Women and IBS

The following research article summaries deal with IBS and the menstrual cycle, as well as with IBS and abuse.

Gender-Related Differences in IBS Symptoms

Introduction & Methods

• Female IBS patients curiously outnumber men by ratios ranging from 2:1 to 4:1.
• Patient questionnaires evaluating bowel symptoms, psychological status, and quality of life were examined to determine whether or not men and women with IBS differed in regard to self-reporting of gastro-intestinal, musculo-skeletal and other extra-intestinal symptoms. Research also examined whether differences might be affected by the menstrual cycle.

Results

• Women reported worsening of abdominal symptoms pre-menstrually. However, there was no difference in symptoms among pre or post-menopausal women compared to men in the instance of abdominal pain.
• Women had a higher frequency of nausea and abdominal distension, alteration of taste and smell, and muscle stiffness in the morning. Women reported greater food sensitivity in relation to GI symptoms and a greater amount of perceived side effects from medication.
• Women were twice as likely to have fewer than three bowel movements per week, and to have hard stools. Conversely, men reported more diarrhea than women.
• Women may be more attentive to symptoms, there may be a true physiological difference, or women may have a different reaction to stress (relax and restore in women versus fight or flight in men).

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Evidence for Exacerbation of Irritable Bowel Syndrome During Menses

Introduction & Methods

• This study sought to evaluate differences between IBS and non-IBS women during menses. Women who had a hysterectomy were excluded from this study.
• All patients received questionnaires regarding their gastro-intestinal symptoms during menses and their psychological state. Psychological tests measured neuroticism (anxiety, hostility, depression, self-consciousness, impulsiveness and vulnerability), extraversion, openness, agreeableness and conscientiousness.

Results

• Significant menses-related increases were seen in the following symptoms in IBS patients: Gas (48%), diarrhea (29%), constipation (24%).
• There was no significant correlation between negative affect and behavior (i.e. irritability) and bowel symptoms during menses.
• Women with IBS have greater exacerbation of gastro-intestinal symptoms during menses than non-IBS women.

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The Menstrual Cycle and its Effect on IBS and IBS: A Prevalence Study

Introduction & Methods

• IBS patients were compared to healthy controls and to patients with inflammatory bowel disease (ulcerative colitis and Crohn's disease). They were asked about typical premenstrual syndrome symptoms, as well as nausea, vomiting, diarrhea, and constipation during pre-menstrual or menstrual cycles. They were also asked whether they noticed bowel habit changes during pregnancy.

Results

• Pre-menstrual: There was a significant increase in diarrhea and nausea pre-menstrually in both IBS and IBD. There were no significant differences in non-specific symptoms such as irritability, depression or weight gain in IBS patients.
• Menstrual: Diarrhea was increased in IBS and IBD, while constipation was significantly increased only in IBS.
• Pregnancy: There was no significant difference in bowel habit changes among IBS, IBD, and control patients.
• Patients' IBS symptoms occurred in a cyclical pattern. They noted increase in diarrhea, constipation or abdominal pain, in the pre-menstrual or menstrual phase of their monthly hormonal cycle. Thus, patients with IBS symptoms such as abdominal pain, diarrhea, and constipation may expect an increase in their symptoms during the menstrual phase of the monthly cycle.

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Sleep Disturbance Influences Gastrointestinal Symptoms in Women with Irritable Bowel Syndrome

Introduction & Methods

• Sleep disturbance, gastro-intestinal symptoms, and psychological distress (e.g. stress) in women with irritable bowel syndrome was compared to non-IBS women.
• Women completed a 7 day retrospective assessment of sleep disorder and for 2 consecutive months, a daily diary from the first day of menses through the fifth day after cessation of menses for 2 consecutive months.

Results

• IBS patients had significantly more sleep disturbance, psychological distress, and GI symptoms.
• For both groups, women with higher average sleep disorder displayed a higher average of GI symptoms. In IBS women worsening of IBS symptoms was followed poor sleep—not the other way around. Controlling for psychological factors, statistical testing found that stress and emotional factors were not the reason for the association between sleep and GI symptoms.
• In other reports, it has been shown that REM sleep is increased in IBS. REM sleep is associated with increased activity of the autonomic (involuntary) nervous system, especially increased sympathetic output. This can result in increased colon sensitivity, one of the features of IBS.

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Emotional Abuse, Self-Blame and Self-Silencing in Women with IBS

Introduction & Methods

• It has been suggested that women with IBS have a higher incidence of physical and sexual abuse in their childhood than the normal population.
• Current degrees of emotional abuse, physical abuse, and sexual abuse were measured and compared between women with IBS and women with inflammatory bowel diseases (IBD = ulcerative colitis and Crohn's disease).

Results

• Women in the IBS sample were more depressed and had significantly higher scores on emotional abuse, self-blame (blaming oneself for an event that was out of her control) and self-silencing (not speaking one’s mind; putting other’s feelings first).
• Emotional abuse had much more significant effects.
• Levels of depression were higher in the IBS patients, but depression was not connected to emotional abuse and self-blame.
• IBS is associated with adult emotional abuse and self-blame more significantly than IBD (inflammatory bowel disease).

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