Unsurprisingly, constipation isn’t talked about much, let alone during menopause. But it can be a particularly formidable challenge at this time. Nutritional therapist and founder of The Better Menopause Jo Lyall looks at the connection between menopause and constipation. She explores how hormonal shifts may contribute to irregular bowel movements and suggests ways to prevent and manage constipation.
What is constipation?
Constipation is when you have difficulty having a poo and don’t have bowel movements often enough, which means less than three bowel movements per week. This results in hard, lumpy stools that are challenging to pass. Constipation can be really uncomfortable and take a toll on mental wellbeing and quality of life too.
Constipation symptoms
Common signs of constipation include:
- Hard, dry stools
- Infrequent bowel movements – this means having a poo less than three times per week
- Straining during bowel movements
- Feeling like your bowels are never completely empty
These symptoms can lead to stomach discomfort, bloating and sometimes an unsettling sense of being unwell.
When should you see a doctor?
See a doctor if you:
- Experience a sudden change in your bowel habits
- Are constipated and tired all the time
- Are constipated and/or bloated regularly
- Have blood in your poo
- Are taking medication that is making you constipated
- Have tummy pain
- Have lost weight without trying to
Can menopause cause constipation?
Constipation is common as you age. This can be due to a combination of factors, including a weaker bowel, stomach and pelvic floor muscles, slowed movement of food through your gut, lack of exercise, inadequate hydration and low fibre intake. This is because food may take longer to break down, slowing the digestive process, and making bowel movements more difficult. Menopausal changes may also contribute to constipation…
Hormonal changes
Oestrogen and progesterone levels fluctuate and decline during perimenopause. Beyond their reproductive functions, they also play an important role in keeping your digestive system moving. As these hormone levels decline, your gut’s muscular contractions, which move food through your digestive system, become weaker and less frequent. This can significantly slow down the digestion process, leading to harder stools and more effort required to pass them.
Stress
Menopause is stressful for many people due to the combined effects of troublesome physical symptoms and the psychological adjustment to this new stage of life. Stress triggers the body’s “fight or flight” response, which releases the stress hormone, cortisol. Cortisol can slow down digestion and make constipation more likely. In other cases, stress can lead to changes in what or how you eat, or a decrease in physical activity, both of which can make constipation more likely.
Read more about stress and menopause.
What else can cause constipation?
Dehydration
Dehydration is one of the most common causes of constipation. Water helps break food down so that your body can absorb nutrients and it also keeps stools soft. Not drinking enough leads to drier, harder stools that are more difficult to pass. Changes in the body during menopause may also affect hydration levels, making it even more important to ensure you are drinking enough.
A low-fibre diet
A diet low in fibre is a common cause of constipation. Fibre adds bulk to stools, making them softer and easier to pass. It also improves your gut microbiome – the ecosystem of microbes in your gut – which helps keep your bowel movements regular. Menopause can lead to dietary changes for many reasons – some people find that foods they once enjoyed are now off the menu because they cause digestive issues, including constipation. Eating a variety of fibre-rich foods is key to managing this.
Some medications
Various medications commonly taken during midlife, including analgesics found in painkillers, antihypertensives for blood pressure, and antidepressants, can have side effects that include constipation.
Less exercise
Regular exercise is essential for maintaining healthy bowel movements as it helps stimulate the muscles in your gut. This means that spending most of your day sitting down can slow down digestion and contribute to constipation.
Read more about exercise and menopause.
Can you prevent constipation during menopause?
There are lots of ways you can relieve constipation and even prevent it during menopause, these include:
Dietary changes
Your diet can have a huge impact on your bowel movements. Try to eat a variety of fibre-rich foods. These provide bulk and help keep water in your gut, making stools soft and regular. Aim to have 30g of fibre each day, including a balance of soluble fibre (vegetables/fruit/legumes) and insoluble fibre (wholegrains). Here are some examples:
- Fruit, such as berries and apples
- Vegetables, such as kale and carrots
- Legumes, like lentils and beans
- Wholegrains, such as oats and barley
If you feel your diet is currently low in fibre, add it in gradually to avoid unpleasant symptoms such as bloating and wind.
You can also try these tips:
- Avoid skipping meals, especially breakfast, as it can make your bowel sluggish or irregular
- Avoid hurrying your meals and chew your food properly
- Avoid processed foods and foods with a high fat content
- Aim for 5-8 portions of fruit and vegetables per day
Read more about the best diet for menopause.
Hydration
Make sure you drink enough fluids throughout the day. Aim for about 6-8 glasses of water daily, but listen to your body. You may need more if you lose water through sweat when you exercise or if it’s a hot day. Herbal teas and clear broths can also contribute to your daily fluid intake.
Regular exercise
Activities that involve core movements such as yoga or pilates can particularly help stimulate digestion. Even simple daily walks can help reduce the risk of constipation by increasing the speed that food moves through your digestive system.
Stress management
Reflect on times of stress throughout your life. You may find that these periods are linked to digestive health issues. Effective stress management techniques can positively impact your overall digestive health and may help relieve constipation. Try mindfulness meditation, deep-breathing exercises or tai chi.
Probiotic supplements
Probiotics help balance your gut microbiome, which ensures effective digestion and regular bowel movements. Probiotics are found in foods that contain beneficial types of live bacteria. Try to add some fermented foods like yoghurt, kefir and sauerkraut to your diet. A high-quality daily probiotic supplement can also support a healthy gut.
Gut health in menopause
Menopause is known to change your gut microbiome. Probiotic foods and supplements, such as The Better Gut probiotic, may help more than just digestive symptoms, as gut health impacts your immune system and mood too.
For further information on gut health in menopause visit www.thebettermenopause.com or follow @thebettermenopause on social media.
How to treat constipation during menopause
Medication is sometimes required to relieve constipation. A doctor or pharmacist may recommend laxatives for immediate relief if lifestyle changes aren’t working for you, but they are not suitable for everyone – for example those with irritable bowel disease (IBD) – and are not a long-term solution for constipation. The lifestyle changes above outline a sustainable solution that should take just two or three weeks to work – try these first where possible.
Various over-the-counter laxatives are available. Laxatives should always be used under medical guidance to prevent potential side effects.
Different types of laxatives work in different ways:
- Bulk-forming laxatives make stools move through your gut better by increasing bulk
- Osmotic laxatives draw water into the bowels, helping to soften stools
- Stimulant laxatives prompt the gut muscles to contract more effectively
- Stool softeners soften stools, encouraging smoother bowel movements
Read more about types of laxatives and potential side effects on the NHS website.
Can HRT help prevent constipation during menopause?
Hormone replacement therapy (HRT) is the most effective treatment for many menopause symptoms, such as hot flashes, night sweats, sleep issues and low mood. HRT may relieve constipation if any of these symptoms are causing stress or making it difficult for you to exercise, as stress and lack of exercise can make constipation worse.
Read about different types of HRT.
Final word
A balanced diet rich in fibre, drinking enough water, regular exercise, stress management and a daily probiotic can help relieve and prevent constipation. See your doctor if these lifestyle changes aren’t helping, as under medical guidance laxatives can help.
Find out more about menopause on our blog or in our symptoms library.
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