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Women are more likely to be affected by irritable bowel syndrome (IBS) than men. It’s a stand-out fact in even the most cursory online fact-finding mission about IBS, classified as a  disorder that causes a disturbance in bowel function. With symptoms ranging from mild to disabling, IBS can cause discomfort for some and be disabling for others.

In recognition of IBS Awareness Month, gastroenterologist Mindy Lee, M.D., Assistant Professor of Clinical Medicine in the Division of Gastroenterology and Hepatology at ÈÕ±¾avÉ«ÇéƬ (WCM), answers questions about how women experience IBS differently from men, and how that can affect their treatment.

Many fact sheets about IBS state IBS is twice as common in women than men. What’s the medical understanding or explanation for this?

This is a complex question with a multifactorial answer.

First, women are more likely to seek medical help regarding IBS symptoms compared to men, who tend to under-report their symptoms.

Second, many clinical trials related to IBS include more women than men, which may introduce bias into the studies and skew prevalence of the condition.

And third, sex hormones (estrogen v. testosterone), gastrointestinal motility [the movement of food throughout the digestive system], visceral perception, and responses to stress all play a role.

Of the three types of IBS—IBS with constipation, diarrhea, or mixed—which do women tend to experience?

Studies suggest that women tend to experience more IBS with constipation, while men tend to experience more IBS with diarrhea.

Prevalence of mixed IBS tends to be about the same in women and men. This is likely related to fluctuations in estrogen and progesterone in women. Overall women have slower gastrointestinal (GI) transit compared to men, which means that the time for food/content to move through the digestive tract takes longer in women. Another example would be that pregnant women tend to have more constipation, mainly due to the rise in progesterone level.

Why do women experience more IBS symptoms during their periods?

In general, immediate before a woman menstruates, there’s a higher level of estrogen and progesterone that causes more bloating and constipation. Then hormone levels start to fall at the onset of menstruation, and during their periods, women tend to have more symptoms of diarrhea and increased pain sensitivity.

Studies also suggest women who have painful periods also are more likely to have GI-related symptoms before their periods. Some studies suggest that higher estrogen increases pain sensitivity to pain, while testosterone possess some protective properties against pain perception. 

How do women's IBS symptoms differ from men's?

Symptoms of abdominal pain tend to be similar in men and women. But women tend to experience more bloating, nausea, constipation, and extraintestinal symptoms [symptoms that affect other parts of the body].

Women also are more psychologically affected by GI symptoms—they report more depression and anxiety, and a decreased quality of life. 

Are there different approaches in treating women with IBS?

Yes—it’s important to manage the psychological factors of IBS; pay attention to women’s menstrual cycles; and know whether they are pre- or post-menopausal. Certain medications work better in women than men, such as, Alosetron, which is a 5HT3 antagonist, or Tegaserod , which is a 5HT4 agonist, which are more effective for women for reasons that are not completely clear.

Are there research studies that focus on women with IBS?

Many research studies are examining sex differences in IBS. Researchers also are looking to ensure more equal representation of men and women in IBS studies to minimize bias. And there are studies evaluating how pre- and post-menopausal status may affect IBS.

What other diseases may be associated with IBS in women?

It is linked to other forms of chronic pain including fibromyalgia, interstitial cystitis etc.