Irritable bowel syndrome, commonly known as IBS, is an intestinal disorder affecting 11% of the global population that can be experienced as a collection of symptoms including abdominal pain, bloating, gas, diarrhea and constipation.
The first signs of IBS are abdominal pain along with changes in bowel habits.
Women are more likely to have IBS than men, especially if they also have a family history of IBS. According to a 2018 study, “Sex hormones and gender differences may play important roles in the pathophysiology of IBS.”
How IBS Is Different for Women
How do women experience IBS differently than men? While many symptoms found in female IBS sufferers overlap with the symptoms found in males, some are unique to women, especially around the time of menstruation.
What does IBS feel like for women? IBS for a woman can feel like chronic abdominal pain, cramping, and worsened PMS symptoms due to abnormalities in the digestive tract. Women with IBS are also more likely to suffer from other gynecological disorders.
What is the most common symptom in a woman with IBS? The most common symptom in a woman with IBS is abdominal pain, often associated with constipation. The abdominal pain may be caused by colon spasms or other causal factors.
There are 13 common symptoms of IBS in females to look out for when diagnosing and considering treatment options.
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13 Common IBS Symptoms in Females
Some women experience even more frequent loose stools during their menstruation than usual.
2. Constipation-predominant IBS (IBS-C)
More women present with IBS-C due to various factors including anxiety, hormone production, as well as bowel function and motility.
Gas and bloating related to IBS can become more pronounced during certain stages of menstruation in women.
4. Pelvic Pain
Women with IBS frequently report chronic pelvic pain alongside other symptoms of irritable bowel syndrome. In one study, 40% of female participants with pelvic pain met the criteria for IBS.
5. Worse PMS Symptoms
Both IBS and premenstrual syndrome (PMS) symptoms, such as bloating, hormonal acne, and digestive upset, may worsen during menstruation. Researchers point to hormonal changes and the effects of progesterone during a woman’s cycle as possible reasons why PMS symptoms worsen.
6. Severe Menstrual Symptoms
Some studies show that women with IBS may suffer two-fold during menstruation. Increased pain sensitivity during menstruation can exacerbate cramping from both IBS and menstruation. Irregular periods and contraceptives do not seem to affect IBS symptoms.
Women with IBS are more likely to experience urinary incontinence and overactive bladder (OAB).
8. Pelvic Organ Prolapse (POP)
Straining during bowel movements may cause a weakening of the muscles and tissues supporting the pelvic organs. Over time, this means those organs — the uterus, bladder, or rectum — may drop or fall out of place.
Women are more at risk for POP, as it can also happen following difficult pregnancies and labor or due to lower estrogen levels after menopause.
9. Pain During Intercourse
Many women with IBS report pain during sexual intercourse. A decreased sex drive and low overall sexual satisfaction are also more common in women, likely due to the discomfort involved with many of the hallmark IBS symptoms.
Women suffering from consistent sleep deprivation put themselves at risk for several illnesses and chronic conditions, cognitive impairment, and mood instability. A lack of restorative sleep can exacerbate other IBS symptoms and cause quality of life concerns.
11. Mood Problems
Women experience a variety of mental health concerns associated with IBS symptoms, including increased rates of depression and anxiety. The stress involved with managing IBS symptoms, like the constant planning for bathroom access, can be anxiety-producing and further exacerbates IBS symptoms.
12. Increased Endometriosis Risk
Endometriosis is a painful condition causing tissue normally found inside the uterus, or endometrium, to grow outside the uterus. Women diagnosed with IBS are at a higher risk of developing endometriosis. Women who receive a hysterectomy to alleviate endometriosis pain are at a higher risk of developing IBS, too.
13. Loss of Appetite
Women suffering from IBS symptoms can experience a loss of appetite leading to weight loss from taking in fewer calories than they should.
Diagnosing IBS can be challenging, particularly in women on their menstrual cycle. Cramping associated with menstruation may be confused with abdominal cramping and vice versa.
In addition, many women find it’s difficult to have their concerns truly considered in a primary care sitting. It’s common for women to be targets of intentional or unintentional medical gaslighting — for example, for extreme PMS symptoms to be blamed on anxiety rather than a condition like IBS.
Is there a blood test to diagnose IBS? There is no blood test to diagnose IBS. A healthcare provider will use the Rome criteria for a proper IBS diagnosis in both men and women.
According to the Rome criteria, abdominal pain for 6 months or more presenting with 2 out of 3 of the following criteria points to a positive IBS diagnosis:
- Pain or relief related to bowel movements
- Change in frequency of bowel movements
- Change in consistency of bowel movements
Common female-specific conditions may sometimes be mistaken for IBS:
- PMS: Shared symptoms of PMS and IBS include mood changes, bloating, cramps, and exhaustion. If symptoms only occur around the time of menstruation, it may be PMS-related.
- Endometriosis: Shared symptoms of endometriosis and IBS include pelvic pain, constipation, diarrhea, severe menstruation, and pain during intercourse. Endometriosis can also present with nausea and back pain.
