Sometimes it IS a Woman Thing: Solving Gender-Specific GI Issues
By Sonaly Patel, MD, Mercy Digestive Health Services
In the United States, women are two to three times more likely than men to suffer from certain
gastrointestinal (GI) issues such as irritable bowel syndrome or pelvic floor dysfunction. Doctors of many stripes have tried to determine the reason for this disparity. Some have looked at genetic factors, and others environmental factors. Some have explored hormonal effects on GI conditions, while some have looked at the impact of psychological stress on the GI tract. Many studies have shown a difference between men and women and GI problems, from the way a condition comes about, symptoms that present themselves, and response to treatment regimens. These findings have helped doctors realize they need to approach men and women differently when discussing GI complaints.
Irritable bowel syndrome (IBS) is a common GI disorder in both genders, but especially among women. Patients with IBS describe symptoms of abdominal pain and discomfort along with altered bowel function such as diarrhea, constipation or a combination of both. Hormones such as estrogen and progesterone, which fluctuate during a woman’s menstrual cycle and also during pregnancy, can affect both how things move through the gastrointestinal tract and how the brain perceives gastrointestinal stimulus. The decline in estrogen and progesterone production during and after menopause may also affect a women’s gastrointestinal health, causing symptoms such as indigestion, flatulence and nausea. For these reasons, it’s often helpful to track symptoms in relation to a woman’s menstrual cycle. In addition, life stressors like work and family obligations have also been associated with worsening IBS symptoms. In other words, the roles women assume in their everyday lives may account for a large portion of worsening IBS symptoms. Some studies have identified simple lifestyle changes that can help alleviate symptoms of IBS. Yoga and meditation, for example, both have shown to help tackle life stressors and alleviate symptoms of IBS. In addition, a gastroenterologist may prescribe specific medications that can also improve the symptoms of IBS.
One of the most frequent complaints gastroenterologists encounter is constipation. Constipation is clinically defined as difficulty in emptying the bowels, usually associated with hardened stools. When symptoms persist for several weeks, it is termed chronic constipation. Many times, female patients have tried over-the-counter (OTC) laxatives and various homeopathic remedies, without much relief. These women require a unique approach to diagnosis. In their first office visit, taking a very detailed health history is important. Determining when and how symptoms began, as well as modifying factors, helps pin down an accurate diagnosis. It’s very helpful to relate symptoms to pre- versus postpartum in new mothers, for example, or pre- versus post-menopause, to guide how treatment is managed.
Another crucial part of taking a patient’s history is reviewing their diet. A balanced diet incorporating approximately 25 – 30 grams of fiber per day is ideal for preventing constipation and other GI issues. Too little—or too much—fiber can worsen symptoms. Fiber is only effective when taken with adequate (approx. 64 oz daily) amounts of water—otherwise, it can be binding. Although incorporating fiber into your diet may be hard for busy women on the go, simple additions such as high fiber cereals, putting flax seed into smoothies, and picking healthy, fiberrich snacks such as raspberries, strawberries and pineapples will help women reach their daily fiber goals.
As with IBS, hormonal variations can also worsen symptoms of constipation. Some women have changes in severity of constipation as estrogen and progesterone fluctuate during their menstrual cycle. A lack of these hormones during menopause, along with age related gut motility issues, may worsen constipation as women age. Changes in your daily habits like adding exercise and increasing fiber may stimulate gut motility and help with symptoms of constipation. If symptoms continue despite OTC medications and diet modifications, be sure to see your doctor.
Pelvic floor dysfunction (PFD) is a frequently under-recognized cause of GI complaints in women. Clinical symptoms of pelvic floor dysfunction can include constipation, incontinence or incomplete evacuation. In order to have a bowel movement, the colon contracts while the rectal muscles relax. During childbirth or with other injuries to the pelvic floor or abdomen, this coordinated motion is disrupted, resulting in PFD. There are new motility tests which can help identify this disruption and provide a road map for a treatment approach. Because of their specialized training, a gastroenterologist trained in gut motility is the best doctor to order and interpret these tests. One specific test, anal manometry, is a study that allows a doctor to examine the strength of the different muscles of the pelvic floor as well as investigate for any disruption in the coordinated efforts during a bowel movement. With this information, the doctor can guide a specialized physical therapist to help strengthen and coordinate the pelvic floor muscles. Other therapies, such as pelvic floor massage and acupuncture, may be used to help treat PFD.
Fortunately, medical societies such as American College of Gastroenterology (ACG) and American Society of Gastrointestinal Endoscopy (ASGE) have become increasingly aware of differences in women’s GI health and management. This growing understanding has resulted in a concerted effort to educate current practicing gastroenterologists and also increase the number of female gastroenterologists. A multidisciplinary approach, coupled with doctors who are in tune with gender discrepancies, represents the future of digestive health management.
For more information or to schedule an appointment with Dr. Patel, call 610.534.6270.