Women and IBS

In our specialised clinics at Central Middlesex Hospital, female patients are seen three times as commonly as men. Other clinics we are in contact with report a similar weighting and in one study in Bristol, England, women accounted for 75-80% of consulters. Initially we were tempted to think that this may have been that more women with IBS symptoms consulted their doctors but in a recent symptom questionnaire survey of 5430 householders, 7% of men and 14.5% of women reported symptoms. In one of our own early surveys 1185 medically diagnosed females and 603 males responded.

Our conclusion is that women are/could be more sensitive to some of the impacts of IBS - particularly wind and bloating - and because they experience special problems with irritable bowel which for obvious biological reasons do not apply to men. However, evidence points to IBS being more common in women and for that reason, we shall be expanding this section shortly.

IBS and Menstruation

Many women describe changes in bowel habit at different times during their menstrual cycle. Since these changes vary from woman to woman, one issue is whether the changing levels of oestrogen and progesterone result in changes in the rate of movement of contents through the intestines.

There are two phases to the menstrual cycle. The follicular phase which occurs between days 6 and 11 during which ovulation occurs is characterised by rising levels of the sex steroid hormone oestrogen, and low levels of progesterone. The luteal phase occurs on days 16 - 21 and prior to menstruation during which there is a marked rise in the circulating levels of progesterone. Research shows that the average transit time (the time it takes for contents to move from the mouth to the anus) is similar during the follicular and luteal phases making it unlikely that women, as a whole group, will report any consistent change in bowel habit leading up to and just before menstruation.

However, the situation is different during the period and many women, particularly those who are constipated report a greater frequency of bowel habit during menstruation. Very good studies confirm that menstruation does have a deleterious effect on IBS symptoms and show that almost half of IBS sufferers report a worsening of their symptoms in association with their periods. Prominent symptoms that appear to increase are awareness of gas, abdominal pain and diarrhoea. There is now no doubt that psychological factors are not involved in these situations.

Apart from menstruation being a factor that may contribute to a higher instance of IBS in women than men, it should be remembered that depression and anxiety, two important factors that can trigger IBS symptoms, are twice as common in women than men. The gut generally is more sensitive to various stimuli in women than in men. Women, for example, seem to be less tolerant of intestinal distention than men indicating a greater sensitivity of the gut.

It is also likely that women perceive internal events in the abdomen differently from men and that they are more focused on these events. Food and eating, for example, are of special psychological significance for women and that is demonstrated by the increased prevalence of eating disorders such as anorexia nervosa and bulimia nervosa in women. In addition the whole pelvic region may be, rightly, of special significance for women being associated not only with defaecation, urination and sexuality, as it is in males but additionally with menstruation, pregnancy and childbirth.

Finally, women in western societies in general seem more willing that men to seek medical attention for a whole variety of disorders - an interesting point because claims have been made that in the Indian sub-continent, IBS is more common in men that women. In Indian society though men are known to consult doctors more often that women so it may well be that in this region of the world women also suffer from IBS symptoms but are not seeking help for their problem.

   

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