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Irritable Bowel Syndrome in Women
Symptoms Of Irritable Bowel Syndrome
Irritable Bowel Syndrome(IBS) is characterized by abdominal pain, which is usually described as crampy or colicky. There is increased gas and distention. There are alternations between diarrhea and constipation, but one (usually constipation) can dominate. There is not weight loss associated. And all of this must not be due to other diseases or physicial problems.
When a woman is suspected of having IBS, her doctor will start with a history to look for all the symptoms. A particular set of guidelines called the Manning Criteria identifies IBS more often in women. Blood work, urine and stool exam will be done. A woman's physical will include a pelvic in addition to the abdominal exam. The colon will likely be scoped. Some women will warrant a pelvic ultrasound.
If there is no other findings to suggest another disease and the pattern of symptoms fit, then a diagnosis of Irritable Bowel will be established.
Gender Differences in Irritable Bowel Syndrome
Irritable Bowel Syndrome is diagnosed in women twice as often as men. Since it is a diagnosis based totally on symptoms, exactly how symptoms are surveyed can be a source of bias. The Manning Criteria of symptoms picks up more women than men. Also, it is not clear if women simply go for help more often than men. There is also some speculation that there women are more able to perceive gastro-intestinal distention and therefore more likely to feel it as pain. The true gender difference in rates is unclear.
The reason the Manning criteria identifies more women is because it asks about symptoms that are more often seen when a women has IBS. These include: more mucous, incomplete bowel emptying, distension, and hard stools.
Irritable Bowel Syndrome is also associated with a number of other female-specific or female-predominate diseases. There are associations of IBS and Chronic Pelvic Pain, dysmenorrhea, gallbladder, and fibromyalgia. The theory behind this is that there may be some common disturbance with smooth muscle, as all these problems involve it. Stress and IBS go hand in hand and women are know to feel more stress. And while IBS doesn't cause pain that awakens, it is associated with sleep disturbances.
Unique Aspects of Irritable Bowel Syndrome For Women
Many women without IBS report gastro-intestinal complaints around their periods or menopause. For women with IBS, this is much more prominent. Up to 50% of women with IBS report increased symptoms at PMS time. Most studies show more gas and cramping. But some studies show about the same stool frequency and consistency (that means no change in diarrhea or constipation). But others show more constipation before the period and more loose stools at the start. As mentioned, dysmenorrhea is more common in IBS women. It is also thought that the contractions of the uterus with cramping can cause the intestines (also made of smooth muscle) to contract. This is associated with the loose stools some women experience with cramping at the onset of menses.
The relationship with Chronic Pelvic Pain and IBS is confusing. Some believe the common mechanism of smooth muscle derangement is reponsible. Others believe that CPP is misdiagnosed as IBS and vice versa. Still others think the controversial Sexual Abuse theory (see below) is in play and that both are caused somehow by the trauma is the reason.
One study has shown that women with IBS experience more post-birth fecal incontinence. This is transient and not associated with any long-term problems.
After hysterectomy, there is a small but clear increase in symptoms and/or new appearance of IBS. About 10% of hysterectomy patients will develop new IBS. Post-hysterectomy IBS is more often characterized by constipation and pain. It isn't clear if hystectomy without taking the ovaries makes a difference.
Hormonal status alone does. Peri-menopausal and menopausal women have more altered bowel function and develop more IBS at this time of life.
The Sexual Abuse Theory As A Cause of Irritable Bowel Syndrome In Women
This idea is as widespread as it is controversial. It is clear that there's a correlation between a woman reporting sexual abuse in her past and reporting and being diagnosed with Irritable Bowel Syndrome. But, the cause and effect relationship has not been well-established. Sexual abuse history is also implicated in other bowel syndrome and in chronic pelvic pain. Other types of childhood abuse have been associated with IBS.
There are several possible reasons for the association, that are not cause and effect. One is simply that those with childhood abuse tend to have more stressful adult lives. They also tend to feel more stress than others would in the same situations because of poorer family support systems and coping mechanisms learned. Stress is a big factor in IBS. Conversely, some women could simply start out with more suseptibility to stress. As mentioned, stressed women will feel more pain than other women in the same situation. This could lead these stress-suseptible women to be more likely to seek medical care for both. Or once she seeks help for one, the other will be uncovered. The correlation is mostly documented through patient records. So not knowing about the women who have one or both who deal with it on their own can skew results.
There are reasons why sexually abused women may be more likely to be identified as having IBS. Traumatized women may have increased sensitivity to pain and/or be more focused on their body's feedback. Many sexual abused women come into the health care system because of mental illnesses that grow out the abuse. Mental health patients tend to get more attention to their general health and symptoms.
Lastly, some theorize that IBS is really misdiagnosed Chronic Pelvic Pain and that Chronic Pelvic Pain is what is really caused by sexual abuse. While it is true CPP and IBS are confused in diagnosis, it is the weakest of the explanation. Most of the same criticisims made about IBS and sexual abuse could be made about CPP and sexual abuse. There is no evidence that physical injury from sexual abuse causes either syndrome.
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