The gender constipation gap is real — here’s why women are more likely to suffer and how to ease and avoid the discomfort.
When did you last go to the toilet? Not for a wee (we can assume that was recently, given we’re all downing water to deal with the heatwave). We mean when did you last properly poo?
If you are one of the 20% of women who suffers from constipation, it may have been a while ago. Clinical constipation means going less than three times in a week, and according to a paper from 2020, women are nearly twice as likely as men to experience the condition.
That’s a reality dietitian Sophie Medlin regularly sees in her clinic. “Although I still see plenty of men with constipation, because it is a very common problem, I do see a lot more women with the problem,” she says.
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The issue isn’t down to biological differences, as there are no structural differences in the bowel, Medlin says. Instead, it’s about conditioning and lifestyle habits that are messing up our toilet frequency.
Why are women more constipated than men?
Given how entwined our gut and brain are, our psychological and social conditioning has a huge and worrying impact on our bowel habits, says Medlin. “There is a belief that as young children, girls are taught not to be smelly and dirty and they associate toilet habits with these traits, which can become stressful for them.
“As women get older, there’s a taboo about ‘going’ in certain places – for instance, a new partner’s house or the office. That can often mean they stop listening to the cues that their body is giving them to go for a poo and reduces how loud those cues are in the body, meaning we can go less often.”
If that sounds familiar, so too will the impact of stress. While ‘nervous poos’ are a phenomenon you might be more acquainted with, many people find they can’t go during periods of worry or busyness.
According to a paper published in the Expert Review Of Gastroenterol Hepatology, the stress hormone epinephrine directs blood flow away from our digestive system and can slow the movement of food through the bowel. In addition, the body releases something called corticotrophin-releasing factor in the bowels, a hormone that causes the intestines to slow down and become inflamed.
Toilet positioning is another problem for many women, according to Medlin. Ideally, we should be squatting to poo, bringing our knees to our chest to massage our colon, but modern designs mean we don’t sit quite right – especially women.
“Most women are too short to sit on the toilet properly in a way that effectively allows their rectum to open so that they can pass stool in the easiest way as possible,” Medlin says.
And then there are the gender differences in our diets. A decent fibre intake is needed to keep our bowels opening regularly, and where is fibre most likely to be found? In carbohydrates – the same food group that has been historically vilified by a diet industry that targets women.
“Of course, there are lots of complexities in that and some people who suffer from constipation eat plenty of those foods and still struggle. Often, constipation can be part of IBS, in which case reducing fermentable carbohydrates can really help. Other times, it is due to rectile dysfunction often caused by traumatic childbirth – in those cases, which are relatively common, eating more fibre is likely to make the problem a bit worse,” says Medlin.
That’s why talking to your GP is always crucial, as any changes in bowel movements might be a sign of other issues in your body.
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Does constipation matter?
For Meg*, a 26-year-old who works in TV, constipation has been life-altering. “I’ve struggled for the past six years. I only poo once a week, then after about 3 weeks, I get the worst pains in my stomach and end up having diarrhoea for hours.
“It makes me so miserable – I hate trying on clothes that I can barely zip-up when bloated from not going for a few days. The pains often stop me from going out and doing things I enjoy, and I always worry that friends think it’s just an excuse.”
Meg says that she has often been given laxatives by the doctor or told she has IBS, but hasn’t found the root cause. “I haven’t been able to notice any pattern with my food, even after keeping a food diary, but I do know it’s even worse when I’m stressed,” she says.
This discomfort is one of the major side effects of constipation. The feeling of fullness or frustration at just not being able to go isn’t to be dismissed. “The major issue with constipation is that it leads to bloating and discomfort. Sometimes, the stool can press on nerves in the pelvis and lead to stomach, leg and back pain as well as bladder problems,” says Medlin.
“In terms of long-term health problems associated with constipation, it can lead to conditions such as diverticular disease and anal fissures, piles or haemorrhoids and issues with the colon. It can also negatively affect the colonic microbiome, which only makes your digestion worse.”
How to ease and avoid constipation
Use a stool
To counteract high toilet seats that don’t make pooing easy, place your feet on a stool when you’re on the loo. “Make sure your knees are at 90 degrees so that you can open your rectum effectively,” she says.
Eat poo-friendly foods
“Kiwi fruits are associated with having a complete spontaneous evacuation, which is basically having a bowel movement that empties out the colon, rather than feeling like you’re holding on to some,” says Medlin. She suggests two a day for those struggling to go.
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“Chia seeds and chia pudding, in particular, are great ways to avoid and ease constipation,” she adds. When chia seeds are soaked, they absorb water that creates the gel-like consistency of chia pudding. That water travels into the bowels to help loosen stools.
Shed the shame
If you’re not comfortable pooing in certain places and it’s stopping you from going when you need to, it’s time to ask yourself why. Dampening your biological signals makes constipation worse.
Talk to your doctor
“Relieving constipation feels relatively easy when we know that we can buy laxatives to do that. But if you find yourself buying laxatives on a long-term basis, it’s really important to speak to a doctor or to a dietitian who can help you. Investigating why you’re experiencing constipation is really important, particularly if it’s new, because a change in bowel habit can be a sign of something more worrying,” says Medlin.
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