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What causes endo belly flare ups?

Chung, this bloating can occur when endometrial-like tissue builds up and causes inflammation in the abdomen, cysts formed by trapped blood due to endometrial-like tissue covering or growing into the ovaries, small intestinal bacterial overgrowth and fibroids, or issues with digestions, such as constipation and gas.

endofound.org - Managing 'Endo Belly' (Severe Bloating) - EndoFound

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Endometriosis does not just cause basic bloating. Your abdomen becomes so distended that you double over in pain and feel like something is stabbing you in the stomach. Someone I spoke to likened the pain to labor, or a wire hanger scraping her insides.

What is this extreme bloating?

Severe bloating, also known as “endo belly,” is one of the many difficult symptoms we, as endometriosis survivors, need to deal with. “Essentially,” says Dr. Sophie Chung, CEO and Founder of Qunomedical, a 24/7 personalized liaison to connect patients with medical professionals worldwide, “‘endo belly’ can happen for a few reasons.” According to Dr. Chung, this bloating can occur when endometrial-like tissue builds up and causes inflammation in the abdomen, cysts formed by trapped blood due to endometrial-like tissue covering or growing into the ovaries, small intestinal bacterial overgrowth and fibroids, or issues with digestions, such as constipation and gas. Aside from the extreme agony associated with a painfully distended abdomen, endo belly can take a significant hit to a woman’s self-confidence. The common phrase I have heard from countless women—and thought myself on many occasions—is I look 6 months pregnant. Women do not recognize their bodies. Clothes do not fit anymore. All you want to do is curl up into the fetal position and wait for the pain to subside. While preventing endo belly is impossible, I spoke with Dr. Chung, Leeanna Maher (my pelvic floor physiotherapist), and others who suffer from endometriosis to learn their tips and tricks to limit flare ups and cope with the pain.

What can we do to manage the symptoms of endo belly?

Heat

Dr. Chung recommends a hot water bottle or wheat bags to lay on your bloated stomach since heat helps muscle tissue to relax, which soothes cramps. “Heat over 104 degrees Fahrenheit (40 Celsius) stimulates your sensory receptors, which block the transmission of pain signals to the brain, resulting in an instant and effective pain relief,” says Dr. Chung. This tip is by far the one I use most. During flare ups, a heating pad is constantly on my body, as if it was glued there.

Diet Changes

Anita Jones, an ambassador for Endometriosis UK, was diagnosed with endometriosis in 2019. Following her surgery, her pain did not subside. She was recommended to try a no “CRAP” (caffeine, refined sugars, alcohol, or processed foods) diet. “I generally feel lighter and my stomach ‘behaves’ more because there’s less to irritate it,” says Jones. Personally, I have switched to a gluten-free diet and it has made the world of a difference. Rather than having regular endo belly flare ups, my bloating has been limited to mostly around my menstrual cycle since I have eliminated a major trigger for my inflammation.

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Yoga and Meditation

Michelle Maslin-Taylor, a yoga teacher and intuitive coach, uses yoga poses to help balance her hormones and deal with bloating. “Opening up your pelvic area, and increasing flexibility and circulation in this area, can help with pain relief,” says Dr. Chung. “Moderate exercises such as Pilates and yoga can be fantastic to support this process; seated hip flexor stretches, and a wall side bend stretch can really help to release those muscle groups.” Meditation can also help lower your anxiety and relax your pelvic floor. “By working on your breathing or meditating, you’re relieving some tension which helps to manage stress levels,” says Dr. Chung. “Certain tricks when meditating can trigger the pineal gland which is responsible for managing your stress levels.”

Pelvic Floor Physiotherapy

This tip is another one of my favorites. “Pelvic physiotherapists provide education on a comprehensive stretching and exercise program that addresses altered posture, optimizes breathing mechanics, normalizes pelvic muscle tension and weakness,” says Leeanna Maher, Pelvic Health Physiotherapist at Alpha Health Services in Toronto and a vital member of my personal endometriosis treatment team. “We provide internal and external manual therapy techniques to normalize the muscle tone, restore mobility and strength throughout the pelvic floor and the core muscles.” Maher explains that since finding a diagnosis for endometriosis can be lengthy, “the body can alter its alignment, breathing strategies, and muscle tone to protect and guard from the pain. Repeated episodes of pain can sensitize the nervous system,” and in turn, increase pain. Along with breathing techniques, Maher taught me the “ILU” massage that has been immensely helpful when I am experiencing endo belly. While pressing on your bloated stomach may seem like the last thing you want to do, trust me, you will feel so much better after. With moisturizer on your fingertips, start with downwards strokes from your left rib cage to the front of your left hip (to form an “I”). Repeat this ten times. Next, create a vertical line underneath your rib cage from the right to left side, continuing the motion down your left side into the “I” (to form an upside down “L”). Repeat this ten times. Finally, move your fingertips from the front of your right hip bone, up to the bottom of your right rib cage, underneath your rib cage, then down your left side to your left hip bone (to form a “U”). Repeat this ten times. This massage, in addition to deep breaths, calms my stress levels and assists in moving irritants in my stomach, like food or gas. “All of these strategies, in turn, help to calm the nervous system, as this provides clients with the self-efficacy and tools in their life to integrate into a practice, improve functional mobility, and help manage and reduce their pain,” says Maher.

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Herbs and Supplements

Melissa MacKenzie was diagnosed with endometriosis in November 2020. “I do find it harder to eat with the bloating, as it usually kills my appetite,” says MacKenzie. While she is early in her journey, she has found herbal Gravol and sipping on ginger ale help to cope with the effects of endo belly. Cathy Schwenning, who suffers from umbilical endometriosis, drinks turmeric tea during the day and “Soothe-Me” chamomile tea at night. Both turmeric and chamomile are known to have anti-inflammatory properties that can help relieve symptoms.

Switch Your Mindset

“I try to remember that there are times during my cycle when I have no control over how my body behaves. Bloating is unfortunately a common symptom of endometriosis,” says Tara Mandarano, who has been suffering with endometriosis for about 20 years. For Mandarano, reminding herself that the bloating is temporary and will subside helps to reduce her stress. “I try to wear my loosest, comfiest jogging pants and try not to berate myself for looking 6 months pregnant. I wear flowy tops that make me feel less self-conscious. I don't even attempt to put on jeans, otherwise I'd have to walk around with the button(s) undone.” Before trying any treatments, Dr. Chung advises to always consult with your physician first.

endofound.org - Managing 'Endo Belly' (Severe Bloating) - EndoFound

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