Constipation and the menopause: what do you need to know?

Many high profile people have been coming forward in the media to talk about their experiences of menopause.  It’s a relief to see this significant aspect of life being discussed more openly and today I caught up with Dr Mayhead, Consultant Gastroenterologist, to get his perspective on constipation with specific relevance to post menopause. 

But first of all, what is constipation and what do we mean by post menopausal? 

Simply put, constipation is a prevalent gastrointestinal issue that affects people of all ages, and refers to difficulty with or infrequency of passing stools.

Post-menopause refers to the stage in a woman’s life after she has experienced 12 consecutive months without menstruation. During this period, hormonal changes can contribute to various health concerns, including constipation but other factors, such as those below can also contribute.

Hormonal Changes

One factor influencing bowel movements is hormonal fluctuations. During menopause, there is a decline in oestrogen and progesterone levels, which can lead to changes in the digestive system. Oestrogen helps regulate bowel movements by promoting healthy muscle contractions in the intestines. When its levels decrease, the bowel movements may become irregular, resulting in reduced movement of food through the gut and constipation.

Reduced Physical Activity

Many postmenopausal women may experience a decrease in physical activity due to reasons such as reduced sleep quality, joint pain, concern around hot flushes or lifestyle changes like retirement. A sedentary lifestyle can contribute to constipation by slowing down the digestive process. Regular exercise helps stimulate the muscles in the intestines, aiding in proper bowel movements. 

Dietary Factors

The composition of one’s diet plays a crucial role in maintaining regular bowel movements. Diets that lack adequate fibre intake can contribute, as fibre adds bulk to the stool and facilitates its smooth movement through the intestines. Insufficient consumption of the right type of fibre can result in constipation. Moreover, dehydration, caused by inadequate fluid intake, can also contribute to constipation. Drinking enough fluid is also essential for maintaining healthy gut function.

Medications 

For many, an increase in medications to manage various health conditions such as hypertension, osteoporosis or arthritis is a fact of later life. Some medications, including certain pain relievers, diuretics, iron supplements, and antidepressants, can have a side effect of constipation. If constipation occurs after starting a new medication, it is essential to consult a healthcare professional to discuss potential alternatives or ways to manage the side effect.

Structural and Functional Issues

Certain structural or functional issues in the gastrointestinal tract can cause constipation in postmenopausal women. Benign conditions such as pelvic floor dysfunction, common in those who have been through pregnancies, can hinder the ability to pass stool but can often be improved with medical or therapeutic intervention. However, new onset constipation, especially associated with weight loss or blood from the back passage needs to be investigated in case more sinister causes, such as bowel cancer, could be the cause.

I asked Dr Mayhead how important he felt this condition was to address in ladies post menopause.

“In clinic, I see many ladies who have experienced significant changes in their gut function that have coincided with the menopause, and increased constipation is a frequent experience they report.  It’s hugely important to get to the root of the issue, not only to rule out any sinister causes but also to give us the best possible chance of finding effective treatments.  Constipation can create a huge burden in someone’s life, not just due to discomfort or time spent in the loo but all of the associated issues like bloating, reduced appetite, anxiety, embarrassment and the potential further pressure on the pelvic floor that repeated straining can cause.”

So what does he feel are the most important things for any lady in this position to know?

“Once there are no concerns that anything sinister is causing the constipation, ensuring you are having enough fibre and fluid – and for that matter the right type of fibre – is hugely important.  A dietitian who specialises in gastro issues an be hugely helpful here as they are trained to understand the different types of fibre and optimise your diet. 

From a lifestyle point of view, making sure you remain active is crucial as exercise is one of the best laxatives.  Even a brisk walk round the block can help to get things moving. 

When it comes to medications, both a comprehensive review of your current medications that might be causing the issues and appropriate prescription of laxatives, bulking agents and / or fibre supplements needs to be undertaken.  Laxatives have moved on significantly over the last decade, although primary care prescription of these has not necessarily kept up.  There is a whole class of medications like Prucalopride and Linaclotide that gastroenterologists have available to them which work on the endogenous laxative pathway – the natural means that your body uses to keep stools moving through the gut – and where appropriate, these can be hugely effective.

Finally, there are times when constipation is being caused by structural elements like pelvic floor dysfunction when my job is to optimise the care within my sphere but then pass my patients on to a surgeon specialising in this area who can advise on the possibility of exercises, therapy or even surgery to improve things further.”

So, what are my takeaways from this conversation? It was really refreshing to be able to talk so candidly to an expert about a condition that is rarely discussed.  I always feel that, as a woman, I want to be there for my friends to support them, without embarrassment, and so my resolution is to be open to having conversations about topics that we might naturally shy away from to ensure none of my tribe are left feeling alone or ashamed.  And who knows, I might be able to point someone I know in the right direction in the future.

Disclaimer: The information provided in this article is for informational purposes only and should not replace professional medical advice.