Navigating menopause when you already live with a stoma can bring about a whole host of additional challenges. In this article I’ll take a look at these challenges and things you can do to help yourself.
Author – Sarah Russell MSc – Clinical Exercise Physiologist www.theostomystudio.co.uk
*This article first appeared in the IA journal, now edited and reproduced.
What happens during menopause?
The menopause is a phase for women which can take anything up to a decade to move through. It’s not just a moment in time when we wake up and our periods have stopped. It starts with perimenopause in our mid 40’s when the hormones (which regulate our monthly cycle) begin to fluctuate and decline. This can lead to various symptoms and changes in our body. We are considered to be post-menopausal only when we have gone a full year without a period. The average age for this is around 51.
Every woman will experience menopause differently. Some will sail through it, and others will have a tough time.
But for women who also have a history of bowel surgery, there are some other important things to consider, especially regarding body composition changes/muscle loss (percentage of fat and muscle) – and how this impacts parastomal hernia – pelvic floor health and exercise.
Symptoms of perimenopause and menopause
Ask anyone about the symptoms of menopause and they’ll no doubt talk about hot flushes and night sweats. But there’s much more to it than that. The hormones we’re talking about are oestrogen and progesterone, and they are messengers which communicate with almost every cell in the body. So low/fluctuating hormones create chaos and can trigger a huge range of symptoms/changes including headaches, body fat increase, muscle loss, night sweats, hot flushes, mood changes, insomnia, brain fog, fatigue, incontinence, fatigue, heart palpitations, muscle/joint pain and vaginal discomfort/dryness.. and many more.
What does this mean for women who also live with a stoma?
For me as an exercise specialist, I’m particularly interested in the holistic wellbeing of people who live with a stoma.. and thus how we navigate midlife is critical. I want to try and help you connect the dots if you’re a menopausal woman who also lives with a stoma; and to understand the role of exercise. If you’re also living with symptoms of IBD, going through cancer treatment or have ongoing bowel related health problems, adding menopause to the situation can make things seem really challenging indeed.
So how can we help ourselves?
Weight gain
Increase in belly fat is super common during menopause. The average increase in weight during menopause is around 5-8 lbs, even though you may not have changed much about your eating or exercise habits. It just sort of creeps on! But the very last thing anyone with a stoma needs to do is gain belly fat. Aside from the increased risk of heart disease (and other diseases linked to weight gain), the more belly fat we have the more our stoma will bulge and the chances of developing a hernia are increased. When it comes to hernias, the leaner we are (around the tummy) the better.
But just because something is common, doesn’t mean it’s inevitable and there are things you can do to blitz the belly fat. Changes to your diet and changes to the way you exercise can be really helpful as well as working on your sleep and stress levels. High levels of cortisol (stress hormone) encourage the body to lay down abdominal fat, so when we’re stressed and not sleeping well, weight gain is much more likely. Of course these are all inter-connected, so working on one aspect may well improve another (better sleep = more energy = ability to exercise).
I’m not talking about ‘dieting’ or weight loss however. Instead, simply focus on eating less sugar, fewer processed foods, increased fruit and vegetables (the ones you can tolerate) and increased protein foods, and look at the way in which you exercise. Any type of exercise is great for health, so please continue walking, cycling, swimming, dancing, playing badminton or going to the gym or whatever you do.
But if you’re a woman aged around 45-55 then you need to change things up and place more focus on the following 3 areas:
- Include higher intensity interval exercise (anything that gets you hot, sweaty and REALLY out of breath for short bursts – a stationary bike is a great place to do this). Groups of 30-60 second intervals with equal rest, and repeat for around 30 minutes
- Weight train 2-3 times per week using weights or machines. Ideally 8-12 reps x 3-5 sets with a mix of 6-8 exercises per session
- Focus on Pilates, deep core and pelvic floor training – 2-3 x per week. Classes at The Ostomy Studio are perfectly curated for people with stomas.
Not only will this help you mitigate some of your symptoms, it will also improve your overall health and if you can shed some belly fat, your parastomal hernia risk/size will also reduce.
Contrary to what you might think, you CAN exercise if you have a hernia and it can be an important way to prevent it getting bigger, to keep your weight in cheek and also to prepare for surgery. Often people are advised to lose weight before hernia repair or just to manage their hernia. Things like cycling, swimming, aqua jogging or aerobics, hiking etc are all fine, and weight training can also be done safely if you’re shown the right techniques and build up to it slowly.
