Why You May Be Experiencing Diarrhoea and Painful Bowel Movements on Your Period with Endo - a podcast by Jessica Duffin

from 2022-03-28T17:11:27

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Every time I meet a potential new client, I go through their symptom history with them. About 90% of the time, they tell me they have cyclical diarrhoea, and some of them experience pain with that diarrhoea. Naturally, many of them are really worried by these symptoms and are concerned it’s endo related, and that it mean there’s endo in or around the rectum, but the truth is, that it might not be directly caused by endo itself. In fact, diarrhoea or loose stools during your period is very common, for people both with and without endometriosis.

Now, this doesn’t mean it’s normal and that we should put up with it. There are some very real reasons this issue can occur and some very tangible ways to reduce it, so let’s get into it.

Inflammation and the menstrual cycle

Okay, so the number one reason most of us get diarrhoea or loose stools on our periods is inflammation. This is the biggest take away from today’s episode.

Inflammation is a normal part of the menstrual cycle – we have higher levels of inflammatory chemicals prostaglandins E2 and histamines during both ovulation and menstruation. These chemicals aid the shedding of the uterine lining by causing contractions, and they aid with the egg release during ovulation.

It’s healthy to have these in normal levels and these normal levels, can cause more frequent and a little looser bowel movements. This occurs because prostaglandins sort of ‘spill’ over into the surrounding area, and if you look at a cross section of the pelvis, you’ll see that the colon is directly behind the uterus, so it is very easily affected. So, these prostaglandins not only cause a contraction sensation in the uterus, but in the bowel as well.

So as a result, all of us, to a degree, will have more frequent, maybe a little less formed stools, during our period. Especially just before and on Day 1 when levels of these inflammatory chemicals are at their highest.

The issue of course is that for those of us with endo and/or painful periods, we don’t tend to have normal levels of prostaglandins, in fact, research has shown us that people with endo and people who experience painful periods, have higher levels of prostaglandins. Which means severer cramps, heightened pain and very likely, diarrhoea. And of course, this excessive inflammation is painful – that’s one of the symptoms of inflammation – pain, and when it’s too high, it can be very severe, so if you’re getting pain in your rectum or gut, it could be due to the severity of the cramping and swelling caused by excessive inflammation in the area.

Now, just because we have endo, that doesn’t mean we have to put up with high levels of prostaglandins. Yes, the endo lesions themselves release prostaglandins and the body releases excessive amounts because our immune system is constantly trying to repair and protect the area from endo, but we can lower these levels, and as a result, see an improvement in pain with endo, as well as an improvement in diarrhoea and painful bowel movements during menstruation.

I’ll get to how to do that shortly, but let’s move onto my second reason as to why you may be experiencing painful bowel movements and diarrhoea during menstruation.

Aggravated pelvic floor dysfunction and nerve sensitivity

We know that many people with endometriosis have a tight pelvic floor, where the muscles are tense and constricted. Contrary to popular belief, this can mean the muscles are weak – yes, they are tight, but that doesn’t mean they’re strong. In fact, muscles need to be able to contract and release in order to perform the correct movements, and if they’re tight all the time, they can’t do that, and so the function of muscles that control bowel movements and urination can become impaired.

Now some of us can feel the effects of this all month long, and it might look like constipation or faecal urgency (which is when the urge to go just can’t wait), but when we have excessive prostaglandins causing a lot of cramping and movements in the bowel, we suddenly have loose and watery stools sitting in the colon and weak muscles with the inability to hold them. So we end up having to dash to and fro from the toilet.

Additionally, the tightness of the muscles can be aggravating the nerves in the area, creating hypersensitivity, resulting in pain or urgency. This can of course be worsened if you’ve had surgery which could have affected your nerves (and I’ve linked to an article that explains why this can occur) and of course constant pain can cause nerve sensitivity, and endo on the nerves can also do this too. So, your nerves may be responding with even more sensitivity to this situation.

Endo and adhesions

Next up is of course an obvious one, and that’s that you may potentially have endo or adhesions on the bowel. Now, what I will say is that most of the clients I see, don’t have endo on or in the bowel, so please don’t panic and assume that because you have diarrhoea or cramping on your period that must mean you have endo there. As I hope I’ve explained, this is naturally going to occur with excessive inflammation and so the key is to reduce those levels. And with these clients, the painful bowel movements and diarrhoea significantly improves or resolves entirely with making some lifestyle and dietary changes.

