On today’s show I’m going to explain why women have so much more bloating and constipation than men. And you might be surprised to learn that the reasons are primarily anatomical, rather than hormonal or food related. If you struggle with constipation, bloat, and back-up, I have lots of tips in this episode for how to get that curvy colon to empty and decompress. And by the way – men can have a voluptuous Venus colon too!.
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On today’s show I’m going to explain women have so much more bloating and constipation than men. And you might be surprised to learn that the reasons are primarily anatomical rather than hormonal or food related. There are significant differences between male and female digestive tracts that explain why women are so susceptible to bloat and backup. I see both men and women in my gastroenterology practice, but I see a lot more women than men. And that means I do a lot more colonoscopy in women. Anyone who thinks women are just smaller versions of men has never been inside the female colon.
The typical female colon has multiple twists and turns and switch-backs and loops that can be very challenging to navigate. It takes me 2-3 times longer to do a colonoscopy in a female patient compared to a male. If you’re a woman and you suffer from bloating and constipation, and you’ve had a colonoscopy, you may have been told after the procedure (or it may be noted on the colonoscopy report) that you have a tortuous or redundant colon. Now, I don’t know about you, but I would rather not have my body parts described as tortuous or redundant. So I tell my female patients with the twisted loopy colons that they have a voluptuous venous colon. I think that just has a nicer ring to it than tortuous and redundant.
If you read the scientific literature you’ll see lots of articles about colonoscopy being more difficult in women, about colonoscopy requiring more sedation in women, and about colonoscopy taking longer in women. Those things are all true, BUT those differences have usually been attributed to women having a lower pain threshold—something I find hard to believe, given the fact that many women go through labor with no anesthesia and there are over 100 million babies born every year. The real explanation for why colonoscopy is a lot more challenging in women – and I can tell you as somebody who’s done thousands of colonoscopies that that is definitely the case – has nothing to do with differences in pain threshold and everything to do with differences in ANATOMY between the female and male colon, and coming up, I’m going to tell you exactly what those differences are.
The first thing you need to know is that women have longer colons than men, on average about five inches longer. Now, that might not seem like a big difference, but those extra 5 inches lead to a lot of additional loops forming in the colon and that is part of what makes colonoscopy more challenging is trying to navigate through those loops. And those loops don’t only form during colonoscopy. The female colon is also prone to loop formation at other times, too, like during digestion when colon fills with gas or stool. The products of digestion get stuck in these loops, causing gas to build up behind the area in the colon where things are stuck – or slowed down, and that can cause tremendous discomfort and bloating. In fact, the pain from the stretching of a full segment of colon, can lead to what’s called a “vasovagal reaction” where the heart rate drops, and you feel sweaty, nauseated, and dizzy. And some people even pass out. This can occur in people with extreme constipation and bloating when the colon gets really full of stool or gas. It can also happen after colonoscopy if your gastroenterologist isn’t paying attention and doesn’t suck out all the air that they’ve pumped into your colon during the procedure.
So this extra-long colon sounds like a lot of pain and discomfort and inconvenience, so why DO women have a longer colon – what’s the reason? Is it just a design flaw? The main reason for the additional length is to allow for more absorption of fluid during pregnancy to maintain the amniotic fluid. Remember, one of the functions of the colon – in addition to transporting the products of digestion out of the body – is to allow water from the stool to be reabsorbed through the lining of the colon back into the body. This extra length of colon means that more fluid can be absorbed, and that helps to maintain the amniotic fluid
The second important anatomical difference is that women have a more rounded, deeper pelvis than men. In women, the colon drops down into the pelvis where it has to compete for space with the ovaries, the Fallopian tubes, the uterus, and the bladder. That’s a lot of organs in a relatively small space, and it can lead to even more looping, crowding, constipation, and bloating. Men also have a much narrower pelvis, so the colon doesn’t tend to drop down as deeply into their pelvis. In men, the reproductive organs take up much less space – they just have a small prostate gland about the size of a walnut, so things are much less crowded. So, again, you might ask, why this difference in pelvic size and structure? What’s the reason for this difference in shape that causes more bloating, back up, constipation, and congestion in women? And again, the reason is childbearing. Women have a wider, deeper pelvis so they can accommodate an additional human being down there when they’re pregnant. Men don’t have that need so they have a narrower pelvis. The difference between the wider female gynecoid pelvis and the narrower male android pelvis is really striking. You can identify a female versus a male skeleton pretty easily when you see them side by side just based on the shape of the pelvis.
So far I’ve outlined two major anatomical differences between the female and the male colon: a longer colon, and a deeper wider pelvis in women. But there’s a third difference that causes women to have way more bloating than men. And while this one is also anatomical and structural, its origins are hormonal. Men have higher levels of testosterone than women – women also have testosterone but just less. Higher testosterone leads to an abdominal wall that’s more muscular and defined, and that buttresses the colon, preventing it from forming extra loops and keeping things moving through more smoothly. Men’s abdominal wall is like a new Spanx that holds everything in nice and tight. Our Spanx is more stretched out. Even men with a beer belly have a relatively tight abdominal wall underneath. So they’ll complain about being overweight and having a belly, but not about being bloated.
A visual representation of the male colon would be a gentle horseshoe shape, while the female visual would be a Six Flags roller coaster.
If you have a voluptuous Venus colon you may find that doing things that are supposed to make you less bloated and constipated – like eating more fiber – actually make things worse. Those fiber-filled bulky stools can get stuck in the hairpin turns in your colon, causing a lot of discomfort. You may need to modify your diet to keep the total intake of fiber the same but spread it out throughout the day. You may also need to ramp up your water consumption – drink at least half your body weight in ounces of water, plus some extra. Remember, the GI tract is simple plumbing! Liquids help move things through the digestive tract more efficiently. Some patients when their bowels get backed up and they start to become really bloated and constipated benefit from a liquid diet for a few days: green veggie juices and broth. And sometimes people may even need an osmotic cathartic to help clean things out. On occasion I’ve had to prescribe a full bowel prep for patients with a voluptuous Venus colon filled with stool, but I recommend not letting things get to that point by doing a day or two of liquids, instead of blasting your bowels with medications.
I want to leave you with 3 takeaways about the voluptuous Venus colon:
1. A longer colon, a deeper pelvis, and a less defined abdominal wall can all add up to more constipation and bloating in women.
2. Spreading out fiber and increasing water consumption can help you manage your symptoms
3. If you get really backed up – consider doing a liquid diet for a day or two to give your curvy colon a chance to empty and decompress
So that’s it for this edition of the Gutbliss podcast on the voluptuous Venus colon
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