My bowel had to be removed after years of constipation

A woman whose bowel had to be removed due to chronic and severe constipation says we should all be more open to talking about basic bodily functions.

Kathryn Nicklas, 26, was told for several years that her constipation was caused by irritable bowel syndrome (IBS) and she was repeatedly prescribed laxatives.

She said embarrassment about her symptoms as a teenager meant she had struggled to advocate for her condition to be taken seriously.

Prof Julie Cornish, a leading pelvic health doctor, said many patients required surgery for pelvic health problems but that simpler solutions were possible when symptoms were spotted sooner.

Ms Nicklas, who works in north Wales, said before her surgery she was "taking laxatives like they were smarties" but "still struggling to go to the toilet".

"I was forever living in floaty dresses because of the bloating and even bought maternity jeans just to be comfortable," she said.

"If I was able to go [for a poo] it would only be as a result of irrigation or an enema. I'd come home from work and spend an hour on the toilet – I had no life, because I was always uncomfortable."

She added: "On one occasion I didn't go to the toilet for four weeks and was admitted to hospital.

"They said I was so full of poo, everything had just stopped working."

Despite various tests and changes to her diet, no cause was ever found, but years of constipation had a long lasting impact on Ms Nicklas' pelvic organs – causing pain, vaginal bleeding and bloating.

Ms Nicklas' large bowel was removed in 2022.

As an adult, Ms Nicklas said she advocated for her symptoms to be taken seriously, but as a teenager she said embarrassment about bodily functions had made that more difficult.

"Looking back now, why is that such an embarrassing thing?

"Why is going to the toilet so embarrassing when it's just a normal function that everybody does?

"Would my constipation have been better if I hadn't have refused to go to the toilet unless I was at home and my brothers weren't around and no one could hear me? Because that's not healthy decision making," she added.

"As a result of the constipation and so many years of it my body's been affected.

"Your pelvic floor gets absolutely destroyed by the fact that you're constantly trying to go but you can't go."

Prof Cornish, a colorectal surgeon, said pelvic health issues affected both men and women.

"It is a public health issue that actually we need to be giving information to people at an earlier stage – and it's not just women and girls, it's also boys and men because pelvic health issues affect everybody in different ways," she said.

"We're not just talking about gynaecological bits, we're talking about the bladder and bowel which can be impacted and that does have a bearing on things like pelvic organ prolapse.

"So if you are chronically constipated for many years you are far more likely to develop problems with a prolapse."

The need for better understanding is part of the reason why Prof Cornish set up the Everywoman health festival in Cardiff, which is now in its third year.

A thousand tickets will be given free to teenagers this year, with educational sessions planned on menstrual health, pelvic health and knowing basic body parts.

Shakira Hassan, a specialist women's health physiotherapist, treats a wide range of conditions including pelvic pain, bladder, bowel and prolapse issues, where pelvic organs have lowered out of place.

"If you were to examine most women over 40, 50% of those women will actually have a pelvic organ prolapse, so it's about being able to educate and empower those women to be able to still lead a really normal and well life," she said.

Ms Hassan said stigma was a huge factor, which could be worse in some cultures.

"We know that potentially one in three women will experience some urinary incontinence and potentially one in four women will experience some level of faecal incontinence throughout their life. That's huge numbers – it's really common."

"Education is key," said Prof Cornish.

"And the difficulty is that whilst there are some people who have that understanding or are able to access that education, you're essentially disenfranchising a large proportion of the population who may not be able to access it, and they may end up being the patients that I see more of.

"You see the inequalities that are out there.

"But all of this leads to a massive delay in treatment and usually an increase in the severity of symptoms and treatments needed.

"We all have a responsibility for our own health and that is going to be key – it's not just about off-loading it to the NHS, so I think the more we teach our children, that's going to empower them to take responsibility going forward."

The Welsh government said: "Health and wellbeing is a mandatory part of the curriculum for Wales and helps learners to understand different factors that affect their physical health.

"Our guidance expects children to learn about a range of health conditions that can affect them."