Studies have demonstrated a higher prevalence of gynecologic disorders, such as pain associated with menstruation (dysmenorrhea) and premenstrual distress syndrome in women with irritable bowel syndrome (IBS) as compared to those without IBS. In a variety of cultures, more women than men seek health care services for symptoms of IBS. These observations have led a number of clinicians to ask questions as to whether and why gender differences in IBS exist.
Symptoms related to menstruation
Many women (with and without IBS) experience variations in gastrointestinal (GI) symptoms – including abdominal pain, diarrhea, bloating, and constipation – during their menstrual cycle. Abdominal pain and diarrhea tend to increase in the pre-menses phase of the cycle and reach a maximum on the first to second day of menstrual flow. Bloating and constipation, on the other hand, tend to increase post ovulation (around day 14) and stay increased until the day before or the first day of menstrual flow.
Women with IBS have overall higher levels of symptoms (more frequent, more bothersome) regardless of cycle phase and also demonstrate these same menstrual cycle-related patterns. Women with IBS also report other more frequent and more bothersome symptoms such as fatigue, backache, and insomnia, and may have greater sensitivity to particular foods, such as those that are gas-producing, around the time of menstruation.
For many women, the link between GI symptoms and their menstrual cycle may not be intuitive. The use of a daily diary in which both menstrual cycle days and symptoms are tracked often helps women see patterns in their symptoms. This may provide reassurance that symptoms are cyclical and help women plan strategies related to diet or medications.
The overlap of IBS and gynecological disorders
Women with IBS more frequently report gynecological disorders such as painful menstruation (dysmenorrhea) and premenstrual syndrome (PMS) compared to those without IBS. Many women with IBS report higher levels of uterine cramping pain at menses than women without IBS.
In one study, approximately one-third of women with IBS reported a history of chronic pelvic pain. Perhaps more difficult to clearly discern is the overlap between IBS and endometriosis [a condition in which tissue more or less perfectly resembling the uterine mucous membrane occurs abnormally in various locations in the pelvic cavity]. Several studies suggest that women with endometriosis have greater bowel symptoms compatible with a diagnosis of IBS. Such overlaps in gynecological and gastroenterological conditions are noteworthy and are important areas of further investigation.
Based on the prevalence of these chronic painful conditions in women, the question arises as to whether there are gender-specific mechanisms underlying IBS. Laboratory and clinical studies support the hypothesis that increased pain sensitivity plays a role in functional bowel disorders such as IBS and non-ulcer dyspepsia, as well as in interstitial cystitis (inflammation of the bladder), dysmenorrhea, and ureter colic pain.
Sexual functioning can be affected by both gynecological and gastroenterological conditions. Sexual dysfunction is reported by a disproportionately high number of patients (both men and women) with IBS, as well as women with painful menstruation. Studies have found that nearly a third of women with IBS report concerns related to sexual functioning, and report that their IBS has an impact on their intimate relationships.
Sexual dysfunction can range from decreased sexual drive (the most common symptom reported by both men and women with IBS) to painful intercourse. The role increased pain sensitivity appears to play in IBS may be related to this finding. This sensitivity may extend to all visceral organs, both gut, and glands, including the vagina.
There has been increased attention given to the impact of IBS symptoms on women’s lives. Chronic, persistent symptoms along with strategies to reduce symptom experiences can be disruptive to work and family responsibilities, and reduce the overall quality of life.
There is a clear need for greater collaboration among health care providers in the fields of gynecology and gastroenterology. Research focused on women with overlapping medical conditions including dysmenorrhea, IBS, chronic pelvic pain, PMS, and chronic constipation needs to focus on the factors that may be amplified in these conditions. Clinicians need to be aware that these conditions often co-exist and use this information to select appropriate therapies.
Adapted from IFFGD Publication #123 by Margaret M. Heitkemper, RN, Ph.D., and Monica Jarett, Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA.