seek urgent medical help

Seek urgent medical help for severe sudden abdominal or pelvic pain, heavy or concerning bowel bleeding, black stools, vomiting with severe pain, inability to pass stool or wind with severe pain or bloating, fever, fainting, unexplained weight loss, or new loss of bowel control.

Final reminder

Bowel symptoms linked with endometriosis are real and can be distressing. They deserve to be taken seriously, especially if they are cyclical, painful, worsening or affecting life.