Someone you love is FOS (Full of Stool). Maybe it's you? Why aren't we talking about poop? In this episode of the Menopause Chicks Podcast, Shirley Weir is joined by Jen Howker, RD (Registered Dietitian) to crack open the conversation around digestion, constipation, and gut health — because if you're not talking about it, you're probably suffering in silence. Jen breaks down what constipation actually looks like (hint: you can go every day and still be full of stool), how to read the Bristol Stool Scale, and why women's colons are literally longer and twistier than men's. From hydration and fiber to magnesium citrate, kiwis, and the pharmacy aisle no one explains, Jen offers practical, evidence-based guidance for navigating gut issues at midlife. Plus: audience questions on progesterone and gut motility, fecal urgency, pencil-thin stool, medication-induced constipation, pelvic floor dysfunction, the best fiber supplements, and why you should aim for 30 different plants a week. It's time to stop "shoulding" on yourself (trying to figure this out on your own.) Seek support from a Registered Dietitian and Pelvic Floor Physiotherapist.
Guest Expert: Jen Howker, RD (Registered Dietitian)
Key Topics:
Audience Questions:
Resources Mentioned:
Timestamps:
Sponsor: Menopause Chicks Vulva & Vaginal Moisturizer — moisturizeyourvagina.com
Full of stool or FOS, or full of shit....
But- You said that this morning. I thought you were being, like, gentle with my full of shit comment, and then I realized it's actually a... F- FOS is actually a clinical term. It's a term. FOS, full of stool. Yeah.
Welcome, everyone, to the Menopause Chicks podcast. My name is Shirley Weir, and I am the founder of Menopause Chicks, and we do this live most Mondays. And I have some very special guests today to introduce you to. So if you've been listening to the Menopause Chicks podcast this season, you probably already know my friend Jen.
She's at the bottom of my screen. I don't know if you, I think everyone's screen looks different, but Jen, say hi. Hi. Thank you for doing this with me. Jen is the Menopause Chicks and menopause information whisperer. If you've been listening to a couple of our episodes, you know that she is out in her circle and her community as an ally and as an advocate, and if you run into her in Costco, she is most likely going to start talking to you about menopause.
So thank you for doing this with me, Jen. Jen also went through the Speak Menopause for Allies and Advocates program this year which is amazing and one of the reasons that we landed here and we get to do this together. So I'm really grateful. And I don't even, I don't even know how to introduce our special guest expert today, because she means so much to me.
Jen Howker is a registered dietician, and she is an expert in all things poop and constipation- ... and digestion, and she is a neighbor and a friend for over 20 years. I love her dearly, and I know that you are going to too after we get a chance to talk shit tonight together. Oh, thank you, Shirley Yeah, thank you for being here.
So give us a little bit of your background. Tell us, how you got to talking shit with us tonight. Sure. And give us some insight into your passion. Okay. First of all, I love you two. It's mutual. I've rarely met someone so just capable and driven and wonderful. I just- You're kind ... it's... No, it's not kindness.
You wanna- But in terms of my path I n- I was just always fascinated by food, and I think I remember it was a children's book when I was, probably... It was a picture book, so I'm gonna say five or six years old, and it talked about how you are what you eat. And I thought, "How is that? How can that be?"
And I've thought about that ever since, and I just am fascinated by all things food and digestion and the, our GI tract the complicated plumbing basically that it is. And yeah, I just am really lucky that I got to go to school for that. And I've, I just love what I do.
And I think I was inspired by you, I don't... I'm gonna say 10 years ago around breaking open conver- open conversations, and at the time it was breaking open the conversation around menopause. And I just started thinking, "What other things do we not talk about that impact us on the regular?"
And digestion bowel movements constipation, diarrhea reflux, all things digestion that impact people daily and often limit their quality of life to a large degree. So I thought maybe if I focus on that it would bring about some real kind of job satisfaction and- I was thinking about that this morning, because of course I've been so focused for years on cracking open the conversation and how menopause can have so much stigma attached to it.
I think we can probably agree that in 2026 that conversation is fully cracked open, but yet digestion, the whole everyone poops or doesn't concept, is not really out there. Why aren't we talking about it, and why do so many of us continue to suffer? Yeah, I think whenever there's something that we are really struggling to put words to or ta- or put it out there that we can relate, it's usually because there's an element of shame.
And usually that's because we think we're the only one or it's our fault somehow that we're not- Yeah ... eating enough fiber or whatever it is. And so people clam up and and that's really not the case. I think we do need to talk about it put words to these conditions and normalize it because, yeah, everyone does poop, and if you don't that's a really big problem.
Totally. And I want you to take a minute and walk us through, the 411 of what we're talking about. But as I was getting ready to jump on this call, I was thinking about what some of our normal... Let's, I don't like the word normal. What some of the more common ways of navigating our healthcare, for example, right?
And so if a doctor or a nurse in the traditional healthcare system said to me, "How are your bowel movements?" I'd say, "Fine." But compared to what? How- Yeah. I don't know. Are they? Yeah. And fine or a lot of people will say normal. Normal. I'm like what's normal to you?" Because normal to you- Could be constipated
could be... 100%. Yeah. It's just if we wanna look at the clinical definition of, say, constipation it's one of those things where if you have two or more of the following. And so there's variations there. But certainly less than three bowel movements a week would be considered constipation.