However, even in my clients who do have endo in that area, we can still see improvements and do see improvements. Remember, endo is an inflammatory disease and the inflammation is really the leading source of our symptoms, so by targeting the inflammation, we can target the symptoms.

So basically, what I want to get across here is that endo on the bowel or adhesions on the bowel doesn’t sentence you to diarrhoea and painful bowel movements for the rest of your life, and equally, having diarrhoea or painful bowel movements on your period doesn’t automatically mean you have endo there. Having said that, I do want to acknowledge that for some people, bowel endometriosis can be very difficult to manage, especially if it’s excessive, and so I appreciate that there may be more work to be done, and you’ll need a specialist surgeon to support you with improving these symptoms.

Stress

Lastly, menstruation with endometriosis can be a stressful experience, to say the least. The anxiety of anticipating our period starting alone can cause diarrhoea, and that’s because the stress response directly affects our gut. Stress slows down the digestion process, resulting in slowed digestion and motility in the stomach and small intestine, but it often can speed up motility in the large intestine, which is where all the waste lives and so of course, when motility speeds up here, we get diarrhoea and cramping, which could of course be worsening all of the above issues I’ve already mentioned.

So, what can we do to improve diarrhoea and painful bowel movements on our period?

Lower inflammation

Of course, the first place we want to start is with lowering inflammation. We can lower inflammation overall with a diet rich in anti-inflammatory foods like vegetables, fruits, healthy fats like avocado, olive oil, nuts and seeds; lean organic proteins and whole grains. Lowering inflammatory foods like alcohol, trans fats and refined vegetable oils, processed foods and refined carbs, and added sugar can of course make a big difference as well, but I appreciate that can be triggering for some, so I would rather suggest we first start with just adding in more of the good stuff!

Additionally, we can give our body a bit of a helping hand by using supplements which can lower the inflammatory prostaglandins, prostaglandin E2. Magnesium lowers inflammatory prostaglandins and cramping, so having a couple of Epsom salt baths before your period and during can really help as this is a great way to absorb magnesium. To get the right amount of magnesium, you’ll need 500 g – 600 g of Epsom salts per bath. Additionally, I swear by magnesium oil sprays! I spray daily on my body after my shower, but I use the spray directly on my pelvic area, back and abdomen to ease any cramping on my period and it works within minutes.

Omega 3 fatty acids also help to lower inflammatory prostaglandins, and are best used daily because these are essential fats we need all cycle long. The therapeutic dose is between 1000mg to 3000mg a day, but it can be tricky to get hold of those levels without exceeding the dose recommendations on the bottle. If you chose to exceed the dose recommendations on the label, obviously that’s your choice but you’ll need to consult with a practitioner to be on the safe side.

If you’re vegan, look for an algae-based supplement that contains both DHA and EPA, because we need both.

The only risk is that they can sometimes thin blood, so speak to your surgeon ahead of surgery to see whether you need to stop taking them a few days beforehand, for keyhole surgery it’s unlikely, but just check.

There are multiple supplements you can use to lower inflammation, such as curcumin and quercetin, but one I love for in-the-moment relief during menstruation is ginger. Ginger has been shown to be just as effective as ibuprofen and mefenamic acid for painful periods, so if you’re looking to get off NSAIDS, this could help. It’s been shown in multiple studies to reduce dysmenorrhea and is generally a wonderfully powerful anti-inflammatory and pain reliever, demonstrated in numerous studies. The recommendation for dysmenorrhea is between 750mg to 2000mg per day, split into doses of around 250-500mg in the lead up to your period and during the first 3-4 days of your cycle and I’ve linked to the studies so you can have a little look.

What I will say is excessive amounts of ginger in one go can ironically cause diarrhoea, which is the opposite of what we want, we just want to lower inflammation, so I would start at the lower dose and work up until you find a dose that relieves your pain and cramping but doesn’t cause more diarrhoea.

Of course, as always, please consult your practitioner before using any new supplements. Ginger is also a natural blood thinner, so this is especially important if you’re already on blood thinning medication.

Slow large intestine motility

Next up, it can be helpful to avoid caffeine, which can actually stimulate motility in the large intestine and speed up bowel movements. So, the day or so before your period and during your period, you may want to avoid coffee, tea and energy drinks and maybe even chocolate if you’re sensitive.

