It’s not sexy, it’s not fun, it IS disruptive and annoying, and we’re just going to talk about it because it needs to be talked about: constipation.*

Increasingly common among women after menopause, constipation isn’t generally dangerous, but it can really affect your ability to enjoy life. Given that so many women suffer from constipation during perimenopause and after menopause, we’re making it August’s Symptom of the Month.

How do you define “constipation”?

Bodies are different, including how often we eliminate solid waste. For some, it’s a daily event, happening at least once and possibly more often. Others may go a day or two without discomfort.

According to Harvard Health, “It [constipation] is characterized by fewer than three bowel movements a week, hard dry stools, straining to move one’s bowels, and a sense of an incomplete evacuation.”

Why does constipation affect so many women after menopause?

Constipation is common during pregnancy and at times during a woman’s menstrual cycle, making it pretty hard to argue against a hormonal aspect to regularity.

Estrella Jaramillo

Estrella Jaramillo

For more information on what causes constipation in menopause, as well as help to return to regularity (in this one area of our lives, at least!), we talked with Estrella Jaramillo, co-founder of B-wom, a digital coach for women’s intimate and pelvic health.

Why is chronic constipation a particular problem for women in midlife and menopause?

Constipation is more prevalent in older age and more likely to be present in women. But why?

According to Estrella, “there is a direct link between hormonal changes and our bowel activity. Menopause is marked by a drop in female hormones such as estrogen and progesterone, and these hormones affect the digestive tract, among other areas of the body. Additionally, conditions such as hypothyroidism or diabetes are linked to constipation.”

And that’s not all. Diminished core strength might also be an issue. “The likelihood of experiencing pelvic floor weakness and related dysfunctions is higher as we age,”says Estrella. “Our abdominals are usually also less toned, and the muscle structure around our pelvis has an important function in evacuation.”

The good news: chronic constipation can be treated

The first step is to identify the main causes or triggers and then create a plan aimed at changing the potential causes, Estrella says. And understand that these are not temporary fixes – we’re developing new habits you’ll need to stick with.

Estrella’s B-wom program helps you understand the habits in your life that may be causing issues, determine better ones with the B-wom coach, and track your progress toward achieving your goals.

app in use

the b-wom app

B-wom tackles lots of intimate female health concerns, including constipation. Says Estrella, “we always apply a holistic approach and we look into three different areas that might be causing influencing your difficulties with bowel movements.”

  1. Daily habits: We provide exercises based on your own observations of your body and your habits. The goal is for you to know the rhythms of your body and break the habit of holding it in when you have the urge to have a bowel movement, since this causes constipation.
  2. Excess pressure / posture: An adequate posture facilitates bowel movements and prevents excess pressure to your pelvic floor. What do you do when you go to the bathroom? Curl up in a ball? Sit up straight and push? Do you massage your stomach? Pushing in an upright position is the first habit you need to break. It’s extremely harmful to your pelvic floor because the force you use pushes your bladder and uterus downward causing all the pelvic floor muscles to be stretched and weakening them.
  3. Kegel exercises: There are different types of constipation, depending on the main cause. Distal and outlet constipation are related to a lack of muscle tone in the abdominal wall and/or a pelvic floor dysfunction, and cause incomplete or difficult evacuation of the rectum following defecation. This type is very common among women. The weakening of the pelvic floor muscles can result in them not “pushing” correctly. Kegel exercises are well-known for strengthening the pelvic floor, but the benefits Kegels offer for improving constipation are rarely mentioned. And they’re so effective!

Other ways to “get regular”

In addition to strengthening your pelvic floor (which you should do anyway to combat incontinence and prolapse), and fixing your (sorry) poop posture, there are other things you can do to aid with the going, going, gone part of digestion:

  • Eat enough fiber. If you’re over 50, 21 grams a day. Legumes (lentils, chickpeas), whole grains (oatmeal, brown rice, even popcorn!), fruits (berries, apples), greens such as spinach and broccoli, nuts, pears, and that favorite fruit-that-doesn’t-exist-any-more: prunes (now “dried plums”). Skip cheese and underripe bananas.
  • Check your meds. Antidepressants, pain relievers, cold medicines, and sleeping pills can all cause constipation, so read the label and ask your doc for a substitute, if needed.
  • As any runner will tell you, the act of getting going can sometimes cause things to … get going. “Exercise … stimulates colon contractions,” says Harvard Health, so move on.
  • Bodies in menopause dry out, leading to less mucus to keep things moving along. Drinking enough water (WATER) can help.
  • Drink coffee. Again, ask a runner. Any hot liquid can help with occasional constipation, but coffee seems to be particularly effective.
  • Get a squatty potty  or similar. Having your body in the proper position (see #2 above) can help make it easier to go and go without straining (which is bad for your pelvic floor).
  • Don’t ignore the call. Our bodies, male and female, operate according to certain rhythms, and our pooping is no different. Go when you need to – consistently ignoring the “poop window” may cause it to slam shut.

When should I talk to my doc about my constipation during peri/menopause?*

Constipation isn’t normally something to be terribly concerned about. If you’re on vacation, eating different foods, under an abnormal amount of stress, etc., you may find yourself bound up for a few days. That said, if any of these occur, it’s time to call for some professional health:

  1. You’re in pain. Cramping, a feeling of being overstretched – don’t live with it, see a doc and get the right treatment.
  2. You’ve been unable to go for more than a week. Especially if you’re a pretty regular person, this may be entering into cause-for-concern territory. Talk to the doc.
  3. You’ve been having difficulty for several weeks.
  4. You think your medications are to blame.
  5. There’s blood in the stool you do pass, or on your toilet paper.
  6. You’re losing weight without trying.

If you’re in the perimenopause > menopause transition, your body is changing. And that’s OK. You just might need to make a few adjustments so those changes don’t completely disrupt your life. Bonus: many of these changes will make you healthier generally, so it isn’t just your colon that will thank you.

*As ever, the information in this blog is not intended to replace care by a medical professional. If you are experiencing pain and chronic constipation, please see your doc.

Have you dealt with chronic constipation since menopause? What have you done to overcome the issue? It’s OK, you can tell us, we’re all friends here. Share with the community by leaving us a comment below, or talking to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.