In the presence of dry, hard stool in the presence of feeling like you have incomplete bowel movements. All these things weigh in and tip the scale. You can have regular bowel movements, daily bowel movements and still be full of stool or FOS, or full of shit, as we like to market it sometimes.
But- You said that this morning. I thought you were being, like, gentle with my full of shit comment, and then I realized it's actually a... F- FOS is actually a clinical term. It's a term. FOS, full of stool. Yeah. And it just means that your whole... your your colon that is it includes your ascending colon, your transverse colon, and your descending colon with your sigmoid colon attached, is all literally full of stool.
Oh. So you can have stool backed right up to your small bowel and still have daily bowel movements. So this is not ideal. We would like to see people having... not... Everyone's different. And to be honest, I think one thing that isn't considered enough is that, especially in women, we see differences between the length of our colon and also the twistiness of our colon.
So women tend to have longer, twistier colons than men. And I'm guessing, if I had to go out there and guess this is not evidence-based, but I'm guessing it has to do with pregnancy and the the changes that occur in our abdomen and to accommodate for those changes. That would be my guess.
But yeah. So the longer the colon- If you understand what the colon does, the colon is another term for large bowel. The main role of the colon is to absorb fluid back into the body from the stool. So you can see if you have a really long colon, you're gonna absorb more fluid back into the body from the stool, leaving you with drier, harder to pass stool, which is really not uncommon in, in women.
And one of the ways that you can that I find this shows up in people is if you go for a colonoscopy, and in spite of doing all the steps, all the prep properly The prep wasn't great, and they weren't able to do a really good scope. And often that's- Oh ... because your colon is long or redundant or tortuous, we call it.
Ooh, I don't like that word. Um- But you used a word a, a, a couple minutes ago and you said ideal. Can we start there? Like, what would ideal- Sure ... digestion and bowel movements look like, and then maybe we can fill in the gaps with some of the questions that we received. That's a great question because really we're looking at a lot of different things.
We're looking at, um, the consistency. So we have a, uh, the Bristol Stool Scale that we use all the time in the hospital. Um, and it's a really handy tool to help us kind of verbalize what our stool- Right ... looks like. So, um, it's a scale of one to seven, one being very hard, dry pellets. Very hard to pass, painful to pass.
Um, two is, um, a little bit softer but still quite firm. Uh, number three would be like a, a banana. Looks like a banana. It's smooth, um, all one piece typically. Um, and that's kind of what we're aiming for, a three or a four, which is about the same, only maybe some more cracks in the, in the, the bowel, in the feces.
And then, um, as we get to the other end, so a seven on the Bristol Stool Scale would be liquid. Okay. So also not ideal. So a six, seven is basically diarrhea. Um, anywhere between a three and a five is where we'd like to be in terms of consistency. The other thing we're looking at, of course, is color. Um, I know most people just think stool is brown and that's good.
If your stool is brown, that's what we're looking for. Um, but it can be, depending on your issues, it can be a clay colored, kind of gray. Right. It can be yellow if you're mal-absorbing, um, fats. It can be, you know, different colors. I've actually had, um, one of my son's friend send me a picture of his stool because it was, uh, bright green and he was concerned.
But it turned out he had had, um, a blue Gatorade the day prior, and so that's what that was. But, uh, so color, consistency, um, and then again, you know, how the stool behaves. Is it, is it greasy? Is it fatty? Is it... Uh, you know, that, these are all clues as to what's going on inside your gut. Um, is it, does it float?
Does it sink? Mm-hmm. Um, all these things give us, uh, clues as to what's going on. Yeah. So, and then in terms of frequency, a normal, um, is gonna be different for everybody. So it's not always the best indicator in terms of gut health. Like I said, you can have a bowel movement every day and still be backed up.
You can have three bowel movements a day and still not feel like you're, you're having a complete bowel movement. So frequency is less, um, of an indicator in terms of what's going on. But at least three per week This is fascinating based on that thought I was having about, like, how do you know? Because you have nothing to compare it to.
Right. So without this information going in, so if you're on team prevention, let's say you just never want to be constipated, what are some of the tips that you have for- Sure ... achieving that ideal scenario? Sure. So first of all, it would be hydration. Okay. You have to be hydrated, especially since that job of your colon is to draw fluid back, um, from the colon into the body.
So if you're dehydrated, you're gonna pull more fluid out of your colon. So we need the water, um, in our GI tract to keep things moving along. Um, another thing would be, uh, a no-brainer thing, is fiber. We need to have, uh, enough fiber in our diet that will... Uh, insoluble fiber does a different job than soluble fiber, but- Okay
insoluble fiber provides bulk, and the bulk inside the lumen of our GI tract or our colon, um, exert pressure against the tube that is our colon, and that pressure sends messages to our body to, okay, we n- there's the presence of something here. We need to move things along. So, um, GI motility depends on the presence of bulk bulk in our GI tract, and fiber is a good way to do that.
Um, soluble fiber kind of, um, softens stool and, um, makes it a little bit slippery. It, it kind of helps it pass easily, um, without, um, discomfort. Um, and, and helps you in that way. Uh, you know, that's that same mechanism on how we control cholesterol with, with increasing dietary fiber. Mm-hmm. So cholesterol is trapped in the soluble fiber matrix, and, and blood sugars as well are, are improved this way.
