Is IBS just a women’s problem?

Irritable Bowel Syndrome (IBS) is one of the world’s most common gut disorders affecting 1 billion people globally. 

Many sufferers keep quiet about their embarrassing gut symptoms. Let’s face it, talking about smelly gas, grumbling guts and diarrhea can be as uncomfortable as the symptoms themselves! 

We first looked at some of your frequently asked questions for Women’s Health Week and we are revisiting them here for International Women’s Day. We trawled the internet to find out:

• Is IBS a women’s problem? 

• Is IBS experienced differently by men and women?

• Do treatment options differ for men and women?

• Can hormones worsen IBS symptoms?

What is IBS?

Irritable bowel syndrome (IBS) is a debilitating and chronic gut condition affecting the quality of life of around 11% of the world’s population. 

IBS is a functional gut disorder which means that your insides are structurally fine, but your gut simply doesn’t function normally. Researchers are still not clear on the exact causes of IBS. Does it start in the brain or the gut?  

While IBS does not cause any obvious structural changes in the gut, it does affect the gut’s motility and the amount of water and gas present. And it can also affect the nervous system leading to increased sensitivity. Commonly experienced symptoms include abdominal pain, cramping, bloating, excessive flatulence and altered bowel habits. 

IBS affects up to 1 in 5 Australians which equates to over one million Australians. It affects all ethnic and socio-economic groups.

IBS can have a massive impact of quality of life, leading to time off work and diminished social lives. Many sufferers report that that they don’t feel understood by their partners, friends or family. The social impact of IBS is greatest in women, perhaps because women are more embarrassed by their symptoms and this stigma leads to social isolation.

Diagnosis can be a problem

On average, it takes up to 4 years for patients to be diagnosed with IBS. IBS is typically diagnosed (in around 72% of cases) using a process of exclusion, often using a colonoscopy to rule out other conditions like ulcerative colitis or cancer and an endoscopy to rule out coeliac disease.

Using symptom surveys to give a positive diagnosis in low-risk groups can save discomfort and time. These can be paired with simple blood and stool tests to rule out other conditions. This approach also reduces confusion in patients and increases confidence in the diagnosis. It also helps patients feel that they have been taken seriously, rather than having their condition dismissed by their doctors.

Who gets IBS?

So who typically ends up with an IBS diagnosis? A recent systematic literature review examining the sex-gender differences in IBS found that IBS was more common in women. In fact, rates of IBS in women are 2 to 2.5 times higher than those in men (amongst those that sought medical care).

While the numbers alone make it look like IBS affects more women than men, is this related to physiological differences or simply because more women seek medical care to manage their symptoms?

The research data is mixed. In 2014, a landmark study found that in most regions across the globe, women were more likely to suffer from IBS than men. While other data showed that across South Asia, South America and Africa, the proportion of men and women affected by IBS was similar. 

Many studies have found that IBS-C (constipation predominant) is reported to be more prevalent in women, while IBS-D (diarrhea predominant) is more prevalent in men.

Because more women experience constipation, they are also more likely to report the associated symptoms of bloating and abdominal pain than men.

At what age does IBS affect men and women?

The incidence of IBS in women increases and surpasses that of men from the ages of 12 and 70 years. Researchers suggest that hormones play a major role in explaining the gender gap. However, from 70 years of age, the incidence of IBS in women and men level out.

Why are my IBS symptoms worse during my period?

No, it’s not just you. Many women report that their IBS is worse during their monthly periods. Why? Researchers have observed that IBS symptoms tend to worsen as oestrogen and progesterone levels fall, affecting gut contractions, sensitivity, motility and levels of inflammation. 

IBS can alos co-occur with endometriosis. Given both conditions are difficult to diagnose, it is a good idea if you have had a diagnosis of IBS to get your doctor to check you carefully for signs of endometriosis, especially if your symptoms are worse around the time of your period or if you have a family history of the condition. Endometriosis can take many years to diagnose, but early diagnosis leads to better outcomes. Check out our blog on Endometriosis, IBS and Diet for more infomation.

IBS treatment options for men and women

Despite the size and scale of IBS, there is no cure. And sadly, there is no one-size-fits-all treatment regime. There are some medications that can help relieve IBS symptoms. Each treatment regime is highly individualised depending on the most troublesome symptom(s). Because men are more likely to have IBS-D and women IBS-C, the treatment options can vary by gender.

For pain, an antispasmodic like peppermint oil or hyoscine may be prescribed by your doctor. If this isn’t effective, your doctor may suggest neuromodulators such as tricyclic antidepressants or less commonly SSRIs. This isn’t because your doctor thinks the symptoms are related to depression or are ‘all your head’, but because the gut is closely linked to your nervous system and these drugs can improve motility and pain perception. 

For diarrhea, your doctor may recommend loperamide. Second line medications have been developed but appear to have a chequered safety history, such as alosetron, which was licensed in the USA for women with IBS-D, withdrawn and then reintroduced for women with the most severe IBS-D symptoms only. It is not approved for use in Australia. 

For constipation, your doctor may recommend laxatives. If these are not sufficient, they may prescribe a secretagogue. 

Whilst these are back-ups, most gastroenterologists would recommend that you DON’T jump straight to the medicine cabinet to improve your IBS symptoms. You should first try lifestyle measures like exercise, diet and stress reduction. 

For more information about IBS treatment options from frontline gastroenterologists, read this information.

Diet is a frontline therapy for IBS  

About 70% of IBS sufferers gain relief from their gut health symptoms by following a diet low in fermentable carbs – the low FODMAP diet. Unfortunately, following a diet that limits fermentable oligosaccharides, disaccharides, monosaccharides and polyols is as fun and easy as it sounds - NOT!

The result is that people following a low fodmap diet have to BYO food everywhere they go or they risk becoming hungry and hangry.

And that’s why we developed Superflora Gut Health shakes.

Our shakes are low in fodmaps, gluten-free, and contain only gut-friendly ingredients. They contain clinically validated probiotics: The probiotic LactoSpore Bacillus coagulans MTCC 5856 contributes live beneficial bacteria and reduces irritable bowel discomfort and bloating.

We only use the highest quality ingredients including rich Cocoa Powder, Peruvian lucuma and 100% Australian whey protein isolate, with no artificial additives, colours or flavours. 

Having a shake on hand means that you always have a gut-safe meal close by. They are quick and easy to prepare, as you only need to add chilled water, although they also work as a fantastic smoothie base if you add lactose-free milk and a little fruit.

Our shakes also contain a gut-safe fibre blend including psyllium which has been shown to be useful for sufferers of both diarrhea and constipation predominant IBS.

Best of all, our shakes are Australian made and recommended by our medical advisor WA’s favourite gut health guru Nobel Laureate Professor Barry Marshall.

And you can enjoy Superflora Gut Health Shakes regardless of your gender!

Written by: Dr Mary Webberley, Chief Scientific Officer at Noisy Guts. Mary has a background in biology, with two degrees from the University of Cambridge and post-doctoral research experience. She spent several years undertaking research into the diagnosis of IBS and IBD. She was the winner of the 2018 CSIRO Breakout Female Scientist Award.