Women's health
Menopause
Hormonal changes during menopause—particularly with a reduction in oestrogen and progesterone—can have an impact on bowel function. Women often report bloating, wind, abdominal cramps, constipation, diarrhoea, urgency, and a sensation of incomplete evacuation. These symptoms closely resemble IBS and are thought to arise from altered gut motility, changes in the gut–brain axis, evolving microbiome balance, and increased cortisol affecting transit time.
Source references
Sturdee, D.W. and Panay, N. (2010) ‘Recommendations for the management of postmenopausal symptoms’, Climacteric, 13(6), pp. 509–529.
Turner, L. and Reyes, J. (2023) ‘Digestive & Bowel Changes – Menopause Guidance’, Menopause Guidance, 12 October.
Women’s Health Concern (2025) Digestive health and menopause. Available at: https://www.womens-health-concern.org (Accessed: 15 December 2025).
The British Menopause Society: https://thebms.org.uk/
Childbirth
Pregnancy and vaginal delivery exert substantial pressure on the pelvic floor, which can diminish support for bowel structures. Following childbirth, women may experience altered bowel habits—including constipation, urgency, and difficulties with gas and stool control—often linked to factors such as prolonged labour, instrumental delivery, or perineal trauma.
Source references
MacArthur, C. et al. (2013) ‘Faecal incontinence and mode of delivery: a six‑year longitudinal study’, BJOG, 120(2), pp. 169–179.
Royal College of Nursing (2024) Bladder and Bowel Care in Childbirth. London: RCN.
Webb, S., Sherburn, M. and Ismail, K.M.K. (2014) ‘Managing perineal trauma after childbirth’, BMJ, 349:g6829. doi:10.1136/bmj.g6829.
Childbirth trauma
Obstetric anal sphincter injuries (OASI), including third- and fourth-degree perineal tears, significantly increase the risk of bowel dysfunction. Symptoms include faecal urgency, incontinence, obstructed defecation, and long-term pelvic floor disorders. In the UK, approximately 6% of vaginal births involve OASI, with up to 20% of affected women experiencing persistent fecal incontinence up to five years post-delivery.
Source references
Elsaid, N. et al. (2025) ‘Care pathways and anorectal evaluation for obstetric anal sphincter injury-related incontinence: a UK survey of obstetricians’, Colorectal Disease. doi:10.1111/codi.70140.
Sultan, A.H., Thakar, R. and Fenner, D.E. (2017) Perineal and Anal Sphincter Trauma: Diagnosis and Clinical Management. London: Springer.
MASIC Foundation (2021) ‘Breaking the taboo: the impact of severe maternal birth injuries on the mother‑baby bond’, London: MASIC Foundation.
Webb, S., Sherburn, M. and Ismail, K.M.K. (2014) ‘Managing perineal trauma after childbirth’, BMJ, 349:g6829. doi:10.1136/bmj.g6829.
https://masic.org.uk/
Rectocele
Rectocele is a pelvic organ prolapse where the anterior wall of the rectum bulges into the posterior vaginal wall due to weakening of the rectovaginal septum, causing a pocket. Causes can include childbirth (especially difficult or instrument-assisted), chronic straining with constipation, ageing, hormone-related tissue changes, hysterectomy, or previous pelvic surgery.
When a rectocele occurs, stool can become trapped in the pocket during defecation, making evacuation difficult. This often leads the need to press on the vaginal wall and/or perineum (“splinting”), to aid evacuation.
Resources:
https://www.nhs.uk/conditions/pelvic-organ-prolapse/
Source references
Knowles, C.H. and Bharucha, A.E. (2022) ‘Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era’, Neurogastroenterology and Motility, 34(11), e14453. doi:10.1111/nmo.14453.
Bowel Research UK (n.d.) ‘Rectocele and enterocele’. Available at: https://bowelresearchuk.org/about-bowels/other-bowel-disorders/rectocele-and-enterocele/ (Accessed: 15 December 2025).
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