So, um, soluble fiber's a good trap for things like that, but also just keeps your stool soft and, and really those are the two main things, hydration and fiber. Hydration- And what are some examples of insoluble versus soluble fiber? Good question. So, um, insoluble fiber is anything that you would put in a glass of water and it would sit there and, and 10 days later you would look at it and it, it hasn't dissolved.
So like an apple peel or like, um- Oh ... you know, those ribs from celery that you, you- Yeah ... pull off sometimes if you're making soup or something. Um, and then soluble fiber you can think of like, um, psyllium or, uh, chia seeds- Mm-hmm ... or, um, even, um... I was- I saw today, it was really interesting, basil seeds were used as a really good source of soluble fiber.
And so those kind of, if you put them in water, stir them up, they, they literally turn into a gel and you can see how they behave in your GI tract. So, um, if you're not sure, you can just do a quick, quick Google search what, you know, what foods are really high in fiber, um, soluble fiber, insoluble fiber. And, um, that it's just the combination is what's important.
We need both. Okay, we've talked about this before, kiwis. Where do they fit? Yes. Yeah. So kiwis have both. Okay. Uh, especially if you eat the peel. I don't. So the peel would be insoluble, the seeds are insoluble, and then the fruit itself, um, is very high in soluble fiber. So kiwis are a magical fruit in terms of gut health and gut motility, and one of the easiest things people can do to ensure that they're having, uh, daily bowel movements is to have two kiwis a day.
It's that easy, and I think it probably has to do also with, uh, the vitamin C content. So we know vitamin C- Oh ... does help with gastric motility as well. Very cool. Yeah. Um, Jen, you play two roles. You work in our healthcare system as a registered dietician, and you also have your own site, and you do consults with women.
So let's kind of bring somebody to the place of they're not in the health- they're not in the hospital, and they're not in the healthcare system. Maybe they're not even, like, taking any medications or have overlapping health conditions, but they're experiencing constipation. Okay. What, what's your advice for them?
Well, um, the first thing I would do is we would gently try to increase fiber and then pay attention. Okay. Because everyone's different, and we don't know if you are full of stool or if you just have, um, discomfort, or maybe you have pelvic floor dysfunction and- Right ... and mechanically you have a blockage or a, an obstruction, a partial obstruction.
So, um, what I would do is, uh, gently increase fluid and fiber because if you increase fiber without increasing fluid, you actually run the risk of, um, worsening constipation, and we- Mm ... definitely don't wanna do that. And like I said, we don't know if you're full of stool, and we don't know if you have a really long colon, so it's a matter of trial and then seeing what happens.
And then we pivot depending on how your body responds to that. So the next thing I would do if, say, for example, there was no discomfort, no increase in gas or bloating, um, uh, often that's enough. Uh, if not, uh, I would look at something like an osmolar, um, or osmotic, uh, laxative- Okay ... which, um, basically pulls liquid back into the lumen of the colon.
So very mild, um, not gonna cause explosive diarrhea like some of the other laxatives. Um, yeah, just, just, uh, so even, m- I mean, my preferred choice, uh, is just magnesium because I think most of us need it anyways, and why use a medication when you could be replacing something that we need anyway? Right. Um, if somebody did experience an increase in bloating or discomfort after increasing fiber intake, that's a sign that you are full of stool So that tells me something different, and we need to go in a different direction.
So in that case, I would, um, be back off on the fiber, and I would resort to, uh, a stimulant laxative, which, um, I don't love using for, you know, chronic constipation, but for a fresh start, basically, to clear out your, your colon, your, your large bowel, um, I think it's a good idea. And then going forward, we can assume there's an empty colon and, and things that happen after that we know are happening in the setting of an, a relatively empty colon.
So how your body responds to these things, um, tells me actually quite a bit. Yeah. So you mentioned pelvic c- floor dysfunction as a possibility. So can I see you, could I work with a registered dietician and a pelvic floor physiotherapist out of the gate together? You can. Um- Or what would you suggest? You can.
I would say, um, the addition of fiber and how your body reacts, and, and fluid, um, is going to give me and the pelvic floor physiotherapist a little bit more information. So I would start with, uh, dietary lifestyle changes. If you're not getting the results that you should be getting, then absolutely my very next phone call would be to a pelvic floor physiotherapist and find out if you have some kind of prolapse that might be blocking your- Yeah
stool or affecting, um, uh, GI motility. Okay. Yeah, for sure. Um, before we get... j- we have, uh, we have a few questions for you. Good. It's so exciting. Um, but let's clarify just bef- well, we don't jump over it, there are different types of magnesium, and there are als- Yes ... I heard you say there's different types of laxatives, so- Yes
can you explain both of those, please? Sure. So, um, the, the best magnesium for constipation In my opinion, is, uh, magnesium citrate. Okay. Because it is not as well absorbed. It stays in the lumen of your colon, and it acts to draw the fluid in. If the magnesium's absorbed through your small bowel, by the time you get to the colon, there's not enough there to pull that water in.
So whereas magnesium biglycinate, magnesium malate, magnesium carbonate, all these different s- magnesium salts, um, uh... And in fact, a combination is not a bad thing. Uh, if your goal is to have them absorbed, and maybe for sleep, uh, improved sleep or, uh, improved stress response, then you would want something that's more absorbed.
Whereas if you are looking for laxation only, um, magnesium citrate is the one I would use. Awesome. Yeah. And then you were asking about laxatives? Yeah, I think it's actually one of our questions that we got, but I mean, let's do it right now. Sure. Getting to the dra- getting to that aisle in the pharmacy, if it's kind of your first time, it can be overwhelming, and I didn't know before this person even asked the question that there are different types of laxative products.
Yeah. So help us. Yeah. So depending on what we determine the cause of your constipation to, to be, um, we would go a different route if we do end up needing to use, um, pharmaceuticals. So, um, uh, there are bulk-forming laxatives. Those are basically fiber supplements. So like Metamucil- Oh, okay ... would be a bulk-forming laxative.
Um, then there are, uh, stimulant laxatives that actually work on, um, uh, the muscles surrounding the colon. So they actually stimulate muscle contractions. So, um, that- is one that I would use to clear someone out. Okay. Uh, but I wouldn't use that regularly. They're not indicated for chronic constipation, and they will increase cramping and things like that.
I mean, that's the whole point. They cause muscle contractions around your GI tract, and they are great in terms of clearing you out for a fresh start- Mm-hmm ... or if you're severely constipated. Um, but in terms of chronic constipation, they, they're not, uh, suitable. Okay. Um, even once a week, you know, if you really have slow-moving bowels and find that you need to use something like that once a week, I would be...
I would rather you do that than be severely constipated, because we know that that's a risk factor for, for a lot of different things. Um, we also have, uh, stool softeners, which are less effective, but like docusate sodium, Colace would be a stool softener. Um, and, uh, these actually, uh, wouldn't be something that I would recommend for established constipation.
Okay. If, if you've had a surgery, um, you'll often be put on this kind of thing in the hospital to prevent constipation, but if you have well-established constipation, you know you're full of stool, these aren't gonna help you too much. And then, um, let's see. What else do we have? Bulk forming. Um, yeah, so I, I think the best combination, and the one I've had the most success with, is actually using a bulk forming, um, laxative or fiber supplement with the osmolar or osmotic, um, uh, laxatives.
So magnesium was the example that I gave, but there's lactulose, there's RestorLax- Mm ... Peglax. Those are all, um, osmotic, um, mechanisms to pull liquid into the lumen of the colon, and they work really well with, um, soluble fibers, um, to, to kind of pull the liquid in, then the soluble fiber can do its thing, and it's just a great, uh, a great combo, yeah, for regular, for typical constipation.
Why does, why does coffee work so well for me? So coffee is, is a really interesting thing actually. It, it does two things. So it, um, it, it acts- Hot ... as a stimulant. It's hot. That's the other thing. Yeah. Yeah. Absolutely. Temperature, um, whether it's a warm beverage or alternating hot and cold beverages, you can get a similar result.
And then the caffeine itself is a GI stimulant, um, which, um, there's, there's a, um, a reflex. It's c- I think it's called the gastrocolonic reflex or something like that, and it's, uh, when you eat something, some people get the urge to go right away, and that is overactive in some people. Uh-huh. So that, that could also be playing a role.
But the, the caffeine is, uh, is typically a culprit there. Okay. Thank you. Yeah. Um, so Jen too, I think we have some questions, uh, that were submitted in advance. I'm gonna pop them up on the screen for you here and, and go to a full screen. Just give me one second.
And can you see that okay? I can see that. Can you see that? Yeah. Yeah? Okay. And, um, and then, uh, if anybody has, uh, any questions for Jen Howker and they wanna pop them into the chat, uh, or you're also welcome to put your microphone and your, and/or your camera on at any time. Let me just get that. Okay Well, why doesn't that wanna go away?
So I'll just address that question. Yeah. So, uh, for people who maybe are just listening, um, the question is, "60 years old. Um, my last period April 2026. I was on 100 milligrams of Prometrium for the last 10 years. I tried Estrogel a couple of times but never felt good on it. During those 10 years, I had a lot of constipation and gut issues, mainly bloating and gas.
I've been off the Prometrium, which is, um, a progesterone supplement, for three months, and my gut has felt so great and the constipation is gone. Is there a link between progesterone and gut motility/gut issues?" And this was submitted by Kelly. Um, great question, Kelly, and also really good, um, awareness. So we do know that progesterone, um, in, in the body is a very, uh, relaxing muscle.
And we know that it's associated with kind of chiller mood and, uh, better sleep and, um, and it, it really has the same effect on our, uh, smooth muscles in our GI tract, around our GI tract. So, um, it is very common, especially, um, in your situation where you were on the Prometrium but not on estrogen. Um, so estrogen is an excitable, um, kind of, uh, movement-oriented hormone.
And so in the GI tract it moves things along quite quickly. And, uh, progesterone kind of does the opposite. It slows down and it, um, it relaxes. The sphincters in your GI tract relax. You can get more reflux for that reason if you're on progesterone, um, without, um, estrogen. So yes, it is very much, um, linked, uh, progesterone and, um, constipation for sure.
If there's one more thing, I know ... I don't think Kelly is on the call tonight. She might be. But, um, what's really important here is it's ... When we ever get a chance to talk with members, it's always great for some clarification, because I'd need to know if she has a uterus. And if she's taking estrogen and not taking progesterone, we have to find another solution for Kelly, because she needs, uh, uterine protection.
So I understand there's a lot of members in this community who s- will show up as having some issues with progesterone, but there are other alternatives we can work with. All right
I heard there are exercises or massage techniques that can help with constipation. Anything that you can recommend? Yes. Um, so basically if you put your hand on your lower right quadrant, so below your belly button and to the right, that's where your ascending colon starts. And if you move that up just under your belly button and across to the left-hand side, that is your transverse colon.
And then down again on the left side to right about where your, your hip is, that is your descending colon. So massaging in that way, in that order, so bottom right, up, across, and then down again, is in keeping with the route of our, um, stool through the colon. So that certainly helps. The pressure can help, um, with cramps, um, and it can also improve motility by telling your colon that there's something there.
So your colon is really sensitive to pressure, and so that's, um, actually a really good technique to kind of making yourself feel more comfortable and helping things move along as well. That's so cool. I've never heard that before. Mm-hmm. I love that. Love that question. Um- Oh, I think you... D- did you answer this one, Jen?
I heard a doctor on a podcast saying there are different types of laxative or laxative ingredients, but when I get to the drugstore, I couldn't tell which was which. So, the... What I would avoid if you are just having the occasional constipation, um, is the stimulant laxatives. So Senokot, um, those... or anything with senna in it is, uh, is a stimulant laxative.
And, and it's good if you have severe constipation that you're treating once in a while. But if you have run-of-the-mill, um, kind of not enough fluid or fiber, it's overkill, and that's, um, yeah, it's, it's something I would avoid using. You know what popped up for me when I, when I saw this question come in is I'm, I'm thinking, you know, if you're not in this market, if you're not in the market for support for constipation- Yeah
and you, if you're, like, roughly my age or around there, like, there was only one brand that was ever advertised. I'll- I'm just gonna say it. Right. It was Ex-Lax, right? Yeah. And now there is a basically a whole aisle in the pharmacy that addresses constipation, so it's very easy to get confused. Totally. I, I...
Yes, it's, it's overwhelming I'm sure. And, um, you know, depending what you suspect the cause to be, um, you would definitely choose, um, a laxative that would address that issue. Uh, yeah, so if, if you have a very long colon, if you know that, I, you know, there's certain people who I come across in my practice where, um, we know for a fact they have a very long colon.
It's been seen on imaging. Um, and so with them, I'm a lot more likely to use something like a senna or a Dulcolax, which is also, um, a stimulant laxative. Otherwise, um, just, uh, fiber and then an osmotic laxative. Not everyone responds, but most people do. Yeah. And I'm thinking don't... It's not DIY. Like, don't do it yourself.
Like, do the food- Yeah ... and the hydration yourself, but get some advice from your registered dietician, from your pharmacist, from somebody on your health team, um, 'cause that can also... Doing it yourself could backfire. Yeah. Yeah, for sure. There was a question... Yeah, so- This one. "Why is my poop suddenly pencil thin?"
This is a really, um, interesting question because, uh, we can have occasional, um, changes in- to what our, you know, poop looks like, and it, it could be maybe we ate something. Maybe, um, you know, we've gone a couple days without fiber, or we're away and we're not using our normal, uh, bathroom. A lot of people are sensitive to that.
Yeah. Um, however, if you notice a change in the size or the, um, consistency or the color of your stool, um, that persists for more than a week, I would make an appointment with your physician, um, because you need to rule out more sinister causes. Um, you know, like, um, uh, colon cancer, um, often one of the first things y- you will see is, um, a thinner, um, irregular, um, uh, feces.
So it's really important to pay attention. Don't just flush and walk away. Have a look. Have a look- Right ... and, and see what color it is, um, if there's any changes that might be a little bit, um, concerning. This I would, um, I would pay attention to. Okay. Good advice. Uh, was there one more, or we can go, we can go to the chat and see if any of our live attendees have anything.
Oh, this was one for... I told you about this one. Um, and, uh, and co-host Jen, you'll remember this I think from the first- Mm-hmm ... the first episode of this season. But I wanted to bring it to you because, um, we got this question on an Ask Anything, I think it's in the first episode, and it is, um, "I am 60. My last period was six years ago," and her question relates to gut and bowels.
"I've noticed such a change in my bowels, particularly the smell. I do the FIT test every year, and it's always negative." You can tell everyone what a FIT test is. "And I really seem to struggle with more gas, bloating, and food sensitivities in the last few years." What do you think? Okay. So, um, first of all, um, the only thing a FIT test is assessing for is the presence of blood in your stool.
Okay. So microscopic levels of blood, because often that is a first indicator of, um, uh, a GI cancer. Okay. So that's what it's screening for only. It doesn't tell you anything about how robust your microbiome is or, um, otherwise the health of your colon. It just tells you if there's blood present or not. So, uh, in terms of more gas bloating, um, i- in the past few years, um, definitely, uh, gastric motility, um, the variety of microbes in your microbiome is decreased.
Um, our ability to digest and absorb the micronutrients decreases as we age. Right. And certainly as we, um, uh, as we reach menopause with that decline in estrogen, uh, and progesterone, we know that that definitely affects our gut health and motility. So as GI motility slows down, we tend to have more gas and more bloating.
So certainly if, if someone's on a GLP-1 agonist or if they are, um, on a higher dose of progesterone, they may experience, um, this kind of thing for sure. Yeah, not uncommon. Okay. Thank you. Um- You're welcome ... I'm gonna stop sharing and see what our lovely audience is saying in the chat. I know there was one question: Can you address fecal urgency?