It’s also important to know that if you’re having treatment for cancer, it’s not only safe to exercise, it’s actually recommended and it’s important to do weights to prevent muscle loss.
Otherwise, it become a vicious circle, where lack of exercise leads to poor health, increased weight, increased parastomal bulge size and poor sleep. Try to keep your overall health in perspective and don’t hyper focus on hernias.
If you don’t know where to start with exercise or weight training, please seek advice from a qualified trainer.
Muscle loss
As well as ‘fat gain’ during menopause, we also lose muscle. Oestrogen is ‘anabolic’ and is involved in building metabolic tissue in the body – i.e. muscle. And so during menopause when oestrogen levels drop we start to lose strength and muscles become smaller and weaker.
For the menopausal woman with a stoma this is a huge problem for 2 areas. The abdominal wall (and therefore the risk of hernia) and the pelvic floor.
If you’re menopausal, you may well notice an increase of urinary incontinence or leakage when you laugh or sneeze, or a feeling of fullness, heaviness or bulging around your pelvic floor and vagina. These are signs that your pelvic floor is not operating as it should and that the loss of oestrogen is having an effect on muscle tone, strength and pelvic floor control.
You might also notice an increased bulge around your stoma or an increase in an existing hernia, more discomfort and a feeling of it increasing and decreasing in size throughout the month. What you’re noticing here is a decrease in muscle and fascia strength and tone due to declining oestrogen levels.
Now is the time to work on your pelvic floor and core strength. Do not delay another minute. This starts with deep core activation exercises and working on breathing exercises (diaphragm/rib breathing) and learning how to co-ordinate your pelvic floor, diaphragm and core muscles correctly. Pelvic floor squeezes are helpful, but only part of the picture.
The NHS squeezy app can be a useful resource to help guide you through a pelvic floor exercise programme but you also need to add some core work (pelvic tilts, bridges etc) too, to create a co-ordinated core. This is what I teach in my clinical Pilates classes www.theostomystudio.co.uk which are perfect for menopausal women needing to work on core and pelvic floor.
Hydration – hot flushes/night sweats
One final word on night sweats, hot flushes and hydration. If you have an ileostomy or internal pouch, your hydration needs are greater, and you need to be sure you include electrolyte drinks and additional fluid intake as part of your usual routine. This might mean using drinks like Dioralyte or St Marks solution as and when you need them, plus having a bit more fluid on a day to day basis. However.. with the menopause comes body temperature changes, hot flushes and night sweats. If you’re waking up in the night drenched in sweat, you’ll be waking in the morning dehydrated and chasing your fluid intake all day. Try to be aware of this and watch out for signs of fatigue, dark urine, headaches etc and increase your fluids and electrolytes to support your changing needs.
Finally…
My view is that menopause is not a time to ‘ignore and put your head in the sand’ hoping you’ll come out the other side. It’s a time to take stock, to get help and support and put as much in place to help yourself as possible – whether that’s medical or lifestyle interventions.
Living with a stoma comes with challenges and adding the menopause to the mix can make life feel pretty tough. It’s hard to unpick the symptoms and understand what might be menopause, bowel/IBD/cancer treatment related or otherwise. I thought I had a recurrence of diverticulitis when I first started with heart palpitations and night sweats, which of course turned out to be the start of menopause – which HRT has helped enormously.
So keep in close contact with your doctor and medical team and ask for blood tests (to eliminate other conditions) and consider a symptom diary to try and make sense of it all. Please consider everything that’s on offer, HRT, therapy or anything else that may help you navigate this phase of life.
*Note on HRT – if you have issues with absorption of oral medication, request transdermal HRT patches instead
Midlife is the perfect time to stop and take stock and assess your lifestyle. Focus on reducing stress, improving your nutrition and diet, up your game with your exercise and really take care of your abdomen (through weight loss and core strength) and neglect your pelvic floor at your peril!. Having a stoma may make some of those things a little more challenging, but I’d argue that it’s even more important for us to find solutions and stay as healthy as we can. You can find more information about my core and Pilates classes at www.theostomystudio.co.uk
