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When Pelvic Pain Meets the Gut: Neuro-GI and Colorectal Experts on Endometriosis, Mast Cells, and Real Recovery
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What if your “IBS” isn’t just a gut problem—but part of a larger endometriosis story that involves nerves, immune triggers, and the way your body processes pain? We sit down with a neurogastroenterologist, Dr. Zachary Spiritos and colorectal surgeon, Dr. Vincent Obias, to connect the dots between bowel endometriosis, mast cell activation, dysautonomia, and the stubborn symptoms that linger after surgery. No platitudes here—just clear explanations, candid timelines, and practical strategies that help you make sense of complex, overlapping conditions.
We explore how deep infiltrating endometriosis can change rectal compliance and bowel habits, why post-op bloating and urgency often follow colorectal procedures, and when those symptoms should improve. From the GI side, we challenge the “IBS” catch-all by listening for patterns—cyclical pain, flushing, migraines, brain fog, POTS—that point to mast cell activation or brain–gut dysregulation. You’ll hear how perioperative planning for MCAS (H1/H2 blockers, steroid rescue, anesthesia choices, fluids for POTS) reduces flares, and why excision by experienced teams beats ablation for long-term outcomes.
We also get real about the gray areas: normal tests with abnormal lives, “invisible” inflammation, and how hypermobility can complicate recovery. Expect concrete ideas—targeted imaging and ultrasound for bowel nodules, timelines for healing, SIBO and adhesions as culprits, pelvic floor retraining, sleep as a pain modulator, and GI-focused CBT or hypnosis to calm anticipatory anxiety. The big takeaway: better results come from better teams. When surgery, neuro-GI care, anesthesia planning, and pelvic rehab align, the gut, the nerves, and the person finally get on the same page.
If this conversation helped you see your symptoms in a new light, follow the show, share with a friend who needs answers, and leave a review with your top question for a future episode. Your story might guide our next deep dive.
Website endobattery.com
Chapters
1. Endo Beyond the Pelvis (00:00:00)
2. Two Specialists, One Complex Problem (00:00:08)
3. Why Answers Aren’t Straightforward (00:00:29)
4. When Surgery Doesn’t End Symptoms (00:00:35)
5. Welcome And Host’s Mission (00:00:46)
6. Community, Not Medical Advice (00:00:50)
7. Many Views, One Table (00:01:05)
8. Stories And Expert Insights (00:01:13)
9. Meet The Host And Show (00:01:20)
10. Coffee, Table, And Guests (00:01:27)
11. Introducing The Physicians (00:01:33)
12. Dr. Spiritos’ Background (00:01:43)
13. His Focus And Approach (00:02:04)
14. Hypermobility And GI Links (00:02:27)
15. Holistic Gut-Brain Care (00:02:47)
16. Dr. Obias’ Surgical Profile (00:02:55)
17. Training And Specialties (00:03:10)
18. Robotic And DIE Expertise (00:03:30)
19. Upcoming Practice Move (00:03:50)
20. Why This Duo Matters (00:04:08)
21. Setting The Conversation (00:04:36)
22. Bowel Endo: Team Approach (00:04:48)
23. Symptoms And Broad Workups (00:05:17)
24. How Endo Alters Mechanics (00:05:51)
25. IBS Labels And Missed Clues (00:06:27)
26. Pain, Periods, And Pattern (00:07:00)
27. Mast Cells, POTS, Hypermobility (00:07:36)
28. Post-Op Symptoms Explained (00:08:15)
29. Nerves, Adhesions, Expectations (00:08:51)
30. Does The Story Fit The Surgery? (00:09:39)
31. When It’s Not Endo—It’s MCAS (00:10:23)
32. Surgeon Skill And Residual Disease (00:11:00)
33. Pre/Post-Op MCAS Protocols (00:11:44)
34. Anesthesia, Narcotics, Flares (00:12:15)
35. Multidisciplinary Care Wins (00:12:36)
36. Early Mobility, Simple Hacks (00:13:06)
37. Rewiring The Brain-Gut Loop (00:13:34)
38. Therapy, Sleep, And Habits (00:14:23)
39. The 21-Year-Old Case Puzzle (00:15:04)
40. Narrative Over Normal Tests (00:15:35)
41. Surgery Isn’t A Magic Blade (00:16:10)
42. Imaging And Limits Of Scopes (00:16:36)
43. Inflammation Or Nerve—Or Both? (00:17:10)
44. The MCAS Knowledge Gap (00:17:40)
45. Hypermobility And Vascular Overlap (00:18:15)
46. Environment, Food, And Triggers (00:18:43)
47. Old Theories, New Evidence (00:19:22)
48. Many Diagnoses, One Patient (00:20:00)
49. Where To Find The Guests (00:20:30)
50. Closing And Advocacy (00:21:07)
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