Can Endometriosis Cause Vomiting and Diarrhea?
Yes, endometriosis can cause both vomiting and diarrhea, though these gastrointestinal symptoms are typically part of a broader symptom complex that includes cyclic abdominal pain, bloating, and other bowel disturbances.
Gastrointestinal Manifestations Are Common
- Approximately 90% of women with endometriosis experience gastrointestinal symptoms, with these symptoms being nearly as common as the classical gynecological presentations 1
- Specific gastrointestinal complaints include cyclic diarrhea, constipation, nausea, vomiting, and nonspecific stomach complaints 2
- These symptoms can occur even without direct bowel involvement by endometriotic lesions—only 7.6% of women with endometriosis have histologically confirmed bowel lesions, yet 90% report gastrointestinal symptoms 1
Mechanisms Behind GI Symptoms
- The chronic inflammatory nature of endometriosis creates extensive inflammatory reactions throughout the pelvis, which can affect bowel function independently of direct tissue invasion 2
- Women with endometriosis demonstrate a reduced stretch pain threshold of the intestinal wall, making them more sensitive to normal bowel distension and contributing to symptoms like bloating, pain, nausea, and altered bowel habits 2
- When bowel obstruction occurs from direct ileal or intestinal involvement (though rare), patients present with repeated episodes of abdominal pain, non-bilious vomiting, and diarrhea 3
Clinical Recognition Patterns
- Gastrointestinal symptoms in endometriosis are often cyclical, worsening during the second half of the menstrual cycle and menstruation, though they may become continuous as disease progresses 3, 2
- The constellation includes dyschezia (painful bowel movements), cyclic diarrhea, constipation, nausea, vomiting, and the characteristic "endo belly" (cyclic bloating causing abdominal distension and discomfort) 2, 4
- 21.4% of women with endometriosis had been previously misdiagnosed with irritable bowel syndrome (IBS), and 79% of those labeled with IBS actually had histologically confirmed endometriosis 1
Critical Diagnostic Pitfall
- Do not dismiss gastrointestinal symptoms as IBS or other functional bowel disorders in reproductive-age women without considering endometriosis, especially when symptoms are cyclical or associated with dysmenorrhea, dyspareunia, or chronic pelvic pain 1
- The clinical and radiological similarities between endometriosis and inflammatory, infective, or irritable bowel diseases create significant preoperative diagnostic challenges 3
When to Suspect Direct Bowel Involvement
- While most GI symptoms occur without bowel lesions, consider imaging for deep infiltrating endometriosis if symptoms are severe or progressive 5
- Transvaginal ultrasound with expanded protocol or MRI demonstrates 92.4% sensitivity and 94.6% specificity for intestinal endometriosis when present 5
- Rare cases of small bowel obstruction from endometriotic strictures present with repeated episodes of vomiting and diarrhea, particularly when symptoms become continuous rather than purely cyclical 3
Management Approach
- Empiric hormonal therapy (combined oral contraceptives or progestin-only options) is appropriate as first-line treatment even without surgical confirmation, as these medications address the underlying inflammatory process 6, 4
- Surgical referral is indicated if empiric therapy fails, immediate diagnosis is necessary, or the patient desires pregnancy 6