So, you’ve read our article on IBS in women, but why does IBS affect more women than men? Canada has one of the highest prevalence rates of irritable bowel syndrome (IBS) in the world – estimated 18% vs. 11% globally. (Lovell et al. 2012). Irritable Bowel Syndrome is a complicated functional gut disorder, and although the condition affects both men and women in similar ways, there does seem to be some evidence that supports a slight variation between how IBS presents itself between the two sexes.
In this article, we’ll dive into exactly what those differences are, how IBS affects men and women differently in prevalence, symptoms, hormones, and quality of life.
IBS is a disorder affecting the intestine. IBS involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns and other symptoms.
IBS is a functional gut disorder. Functional means that the affected area (intestines) are impaired and not working the way they should, however there are no visible abnormalities that can be observed through testing. Because the cause of the problem cannot be physically detected (no sores, tears, polyps, etc) functional gut disorders are often diagnosed based on the characteristics of symptoms.
Some of the more debilitating symptoms of IBS involve debilitating abdominal pain, chronic and sever bloating and abnormal bowel patterns. Patients with IBS can struggle with chronic diarrhea (IBS-D) constipation (IBS-C) or a combination of both (IBS-M).
IBS is not a fatal condition, however, depending on the severity, IBS can be extremely debilitating and drastically affect an individual’s quality of life. In fact, in an impact report on IBS done in 2016, more than 70% of patients interviewed indicated that their symptoms interfere with everyday life and 46% report missing work or school due to IBS. On average, IBS patients reported they would give up 25% of their remaining life (15 years) to live a symptom-free life (Gastrointestinal Society, 2018).
IBS is difficult to diagnose and difficult to treat, often requiring the assistance of both a doctor and a registered dietician to get symptoms under control.
IBS has been reported to be a more common disease in women, with a female-to-male ratio of 2-2.5:1 in terms of those who seek medical care. (JNM, 2018) However this number is believed to be influenced by multiple factors, such as race, geographical location, access to healthcare, cultural factors as well as differences in help seeking behavior (JNM, 2018). So, although there is a skew in numbers between men and women IBS patients, it is still unclear whether these differences have to do with with physiologic differences or simply differing medical care seeking behaviours between men and women.
A recent study did show that women are at higher risk of developing IBS as result of infection (Klem, Grover, 2017). There’s another influx of sex-related differences in prevalence of IBS around puberty. The incidence of IBS in women increases and surpasses that of men from the ages of 12 and 70. Around 70 the number of IBS cases in women levels out with that of men.
To compare, the occurrence of IBS in men stays consistent from the ages of 20 to 70 (JNM, 2018). It has been proposed that hormones may affect these sex-differences in patients, as well as the connotation between IBS symptoms and the varying hormonal phases that women are subjected too such as menstrual cycle phases, pregnancy, and menopause.
Interestingly enough, there are differences in prevalence of symptoms demonstrated in men VS women who suffer from IBS. For instance, women reportedly tend to suffer more from IBS-C (constipation) than men, who more frequently suffer from IBS-D (diarrhea) (Chial,Camilleri, 2002). Other differences in symptoms were derived from a review and meta-analysis performed for 22 studies regarding gender differences in IBS symptoms.
40% of women reported IBS-C as opposed to the 21% of men, whereas 50% of men reported symptoms of IBS-D in comparison to the 31% of women. As a result of the tendency for IBS symptoms to manifest in women in the form of constipation, women with IBS are more likely to report bloating and abdominal pain than men (JNM, 2018).
There are conflicting studies on the hormonal impact on IBS.
In women, there is a clear connection between certain hormones and their impact on things like stress and gut motility. For example, both estrogen and progesterone are known to obstruct ‘smooth muscle contraction.’ Smooth muscle cells line the walls of your stomach and intestines and contract automatically to help you digest your food. When high rates of estrogen and progesterone interfere, it can slow down gut motility. This is why women tend to suffer more from IBS-C than men do. Women also have expressed more persistent and intense IBS symptoms during menstruation such as soft bowel movements, severe bloating, and increased abdominal pain during their menstrual cycle (Mulak, Tache, 2010).
However, the roll of hormones in IBS is not always so cut and dry. For example, there are some studies that suggest menopause also seems to play a hand in the exasperation of IBS Symptoms. Women diagnosed with IBS reported more severe symptoms after the onset of menopause in one study (Georgescu et al, 2010), and another study the opposite was found. In fact, many of the studies focused on tracking correlation between IBS symptoms, menstrual cycles, menopause and pregnancy are dependent on patient symptom recall, which isn’t always reliable.
There are also conflicting results on whether or not hormone replacement therapy in menopausal women has an effect on IBS symptoms. Some studies seem to suggest that women who use hormone replacement therapy may trigger IBS in post-menopausal women (Ruigomez et al, 2003), whereas others suggest that that prevalence of IBS symptoms in women who have undergone hormone replacement therapy are similar.
Ultimately, the results are skewed, and more attention needs to be paid to the correlation between women’s hormonal cycles and the correlation between IBS symptoms to help paint a clearer picture on how exactly hormones affect women with IBS.
