No anatomical differences are seen between the intestines of males and females. Nevertheless, there are differences in the symptoms and other expressions of IBS in men and in women. These differences include the illness experiences and responses to treatment of IBS. Regardless of gender, you should not be shy to seek proper diagnosis and advice.
In Western countries, women appear more likely than men to have IBS, and are 3 times more likely to see their doctor about symptoms. The reasons why men are less likely to report symptoms to a doctor are unknown.
In many Eastern countries, it appears from some studies that men with IBS are 4 times more likely than women to consult doctors.
So it seems that cultural and other reasons for the health care seeking may differently influence men and women who have IBS symptoms.
In the past, diagnostic criteria appear to have been less effective in diagnosing IBS in men than in women. These served as the basis for many population surveys and clinical studies. So for example, if abdominal distension (which is more prevalent in women) was one of the required symptoms, fewer men would meet the criteria. Current diagnostic criteria (Rome III) aim to be gender-neutral.
Hormonal effects appear to play a role in women. No comparable hormonal effects have been demonstrated in men. Women both with and without IBS report changes in GI symptoms just prior and through the menstrual cycle with symptoms reported as more intense in women with IBS.
Clinical studies of IBS include so few men that comparisons of the prevalence of psychological states may not be justified. Nevertheless, psychosocial differences may help to explain why fewer men with IBS see doctors.
There are suggestions that the male gut may be less sensitive than that of females. It is speculated that hormones such as estrogen may increase gut sensitivity. Gender differences of hormone activity in the enteric nervous system (which regulates intestinal activity) and its connections to the central nervous system deserve much more study.
There is reason to suspect that treatment responses in men may be different from those in women. Certain opiates provide less post-operative pain relief to men than women. It also appears that men experience fewer side effects to drugs.
Until recently, the only gender differences in IBS treatment were the reluctance of men to seek health care, their hesitance to comply with advice, and perhaps their lesser risk for unnecessary surgery. There is a suggestion that men may not respond as well to hypnotherapy.
Could it be that IBS in males and females is fundamentally different after all, and that the above observations reflect these differences? Or, is there some hormonal difference that affects gut function and the response to certain drugs?
The number of men in existing clinical studies is small, and more data is needed before jumping to conclusions. If there is a true difference in male and female IBS, then we must explore the reason. Future IBS trials should include more men.
Whether or not there are true gender differences in IBS is debatable. The truth will have to await a more clear understanding of the disorder. However, in North America, men are less likely than women to report IBS symptoms, to see doctors for them, to be found in specialist clinics, and to participate in clinical trials.
There may also be differences in the symptoms themselves, in psychosocial factors, and in responses to therapy. With better understanding of the diagnosis, gender differences, and meaning of IBS symptoms, we may better design treatment of irritable bowel syndrome in men and women.
Meanwhile, it should be understood that IBS does commonly occur in men. It is distressing and disabling for some. It is important to seek medical help when needed, where the principles of diagnosis, treatment, and management equally apply to men and women. We need to understand why men in North America seldom seek medical help for their IBS, and why they are apparently less reluctant in other parts of the world. Finally, whether or not they are fewer in numbers, men should be appropriately represented in therapeutic trials and studies of the IBS.
Adapted from IFFGD Publication #166 reviewed and updated by W. Grant Thompson, MD, FRCPC, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada.