Why You May Experience Constipation in Your Luteal Phase andWhat to Do About It - a podcast by Jessica Duffin

Today we’re continuing with our endo and IBS theme as part of my IBS Awareness Month series.

Most of the clients who come to me have endo and IBS, now of course, I tend to see more of these clients because I am specialised in endometriosis, endo belly and SIBO, so naturally I attract these types of endo clients – but, generally, the majority of people with endo tend to have IBS problems in some form. In fact, more research is being done into this area, but The Center for Endometriosis Care found 25% of patients had painful bowel movements, 35% had constipation and 60% had diarrhoea. 

But that doesn’t mean that we just have to put up with it. And it doesn’t mean that all of your IBS issues are because of endo, in fact, some of them may just be because of your hormones – and people without endometriosis will be affected by these issues too. A very common problem, is constipation, during the luteal phase, which is the phase after ovulation and before your period.

When clients come to me, they often report this symptom, and many of them are perplexed by it, and think it’s to do with endo. They report constipation in their luteal phase, and then diarrhoea during their periods, and maybe, if they’re lucky, they get some normal bowel movements in their follicular phase.

So what’s happening here?

Well, a few weeks back we discussed why the inflammation from our periods can cause diarrhoea, so if you experience that, head back to 188 for tips.

But in terms of constipation during the luteal phase, let’s look at what’s happening in this time of our cycle. The luteal phase occurs after ovulation, the follicle that once held your egg, has released the egg during ovulation, and the follicle has transformed into a temporary gland, called the corpus luteum. The corpus luteum releases the majority of our progesterone supply during this part of our cycle and oestrogen levels decrease.

Now progesterone has many roles, and one of them is to relax our muscles, in case pregnancy has occurred, and this is so the pelvic muscles can begin relaxing to allow for expansion. However, this muscle relaxant effect affects all of the body – including the muscle of the intestines.

The muscle of the intestines is responsible for the movement that pushes food through the large intestine, and out of your colon. When we are in the luteal phase, this process slows down because the contractions, known as peristalsis are lessened.

Now, it should take two hours for food to travel through the small intestine, but once it’s in the large intestine, it should take about 12-24 hours. And in terms of optimal health and bowel movements, we’re aiming for at least one bowel movement a day, but ideally, 1-3. This allows for old hormones, waste materials,  and food to leave regularly, as a build-up of these in the body can start to create problems because hormones, etc. can be reabsorbed.

So, ideally, even if things slow down during this phase and your bowels feel a bit more sluggish, you should hopefully still be having at least one bowel movement a day. Now, a really easy way to test how long it’s taking your gut to process food, is the ‘polka dot poo’ test, which Dr. Nirala Jacobi teaches us in our training. So all you need to do is swallow hulled sesame seeds with water, so don’t chew, just swallow, and then look for sesame seeds in your stools, and when you see them, that is your transit time. You could do this in your follicular phase to see what your normal transit time is like, and then in your luteal phase, to see if things slow down.

Now of course, if things have slowed down, it means there’s more waste built up in your intestines, more gases building and more time for bacteria to eat our food and ferment that food, creating more gas, so then as a result, you may also have more bloating during this time, due to the expansion of the intestines. And it’s important to note that you might not think you’re gassy because you’re not passing wind frequently, but this will happen with motility and peristalsis being slower, because it’s not just food that’s moving slowly, but gas too. 

Now, there are quite a number of other things that can contribute to the endo belly in the luteal phase, including inflammation and oestrogen dominance, and I have a whole episode on that which I’ve linked in the show notes. But back to constipation.

Whilst it’s normal for there to be a level of slower bowel movements during this time, we want to still try to aim for once a day if doable. 

If you’re prone to a history of SIBO, or gut dysbiosis, and both are common with endo, you’re likely going to need to do some additional gut healing because those can both create IBS and constipation, so you may experience worse constipation than others during this time, and I do tend to see this to be true with many of my clients with SIBO or extensive gut health issues.

Additionally, if you already have adhesions from endo or surgery pulling on or distorting your intestines, that could create more intense problems with constipation during the luteal phase, so looking into getting those addressed with some adhesion treatment like visceral manipulation, Clear Passage, Neural Therapy or Frequency Specific Microcurrent would be part of treating the root problem.

But for now, I’m listing some short-term strategies to bring you relief on a day-to-day basis. If you find that these don’t work for you, or don’t help that much, look into the other root causes I mentioned. It simply could mean that you need to try some other strategies, of which there are many, but if you suffer with bad constipation in this phase and you tend to get a lot of IBS all cycle long too, it may be worth doing some more in-depth gut healing, like taking a course, doing a gut healing protocol or doing some testing to determine what’s going on.

