Perimenopause And Constipation: How To Deal With A Stubborn Bowel
Are you feeling sluggish and bloated, frustrated that your bowel movements just aren’t as regular as they used to be?
Are you finding yourself constantly straining when trying to have a poo?
Constipation can strike at any time of life but with the hormonal changes happening in perimenopause and menopause, some women find they have quite significant changes to their bowel movements.
Today I’m going to explain why you might be experiencing perimenopause or menopause-related constipation and what you can do about it.
I’ll also cover when it’s time to seek medical help from a doctor/GP and dietitian.
Onto the good stuff.
HOW ARE PERIMENOPAUSE AND CONSTIPATION RELATED
FLUCTUATING ESTROGEN & PROGESTERONE
As you may already know; during perimenopause, our hormone levels fluctuate. Progesterone levels decline, stopping altogether (more or less) 12 months after your last period. Estrogen levels become irregular and unpredictable, ultimately declining but not in a straightforward fashion. (4)
Many studies show that estrogen and progesterone have an effect on gut movement, especially when levels are low, our gut can slow down significantly (5). Because of this you may experience gastrointestinal (stomach and gut) problems, including constipation.
These hormonal changes can also be partly responsible for constipation during pregnancy and at certain times during your menstrual cycle.
CORTISOL
Other studies say that our stress hormone cortisol affects our digestive system the most. With age, cortisol levels gradually increase in women. Cortisol has been found to be raised in women with IBS (particularly IBS-C * Irritable Bowel Syndrome - constipation) (5b).
Elevated cortisol levels are associated with oral estrogen, so if you are taking oral HRT (hormonal replacement therapy) with estrogen and have constipation, this might be a contributing factor. This effect hasn’t been seen with transdermal (e.g. patches) estrogen. (6)
Speak to your doctor/GP if you have questions about your HRT.
ESTROGEN & THE PELVIC FLOOR
Decreasing estrogen levels also affect our pelvic floor muscles (8). The pelvic floor is made up of layers of muscles that support the bladder, bowel and uterus (7). A weak pelvic floor can mean that it’s harder to control bowel movements.
Want to learn more about gut symptoms in perimenopause along with bloating? Download our “Guide to Gut Calm for Bloating” E-book
Looking for more support? Grab my Digestive Issues in Perimenopause (and beyond) Workshop. Put yourself back in the driver’s seat of your gut and “get your life back”.
WHAT IS CONSTIPATION?
There are several symptoms that can indicate you have constipation.
These include:
You haven’t had a poo at least three times in the last week.
The stool you pass is often large, dry, hard or lumpy.
You are in pain and straining (pushing with not much happening) when you are on the toilet.
Abdominal pain or feeling bloated also can accompany this. (3)
If you experience at least one of the above, it probably means that you are constipated.
HOW TO FIND RELIEF FOR CONSTIPATION
As we’ve already briefly covered, there are lots of reasons why you may experience constipation in perimenopause and menopause.
The upside is there are definitely some things you can do to help ease your constipation and get your bowels back on track.
Tips for relieving constipation:
Fibre is your friend
A fibre-rich diet can be a key to regulating bowel movements. Our gut needs lots of fibre to stay healthy, the guidance in the UK is 30 grams per day for women. This is slightly concerning as we know that in the UK most people are only having 18 grams per day (11).
NOTE: If you have IBS (Irritable Bowel Syndrome) or IBD (Irritable Bowel Disease) and you’re having flare-ups the amount of fibre you want in a day is something you’re going to want to personalise as it can have a negative effect during these flare-up times. Speak to a dietitian or GP/doctor for advice on fibre if you’re IBS or IBD is particularly tough – often a low-fibre diet is recommended during these times.
The suggestion I would make to everyone for fibre is to start slow and build up to 30g per day. Otherwise, it may cause gut distress and that’s not what we’re after!
What does a fibre-rich diet look like?
Whole grains, fruits, vegetables, nuts, seeds, pulses and beans have lots of fibre in them. A Mediterranean diet is a great example of a high fibre diet.
Try the tips below to increase your fibre (11) :
Swapping your white bread or pasta to a wholemeal option. 2 slices of wholemeal bread roughly equal 4-7 grams of fibre.
Try adding an extra serving of veg with your lunch and dinner. Keep chopped vegetables like mushrooms or peppers in a container in the fridge that you can easily add to meals. As soon as you get home from the supermarket wash your lettuce so that when you go to make a meal later in the week it is easy to add a side salad.
Remember legumes! Legumes are your beans and peas. Think lentils, kidney beans, split peas, garbanzo beans, black beans, navy beans, soy beans, fava beans … and the list goes on.
Beans and lentils are amazing to add to soups, stews and sauces. They’re also easy on the wallet – packing a heavy punch of protein and fibre for such a low price.
Check out this Turkish lentil soup recipe here!
Have a look at the nutrition label for fibre when shopping. Look out for high fibre content, 3 grams per 100 grams or more is considered high fibre food.
Dry fruits. Dry fruits are a great source of fibre. Grab a small handful of prunes or dried figs for snacking. Remember not to go overboard with these as they often contain quite a bit of sugar – one serving per day is enough.