- Fibroids: Fibroids in the uterine lining share symptoms of IBS such as constipation, bloating, pelvic pain, severe periods, and exhaustion. Fatigue due to fibroids is likely related to anemia.
What is the difference between IBS and IBD? Inflammatory bowel disease (IBD) is chronic inflammation of the gastrointestinal (GI) tract. IBD can present as Crohn’s disease or ulcerative colitis, conditions sometimes mistaken for IBS. Unlike IBS, a physician may recommend a colonoscopy for IBD as both a diagnostic tool and to see the extent of inflammation in the bowel.
Risk Factors for IBS in Women
Are there IBS risk factors specific to women? Many IBS risk factors are the same for men and women, such as family history of IBS, intestinal infections, and fibromyalgia. However, women almost always present symptoms before the age of 50 and more frequently suffer sexual abuse or fibromyalgia than men.
Risk factors for IBS in women include:
- Age: IBS symptoms in women typically present before 50, during a woman’s menstruation years. It is very rare for a woman to report her first IBS flare-up after 50.
- Family history: Women with a family history of IBS are at higher risk for developing the condition. Researchers suggest environmental factors play an essential part even in these cases where genetics may be involved.
- A history of abuse: IBS and other functional disorders are reported at a much higher rate in women with a history of sexual abuse. This may be linked to other IBS triggers associated with abuse, such as sleep disruption and mental health disorders.
- Fibromyalgia: IBS often coexists with functional disorders like fibromyalgia. Mental health conditions associated with chronic pain also worsen IBS symptoms. Some providers suggest antidepressants, but it’s important to get to the root of your symptoms, too.
- Intestinal infections: Some patients experience their first IBS flare-up following a bout of stomach illness or infection. That can include gastroenteritis, or stomach flu. This is referred to as post-infectious IBS.
If you suspect you have IBS, your physician can determine the type of IBS you have.
There are 4 main types of IBS:
- Diarrhea-predominant (IBS-D)
- Constipation-predominant (IBS-C)
- Mixed, or mixed pattern (IBS-M)
- Unspecified (IBS-U)
Common IBS Triggers
Triggers for IBS flare ups include stress, food, caffeine, carbonated beverages, and infectious diarrhea. Syndromes such as leaky gut syndrome and small intestine bacterial overgrowth (SIBO) can also trigger IBS.
- Food allergens (often lactose/dairy or gluten)
- SIBO (small intestine bacterial overgrowth)
- Antibiotic use or overuse
- Leaky gut syndrome
- Hormone imbalance
- Candida/yeast overgrowth
- Excessive alcohol use
- Low vagal tone (low vagus nerve activity, which may result in fainting)
- Thyroid dysfunction
- Histamine intolerance
- Poor hydration
- Fructose malabsorption (most common for people who eat many foods continuing high fructose corn syrup)
- Food poisoning
How to Treat IBS
While there are a variety of alternative treatments out there like hypnotherapy and cognitive behavioral therapy, those treatments come with varying levels of research-backed success.
What are some ways to help relieve IBS? The best ways to relieve IBS are to lower stress levels, avoid short-chain carbohydrates (sugars), and cut out caffeinated and carbonated beverages. For immediate abdominal pain relief, apply a gentle heating pad to the location of abdominal discomfort. Sip herbal teas known to soothe the stomach, such as peppermint and chamomile.
Over-the-counter laxatives may help on rare occasion, but using these or medications like Pepto-Bismol may increase the risk of side effects like vertigo, lethargy, or vomiting.
At PrimeHealth, we know you can cure IBS if you identify the root cause of your symptoms. To do this, we lead patients through a 5-step process:
- Discuss your history and test for IBS triggers. A patient’s triggers can range from chronic stress or trauma to gut infections like parasites or a condition called small intestine bacterial overgrowth (SIBO). Completing stool and breath tests can help us to diagnose root causes like these.
- Inquire about medications. Some medications help treat IBS. At PrimeHealth, we try to keep medications to a minimum to focus on functional treatments but recognize that some conditions must be treated with antibiotics. The most commonly prescribed medications include PEG, linaclotide, and lubiprostone for IBS-C and antispasmodics and diphenoxylate for IBS-D.
- Start a low-FODMAP diet or other IBS diet. Dietary changes, like eliminating gluten and dairy, may signal an underlying digestive system condition. A low-FODMAP diet may also help reduce or reverse IBS symptoms.
- Make lifestyle changes. Regular exercise, resting your bowel using intermittent fasting, and stress management may help alleviate IBS symptoms. Meditation, yoga, and spending time outside are all good ways to manage chronic stress.
- Take gut-healing supplements. Natural remedies that may help with IBS include probiotics, herbs, fiber supplements, and digestive enzymes. Your physician can help you find supplements that treat your unique case after a diagnosis of IBS. Keep in mind that not all IBS supplements are suitable for every patient.
You can reverse IBS by treating it at the root cause. At PrimeHealth, we have patients who suffered from digestive issues for 10 years or more that are now seeing massive improvements with the treatments we do.
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