As a pelvic health and bowel specialist surgeon, professor Julie Cornish has seen hundreds of women come through her clinic with serious health issues. Frustratingly, many of the cases she sees could have been prevented if women had been given better information about their bodies and health.
“When I give my patients advice, most of them tell me: ‘I wish I’d known this years ago’,” says Cornish, an NHS consultant colorectal surgeon at the University Hospital of Wales in Cardiff. She was so exasperated about the lack of information women get about how to stay healthy after childbirth and in the run-up to menopause, that she launched an annual not-for-profit women’s health festival in 2023 – The Everywoman Festival – aimed at educating women to understand their bodies and keep well.
Here, she shares eight things she wishes every woman knew about staying healthy in midlife:
Increase your fibre and water intake – and don’t skip breakfast
The majority of people in the UK do not eat enough fibre and this has a huge impact on bowel health. I recommend almost all of my patients consume one to two teaspoons of psyllium husk – a plant-based fibre derived from seeds of the Plantago ovata plant – daily with plenty of water. It’s really good for normalising bowel movements. Chia and flax seeds can also help.
Eating breakfast gives your digestive system a sign it’s time to fire up. If you skip it, your gut doesn’t get that signal, which can slow you down and worsen bowel symptoms.
Make sure you are drinking enough water, too. I find women who are busy juggling work and caring roles tend not to drink enough water – especially if they are also worried about leaking urine due to bladder weakness. But being dehydrated can cause constipation, which puts more strain on the pelvic floor and can make leaks worse.
The women’s health festival, that first launched in 2023, aims to educate females on their bodiesStop ignoring constipation
Most people don’t understand what “normal” looks like when it comes to going to the toilet. You should be emptying your bowels somewhere between three times a day and once every three days. If you’re waiting days between toilet visits or you’re regularly passing hard, pellet-like stools, that is putting a strain on your body which can cause health issues over time.
If it is not dealt with, constipation can cause diverticular disease, where small pockets form in the bowel wall. These can perforate, requiring emergency surgery and sometimes a stoma. It can also lead to rectal prolapse – where the inside of the rectum slides down and forms a lump outside the body, causing discomfort, pain or difficulty going to the toilet.
Most of the time, constipation is caused by our poor diets and low water intake. Busy midlife women tend not to drink enough water and may eat more ultra-processed foods, which contain little fibre.
Never bring your phone into the loo
I tell all my patients never to look at their phones while on the toilet, however tempting it is to use that time to catch up with your messages.
When you sit on the toilet, your pelvic floor gets the signal to move to empty your bladder and bowel. While you are distracted by scrolling online, you might not be consciously pushing, but your internal muscles will be continuing to strain for far longer than they need to.
Over time, this can put pressure on the pelvic floor and worsen issues like prolapse (where the bowel, bladder or womb fall out of place and press against other organs) or haemorrhoids (swollen blood vessels which cause lumps in and around the anus).
Move like a hunter-gatherer
One of the simplest things you can do for your health is to ensure you walk for at least 20 minutes every day. Staying busy on your feet indoors is not the same – we need to stretch our legs to help keep everything moving internally.
Using a footstool when you go to the toilet also helps move your body into a more natural position and make emptying easier. Humans are designed to squat, not sit upright as we do on modern toilets.
Most of us are not active enough. Improving your diet and exercise can make a big difference to every aspect of your health.
Accept your caffeine and alcohol tolerance drops as you age
We know the gut microbiome, which contains a carefully balanced mix of bacteria, can alter as we age and research suggests this can affect our ability to process certain food and drinks. Some women find their ability to metabolise caffeine and alcohol reduces as they go through and beyond menopause – you may need to accept you can’t keep up the same coffee habit as you had in your twenties and thirties without experiencing more side effects.
If you find you’re needing to rush to the toilet, have a look at how many teas and coffees you are having a day. Caffeine stimulates the bladder and bowel, but it always surprises me how rarely my patients link their urges to go to the toilet with their caffeine consumption. Cutting down could really improve your symptoms.
Avoid making “just in case” loo trips
Women often learn to go “just in case” as children and then continue doing this if we have our own children. But going too frequently can mean your bladder stops working efficiently. It is also very common for women in perimenopause or after menopause to have bladder problems, like leaks, urgently needing to rush to the toilet or having difficulty emptying.
In perimenopause, these symptoms can be related to vaginal atrophy (when changing hormonal levels thin, dry and inflame the vaginal walls) which can be treated with an oestrogen cream you apply internally. Other issues may be caused by damage to the bladder or muscles around it, which can happen during pregnancy or childbirth and is often left untreated for years. Don’t ignore these symptoms, as often they can be treated effectively with physiotherapy.
It is normal to empty your bladder around four or five times a day. If you find yourself going more frequently, feeling unable to hold it and having to rush to the toilet, or going multiple times because you have difficulty emptying, speak to a doctor.
Do pelvic floor exercises – even if you had a C-section (or no children)
It really frustrates me that women who have C-sections are often not told about the importance of pelvic floor health. I have seen women following caesarean births with serious incontinence who were never offered any advice about their pelvic floor.
Carrying a pregnancy – or even just doing strenuous exercise – puts pressure on your pelvic floor. As women get older, hormonal changes increase strain on the pelvic floor, whether or not we have had children, so we all need to exercise these muscles to keep them functioning normally.
Never ignore these cancer red flags
Bowel cancer is most common in people over 50, but we’re seeing a rise in younger people, too. The red flag signs are: blood in your poo, unexplained weight loss and any change in the consistency or frequency of your bowel movements which lasts more than a couple of weeks.
You do not need to have all three symptoms together, any of these could be a warning sign. I have seen cancer patients who put off seeing a doctor because they blamed their symptoms on stress or their diet. If something feels different, please get checked.
The Everywoman Festival is in London on 13th June, and as a pop-up event in Edinburgh on 6th and 7th June
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