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Hello! I do hope you are doing well in these ever changing and challenging days – has it really just been like this for nine weeks? It feels like FOREVER but I have found a lot of positives (as well as some worries) and I hope there are glimmers of happiness in your life. The phrase ’emotional rollercoaster’ wouldn’t be out of place – I feel like some days that this is great, what joy there is in simplicity, and the realisation of what we REALLY need in life…to bouncing off the walls and longing for some casual retail therapy and eating a meal outside of the house that somebody else has planned, shopped for and prepared!! But…at the end of the day, we have a roof over our head, food in the fridge and nobody is bombing us in our beds…we’ll get through this and hopefully take some of the lessons learned with us into our ‘new normal’

I was recently delighted to be interviewed by Katie Kelly for the Women’s Health Division of the Canadian Physiotherapy Association – I got to talk about two of my favourite and intertwined topics – menopause and constipation – I’m going to share some of the highlights below, as well as a new video on abdominal massage for constipation.

Here’s Part 1 of the Interview (I’ll share Part 2 in the next blogpost)

Katie asked: COULD YOU TELL US WHAT MOTIVATED YOU TO PRODUCE SO MUCH EDUCATION AROUND MENOPAUSAL WOMEN?

In the world of women’s health, the focus has been on either specific issues, such as urinary incontinence or the peri-natal year, and although these are hugely important individual topics, what I wasn’t seeing in our world of pelvic health, was an awareness of how the menopausal transition (and life beyond) impacts women. I realised that menopausal women were a hugely under served population and there wasn’t enough awareness of how menopause and ageing affects not only pelvic health, but also heart, brain, bone and metabolic health.
For example, many of the pelvic health issues we see at menopause, such as bladder, bowel, sexual or prolapse dysfunctions, can often be traced back to previous obstetric events but with a changing hormonal profile (oestrogen alone has approximately 300 separate functions in the female body!), these pelvic health issues can be an impediment to leading a full rich life, with issues ranging from sexual health to a reluctance to exercise because of fears around continence or prolapse. Too many women are directed towards medical or surgical interventions as a first line, when often education can be helpful (for example around lubrication/ sexual ergonomics/ exercise prescription) which we as physiotherapists can provide.

Sometimes, we can zoom in on a person’s ‘problem’ or dysfunction, but I think that as physios, we can zoom out and see the big picture too – so for example – a peri-menopausal women who is having pain with sex – is it because of vulvovaginal issues? Or pelvic floor muscle dysfunction?Or an ortho issue like gluteal tendinopathy, which affects 1 in 4 women in their 50’s?
We need to take an overview of the whole person – and not be too ‘vagina-centric’! How is she sleeping? Are hot flashes/ night sweats disturbing her rest? (We can then discuss strategies like sleep hygiene, or guided imagery/ CBT which has been shown to decrease hot flashes by up to 46%)

Is it a partner-based issue? If she has a male partner in the same age range, it’s worth remembering that the prevalence of erectile dysfunction in men in their 50’s is around 50% and increases approximately 10%/decade.

When we realise how lucky we are, to have the gift of time with our clients (never enough, I know, but more than many of our healthcare colleagues!) and we can couple that with knowledge of the specific issues that peri and post menopausal women may be dealing with, then we can take a whole woman overview and ask specific questions that are relevant to a particular life stage – really having that depth of knowledge and a commitment to a truly biopsychosocial approach – that is often the missing link in menopausal wellness.

Katie also asked: ‘WE KNOW THAT YOU LOVE TO TALK ABOUT CONSTIPATION! WHY IS THIS SUCH AN IMPORTANT TOPIC WITH REGARDS TO MENOPAUSE?

You Know I Love To Talk About Bowel Health!!

Constipation may just be the answer to everything! It’s how we excrete excess oestrogen (many of the ‘symptoms’ of menopause are due to an imbalance of oestrogen relative to progesterone). Constipation is also linked to bladder urgency, prolapse, back pain and mood disorders. Our gut and bowel function changes as we age, and we have to take that into account when we are looking at menopausal health issues – foods that we used to tolerate well may become problematic. We all have our own bowel- based stress responses – some favour constipation, others veer towards diarrhoea. Our enteric nervous system and the role of the vagus nerve are only just beginning to be fully explored. Constipation becomes even more important in hormonally driven Breast Cancer, where we want to eliminate excess oestrogen and focus on the beneficial aspects of exercise, including decreased treatment side effects and reduced risk of recurrence! Constipation in particular, can also be driven by pelvic floor muscle dysfunction or slow transit through the intestines, or dehydration, or lack of exercise… Ultimately, I am a subscriber to the belief that not only you are what you eat, but you are what you eat, absorb and don’t poop out! (Disclaimer: I am moderately obsessed with good bowel function!)

So, that’s Part1 of our interview, I’ll share Part 2 soon!

In the meantime, if I’ve whetted your appetite for improving your knowledge on Menopausal Wellness, and you’d like an in depth online certification, let me introduce you to the 3rdAge Global Certification, an updated and expanded collaboration with my favourite colleague and co-conspirator, Jenny Burrell…

And finally! As promised, here’s a video where I talk you through a gentle abdominal massage to help counteract constipation – a noble goal, I’m sure you’ll agree!

Until Next Time!

Onwards & Upwards!

Mx