Women: Special IBS Issues

It has long been known that women, especially those age 15 to 45, make up the bulk of IBS patients — approximately two-thirds of IBS patients are female.

This section was developed in response to an e-mail inquiry to us by an IBS patient. She described her elation in being freed from IBS symptoms during her pregnancy. However, one month after delivery, her symptoms returned. This prompted a search of the IBS literature for the effects of female hormones on IBS.

You can find further information on Women and IBS in our IBS Research & Resources section, which has research article summaries that deal with IBS and the menstrual cycle, as well as with IBS and abuse.

A Woman’s Physiology and IBS

Women, IBS and Menstruation

  • It is quite common for women to experience GI symptoms such as constipation and diarrhea prior to menstruation. A majority of women describe some change in bowel habits during menstruation such as nausea and painful uterine cramping.
  • In women with IBS, GI symptoms are even more common around the time of menstruation. Symptoms may include abdominal pain, diarrhea, constipation, flatulence and nausea. It is not yet clear how menstrual cycle hormonal changes result in this increase in IBS symptoms.

Gynecological Problems and IBS

  • While CPP (Chronic Pelvic Pain) is distinct from IBS, there is an increased frequency of IBS in CPP patients; psychological testing shows many of the same psychological patterns in both conditions. Like the colon in IBS, in CPP there is no discernible pathology of gynecological organs, and the pain of chronic pelvic pain is considered to be "functional."
  • Women with IBS may also experience pain during intercourse.

IBS and Gynecological Surgeries

  • It is possible that women who have gynecological surgical procedures (hysterectomy or laparoscopy) for pelvic complaints actually have CPP (chronic pelvic pain) and IBS. If these women have IBS and CPP, a functional disorder that does not necessarily require surgery, the symptomatic outcome of surgery may be adversely affected. Therefore, women with pelvic pain should be carefully evaluated before a decision for surgery is made.
  • A study showed that 47.7% of women having diagnostic laparoscopy for chronic pelvic pain had IBS. One year after laparoscopy, IBS laparoscopy patients had lower overall health status and lower pain improvement ratings than non-IBS laparoscopy patients.
  • A study showed 39.5% of women having elective hysterectomy had IBS. Furthermore, 21% of women with IBS had a hysterectomy compared to a national average of 5.5% of women.
  • IBS patients were more likely to have chronic pelvic pain and abnormal menses as a reason for surgery than non-IBS patients. For women who had a hysterectomy because of pelvic pain, those with IBS had less pain improvement.

Surgery May Help Some IBS Patients

  • While caution is advised, there may be situations where reduction of hormonal levels results in improvement in IBS. One study showed that some women with IBS improved after a hysterectomy performed for gynecological reasons. Another describes several IBS patients who improved after medication-induced cessation of menses. Thus, surgery for gynecological reasons may help some IBS patients.

Abuse and IBS

Defining Abuse

  • Sexual abuse involves force or a threat of harm and can occur at many levels of severity.
  • Physical abuse may range from one experience of being "mugged" to repetitive and severe domestic violence.
  • Emotional abuse has not been considered in IBS (but may be just as important as other forms of abuse).

A history of sexual and physical abuse is more common in IBS than in a normal population

  • 50% of 130 cases of IBS reported a history of abuse compared with 23.3% of those without IBS (Talley et al., 1994).
  • 47.1% of IBS patients reported childhood sexual abuse compared with 29.6% of nonpatients (Blanchard et al., 2001).
  • The more severe the IBS, the greater the history of abuse. (Drossman, 1995).

Higher percentage of abuse history in IBS possible than in organic GI diseases such as Inflammatory Bowel Disease

  • There was a higher level of pre-adolescent sexual and physical abuse among female patients with functional GI disorders (IBS) than among female patients with organic GI diseases (IBD) (Drossman et al., 1990).
  • Of the IBS patients, 50% (19 out of 38) reported early physical or sexual abuse.
  • There was a significantly greater history of sexual abuse among IBS patients (54%) than among a group with IBD (5%) (Walker et al., 1993).

Contradictory evidence shows no significant correlation between abuse and IBS compared to abuse and other GI disorders

  • Among 997 GI patients: 22.1% of patients with functional GI disorders had early abuse compared with 16.2% of those with organic disorders (Talley et al., 1995).
  • Leserman et al. (1996) also failed to find significant differences on abuse between patients with functional vs. organic GI disorders.

Cultural Differences in IBS and Abuse

  • Porcelli reported a 7% rate of abuse in an Italian tertiary center for treatment of functional bowel disease
    32% of French subjects with IBS were found to have a history of physical and sexual abuse.
  • These figures are somewhat lower than reported in the U.S. (about 48%) and suggest that there may be cultural differences in abuse rates. On the other hand, cultural difference may affect the degree with which IBS patients are willing to report a history of abuse.

Why Is There a Possible Relationship Between Abuse and IBS?

A history of abuse may result in a higher level of physical sensitivity. Secondly, abuse history may naturally lead to a greater sense of physical vulnerability and thus more preoccupation with physical symptoms. It may, unfortunately, leave a psychological trauma residue of depression and/or anxiety, which only intensifies the experience of having a difficult to manage, unpredictable illness.