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Three Ways Stress Can Impact Gut Health with Endo

Endometriosis is, arguably, not an easy condition to live with. Many of us with endo experience ongoing stress and this can be both physical or mental, such as chronic inflammation or the anxiety of worrying about your next flare up.

Additionally, lots of endo patients report gut health issues, particularly constipation, bloating, and diarrhea. While research has shown that 80% of people with endo may have small intestine bacterial overgrowth, stress can also play a lead role in upsetting the gut, and managing any gut health issue also requires us to manage our stress.

So how can stress exasperate our IBS issues? And can that in turn have a knock-on effect on endo?

Leaky gut

Chronically elevated cortisol (the stress hormone) eventually leads to something called leaky gut or intestinal permeability.1,2

Think of your gut lining as a tube made of sausage skin which travels from your mouth to your colon. Your gut lining is just one cell thick, and those cells are tightly packed together with only the tiniest gaps between them to allow for the absorption of nutrients into the blood stream on the other side. When these gaps start to widen, which occurs during times of stress (and can also occur from other issues) they allow food particles, bacteria, and toxins from bacteria (known as lipopolysaccharides or endotoxins) to travel through and enter the blood stream.3 When this occurs, the immune system - which predominantly resides in and around the gut – reacts with inflammatory immune cells. These inflammatory immune cells get swept into the blood stream, causing full body inflammation.4 If this is constantly occurring every time we eat because we have leaky gut, then we’re going to have chronic inflammation, which is a leading cause of chronic pain.

The microbiome

Additionally, stress also alters the gut microbiome.5 The microbiome consists of all those gut bugs (bacteria) that live in our large intestine, which are vital for full body health, as they play a crucial role in essential bodily functions. During stress, the balance of bacteria (there are lots of different types of bacteria, known as strains) becomes altered and this imbalance, known as dysbiosis, creates an inflammatory environment in the gut. This inflammation can then further aggravate the gut lining and can again cause chronic inflammation in the abdomen/pelvic area and across the rest of the body.

Equally, the changes to the microbiome can also induce IBS issues such as diarrhea or constipation.6


Finally, stress also turns off digestion. Your digestion is controlled by your parasympathetic nervous system, known as the ‘rest and digest’ response and in contrast, your stress response is controlled by the sympathetic nervous system, known as the ‘flight or fight’ response.

Because your stress response is essential to our survival (it’s the response that kicks in whenever we encounter a real or perceived threat) it will always reign supreme, and when it kicks in, the ‘rest and digest’ response shuts down and digestion is halted or significantly slowed. This is because the stress response deliberately directs blood flow and resources away from non-essential functions like digestion and redirects them to the heart, brain, lungs, and muscles.

When this happens, it can slow down the movement of food in the digestive tract, leading to constipation and fermentation, which then results in gas, bloating, and abdominal pain.
However, stress can also speed up the gut motility of the large intestine and that can cause diarrhea.

In my next article, I’ll share some tips on supporting your ‘rest and digest’ response and for managing stress with realistic and actionable strategies.

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