Constipation

Constipation means having infrequent bowel movements, hard stools, straining, or a feeling that you can’t fully empty. For people with suspected or confirmed endometriosis, constipation is especially important when it is cyclical—noticeably worse right before or during menstruation—or when it comes with pelvic pain, bloating, or painful bowel movements.

In endometriosis, endometrial-like tissue can grow on or near the bowel (commonly the rectum and sigmoid colon), the pelvic peritoneum, or ligaments behind the uterus. This can trigger inflammation, scarring (adhesions), and spasm of nearby muscles, all of which may slow bowel movement or make it mechanically harder to pass stool. Endometriosis can also irritate pelvic nerves, amplifying the “constipation + pain” cycle and causing a sensation of blockage even when the bowel isn’t fully obstructed.

Adenomyosis can contribute too. With adenomyosis, the uterus itself becomes inflamed and often enlarged. That uterine tenderness and pressure—especially during a period—can worsen pelvic floor guarding, reduce comfortable abdominal/pelvic motion, and make bowel movements more difficult. Many patients have both conditions, which is one reason constipation can be persistent and complex.

Constipation from endometriosis/adenomyosis can look similar to constipation from diet changes, dehydration, hypothyroidism, iron supplements, IBS-C, or medication side effects. A key clue is the timing with the menstrual cycle and the presence of other pelvic symptoms (pain with bowel movements, painful periods, deep pain with sex, urinary symptoms). If your constipation is repeatedly dismissed as “just IBS,” you’re not alone—endometriosis commonly takes years to diagnose, and bowel symptoms are a frequent reason.

Living with constipation can affect far more than digestion: it can disrupt sleep, worsen nausea and bloating, limit social plans, and make workdays feel unpredictable. It can also change how you eat (often restricting foods out of fear of flares), which may reduce nutrition and energy over time. If this is happening, it’s reasonable to ask for a targeted evaluation through an endometriosis-informed team via Evaluation & Diagnosis.

People often describe endometriosis/adenomyosis-related constipation as “stool won’t move,” “like I’m blocked,” “I have to strain even when I don’t want to,” or “I can’t fully empty.” Some notice thin stools, intense rectal pressure, or needing to change positions to pass stool. Others feel a deep ache behind the uterus or in the rectum, especially during their period.

For many, the experience is cyclical: constipation ramps up in the days leading into menstruation, peaks during bleeding, and improves afterward—only to recur next cycle. It may come with cramping, pelvic heaviness, or flare-ups of bloating and nausea. If bowel endometriosis is present, bowel movements can also be painful (sometimes sharp, tearing, or burning).

There’s wide variation. Some patients mainly notice constipation and bloating; others have constipation alternating with diarrhea. Some feel significant pain with only mild changes in stool frequency. Over time, symptoms may gradually worsen, become less tied to the cycle, or expand to include urinary urgency, back pain, or fatigue—often reflecting inflammation, muscle guarding, or progression of deep disease.

It’s also common to develop anticipatory tension—holding the pelvic floor tight because bowel movements have hurt in the past. That guarding can become a pattern, keeping constipation going even on “good” days.

GI symptoms are very common in endometriosis, and constipation is one of the most frequently reported bowel complaints—especially in people with deep disease near the rectum or sigmoid colon. Studies consistently show higher rates of constipation, bloating, and painful bowel movements in people with endometriosis compared with those without.

Importantly, constipation does not always mean endometriosis is inside the bowel wall. Some people have significant constipation with superficial pelvic disease because inflammation, adhesions, and pelvic floor dysfunction can affect bowel function. Conversely, some people with bowel-involving endometriosis have surprisingly mild GI symptoms.

Symptom severity also does not perfectly track stage. Endometriosis stage (I–IV) is based on surgical findings, not symptom intensity—so severe cyclical constipation can occur even when imaging is “normal.” When constipation is strongly cyclical or accompanied by rectal pain, it raises suspicion for deeper pelvic involvement and merits a specialist workup (see Bowel Endometriosis and GI Symptoms).

In endometriosis, constipation can be driven by inflammation and prostaglandins that surge around menstruation. These chemicals can increase pelvic pain and lead to reflex muscle tightening, which slows transit and makes stool passage more difficult. Chronic inflammation can also contribute to adhesions—bands of scar-like tissue that restrict normal movement of the bowel and pelvic organs.