You could further support this by trying bulking agents to bulk up your stools and slow down the transit time. Now, this is tricky because many of us with endo have small intestine bacterial overgrowth, and many forms of soluble and insoluble fibre that can bulk up stools and slow down transit can worsen SIBO, because the SIBO likes to eat these types of fibre. The best thing to do is to test yourself with a little of whichever bulking agent you want to try, and over time increase the dose to test your tolerance.

If you get severe abdominal pain and severe painful bloating during menstruation, I would test these at times when you’re less reactive because we don’t want to put you in more pain and discomfort. A good one to try would be psyllium husk, which you could add to things like a smoothie, yoghurt or oats. If you’re prone to constipation at other times in your cycle, I wouldn’t use psyllium husk at other points - this is just a strategy to using during the times when you get more diarrhoea. Now, it might take 24 hours to slow down the transit so I would maybe consider bringing it in 24 hours prior to when you expect the diarrhoea to start.

If you’re on a SIBO diet or you’re currently treating SIBO, I would talk to your practitioner about trying this first.

You can get psyllium husk supplements, so just follow the label dose but maybe start with the lowest amount you can take first, in order to test your tolerance. You can also just get a powder, and again, follow the label dose, starting with the lowest amount.

Support the pelvic floor

Finally, you may also want to look into working on your pelvic floor if you experience pain with your bowel movements and faecal urgency. This isn’t something that’s going to relieve the pain and the diarrhoea in the moment, but it will improve these issues over time. There are pelvic floor exercises online, as well as online programmes. Of course, the ideal scenario would be to see a pelvic floor physiotherapist, but if you can’t afford that, I’ve linked to a few free videos and some pelvic floor programmes in the show notes. The book Beating Endo also has some fantastic exercises for improving the pelvic floor.

Now, of course, overall, we want to improve your gut health, if there’s SIBO, we want to address that, and if there’s endo in or on the rectum, that needs to looked at by a specialist. There are lots of root causes we can work on here, but lowering inflammation and adding a bulking agent are two strategies that can bring relief instantly and over time, and supporting your pelvic floor can also be done fairly easily at home, so the barrier to entry is pretty low.

If you’re interested in doing more work to dive deeper with your gut health, I have a podcast series on healing the endo belly, and of course an entire course, called The Endo Belly Course, which isn’t open for enrolment at the moment but you can certainly join the waiting list for that, and I’ve put the link in the show notes.

So, now you know why you experience diarrhoea on your period and I really hope that these strategies help you to reduce this and help you to have an easier period! I would love to hear if you’ve found this episode helpful, and if you have, consider sharing it, as you never know who might be suffering with endo in silence.

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On March 28th I am running my second Endo Belly Challenge! In this 4-week challenge, you will learn the first steps to identifying the root causes of your endo belly and the initial tools to heal your swelling, gut issues and abdominal discomfort. Every Monday, you'll receive a new email with a little bit of endo belly education and an action to implement that week! This challenge is perfect for anyone who experiences abdominal swelling/bloating, gas, constipation, nausea, diarrhea/loose stools, acid reflux, indigestion or stomach cramps with their endometriosis - and it's entirely free. You can sign up here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website.

This episode is produced by Ora Podcasts. Ora provides audio editing, management and other services to make podcasting simple and sustainable for their clients. Health coaches, nutritionists, mediums, personal trainers, tarot readers, teachers, or just those striving for a better world, Ora can help you start and maintain your podcast. Get in touch today.

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This episode is sponsored by Semaine. Try their supplement for period pain and daily supplement for hormonal balance and PMS prevention with code ENDOLIFE to get 20% off your first order.

Show Notes

Ginger

https://pubmed.ncbi.nlm.nih.gov/23865123/

https://pubmed.ncbi.nlm.nih.gov/26177393/

https://pubmed.ncbi.nlm.nih.gov/25912592/

https://onlinelibrary.wiley.com/doi/10.1002/ptr.6730

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171779/

https://pubmed.ncbi.nlm.nih.gov/23657930/

Magnesium

https://www.mdpi.com/2072-6643/5/10/3910

https://onlinelibrary.wiley.com/doi/full/10.1111/dme.12250

https://drbrighten.com/boost-low-progesterone/