Women and gut health: Why you feel bloated and what you should do about it

Ever wondered why your stomach looks bigger at certain times of the day – not just at certain points of your menstrual cycle? That’s your gut telling you it’s uncomfortable.

So what causes this? It’s due to your gastrointestinal tract, the GI or the gut.

In your gut lives a complex ecosystem of micro-organisms such as bacteria (both good and bad), fungi and viruses that live in the digestive tract – these make up the gut microbiome.

These micro-organisms play a number of roles in the body, such as fending off infections and regulating metabolism. They break down food and convert it into nutrients the body can use. The micro-organisms also excrete waste matter from nutrients that are not ingested nor absorbed by the body.

Obviously, some gut bacteria are better than others and simply put, the good bacteria keep the bad bacteria in check, creating a balance.

When the balance is tipped the other way, the gut presents a series of symptoms like bloating, gas, constipation or diarrhoea, all of which pose discomfort.

It’s when these symptoms occur often enough that you’ll need to have them checked out.

WHY WOMEN ARE MORE SUSCEPTIBLE TO GUT ISSUES

For starters, the woman’s body is different to that of men.

With more organs in the lower abdomen, such as the uterus, things like menstrual cycles, pregnancy and childbirth, hormonal changes and even other chronic pelvic conditions have an impact on how the gut functions for women.

Women may also experience gut issues from surgeries such as caesarean sections, ovarian surgeries and even hysterectomies.

According to the American College of Gastroenterology, women are more likely than men to suffer from chronic constipation. In this finding, it also showed that while men are more likely to suffer from heartburn, the women who do suffer from it, experience the burn more strongly than men.

Notably, women are more likely to suffer from irritable bowel syndrome (IBS) – from two to six times more than men. What’s more, women who have IBS tend to exhibit worse symptoms and have more trigger foods than men.

FEMALE HORMONES AND THE GUT

For women in their twenties and thirties, hormonal changes such as increases and decreases in oestrogen and progesterone can cause bloating and discomfort in the gastrointestinal tract, said Dr Jaideep Raj Rao, senior consultant surgeon at Arden JR Surgery at Mt Elizabeth Novena Hospital.

The gastroenterologist added that prostaglandins, fatty acids produced when the body has tissue damage or an infection, can also cause period cramps. In the menstrual cycle, these fatty acids are responsible for uterine contractions, releasing the uterine lining and producing a period.

”These prostaglandins are secreted in the intestinal cells and for some women with higher levels [of prostaglandins], it results in an inflammatory-like state, leading to colicky pain, a bloated sensation and even diarrhoea, “ said Dr Rao.

Derrick Ong, founder and principal dietitian of Eat Right Nutrition Consultancy, said: “Oestrogen levels impact gut motility [where the process of food, liquids and waste is being moved through the gut] and sensitivity, while progesterone can affect bowel functions, leading to constipation.”

PUBERTY, AGE AND BEING FEMALE

One study by the University of California San Diego School of Medicine, found that the human gut microbiome matures earlier in younger women, showing a more diverse microbiome, than that of younger men. However, the microbiome diversity plateaus from age 40 for both sexes.

For women, this means that gut issues may reduce with age. According to Ong, life stages like perimenopause and menopause lead to a decline in progesterone and prostaglandins, reducing bowel-motion issues and abdominal pains. Lower oestrogen levels also lower gut sensitivity.

WOMEN AND IRRITABLE BOWEL SYNDROME

IBS is one of the most common gut issues. “The cause of IBS is complex, multi-factorial and not fully understood yet. It can be influenced by many factors such as race, geographical location, access to healthcare, culture as well as differences in help-seeking behaviour,” said Dr Rao.

This Korean study found that for every 2.5 women that seek help for their IBS, only one man does so.

Dr Rao said that IBS generally occurs from age 18 to 30. “It is less likely to develop when someone is 50 years old due to menopause and lesser fluctuating hormonal levels with age.”

He added that older women with a more recent onset of IBS should get it checked out to rule out “more sinister causes like gastrointestinal cancers”.  

Ong also observed that IBS has a large psychological component and is often linked with fibromyalgia – a condition that causes pain all over the body, which is more common in women. 

AGEING AND GUT ISSUES

Just as younger girls and their gut microbiome mature earlier, ageing can also take a toll on the digestive system, from food sensitivities to slower digestion.

Research from Singapore’s National Neuroscience Institute showed that 1.5kg of bacteria in the gut may be able to support and prolong a healthy life. Unlike genetics, gut microbes can respond to diet and even lifestyle changes, which can prevent the onset of age-related diseases such as neurodegenerative diseases.

HOW TO HAVE BETTER GUT HEALTH

According to Dr Rao, it is never too late to make changes to your life to achieve what he calls “gut health nirvana”. He recommends eight steps to achieve a balanced and healthy gut.

1. Diet

• Eat regularly in small portions
• Eat slowly and chew for at least 15 to 20 times before swallowing
• Stop eating when you’re 60 per cent full
• Avoid distractions such as watching TV or using the mobile phone while eating

2. Make wise food choices

• Avoid processed foods as most food intolerances happen with various preservatives in highly processed foods
• Eat more fresh vegetables, and fruit including legumes, whole grains and nuts
• Eat freshly cooked food

3. Incorporate pre- and probiotics in your diet

Probiotics are foods and supplements that improve “good” bacteria in the gut while prebiotics are high-fibre foods that feed the “good” bacteria, stimulating their growth. Consider eating yoghurt, kimchi, sauerkraut and kefir.

4. Test for food intolerance

Take blood tests to check for food sensitivities and allergies.

5. Avoid smoking and limit alcohol

6. Stay hydrated with a minimum of 1.5 litres to 2 litres of water a day

7. Get a good night’s sleep of between seven and eight hours

8. Maintain an active lifestyle and decrease stress levels with exercise

Added Ong, for people with IBS, consulting an accredited dietitian will help point them in the right direction to eat the right foods.

For women who still suffer from any symptoms, sometimes the gut is trying to tell you something and the best way is to trust your gut – and go see a doctor.