Irritable bowel syndrome (IBS) is an intestinal disorder that affects up to 11% of the global population. Among IBS sufferers, only about 30% seek treatment from a physician for their IBS, particularly if those symptoms present alongside other conditions.
Which gender is more likely to have IBS? 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.”
Some women experience worse IBS symptoms during their menstrual cycles, making this condition even more difficult to diagnose.
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. This may be caused by colon spasms or other causal factors.
While many symptoms overlap with symptoms found in male IBS sufferers, some are unique to women. There are 13 common IBS symptoms in females to look out for to assist in diagnosis and plan for treatment, including:
- Pelvic pain
- Worse PMS symptoms
- Severe menstrual symptoms
- Pelvic organ prolapse
- Pain during intercourse
- Mood problems
- Increased endometriosis risk
- Loss of appetite
Changes in bowel habits are a common symptom of IBS in both men and women. Diarrhea is a less common IBS symptom in women than men, although some women experience more frequent loose stools around their menstrual cycle.
An increase in mucus in the stool is another common symptom of IBS.
Keep in mind that diarrhea is also a common symptom of inflammatory bowel disease (IBD), or 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.
Chronic constipation is more common in women than men. More women present with the constipation-predominant (IBS-C) type of the condition.
This may be due to various factors, including anxiety, hormone production, and bowel motility.
Women report more anxiety than men. Hormonal differences and how food moves through a woman’s small and large intestine may also impact IBS symptoms in females.
Constipation presents as infrequent stools, difficulty defecating, and painful cramping associated with bowel movements.
Bloating, excessive gas, and a feeling of fullness in the belly are common IBS symptoms in both men and women. Gas and bloating can become more pronounced during certain stages of menstruation in women.
Discomfort with expelling gas is one of the less-discussed side effects of IBS that can significantly impact a patient’s quality of life.
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.
It’s important to note that pelvic pain affects about 15% of women of childbearing age. This pain may be due to comorbid conditions like endometriosis or severe menstrual symptoms. The connection here is that pelvic pain is often just one of many symptoms in women with IBS.
5. Worse PMS Symptoms
Some studies show that women with IBS may suffer two-fold during menstruation: IBS symptoms worsen and premenstrual syndrome (PMS) symptoms worsen.
What does IBS feel like for a woman? IBS for a woman can feel like chronic abdominal pain, cramping, and worsened PMS symptoms.
Researchers point to hormonal changes and the effects of progesterone during a woman’s cycle as possible reasons why PMS symptoms worsen.
Pain sensitivity seems to increase during menstruation as well, potentially exacerbating cramping from both IBS and menstruation.
6. Severe Menstrual Symptoms
IBS sufferers often report heavier periods and more intense cramping during menstruation. Again, hormones seem to be at play with severe menstrual symptoms during IBS attacks.
Irregular periods and contraceptives do not seem to affect IBS symptoms.
Women with IBS are more likely to experience urinary incontinence (a lack of control over urine output) and overactive bladder (OAB). This can result in more frequent, urgent urination, painful urination, and/or an urge to urinate throughout the night.
Women are more at risk of developing OAB than men, and treatments for this often strengthen the pelvic floor.
8. Pelvic Organ Prolapse
Chronic constipation, straining during bowel movements, or diarrhea may cause pelvic organ prolapse (POP). POP occurs when the muscles and tissues supporting the pelvic organs weaken. This can cause those organs — the uterus, bladder, or rectum — to drop or fall out of place.
Women are more at risk for the condition as it can also happen following difficult pregnancies and labor, or due to lower estrogen levels after menopause.
9. Pain During Intercourse
IBS is linked to sexual dysfunction in both men and women. On top of abdominal pain associated with the most common IBS symptoms, many women with IBS also report pain during sexual intercourse.
A decreased sex drive and low overall sexual satisfaction are also more common in women. This may be because of the discomfort involved with many of the hallmark IBS symptoms.
Fatigue associated with a lack of sleep, even insomnia, is a common symptom of IBS in women.
A lack of restorative sleep can exacerbate other IBS symptoms and cause quality of life concerns.
Women suffering from consistent sleep deprivation put themselves at risk for several illnesses and chronic conditions, cognitive impairment, and mood instability.
11. Mood Problems
Women experience a variety of mental health concerns associated with IBS symptoms, including increased rates of depression and anxiety.
Anxiety and other mood disorders are closely associated with IBS in multiple ways. For instance, anxiety may trigger IBS symptoms, like stress-induced diarrhea.
But new research suggests that there might be a shared genetic link between anxiety, depression, neuroticism, and IBS.
There is stress involved with managing symptoms related to the digestive system, including constant planning for bathroom access. That stress can be anxiety-producing. This causes a cycle where IBS causes a sufferer anxiety, and that anxiety exacerbates IBS symptoms.
Researchers suggest gastrointestinal clinics screen for mental health conditions as part of a complete IBS treatment plan. Treating those conditions can often get to the root of IBS symptoms.
12. Increased Endometriosis Risk
Women diagnosed with IBS are at a higher risk of developing endometriosis. The painful condition causes tissue normally found inside the uterus, or endometrium, to grow outside the uterus.
Women who receive a hysterectomy to alleviate endometriosis pain are at a higher risk of developing IBS, too.
13. Loss of Appetite
IBS symptoms like abdominal cramping, bloating, and irregular bowel movements can cause a loss of appetite. This can lead to weight loss if you take in fewer calories than you should.
Some IBS sufferers also lose weight from anxiety over foods that may trigger their symptoms.
What foods trigger IBS attacks? Foods that trigger IBS attacks include greasy, highly-processed foods, dairy, foods high in FODMAPs, wheat, spicy foods, and artificial sweeteners.