For the most part, studies looking at the differences in IBS symptoms have zeroed in on the idea of female predisposition. As a result, there has not been much research on the role of male hormones in the manifestation and prevalence of IBS.
However, there have been reports that Androgens (any natural steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors) protect against chronic pain disorders in humans (Kim,Kim,2018).
Interestingly enough, testosterone has also shown to work as an effective pain killer in experimental pain models (Alois, 2013).
So, while there is no conclusive data on how pain in perceived differently between the sexes, it is interesting that women tend to report more severe, more frequent, and longer lasting pain than men, considering the natural hormonal differences between sexes.
Differences in social gender norms can also skew data presented in IBS between the two sexes, beyond just healthcare seeking behaviour.
Within society, ingrained expectations of men and women can influence how they behave as patients and alter the way symptoms of IBS present themselves. For example, many women in western countries are socialized to worry about body image and slimness, which can often translate into increased anxiety regarding symptoms like extreme bloating (Toner, Akman, 2000). It was also determined that women found their IBS symptoms interrupted relationships that were important to them, such as their relationships with their children and colleagues at work. Women were also more concerned with losing control over their bowels than men were and their top concern was excessive diarrhea (Toner, Akman, 2000).
Men raised in an environment that pushed a culturally traditional sense of what is ‘masculine,’ expressed that IBS symptoms made them feel ‘weak’ and unable to support their families. These anxieties are born from how they were socialized and have the potential to effect stress related symptoms. Whereas on the flip side, men socialized in a way that celebrated qualities deemed by society as ‘feminine’ had similar anxieties regarding their IBS as women (Ali et all, 2000).
Treatment of IBS is extremely complex and often requires the careful attention of both a doctor and a registered dietitian. Treatment options can range anywhere from medication, diet manipulation, psychological therapy and stress management.
The closer a patient is with their physician the better, as for the most effective treatment, a physician must have a clear understanding of how sex-gender and lifestyle tendencies could potentially be contributing to flairs and symptoms.
The newest treatment option out there has recently been confirmed in a clinical trial, and it comes in the form of peppermint oil. Peppermint can relax muscle, ease hypersensitivity in the bowels, and modulate pain in IBS. IBgard is a new clinically tested capsule filled with tiny beads of peppermint oil, using a technology called SST (Site Specific Targeting). It is the only product of its kind on the market that has gone through a clinical trial. It has been proven to be effective and safe in relieving symptoms in patients with moderate to severe IBS-M and IBS-D.
This product is easily attainable and available at most drug stores. Patients tested saw relief in symptoms over the course of 24 hours and continued relief over a 3-4 week period. You can read the full clinical study here, or, if you’re interested in giving IBgard a try, you can also print out a coupon for your first purchase here.
Aloisi, Anna Maria. “Gonadal Hormones and Sex Differences in Pain Reactivity.” The Clinical Journal of Pain, U.S. National Library of Medicine, 2003, www.ncbi.nlm.nih.gov/pubmed/12792555.
Chial, Heather J, and Michael Camilleri. “Gender Differences in Irritable Bowel Syndrome.” The Journal of Gender-Specific Medicine : JGSM : the Official Journal of the Partnership for Women’s Health at Columbia, U.S. National Library of Medicine, 2002, www.ncbi.nlm.nih.gov/pubmed/12078061.
Georgescu, Doina, et al. “Migraine in Young Females with Irritable Bowel Syndrome: Still a Challenge.” Neuropsychiatric Disease and Treatment, Dove Medical Press, 20 Dec. 2017, www.ncbi.nlm.nih.gov/pubmed/29302188/.
“IBS Global Impact Report.” Https://Badgut.org/, Gastrointestinal Society, 2018.
Kim, Young Sun, and Nayoung Kim. “Sex-Gender Differences in Irritable Bowel Syndrome.” Journal of Neurogastroenterology and Motility, Korean Society of Neurogastroenterology and Motility, 1 Oct. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6175559/.
Klem, Fabiane, et al. “Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-Analysis.” Gastroenterology, U.S. National Library of Medicine, Apr. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5367939/?report=reader.
Mulak, Agata, and Yvette Taché. “Sex Difference in Irritable Bowel Syndrome: Do Gonadal Hormones Play a Role?” Gastroenterologia Polska : Organ Polskiego Towarzystwa Gastroenterologii, U.S. National Library of Medicine, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC4244886/.
Ruigómez, Ana, et al. “Is Hormone Replacement Therapy Associated with an Increased Risk of Irritable Bowel Syndrome?” Maturitas, U.S. National Library of Medicine, 25 Feb. 2003, www.ncbi.nlm.nih.gov/pubmed/12590009/.
Toner, B B, and D Akman. “Gender Role and Irritable Bowel Syndrome: Literature Review and Hypothesis.” The American Journal of Gastroenterology, U.S. National Library of Medicine, Jan. 2000, www.ncbi.nlm.nih.gov/pubmed/10638553.