December 17, 2021
By Lisa Chang, Drexel University College of Medicine
Irritable bowel syndrome (IBS) is a very common GI condition that is classically associated with chronic or recurrent abdominal pain and/or discomfort and associated changes in bowel habits. The type of IBS is categorized as IBS with diarrhea, IB with constipation or IBS with mixed bowel habits. The symptoms can range from mild to disabling. With IBS, these symptoms are present without any visible sign of damage or disease in the digestive tract. This syndrome is a type of functional gastrointestinal disorder, also known as disorder of gut-brain interaction.
Women are about twice more likely to have IBS than men. Some hypotheses for why include differences in sex hormones, gastrointestinal motility, visceral perception and responses to stress. Studies suggest that women tend to experience more constipation type while men tend to experience more diarrhea type. One possible explanation for that is women tend to have slower gastrointestinal transit time than men, and pregnant women also tend to have more constipation due to the rise in progesterone levels. Among women, IBS is most prevalent when women are still menstruating, with severe symptoms common during postovulatory and premenstrual phases. This is also thought to be due to higher levels of estrogen and progesterone, leading to more bloating and constipation. Higher estrogen levels may also increase pain sensitivity. Women also tend to have more gastrointestinal symptoms such as bloating, nausea and constipation. These symptoms are more psychologically distressing to women, leading to more depression, anxiety and a decreased quality of life. Many women present to their gynecologist first for their symptom of lower abdominal pain. They are also three times more likely to receive a hysterectomy than women without IBS.
Other non-GI symptoms include skin rashes, muscle contraction headaches and myalgias. Fibromyalgia, interstitial cystitis and other forms of chronic pain syndromes are also more prevalent in this population. Sexual abuse is an important risk factor in the development of IBS, with one study reporting that 51% of IBS patient had a history of sexual and/or life-threatening physical abuse.
Given the differences in presentation of IBS in women, it is important to manage the psychological aspects of IBS. Emotional stress and life stressors can be triggers or lead to exacerbation of symptoms. Care should be taken in determining how these symptoms relate to menstrual cycles. More studies need to be done in evaluating how pre- versus post-menopausal status may affect IBS symptoms.