Sure. So, um- The fee- the urge to poop is, um, basically rectal spasms. So that feeling that, "Oh, I better go," or, um, "Where's the closest washroom?" Um, that's a rectal spasm saying, "Hey, there's presence of stool in your rectum. We need to make arrangements here." Get to the, you know, the closest washroom. So, um, if you have, uh, that f- a feeling of rectal fullness or an incomplete bowel movement, um, that is often, um, due to a, a prolapse or, or- Ah
um, so- some mechanical blockage that is making it feel like there's stool there when there isn't. If you get rectal... You get urgency and there is stool present, it can also be a sign of, uh, some kind of mechanical blockage, whether it's scar tissue or a rectocele or whatever So, uh, the presence of stool is what's gonna cause that urgency.
Um, there are kind of, um, systems in place that will, uh, feedback to our brain whether or not what's presence in, in the rectum is solid, liquid, or gaseous. Ah, yeah. So t- usually you can know, okay, you know, it's just, it's just gas. I'm okay here. Um, or, um, nope, this is, this is gonna be liquid. I better get moving.
Or if it's solid, okay, I can wait five or 10 minutes. So, um, if that feedback isn't working really well, like say, um, for instance, that you, um, have ignored the need to go, um, have a bowel movement for years. You've just like, okay, well, at the end of the day, at the end of the day, at the end of the day, that communication, um, between your gut and your brain isn't always in good shape.
So we can have, um, you know, no urge, no urge, no urge, and then all of a sudden, okay, now we really need to go. So that urgency, if there actually is stool there, is, is often the result of ignoring those urges for years. Interesting. Um, you just alluded to it, and so I don't wanna miss it, but you said something about like not feeling like you're fully emptying.
Right. So, um, this is one of the things. So if you, if you have a, a bowel movement every day, um, but don't feel like it's complete- Okay ... or if you... You know, when you're cleaning up afterwards, and you're wiping, and you're wiping, and it's still... There's still stool there. You can tell. So this is, is often either a lack of fiber and bulk, or it could be a pelvic floor dysfunction.
So if you find that pushing up on the, your perineum, the space between your vagina and your anus, if you find that supporting your pelvic floor in that way helps you clear out stool, then you definitely should see a pelvic floor physiotherapist for support with that. Good advice. You also said the word rectocele, and I just wanna make sure everyone understands that that is a form of pelvic organ prolapse where the rectum bulges into the vagina.
Right I had never heard that term before until I was diagnosed with a rectocele, so it's important to talk about it I also wanted to say, Shirley, that, uh, positioning is really important. So, um, even if you don't have pelvic floor dysfunction- Mm-hmm ... um, the ideal position for, uh, pooping is to have your knees up above your hips, which is hard to do.
Not, not just holding them up yourself, but supported. So, um, if you're, if you have a Squatty Potty or a stool or something that you can put your feet on and, and get that angle, um, it helps relax the pelvic floor and have the poop pass. Um, another thing you can try is, um, uh, breathing out, as if you're blowing through a straw.
Oh, hmm. And that in itself, um, there's, there's actually a relationship between your diaphragm and your pelvic floor. And so blowing out, as if you're blowing through a straw, relaxes your pelvic floor also. Oh, that's good advice. Yeah. Um, I was gonna add if you're traveling that the s- bring the suitcase or turn the garbage can on its side- Yeah
or use that as your, your mobile stool. Um, okay. Um, anybody that wants to turn their camera or microphone on, you are more than welcome. But, uh, we have another question. Any advice around ... Oh, sorry, I think she rewrote it. Okay, Jane. Any advice around constipation that has increased with my new medications?
Can you, can you see her medications, Jen? No. Do I need to look? Um, it's, it's pantoprazole. Can I try ... Yeah. Oh, panto- pantoprazole? Yes. That and an antibiotic for a UTI. Okay. Um, so antibiotics are going to wreak havoc, um, on your microbiome, and really the best, the best thing to do is, is either, um, you can take a probiotic.
Um, Florastor, i- and Culturelle are both, um, shown to decrease, um, incidents of, of post-antibiotic GI disruption. Okay. Um, the pantoprazole is probably my least favorite medication of all. It's a proton pump inhibitor, uh, and it's an antacid. So, um, I would say, uh, we should work on getting you off of that medication because if you are on an antacid, it, at the very beginning of the digestive process, throws things, uh, off kilter.
So we need a really low pH in the stomach to start a cascade of digestive processes, um, that involve... Um, so the gallbladder won't release bile unless there's the presence of acid. The pancreas doesn't like to release its digestive enzymes unless there's the presence of acid. Um, and then motility as well is affected.
So if we could get you off of that, that would be my preference. Um, but certainly it will, uh, affect GI motility and, um, your microbiome and, um, put you at risk for micronutrient deficiencies as well. Jane's giving you the thumbs up, so thank you for that. I'm gonna ask this question. I don't know if she's thinking it as well, but are some of the other things that you talked about, like, um, when we were talking about the ideal prevention strategy for constipation, will they work alongside of certain, like, these medications that are commonly s- prescribed?
Or it's just very individual. Very individual. Very individual. Very good question, and yeah, very individual. So the... first of all, the only time, in my opinion, someone should be on a PPI, a proton pump inhibitor, or an H2N antagonist, um, these are antacid medications, is if they actually have peptic ulcers.
Mm-hmm. So if you actually have ulceration in your, uh, stomach or your small bowel, and that's very unusual. Um, it happens, and then I think that is a good solution short-term. But these medications are not meant to be used long term, um, and they can wreak havoc two years, five years, 10 years down the road.