Add flaxseed (linseed) and a handful of fruit to a cup of yoghurt. In a recent study, flaxseed can be helpful in constipation (16).
Keep Hydrated
We typically need 2 litres of water every day. This is equivalent to 6-8 mugs/cups per day. If you are struggling with drinking plain water, you can always make it interesting by adding some fruit (like lemon or orange), herbs (mint, basil), or cinnamon bark.
Water makes it easier for stool to pass through the gut, helping to ease and prevent constipation.
Keep active
Physical activity can help with constipation as it helps food move through your digestive tract by keeping your muscles moving (12).
Remember that anything that keeps your body moving for 10 minutes or more can be considered exercise, from walking to the bus stop to housework to walking your dog.
150 minutes of moderate exercise a week is suggested for healthy adults, this might seem like a lot, but it works out to about 30 minutes per day, 5 days a week.
A personal favourite of mine is yoga. In a 2016 study, 12 weeks of yoga training for menopausal women was seen to ease a variety of menopause-related symptoms as well as stress (13).
What a jackpot!
Stress can be a killer for gut health so not only are you staying active but you’re reducing a major enemy of gut health.
It’s worth noting that a lot of exercises and sports can help to reduce stress levels, so choose something that feels right for you.
If you want to try yoga, some of my favourite yoga online is;
Yoga with Adriene (Free & Paid)
Do Yoga With Me (Free & Paid)
Try Pelvic Floor Exercises and/or Pelvic Floor Physiotherapy
As we age, it is common for the pelvic floor to weaken, keeping our pelvic floor strong is important to keep bowel movements controlled (among other things). Long-term constipation can also cause weakened pelvic floor muscles.
Some women may struggle with pelvic floor dysfunction, which means the muscles aren’t coordinating properly – this is a great opportunity to seek assistance from a pelvic floor physiotherapist.
For those looking to increase their pelvic floor strength, try the app Squeezy.
Toilet posture: how are you sitting on the toilet?
‘Toilet posture’ can make a big difference!
The ‘Western’ sitting position in the toilet makes it difficult to pass stool.
When squatting you’re likely to take less time to poo (14), strain less and have the added benefits of the position itself guarding your nerves that control your uterus and bladder from damage and excessive stretching. (15)
You can go with DIY with this and use a small stool. Put something flat and stable under your feet to raise your knees while sitting on the toilet, your knees should be higher than your hips.
Medication & Supplement Side effects
Certain medications & supplements can often be a cause of constipation (9).
For example, if you’ve ever taken an iron supplement you may have noticed constipation as a side-effect (10).
Depending on the health issues you may be experiencing, it’s worth having a look at your medication & supplements list. Speak to you doctor/GP or pharmacist if you think this may be causing a problem for you.
What about laxatives?
It’s important to know that laxatives are not recommended for everyone, including those with IBD.
Many laxatives are available over the counter however I would always recommend speaking to your doctor/GP or pharmacist prior to using them.
You can read the NHS guide to laxatives here.
Laxatives should not be used as a long-term solution for constipation. Speak to your GP/doctor if you have had constipation for a long time – they may be able to prescribe something more suitable for your condition or ensure the laxative you are using is safe for long-term use.
Want to learn more about gut symptoms in perimenopause along with bloating? Download our “Guide to Gut Calm for Bloating” E-book
WHEN SHOULD YOU SPEAK WITH A PROFESSIONAL?
If you have tried multiple ways to keep your constipation under control but nothing seems to be working, it’s time to seek medical advice.
Speak to your doctor/GP, dietitian or pharmacist.
Additionally, if any of the following below accompany your constipation – please seek medical attention immediately.
You have blood in your stool
You’re losing weight without trying
You feel exhausted all the time
You have felt bloated for a long time
Your bloating is very painful and worsening (3)
Looking for more support? Grab the FREE Ditch Digestive Distress: Gut Control Masterclass. Put yourself back in the driver’s seat of your gut and “get your life back”.
THE TAKEAWAY
In summary perimenopause (and menopause) and constipation are commonly seen together for a variety of reasons. The cause of constipation is different for everyone, from fluctuating hormones to stress levels.
Eating a fibre-rich diet, staying hydrated and getting help with your pelvic floor muscles can all be things that may help to relieve your constipation and improve your digestive health.
Remember that we’re aiming for around 30 grams of fibre per day. Start slow with adding it into your diet and speak to a doctor or dietitian prior to increasing fibre if you have IBS or IBD flare-ups.
As always, if you have other symptoms along with your constipation such as blood in your stool or pain that is worsening, or you’ve been constipated for a long time, book an appointment with a GP/doctor.
Want to learn more about gut symptoms in perimenopause along with bloating? Download our “Guide to Gut Calm for Bloating” E-book
Looking for more support? Grab my Digestive Issues in Perimenopause (and beyond) Workshop. Put yourself back in the driver’s seat of your gut and “get your life back”.
A Gutsy Menopause is a specialist gut health nutrition clinic run by nutritionist and dietitian, Emily Foster. We offer consultations, workshops and online courses. Click here to learn more.