It's likely you’ll need a combination of these things, because they’re sort of targeting different areas of the body to support more regular or easier bowel movements.

Number one is correct positioning on the toilet. The standard way we sit on the toilet for a bowel movement isn’t actually a helpful way to pass a stool, and this is exaggerated if we have pelvic floor issues too, which most of us do. To help your body adopt the best position to most easily pass a stool and to support your pelvic floor, try elevating your feet so that they are higher than your hips – essentially, it’s a bit like a squat. You can do this with a squatty potty, which is just like a step that sits around the toilet, or you can put your feet up on some spare toilet tissue rolls, or a stack of books or magazines. 

Number two is actually helping to push stools through the intestine and break up hard stools with my go-to suggestion, and that’s abdominal massage. There are so many massages that can support with constipation, so I encourage you to do your research, but the ones that I use with clients are Arvigo massage and the ‘I Love You’ massage. You’ll need to learn an at-home method of Arvigo from a practitioner, and my colleague Tara offers online sessions, and I’ve linked to my interview with her and her website in the show notes. Then the ‘I Love You’ massage is free, and that’s on YouTube, and I’ve put the link in the show notes again.

My clients love using these and report that they can feel the hard, stuck stools and can feel them moving along as they massage, and that they’re really effective. These massages also stimulate the motility of the small intestine and digestion overall, so can really speed things up and support healthy digestion and bowel movements in general. 

I see best results when massage is performed nightly or at least a few times a week.

Number three is movement in several forms. Exercise in general can help stimulate gut motility, especially walking, running (if you can manage it) and rebounding (which is essentially the new name for jumping up and down on a mini trampoline!). If you find you’re worn out during this phase of your cycle, try more gentle walking, rather than the more energetic ones.

Anything that gets you to twist or move your abdomen can really help too, so yoga is a great one, and there are actually a number of online yoga videos for constipation and digestion problems, and I’ve linked to one or two that I’m a fan of, but you can look for others online too.

Number four is softening and bulking the stools so they’re easier to pass. I recommend trying magnesium citrate or oxide, which draws water into the intestine, creating a looser stool and stimulating a bowel movement. In my training with leading SIBO doctor, Dr Siebecker, she advises the dose is 500mg  up to 2000 mg at bedtime (two hours after food), daily or as needed until you have a bowel movement. However, 1000 mg is normally effective for many, but see what works for you. It’s best to work up slowly, and give it a good few days between dose changes as it might take a little while to see the initial effects, and you don’t suddenly want to suffer from stomach upset because you moved up too quickly.

If you find you don’t tolerate that too well, high dose vitamin C also acts in the same way, and there’s no maximum dose because what your body doesn’t need, will come out in a bowel movement. You could try a powder form in water or tablets, either way it’s best to use a type of vitamin C that you swallow, rather than a tongue spray or dropper, or a vitamin C skin patch, because we want it to go through the intestines.

Now, to bulk up the stools, you can try chia or flax seed, or partially hydrolysed guar gum. I recently shared how to use flax or chia in a recent episode on constipation, so I’ll link to that in the show notes. 

Partially hydrolysed guar gum is a low FODMAP soluble fibre, and actually helps with both constipation and diarrhoea by bulking up stools. It’s usually well tolerated by SIBO patients too, but each SIBO patient is unique, so test your personal tolerance because for some, it just makes SIBO symptoms worse.

Dose wise, you can try 5-6 g daily, ideally dissolved in hot water on an empty stomach, for at least one month and likely ongoing for maintenance. Some people do put it with tea, coffee, smoothies or even porridge, but many of the labels suggest on an empty stomach – it seems to work well either way. 

To avoid side effects like bloating or gas, increase to full dose across one to two weeks, especially if SIBO positive, so start out lower, with say one gram, and then increase by a gram or half a gram a day.

I wouldn’t use all of the above at once, because you might end up with the opposite problem and you won’t know what’s working or what you’re reacting to! So pick one, and try that for a cycle, then pick another, and try that for a cycle, etc.

Number five is increasing fat content. This is a super helpful strategy in the luteal phase because firstly, fat stimulates large intestine motility, triggering a bowel movement, but secondly, fat helps slow down glucose release to our blood, and in our luteal phase, we’re more prone to blood sugar instability, so this can help manage those levels and as a result, improve PMS and reduce pain and inflammation. I talk more about using fat in my recent episode for constipation, so you can head to that episode for more in-depth details, but generally, look to get two tablespoons of fat with each meal at a minimum, building up slowly to test your tolerance, as high levels can cause abdominal cramps and diarrhoea because it can over stimulate the large colon.

