Endometriosis and IBS – what’s the difference?

Endometriosis and IBS are two different conditions that share symptoms like abdominal pain, bloating, and cramping.

This similarity makes diagnosing both challenging and often leads to misdiagnosis of IBS instead of endometriosis.

In this article, we will discuss the differences between endometriosis and IBS and their symptoms. We will also highlight the diagnosis process for endometriosis and the available treatments.

What is endometriosis and IBS?

Endometriosis occurs when cells similar to the uterus lining grow outside the uterus. It can often affect organs such as the ovaries, fallopian tubes, bladder, and bowel (3).

These cells act similarly to those in the uterus, thickening, breaking down, and bleeding with each menstrual cycle. As these cells cannot exit the body, they remain trapped.

This can result in pain, inflammation, and scarring in the surrounding pelvic organs. As these tissues grow in the bowel, they can cause symptoms that resemble IBS (4). 

It is still not well understood what causes endometriosis. You can read about the possible factors that may play a role in endometriosis here: ‘Low FODMAP in endometriosis’.

IBS is a common condition that affects the digestive system. Around 1 in 10 people worldwide are estimated to be affected by it, with women being twice as likely to have it than men (5).

You can find more about the symptoms and causes of IBS here: ‘What are the symptoms and causes of IBS?’.

What are the symptoms of endometriosis?

The symptoms of endometriosis vary from person to person, and the severity of symptoms can range from mild to severe.

The severity of the pain does not indicate the degree of endometriosis (6). 

Some people have a mild form of the condition and experience significant pain, while others have a severe form and experience minimal discomfort.

Some people with endometriosis do not experience any symptoms. For those who do, typical endometriosis symptoms can include (7): 

• Fatigue
• Fertility issues
• Pain during or after sex
• Painful bowel movements or urination
• Pelvic pain that gets worse around menstruation

What is the difference between endometriosis and IBS?

It is not uncommon to misdiagnose endometriosis and IBS as each other because they share similar symptoms.

In a study, more than 90% of people with endometriosis reported having gastrointestinal symptoms similar to IBS (8). 

Here are the similarities and differences between endometriosis and IBS:

Symptoms	IBS (9)	Endometriosis (10)
Life-long condition	Yes	Yes
Bloating	Yes	Yes
Constipation	Yes	Yes
Diarrhea	Yes	Yes
Abdominal pain	Yes	Yes
Blood in stool	No	Yes
Nausea and vomiting	No	Yes
Heavy periods (menorrhagia)	No	Yes
Painful periods (dysmenorrhea)	No	Yes
Fertility issues	No	Yes
Pain with sex	No	Yes
Bladder issues	No	Yes

There are some key differences between IBS and endometriosis. One way to tell the difference between them is that endometriosis symptoms are usually cyclical (11). 

This means you may only get symptoms at specific points in your menstrual cycle. 

Symptoms tend to get worse in the days before and during a period and lessen following menstruation. 

However, some women can also experience constant pain regardless of their menstrual cycle (12). If you notice you have any of these symptoms, it is important to speak to your doctor.

How do you get diagnosed with endometriosis?

Diagnosing endometriosis can be a challenging process due to its diverse range of symptoms and its similarities to other conditions. 

On average, it can take eight years from when the symptoms start to have endometriosis diagnosed (13). 

Your doctor will ask about your symptoms, so it can be helpful to note them and track your monthly cycle. You can use the pain and symptom diary created by the Endometriosis UK.  

Doctors may use different approaches to diagnose endometriosis, including:

1. Pelvic exam

Your doctor will carry out a pelvic exam to examine your vulva, vagina and cervix to check for areas of scarring (14). 

Your doctor may refer you to a gynecologist for other tests, such as an ultrasound scan, MRI, or laparoscopy (15). 

2. Imaging tests

An ultrasound or MRI exam can help detect endometriosis by analyzing the uterus, ovaries, bladder, bowel and other surrounding areas (16). 

However, a normal scan and internal examination do not mean that you do not have endometriosis (17). 

3. Surgical laparoscopy 

The only way to definitively diagnose endometriosis is surgical laparoscopy, also known as keyhole surgery.

This is where the surgeon uses a camera (a laparoscope) passed through a small cut in your stomach to look for signs of endometriosis (18).

Sometimes, the surgeon can remove some of the endometrial tissue during the procedure.

Can endometriosis cause IBS?

There is no evidence that endometriosis can directly cause IBS or vice versa.

However, women with endometriosis have a three-fold increase in IBS risk compared to those without (19).

This could be due to endometrial-like cells often be found near the large bowel in the pelvic area and any inflammation nearby may cause changes in bowel habits similar to IBS (20).

It is also possible to have both endometriosis and IBS at the same time. One study showed 24% of adolescent women with endometriosis also had IBS (21). 

Although there is no direct link between the two conditions, they can coexist together. If you notice symptoms of either or both, please speak to your doctor for an accurate diagnosis.

What is the treatment for endometriosis?

Sadly, there is no cure for endometriosis. However, there are plenty of management options available that can help alleviate the symptoms. 

Some people may not need treatment if the symptoms are mild or if they are not experiencing fertility issues. The symptoms may also improve if you are nearing menopause (22). 

Management options for endometriosis include (23):

• Pain relief medications to help with the pain, e.g., ibuprofen and paracetamol
• Hormone treatment to help reduce the womb lining to shorten periods and ease heavy menstrual bleeding, e.g., the contraceptive pill, contraceptive patch, contraceptive injection, intrauterine system (IUS)
• Surgery to remove the overgrowth of endometriosis tissue
• Surgery to remove part or all of the organs affected by endometriosis, e.g., hysterectomy to remove the womb

Your doctor will look at various factors, such as your age, severity of your endometriosis, and symptoms, before discussing the best treatment plan for you (24).

Is there an endometriosis and IBS diet?

Even though many claims on the internet promise improvements in symptoms, researchers have not thoroughly studied diets for endometriosis.

However, studies show that the Mediterranean diet, which is rich in antioxidants and omega-3 fatty acids, could reduce endometriosis-related pain (25).

You can read more about diet and endometriosis in detail in our post here: ‘Low FODMAP in endometriosis’.

Summary

Endometriosis and IBS are two different conditions that can cause gastrointestinal symptoms. Women with endometriosis have a three-fold increase in IBS risk compared to those without.

Both conditions can be challenging to diagnose due to similar symptoms, and there is no single test for both. However, many treatments are available to control or improve symptoms. 

If you notice any symptoms for either or both conditions, please speak to your doctor to find the best treatment to help manage your symptoms.