Understanding IBS in Females: Symptoms and What They Mean

Irritable bowel syndrome (IBS) is a long-term digestive disorder that causes stomach pain and changes in bowel habits. It mainly affects women and often occurs alongside mental health issues like anxiety and depression (1).

Why Does IBS Affect Females More?

Epidemiological studies show that in Western countries, twice as many women as men have IBS, indicating that sex hormones may play a role in its development (2).

Ovarian hormones influence how the intestines function and affect gut motility, which explains why IBS symptoms differ between genders.

The Link Between Hormones and IBS

The levels of ovarian hormones fluctuate during the menstrual cycle, impacting IBS symptoms. Specifically:

• Women often experience more abdominal pain during menstruation, when hormone levels are low.
• Studies indicate that women have slower gastrointestinal (GI) transit than men, leading to delayed gastric emptying and slower colonic transit time.
• During pregnancy, GI transit time increases significantly in the third trimester due to elevated hormone levels.

Symptoms of IBS in Females/Women

Female IBS patients tend to experience more constipation-related symptoms, including:

• Abdominal distension
• Bloating
• Infrequent stools
• Hard stools

In contrast, men with IBS are more likely to report diarrhea-related symptoms, such as loose stools and increased stool frequency. However, during menstruation, when ovarian hormone levels drop, women may also experience diarrhea rather than constipation (2).

Pain Sensitivity and IBS

Women report higher pain perception than men, experiencing discomfort from:

• Colorectal distension (CRD)
• Chronic abdominal pain
• Increased IBS-related pain episodes

This heightened pain perception may be linked to hormonal interactions and differences in how men and women process pain signals (2).

The Role of Stress and Mental Health

Women are more susceptible to life stressors, anxiety, and depression, which contribute to worsening IBS symptoms. It is suggested that ovarian hormones interact with stress hormones, explaining why IBS is more prevalent in women (2).

Pelvic Floor Dysfunction and IBS-C

In women with IBS-constipation (IBS-C), pelvic floor dyssynergia is a common issue. This condition involves difficulty coordinating the pelvic floor muscles, leading to:

• Abdominal pain and bloating
• Feelings of incomplete bowel emptying
• Needing to use fingers for stool removal (4)

Overlapping Conditions in Women

Women with IBS frequently experience overlap syndromes, where multiple conditions occur together, such as:

• Migraine headaches
• Temporomandibular joint syndrome (TMJ)
• Fibromyalgia
• Joint hypermobility syndrome
• Interstitial cystitis
• Anxiety and depression

Additionally, gynecologic conditions like endometriosis, painful menstrual cramps, and vulvodynia can exacerbate IBS symptoms.

Managing IBS in Females

Effectively managing IBS involves a holistic approach, considering lifestyle factors and medical treatments. Some proven strategies include:

1. Dietary Adjustments

• Avoiding trigger foods
• Incorporating fiber to regulate bowel movements

2. Mindfulness and Behavioral Therapies

• Managing anxiety and depression through cognitive behavioral therapy (CBT) and relaxation techniques

3. Physical Activity

• Regular exercise improves gut motility, digestion, and stress levels

4. Medications and Supplements

• Physician-prescribed medications for symptom relief
• Probiotics, herbal remedies, and sleep therapies to improve overall well-being

5. Managing Hormonal Fluctuations

Being mindful of hormonal changes can help women predict and prepare for IBS flare-ups. Adjusting diet, stress management techniques, and medications during certain phases of the menstrual cycle can improve symptom control and quality of life (6).

Gender Differences in IBS Treatment

Research indicates that men and women metabolize drugs differently, impacting treatment outcomes. Women typically have higher drug concentrations in their bloodstream and slower drug elimination rates.

As a result, healthcare providers may need to prescribe lower dosages for female patients to minimize side effects (3).

Conclusion

Understanding the gender-specific factors affecting IBS is crucial for effective management. Women experience unique symptoms influenced by hormonal fluctuations, stress levels, and overlapping conditions.

By adopting a personalized approach that includes diet, stress management, exercise, and targeted medical treatment, women with IBS can significantly improve their quality of life.

References

1. Weaver KR, Boulineaux CM, Robinson JM, Butler K, Heitkemper MM, Henderson WA. Sex Hormones, BDNF, Leptin, and TGF-β1 in Females With IBS: A Pilot Investigation. Biol Res Nurs. 2021 Apr;23(2):231-237.
2. Meleine M, Matricon J. Gender-related differences in irritable bowel syndrome: potential mechanisms of sex hormones. World J Gastroenterol. 2014 Jun 14;20(22):6725-43.
3. Mozaffari S, Nikfar S, Abdollahi M. Pharmacokinetic considerations for drugs that treat diarrhea-predominant irritable bowel syndrome: what's new? Expert Opin Drug Metab Toxicol. 2024 May;20(5):307-317.
4. Harris LA, Umar SB, Baffy N, Heitkemper MM. Irritable Bowel Syndrome and Female Patients. Gastroenterol Clin North Am. 2016 Jun;45(2):179-204.
5. Yang PL, Heitkemper MM, Kamp KJ. Irritable bowel syndrome in midlife women: a narrative review. Womens Midlife Health. 2021 May 31;7(1):4.
6. Camilleri M. Management Options for Irritable Bowel Syndrome. Mayo Clin Proc. 2018 Dec;93(12):1858-1872.

Dr. Pranav Shukla

MBBS, MD Anaesthesia

Disclaimer: This communication does not substitute advice of a medical/healthcare practitioner. Please consult your doctor/healthcare professional for any medical/healthcare advice. Although greatest possible care has been taken in preparation of this response, Dr Reddy's shall not be liable to any person for contents of the same. Images appearing herein are for illustration purposes only.