Our last strategy, is a simple one, but is often very overlooked, and that’s hydration. If you’re not drinking enough water there will be less water in your stools, creating harder stools, that are more difficult to pass when peristalsis slows down in the luteal phase. To work out if you’re drinking enough, the calculation is half your body weight in fluid ounces. So, say you’re 100 lbs, you would halve this to get 50 lbs and then simply replace the pounds sign with fluid ounces. If you’re in the UK you’ll have to then covert to litres. This is the minimum you should be drinking. If you exercise a lot or are breast feeding, you’ll need more. I’ve linked to a water calculator in the show notes which helps you to work out exactly how much you need.

So that’s it, now you have six strategies to try if you struggle with constipation and endo belly in the luteal phase. Like I said, I wouldn’t mix up the laxatives and stool softeners, just try one of those, but combining one of those with a few of these strategies could really help.

If you’ve found this helpful, don’t forget that I’m currently running a free Endo Belly Challenge. We’ve already started, but you can still sign up and catch up on all the previous emails. Each week, I send you a new email with some endo belly education and a tip to help you reduce your endo belly symptoms that week. I’ve put the link in the show notes.

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Sign up to The Endo Belly Course wait list here.

 On March 28th I am running my second Endo Belly Challenge! In this 4-week challenge, you will learn the first steps to identifying the root causes of your endo belly and the initial tools to heal your swelling, gut issues and abdominal discomfort. Every Monday, you'll receive a new email with a little bit of endo belly education and an action to implement that week! This challenge is perfect for anyone who experiences abdominal swelling/bloating, gas, constipation, nausea, diarrhea/loose stools, acid reflux, indigestion or stomach cramps with their endometriosis - and it's entirely free. You can sign up here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website.

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This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This episode is sponsored by Semaine. Try their supplement for period pain and daily supplement for hormonal balance and PMS prevention with code ENDOLIFE to get 20% off your first order.

 Show Notes

https://www.thisendolife.com/this-endolife-podcast-episodes/2021/5/28/bloating-before-your-period-with-endo-the-oestrogen-and-gut-connection

https://www.thisendolife.com/this-endolife-podcast-episodes/tips-reduce-premenstrual-endometriosis-bloating-

https://nicolejardim.com/howyourperiodaffectsdigestivetract/

https://centerforendo.com/endometriosis-and-bowel-symptoms/

Squatty Potty

https://www.youtube.com/watch?v=ZQ5pxBXPJUg&t=4s

Massage

https://www.youtube.com/watch?v=JTOkKVlBHzk&t=2s

https://www.thisendolife.com/this-endolife-podcast-episodes/arvigo-massage-for-endometriosis

https://taraghosh.com

Movement

https://www.youtube.com/watch?v=RVv7sxDGnpg

https://www.youtube.com/watch?v=uP__6dM3SvQ

Magnesium

https://www.siboinfo.com/uploads/5/4/8/4/5484269/sibo_symptomatic_relief_suggestions_jan_2020.pdf

Vitamin C

https://drhyman.com/blog/2017/01/13/simple-steps-dealing-constipation/

https://lpi.oregonstate.edu/mic/vitamins/vitamin-C

https://www.tinypioneer.co.uk/desert-harvest-buffered-vitamin-c

Chia

https://www.thisendolife.com/this-endolife-podcast-episodes/four-easy-home-remedies-for-constipation-with-endo-belly

https://link.springer.com/article/10.1007/s13197-015-1967-0

https://ift.onlinelibrary.wiley.com/doi/10.1111/1750-3841.12444

Flax

https://www.thisendolife.com/this-endolife-podcast-episodes/four-easy-home-remedies-for-constipation-with-endo-belly

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944250/

https://pubmed.ncbi.nlm.nih.gov/8077314/

https://pubmed.ncbi.nlm.nih.gov/15702593/

https://www.annualreviews.org/doi/abs/10.1146/annurev.nutr.17.1.353?journalCode=nutr

PHGG

https://pubmed.ncbi.nlm.nih.gov/25843197/

http://ecite.utas.edu.au/121479

https://pubmed.ncbi.nlm.nih.gov/16413751

https://pubmed.ncbi.nlm.nih.gov/25519526/

https://www.siboinfo.com/uploads/5/4/8/4/5484269/sibo_symptomatic_relief_suggestions_jan_2020.pdf 

 Fat

https://www.thisendolife.com/this-endolife-podcast-episodes/four-easy-home-remedies-for-constipation-with-endo-belly

https://www.siboinfo.com/uploads/5/4/8/4/5484269/sibo_symptomatic_relief_suggestions_jan_2020.pdf

https://www.sciencedirect.com/science/article/abs/pii/S1051227614001411

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460325/

Hydration

https://www.hydrationforhealth.com/en/hydration-tools/hydration-calculator/

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