This isn’t an exhaustive list. An elimination diet and food diary are part of the 5-step process described in our treatment recommendations.
Risk Factors for IBS in Women
Women face a number of additional risk factors for IBS, such as:
- 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 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, as well.
- 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.
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.
There is also no blood test to diagnose IBS. A healthcare provider will use the Rome criteria for a proper IBS diagnosis in both men and women. The method analyzes your symptoms to determine whether you’re suffering from IBS or other gastrointestinal disorders.
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
From there, your physician will 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)
Your treatment plan depends on the type of IBS you’re suffering from and the cause of IBS symptoms.
The Best Way 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.
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). SIBO causes excess bacteria to grow in the small intestine, increasing your risk of gastrointestinal tract disorders like IBS. 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.
- Start a low-FODMAP diet or other IBS diet. Patients on the low-FODMAP diet eliminate short-chain carbohydrates to identify dietary triggers. Gluten and dairy are typical triggers, although that may signal an underlying condition like lactose intolerance.
- 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.
Join PrimeHealth’s Gut Health Group Program to work directly with our providers to give your gut a makeover! This program begins April 12, 2022 and only a few virtual spots remain. Sign up today!
- Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical epidemiology, 6, 71–80.
- Kim, Y. S., & Kim, N. (2018). Sex-gender differences in irritable bowel syndrome. Journal of neurogastroenterology and motility, 24(4), 544.
- Herman, J., Pokkunuri, V., Braham, L., & Pimentel, M. (2010). Gender distribution in irritable bowel syndrome is proportional to the severity of constipation relative to diarrhea. Gender medicine, 7(3), 240–246.
- Choung, R. S., Herrick, L. M., Locke, G. R., 3rd, Zinsmeister, A. R., & Talley, N. J. (2010). Irritable bowel syndrome and chronic pelvic pain: a population-based study. Journal of clinical gastroenterology, 44(10), 696–701.
- Yosef, A., Allaire, C., Williams, C., Ahmed, A. G., Al-Hussaini, T., Abdellah, M. S., Wong, F., Lisonkova, S., & Yong, P. J. (2016). Multifactorial contributors to the severity of chronic pelvic pain in women. American journal of obstetrics and gynecology, 215(6), 760.e1–760.e14.
- Bharadwaj, S., Barber, M. D., Graff, L. A., & Shen, B. (2015). Symptomatology of irritable bowel syndrome and inflammatory bowel disease during the menstrual cycle. Gastroenterology report, 3(3), 185–193.
- Pati, G. K., Kar, C., Narayan, J., Uthansingh, K., Behera, M., Sahu, M. K., Mishra, D., & Singh, A. (2021). Irritable Bowel Syndrome and the Menstrual Cycle. Cureus, 13(1), e12692.
- Matsumoto, S., Hashizume, K., Wada, N., Hori, J., Tamaki, G., Kita, M., Iwata, T., & Kakizaki, H. (2013). Relationship between overactive bladder and irritable bowel syndrome: a large-scale internet survey in Japan using the overactive bladder symptom score and Rome III criteria. BJU international, 111(4), 647–652.
- Sørensen, J., Schantz Laursen, B., Drewes, A. M., & Krarup, A. L. (2019). The Incidence of Sexual Dysfunction in Patients With Irritable Bowel Syndrome. Sexual medicine, 7(4), 371–383.
- Tu, Q., Heitkemper, M. M., Jarrett, M. E., & Buchanan, D. T. (2017). Sleep disturbances in irritable bowel syndrome: a systematic review. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 29(3), 10.1111/nmo.12946. Abstract: https://pubmed.ncbi.nlm.nih.gov/27683238/
- Eijsbouts, C., Zheng, T., Kennedy, N. A., Bonfiglio, F., Anderson, C. A., Moutsianas, L., … & Parkes, M. (2021). Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders. Nature genetics, 53(11), 1543-1552.
- Banerjee, A., Sarkhel, S., Sarkar, R., & Dhali, G. K. (2017). Anxiety and Depression in Irritable Bowel Syndrome. Indian journal of psychological medicine, 39(6), 741–745.
- Khoshbaten, M., Melli, M. S., Fattahi, M. J., Sharifi, N., Mostafavi, S. A., & Pourhoseingholi, M. A. (2011). Irritable bowel syndrome in women undergoing hysterectomy and tubular ligation. Gastroenterology and hepatology from bed to bench, 4(3), 138–141.
- Saito, Y. A., Petersen, G. M., Locke, G. R., 3rd, & Talley, N. J. (2005). The genetics of irritable bowel syndrome. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 3(11), 1057–1065.
- Lee, H. F., Liu, P. Y., Wang, Y. P., Tsai, C. F., Chang, F. Y., & Lu, C. L. (2018). Sexual Abuse Is Associated With an Abnormal Psychological Profile and Sleep Difficulty in Patients With Irritable Bowel Syndrome in Taiwan. Journal of neurogastroenterology and motility, 24(1), 79–86.
- Yang, T. Y., Chen, C. S., Lin, C. L., Lin, W. M., Kuo, C. N., & Kao, C. H. (2017). Risk for Irritable Bowel Syndrome in Fibromyalgia Patients: A National Database Study. Medicine, 96(14), e6657.
- Lee, Y. Y., Annamalai, C., & Rao, S. (2017). Post-Infectious Irritable Bowel Syndrome. Current gastroenterology reports, 19(11), 56.
- Spanier JA, Howden CW, Jones MP. A Systematic Review of Alternative Therapies in the Irritable Bowel Syndrome. Arch Intern Med. 2003;163(3):265–274.