Ladies, have you ever felt bloated or backed up the week before your menstrual cycle? What about noticing diarrhea at the start of your menstrual cycle? I know I have. If you’ve been or are pregnant, have you noticed major changes in your digestive system and bathroom behaviors? Below I explore the connection between hormones and changes in your bowel movements.
Vocabulary! Gastrointestinal Motility is what we should be aware of when reflecting on this research. It is defined as the time it takes for material to move between one segment of your intestinal tract to the next. The way that material moves through your intestines is through the process of peristalsis otherwise known as muscle contraction of the smooth muscles which line your digestive system. As these muscles contract material is propelled from from one segment to the next. So, if ingested food takes longer to move between segments due to a change in the timing of peristalsis, you can see that the end result would be constipation. Conversely, if material moves quickly from one segment to the next due to increased peristalsis the end result may be moderate to severe diarrhea.
Understanding intestinal tract timing affects the outcome of bowel movements, which leads us to triggers, which then affect this timing. The main hormones that affect the GI system and timing are known as Progesterone and Prostaglandins and the amounts of these generated during both your monthly menstrual cycle as well as during pregnancy can result in dramatic changes in our bowel movements.
During your menstrual cycle progesterone is released during ovulation to help prepare the body for pregnancy. If an egg is fertilised then progesterone is a key hormone in stimulating the growth of blood vessels that supply the lining of the womb where the fertilised egg will settle. Progesterone further relaxes the smooth muscles of the uterus allowing for expansion and pregnancy. It is this increase in progesterone that impairs gastric motility and leads a person to feeling constipated and bloated.1
If the egg is not fertilized, then estrogen and progesterone levels drop sharply. The lining of the uterus sheds (starting your period) releasing prostaglandins. Prostaglandins play the opposite role of progesterone. Where progesterone relaxes the uterus, prostaglandins in turn cause the uterus to contract. The contraction of the uterus forcing everything to move towards an exit and this includes your intestines and bowels.
Depending on the hormone levels released we can now see how volatile our GI system can become the days leading up to and during our menstrual cycle. This volatility is one of the main reasons why we may experience diarrhea.
These hormones play a crucial role during pregnancy and so many of the same concepts detailed above apply.
Constipation is the second most common gastrointestinal complaint during pregnancy after nausea.2 During pregnancy Progesterone levels continue to rise for the first 36-38 weeks of pregnancy and then begin to plummet as the due date approaches. During the second and third trimester, the increase in progesterone causes smooth intestinal muscle relaxation to occur and we now know this can cause constipation. A study released in 2016 (conducted on female rats due to the inherent risks of human trials) found that GI motility in females slowed measurably when the subjects were exposed to high progesterone levels.3
Most telling of all during pregnancy is what having loose stools can mean. Loose stool is one of the key signs that labor is imminent and it important to be aware of your bowel movements throughout your pregnancy with specific mindfulness towards any changes in frequency or constipation. As we’ve discussed, your body releases prostaglandins to help soften your cervix, this in turn also causes changes to your GI system and softens your stool.
During early labor doctors may use prostaglandin suppositories to facilitate labor and contractions. Stay calm during this process but also stay close to the bathroom as this pre-labor sign indicates you should get ready to welcome your new baby to the world!
So, what can we do to help or change these symptoms? We can start by paying attention to our bowel movements and relating them to our menstrual cycles. Our patterns will become more predictable as we grow to understand our bodies and the role our hormones play every month.
I leave you with one especially important tip, be mindful of your insoluble fiber intake and proper bowel positioning; these can greatly help reduce bloating and cramping that may occur due to increased constipation. We can’t change the way our bodies function very much, but understanding what’s going on can provide clues to ways we can make out monthlies easier to manage. Talking to a physical therapist about ongoing issues can make a significant positive impact in your daily life. Girls just want to have fun!
For more information check out this blog for the right way to poop and this one for additional information on hormones here.
References:
- Gill R, C, Murphy P, D, Hooper H, R, Bowes K, L, Kingma Y, J, Effect of the Menstrual Cycle on Gastric Emptying. Digestion. 1987;36:168-174
- , . Constipation and pregnancy. Best practice & research. Clinical Gastroenterology.2007;21(5):80
7–18. - Matos JF, Americo MF, Sinzato YK, et al. Role of sex hormones in gastrointestinal motility in pregnant and non-pregnant rats. World Journal of Gastroenterology. 2016;22(25):5761-5768
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.