Why Do Women Suffer from Bloating and Constipation?

A healthy gut is an important part of a woman's overall health. While we often equate women's health with gynaecology and obstetrics, there are other areas of importance, of which gastroenterology is one of them. Always speak to a gastroenterologist if you have concerns about your digestive health.

Common gut disorders in women

There are some gut disorders which are more common in women. These range from autoimmune diseases of the liver to functional and neuro-motility disorders of the gut, such as irritable bowel syndrome (IBS) and bowel disorders.

Learn about digestive health for women and their common symptoms so you can take better care of your health.

Digestion and your menstrual cycle

Many women experience alterations in their bowel habits and abdominal symptoms at various points in their monthly menstrual cycle.

Typically, women feel bloated and constipated pre-menstrual, and have looser stools during their menses. Learn about the healthcare needs of women and live your best life.

Bloating before and during your period

It is common for women to feel bloated before their period, and for some women this may continue into the early part of their period as well.

This is associated with changing levels of the hormones progesterone and oestrogen that cause the body to retain more water and salt. This is what causes the sensation of bloating.

Other factors that may make bloating worse include high consumption of salt, caffeine and alcohol.

Why you get diarrhoea or constipation during your period

A woman's body goes through many changes before and during her period.

Among them is the increased production of prostaglandins, a hormone-like chemical. It assists in the contraction of the uterus, which is felt as menstrual cramps. Similarly, high levels of prostaglandins also cause the bowels to contract, which can cause diarrhoea.

Some women experience constipation instead. This may be caused by rising levels of progesterone, which slows down your digestive system. Women who also have conditions like irritable bowel syndrome (IBS) or endometriosis may be particularly affected.

While these symptoms you experience around your period are normal due to hormonal fluctuations, in women who suffer from IBS, these symptoms and bowel changes can be much more severe.

What is irritable bowel syndrome (IBS)?

IBS is a condition where there is abdominal pain and/or discomfort which is associated with a change in the frequency, form or nature of stool.

Unlike gastroenteritis, where a patient falls ill and recovers quickly, IBS is a chronic condition that can last for years.

What are the symptoms of IBS?

IBS symptoms may be persistent, or they may briefly resolve and recur later. These include:

• Stomach pain or cramps
• Bloating
• Gas or flatulence
• Constipation
• Diarrhoea
• Passing of mucous
• Fatigue

Women who have IBS tend to experience symptoms around the time of their period, or experience more symptoms then.

Some experts estimate that 50% of women with IBS suffer worse symptoms before or during their period. This is due to fluctuating hormone levels that have an impact on the gastrointestinal (GI) system, making GI symptoms more severe.

What are the causes of IBS?

There are many factors that contribute to IBS, including:

• Stress
• Genetics
• Previous gut infection
• An imbalance of the gut microbiota
• An over-sensitivity of the nerves in the gut
• Diet, especially relating to a group of foods referred to as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are short-chain carbohydrates that are poorly absorbed by the small intestine and cause digestive distress in some individuals)

There is no single cause, and some or all of these factors interact together to result in the symptoms of IBS.

How is IBS diagnosed?

There is no single test for IBS, and the diagnosis is made by your doctor, based on your symptoms. Sometimes, additional diagnostic tests such as endoscopy, scans or blood tests may be necessary to exclude other conditions.

Endoscopy

In an endoscopy or upper endoscopy, your doctor will insert a long, flexible tube down your throat and into your oesophagus, which has a camera attached to its end. This is called an endoscope and your doctor will use it to inspect the upper digestive tract. It is also possible to take tissue samples during an endoscopy if your doctor wishes to rule out other conditions.

Blood test

Your doctor may also recommend a blood test to rule out celiac disease, which produces symptoms that are similar to IBS.

Breath test

A breath test can help to check for bacterial overgrowth in the intestines, or to test for what foods you may be intolerant to.

Stool test

If you have chronic diarrhoea, a stool test may be recommended to check for bacteria, parasites or bile acid.

How is IBS treated?

Treatment for IBS will depend on the severity of the symptoms you experience and often include the use of medication and approaches to address and correct the underlying factors.

Your doctor may also recommend medication to control the symptoms and reduce the sensitivity of the nerve endings.

Lifestyle changes

Lifestyle changes can help. These include learning how to manage stress and making an effort to regulate your diet. It is also important to identify and avoid your triggers, as triggers can differ from person to person.

Probiotics

Probiotics are also useful in restoring the balance of microflora in the gut, and have been shown to improve symptoms of abdominal pain and bloating in IBS patients.

Why do women suffer from constipation more than men?

Studies have shown that women tend to have a slightly slower colon transit time (the time it takes for food to travel through the colon) than men, resulting in a higher chance of developing constipation.

Many women believe that constipation refers to a decreased frequency of defecation, but it can also present as hard stools and having to strain to pass stool.

How is constipation treated?

Whilst in most cases constipation can be addressed by dietary changes and drinking more water, there are cases when further intervention is necessary.

These may involve the need for endoscopy or scans to exclude structural lesions or tests to determine the rate of transit in the colon.

Treatment may involve the use of laxatives, or some of the newer medications, to speed up the rate of transit of digested food in the colon.

Defecation disorders in women

Disorders of defecation are also markedly more common in women, such as dys-synergic defaecation or faecal incontinence.

Dys-synergic defaecation

Passing stool requires coordination of the muscles in the abdomen and pelvic floor, so that stool can be easily squeezed out of the colon, almost like how toothpaste is gently squeezed out of a tube.

Dys-synergic defaecation occurs when this coordination is disrupted due to weakness of the pelvic floor muscles or a disruption of the coordination.

Faecal incontinence

Faecal incontinence, on the other hand, is an inability to control the bowels. This may result in stool leaking out.

Faecal incontinence is common in women who have had a difficult vaginal delivery, with damage to the sphincters (rings of muscles that constrict to close an opening in the body) during childbirth and delivery.

Tests such as special pressure testing, called anorectal manometry, and scans, will help determine this condition. It is best diagnosed and treated by your gastroenterologist working together with your gynaecologist.

Common cancers in the gastrointestinal tract

Finally, it must also be recognised that women, like men, can also develop cancers of the gastrointestinal tract. These include stomach, liver, pancreas, gall bladder, bile duct and colon tumours.

Colorectal cancer

Prominent among these is colorectal cancer, which is the 2nd most common cancer in women.

Colorectal cancer is more common among older adults. An early warning sign are polyps, which are small, non-cancerous (benign) growths that form inside the colon. However, your risk of developing cancer increases if you have more than 1 polyp or if your polyp is bigger than 1cm.

Cancer prevention

Colorectal cancer is preventable through early detection with health screening.

Screening involves testing the stool for the presence of occult blood, or performing a colonoscopy using a video endoscope. Stool occult blood testing is painless and simple, but it’s not very sensitive, so the testing needs to be done annually.

A colonoscopy is more invasive, but it allows detection of small tumours and polyps that may be missed by stool occult blood testing.

Polyps, the precursor to colorectal cancer, can also be removed during endoscopy without the need for surgery.

Screening by colonoscopy needs to be performed only once every 10 years, but if there is a family history of colorectal cancer or a personal history of polyps, then it means the woman has a higher risk and the colonoscopy should be performed once every 5 years.

In summary, these are some of the gut disorders that women face. Fortunately, these conditions can be addressed promptly by seeking medical advice for an accurate diagnosis and receiving appropriate treatment. With this, women can prevent unnecessary suffering and experience a good quality of life.

If you're concerned about a digestive condition, speak to a specialist.