Most digestion problems come down to five causes: constipation, reflux, food intolerance, irritable bowel syndrome, and eating patterns that give the gut no chance to work properly. The good news is that all five respond to changes you can make yourself — provided nothing more serious is being missed.
What Do Your Symptoms Point To?
| Symptom | Most likely cause |
|---|---|
| Burning behind the breastbone, worse lying down | Acid reflux |
| Bloating that builds through the day | Fermentation, constipation or intolerance |
| Pain relieved by opening the bowels | Irritable bowel syndrome |
| Hard stools, straining, fewer than three a week | Constipation |
| Symptoms 1 to 3 hours after dairy | Lactose intolerance |
| Feeling full after a few mouthfuls | Delayed stomach emptying — get assessed |
Why Does Digestion Change in Midlife?
Falling oestrogen and progesterone slow gut transit, which is why constipation and bloating so often appear for the first time in perimenopause. Stomach acid production also declines with age, affecting protein digestion and the absorption of iron and vitamin B12. The gut microbiome shifts too — I go into that in ten ways to heal your gut naturally.
What Should You Change First?
- Fibre, gradually. Aim for 25 to 30 g a day, increasing over three to four weeks. Going too fast makes bloating worse. Get both soluble and insoluble types.
- Fluid alongside it. Fibre without water makes constipation worse, not better.
- Eat at regular times and stop grazing. The gut has a cleaning wave between meals that only runs when you are not eating.
- Slow down and chew. Digestion is mechanical before it is chemical.
- Walk after meals. Ten minutes measurably speeds gastric emptying.
- Keep a two-week symptom and food diary before cutting anything out. Guessing leads to over-restriction.
If you suspect a specific trigger, work through it methodically rather than eliminating whole food groups — my guide to identifying your gut triggers sets out how.
When Should You See a Doctor?
- Blood in stool, or black tarry stools
- Unintentional weight loss
- Difficulty swallowing, or food sticking
- Persistent vomiting
- A change in bowel habit lasting more than six weeks, especially over 45
- Iron deficiency without an obvious cause
Coeliac disease should be tested for before you remove gluten, since testing is unreliable once you have stopped eating it.
Frequently Asked Questions
Do I need a probiotic?
Specific strains help specific problems, mainly IBS and antibiotic-associated diarrhoea. A generic daily probiotic for vague bloating rarely justifies the cost.
Is bloating always food-related?
No. Constipation, stress and swallowed air are common causes. Persistent bloating in women over 50 should always be checked, as it can be an ovarian symptom.
Should I try a low FODMAP diet?
Only with a dietitian, and only for four to six weeks before reintroducing. It is a diagnostic tool, not a long-term way of eating.
About the Author
Nidhi Kakar is a nutritionist and the founder of Art of Wellness. She specialises in women’s health through the midlife years, from the mid-30s to the mid-60s, and has guided hundreds of women through perimenopause, menopause, and post-menopause with personalised nutrition and lifestyle plans.
This article is for educational purposes and does not replace personalised medical advice.