When endometriosis involves the bowel surface or deeper layers (often called deep infiltrating endometriosis), it can narrow the bowel lumen, tether the bowel so it doesn’t glide normally, or create painful traction during bowel movements. Even without a true “blockage,” that mechanical resistance plus pain can make your body avoid full evacuation.

Nerves and muscles matter as much as lesions. Endometriosis can sensitize pelvic nerves (visceral hypersensitivity) and trigger protective pelvic floor spasm. A tight, non-relaxing pelvic floor can create outlet constipation—meaning stool reaches the rectum but is hard to pass. This overlap is common and is a major reason some patients don’t improve with diet changes alone (learn more under Pelvic Floor PT).

Adenomyosis may worsen constipation through uterine enlargement and uterine inflammation, particularly during menses. The combination of uterine swelling, pelvic congestion, and pain can increase pelvic floor guarding and make bowel movements feel more difficult or more painful, even if the bowel itself is not directly involved.

Treatment depends on what is driving your constipation—bowel involvement, adhesions, pelvic floor dysfunction, hormonal flares, or overlapping IBS. Many patients benefit from a combined plan that addresses both symptom relief and root causes. A first step is an endometriosis-informed evaluation and, when appropriate, targeted imaging (such as transvaginal ultrasound for deep disease or MRI mapping) through Evaluation & Diagnosis.

Medical options may include hormonal suppression to reduce cyclical inflammation and bleeding activity (see Hormonal Therapy). This can lessen period-linked constipation for some people, especially when symptoms are strongly cyclical. Pain-directed strategies—anti-inflammatories when appropriate, neuropathic pain approaches, and individualized plans—are covered in Pain Management. If you’re using iron for heavy bleeding, ask about formulations and dosing that are gentler on the gut.

Surgical treatment can be important when constipation is related to bowel endometriosis, adhesions, or deep infiltrating disease. Excision surgery (removing disease at the root, rather than burning the surface) is considered the gold standard and may improve bowel symptoms when performed by an experienced team. Lotus Endometriosis Institute specializes in advanced minimally invasive excision—see Surgery & Advanced Excision and learn about Dr. Steven Vasilev. Surgical planning often involves multidisciplinary coordination when bowel disease is suspected.

Pelvic floor physical therapy can be a game-changer when constipation is driven by muscle guarding, dyssynergia (poor coordination), or pain-related tightening. Pelvic PT focuses on relaxation, coordination, breathing mechanics, and strategies for easier evacuation—particularly helpful when symptoms flare cyclically or after years of painful bowel movements (explore Pelvic Floor PT).

Lifestyle and self-care can support daily function while you pursue definitive care: adequate hydration, gradual fiber increases (not sudden), magnesium or osmotic stool softeners if your clinician approves, and using a footstool/squat position to reduce straining. Gentle movement and heat can reduce pelvic guarding. If certain foods worsen bloating and constipation, consider structured guidance (not overly restrictive) through Integrative Medicine & Lifestyle Care and related nutrition resources in Gut Health and Nutrition. For personalized care options, explore our services.

Seek urgent care right away if you have severe abdominal pain with inability to pass gas or stool, persistent vomiting, black/tarry stools, significant rectal bleeding, fever with worsening abdominal symptoms, or signs of dehydration. These can signal bowel obstruction, severe infection, or other conditions that need immediate evaluation.

Schedule an endometriosis-focused appointment if constipation is cyclical with menstruation, keeps recurring despite basic measures, or comes with symptoms like painful bowel movements, pelvic pain, bloating, heavy periods, pain during intercourse, or urinary symptoms. These patterns are common in endometriosis/adenomyosis but are often missed without a specialist lens.

When you meet with a clinician, bring a brief symptom timeline: bowel pattern, stool consistency, relationship to your cycle, pain locations, and what has/hasn’t helped. Early, expert evaluation matters because untreated deep disease and chronic pelvic floor guarding can become harder to reverse over time. If you’re ready for next steps, you can schedule a consultation or contact us to discuss a comprehensive plan.