Wow. Um, but you can, in spite of that, the body's pretty resilient. You can, um, you can Uh, add, add fiber. The problem that I would see arising if you, if you just did the usual things, increase fluid, increase fiber, is, um, first of all, fluid is gonna dilute your stomach acid even more So, uh, drink between meals if you have trouble with GI motility.
Um, and then, uh, the fiber that you take is gonna, first of all, sit in your stomach longer because the acid isn't there, you know, pushing things along. Um, and you run the risk of fermenting things further up in your GI tract than you would normally. So normally fermentation happens in the colon only. Okay.
That's ideal. That's what we want. Um, sometimes if you don't have acid in your upper GI tract, bacteria can migrate up, um, and start fermenting things in the small bowel, which is not ideal. It's uncomfortable. It's, um... impairs digestion and absorption. Uh, so yeah, it really depends. It's super individual.
Right. But as a rule, I just... I would get off the proton pump inhibitor, if you can. Yeah. Well, I mean, the re- the reason that question popped into my head is I'm just thinking, you know, when you do those consults at the pharmacy, right? Like, you need a medication. Lots of us need medications, but I never remember seeing anybody saying, "Make sure you eat two kiwis a day while you're..."
Right. "... like, while you're taking this," right? Right. Or whatever the appropriate recommendation- Yeah ... would be. You just... We only see those lines that say, 'May cause diarrhea', or 'May cause constipation.' And we're like, "Ugh." You know? Yeah. We're moving into that new health process somewhat unprepared, or putting ourselves at risk for another disruption.
Yeah. So yeah. You know, medication, um, induced GI issues are really common, too. So, um, the, the proton pump inhibitors are, are one example, but metformin, widely used, um, to help blood sugar regulation, is known to increase or decrease story GI transit time. So it can cause malabsorption, it can cause diarrhea, it can cause stomach upset, nausea, all kinds of things.
So, um, yeah, it's, it's, uh, important to talk to someone who understands all the different pieces, the moving pieces. Absolutely. Uh, Kim, I see your question here. Do you mean insulin? You can just, um, clarify that in the chat. That would be great. And Brenda wants to, um... Brenda says, "Many of the things you suggest, fiber, bran, prunes, RestoraLAX, work for me, but only for a short time.
Then my body reacts with constipation, and I have to keep switching." Okay. So my, my next question would be... And this is Brenda? Yes. Um, Brenda, do you have pain associated with your symptoms? Okay. No, I don't. Oh, no pain. Okay. So we are just looking at, um... So the reason I ask that is that, um, pain is the difference between a functional, um, constipation and IBS-C.
So IBS, you can have irritable bowel syndrome, so IBS-C, constipation. You can have IBS-D, diarrhea, or you can have a mixed presentation, and that changes how we manage things. Uh, but I would guess that probably on an ongoing basis, you're probably a little bit lower in fiber than you need to be. Um, and there's, um, some really good fiber supplements out there, because it is hard to get, um, your, uh, targets, your fiber targets.
So for, for women, those targets are about 30 grams of fiber per day. 20, 28 grams of fiber per day. That's a lot. It's hard to do. So, um, one of the fiber supplements that I really like is called, um, Fiber For. It's a Webber Natural product. Right. And why I like it is- It, it gives you the benefits of the fiber in terms of softening the stool, but it's not fermentable, so you don't have the increased gas associated with a lot of fiber supplements.
So- So that is opposed to Metamucil? Y- Metamucil's similar. Um, I prefer this one though. I've had better- Okay. I've never tried it. Yeah. It's incredible, and I would actually use, uh, one scoop, uh, twice a day. Split the dose, because our gut bugs like a, a, a nice supply of food throughout the day. Consistent, yep.
Okay. Instead of just loading your breakfast with, you know, 20 grams of fiber and then not having fiber the rest of the day. Um, yeah, it's, it's a partially hydrolyzed guar gum is the source of the fiber. It's very gentle. It doesn't thicken your drink like Metamucil does. So, um, sometimes I'll even put it in my coffee.
You just, you won't even know it's there, and it's, um, wonderful in terms of normalizing, um, a softening hard stool or even thickening up loose stool. So if you have kind of a mixed presentation, it's just a win-win. It's great. Okay. Thank you. You're welcome. Did you say a brand name, Jen, or just the- Yeah. It, well, I said both.
So- So I'll put it in chat. So the brand name is, it's called The Right Fiber, and then it has the number four. Okay. Um, it's a Webber product. Um, but the ingredient that I love, and if you can find another cheaper version, is PHGG, partially hydrolyzed guar gum. And, uh, it's low in fermentability, which makes it really well-tolerated.
And is this something that we get online in a, a natural food store? Costco has it. Oh, okay. Uh, Shoppers has it. Okay, good. Um, yeah, online. Amazing. I use one that is called SoluFiber- Okay ... from EOR. Yeah, that's the one I use. I would have to look it up. Is it, is it a partially hydrolyzed- With- ... guar gum as well?
Yes, yes. Yeah. Amazing. Do you wanna put that- Yeah ... in the chat, too, Jen? Sure. Jen A. Um, and, and Kim Mudge has a question, and it isn't... I, I d- I've never heard this word before, but you probably have. Inulin? Yes. So, uh, she just wants to know what you think of it, and then she said it's a type of fiber, and she wanted to know if it's natural- It is
or not, and if it's recommended. So inulin is from the chicory root. That's the main source. Um, it's also in artichokes and asparagus. Oh. Um, yeah. So it is natural. Um, it is fermentable. So, uh, usually they use this as an additive in food. So, you know, like smart pasta- Yeah ... where they've... It, it's just white pasta, but they've really upped the fiber content by adding this inulin, um, fiber supplement.
Yeah. And so not as well-tolerated, but a great option. Um, it will help, um, increase your fiber intake, and if you have IBS, you might not tolerate it. But o- other than that, um, yeah, it's a great option for increasing your fiber. Amazing. So what about artichokes then? I can just eat- Yeah ... yeah? Good, good source of fiber.
Artichokes are great. In fact, what our recommendations are now are to, um, aim for 30 different plants per week. And, and the, the rationale behind this, the science behind this, is that the 30 different plant foods are gonna give you that wide range of different fibers, phytonutrients, um, uh, soluble fiber, insoluble fiber, fermentable fiber, um, vicious- viscous fiber, um, all these things.
So we know that if you have 30 different types of plants per week, the bugs in your gut, your microbiome, is much healthier and happier. So there, you know, 30 or more. And it's, it, I know it sounds like a lot, but, um, it's, it, it's easy to do. It's easy to do. If you add in, like, parsley flakes or sesame seeds, um, herbal teas count.
Um, you know, sprinkles on things. I always put oregano sprinkles on pizza. Y- it's not hard to do if you start, um, adding, adding in sprinkles especially. That's a good little challenge for menopause chicks. Yeah. Yeah. Makes a huge difference. Just being aware or being conscious of it, too. That's amazing. Yeah.
Um, I think that might be all the questions in the chat. Thank you, everyone. If there's, uh, we'll stay around for another minute or two if you want to turn on your mic and ask a question. Uh, Jane, uh, wanted to know if you're available for online consults. So Jen, I've put your website on here. Thank you, Shirley.
Um, you have also gone through the Speak Menopause for Allies and Advocates this summer, and I know you're a fierce researcher and have spent- ... a lot of time, um, focusing on women's midlife health. So I wanna thank you for that, but also make sure that people understand that, um, that you bring that background, uh, married with your, your dietician expertise.
So yeah. Thank you. It's a good opportunity, and I don't know. I mean, come on, can we just aspire to live in a world where we all have access to the expertise of a registered dietician- Yeah ... and a pelvic floor physiotherapist? Let's just do that. Yeah. Yeah. I love that. You know, and I, I always think about as, uh, you know, a lot of us are mothers, and i- if our kids were struggling with constipation or, um, any- anything, we would advocate like crazy.
But when it's our own, we tend to be okay with a, a baseline level of suffering, and really that is not okay, and we shouldn't, we shouldn't be okay with that. Beautiful words. I mean- Mm-hmm ... I think probably there's a few people here tonight that have heard me go on and on about sleep. But the reason I talk about sleep, because it's the most important pillar of our health, and the Menopause Chicks research shows that of the 70% of our members who meet the criteria for chronic insomnia, 60% of them think they should solve for sleep on their own.
And I'm apply- Mm ... I'm seeing that, um, shoulding, you know, showing up in other areas, and this would be one of them, right? If your mother lived with constipation, then you just think, oh, now I'm unlucky too. And really, you've given us some really great tips to, uh, to carry forward if we are going to address a couple of those things on our own.
But hopefully we'll also reach out for help and support as well. I hope so. Yeah. Yeah. You're worth it. Thank you so much. Thanks everybody. Hopefully you'll take this episode and share it forward, um, 'cause someone you love is FOS too. And I'm gonna get you a shirt that says FOS. Thanks everybody, we'll see you next week.
Thank you. Thanks Jen for your help too. Thank you. Thanks Jen. Thanks Jen. No problem. Mm-hmm.
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[Extro]
Wow. Thank you. And that's it for this week's Menopause Chicks Podcast. A huge thank you to my guest co-host, Jen, for joining me, and to everyone who showed up live, and especially to those of you who trusted us with your questions today. Because when you share your question, you're not only prioritizing your own health, you're helping someone else who has been wondering the exact same thing.
And now, I want your questions for future episodes. What are you curious about? What have you been googling at 2:00 AM? What did you forget to ask at your last health appointment? And what have you been told that doesn't quite yet make sense? Or what's happening in your body right now that has you wondering, what does this mean for me?
Curiosity is where clarity begins. So please go to menopausechicks.com/podcast. You can send me your question privately, leave me a voice note, submit a video question, or find out how to join us live on the next episode of the Menopause Chicks Podcast. And when you submit your question, give me a little context.
Tell me your age, the date of your last period, what you're currently doing or have tried, and then ask your question. Again: menopausechicks.com/podcast. If today's conversation gave you insight or an aha moment, please follow the Menopause Chicks Podcast wherever you love to listen to your favorite podcasts, and share this episode with someone you love, because quality information deserves to travel, and your question might be her question, too.
I'm Shirley Weir. Thank you for listening. Stay curious and keep your questions coming, because you deserve quality information, you deserve quality healthcare, and you deserve to feel amazing.
[Disclaimer]
The Menopause Chicks Podcast is for education and information only, and is not a substitute for personalized medical advice, diagnosis, or treatment. Everybody and every health history is different. Use what you learn here to help you ask informed questions, understand your options, and have conversations with your own healthcare professionals about what is right for you.