The ABC’s of Irritable Bowel Syndrome
Why Women are More Susceptible than Men.
Nearly everyone is familiar with the physical discomfort associated with diarrhea, constipation, abdominal pain and gas. Imagine having those symptoms occur, in some combination, on a regular basis. For millions of people with gastrointestinal (GI) disorders, that is a painful and often embarrassing reality. More women than men know what it feels like.
"Most disorders of the digestive tract are more common in women than men," said gastroenterologist Jeffrey Aron, M.D. He is medical director of the Center for Inflammatory Bowel Disorders at California Pacific Medical Center in San Francisco, which provides comprehensive care for a wide range of ailments affecting the GI tract, from celiac disease and peptic ulcers to inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).
The gender difference is blatantly obvious when it comes to IBS, a common condition that can produce gas, abdominal pain, persistent diarrhea and chronic constipation. An estimated 10 to 20 percent of adults in the United States suffer from the disorder. According to the American College of Gastroenterology, IBS occurs two to six times more often in women than in men.
Looking Inside for Answers
The reasons why so many more women than men suffer from IBS and certain other GI disorders are not completely understood. According to Dr. Aron, there is a theory in which anatomy, physiology and the environment all appear to play a role.
"The gut is the main sensing organ of the external environment in all living things," he said. "The total surface area in humans is more than a quarter mile. There are more immune, nerve and hormonal cells in the gastrointestinal tract than anywhere else in the body."
In other words, the gut is gigantic and powerfully receptive. Dr. Aron asserts that women may be more sensitive to stimuli and attentive to symptoms because of the way in which their brain process information and their bodies are wired.
"The nerve channels that send signals from the gut to the brain are much more developed in women than in men," he said. "Any change that can affect gastrointestinal function is felt much more by them."
Dr. Aron maintains the female brain processes gut signals differently than the male brain, involving more areas that govern the stress response. That results a more intense response to gut signals in women, and signals an inflammatory response in the GI tract.
Structurally, there is nothing wrong with the digestive tract in those with IBS. It is a functional bowel disorder, which means the GI tract looks normal, but doesn’t work properly. With their hypersensitive innards, women may simply be more susceptible to IBS.
However, people of both genders who have the condition react to things that generally wouldn’t bother others. Emotional stress can trigger symptoms. Certain foods do too. Fats are the main culprit, but chocolate, alcohol, dairy products and caffeine commonly cause bowel irritation in IBS sufferers. Their symptoms often wax and wane over time.
For women with IBS, fluctuating hormones could trigger a flare-up as well. According to a study published in the journal Gastroenterology, menstruation exacerbated symptoms of the condition. Pregnancy appeared to temporarily improve them.
"In the short-term of the menstrual cycle, female hormones can produce immediate changes in digestive tract muscle function, so symptoms are often worse near menstruation," said Dr. Aron. "In pregnancy, steady, long-term hormone production by the placenta tends to minimize changes as the pregnancy progresses."
Complex Condition, Comprehensive Care
IBS is not life-threatening, but it can be life-altering. The disorder is second only to the common cold as a cause of absenteeism from work. According to statistics reported by the International Foundation for Functional Gastrointestinal Disorders, IBS accounts for up to 12 percent of visits to primary care doctors in the U.S.
Despite the prevalence of IBS and the number of people seeking care, the condition is often under-diagnosed. Treatment to alleviate symptoms, for men and women, can be tricky. Finding relief could include monitoring foods that cause flares, making smarter menu choices, taking medications and engaging in stress reducing activities.
"With a disorder this complex, it helps to have a team of experts on your side that can provide a holistic approach," said Dr. Aron.
California Pacific’s Center for Inflammatory Bowel Disorders has assembled that team. Specialists from multiple disciplines work to provide care for both adults and children with IBS and a wide variety of other gastrointestinal disorders. From nutritional counseling and lifestyle modifications to medications and psychiatric care, they create individualized treatment plans designed to alleviate pain.
Who to See and When
If your gastrointestinal problems are affecting your quality of life, go see a doctor. If you are apprehensive or embarrassed about talking to someone about your symptoms, know that GI troubles are extremely common. Gastroenterologists spend a good portion of their adult life studying conditions affecting the GI tract and trying to find ways to help their patients get better. Communicating with one, openly, is a critical part of putting better health within reach.
"The most effective care requires a partnership between experts who specialize in this disorder and patients who know their bodies," said Dr. Aron. "If you can, go straight to a gastroenterologist for your care."
Because IBS can present a range of symptoms that are similar to other gastrointestinal disorders, diagnosis can be challenging. Tests may be done to rule out other problems such as ulcerative colitis, Crohn’s disease, ulcers or food intolerance and allergies.
"There is no cure for IBS, but relief is possible," said Dr. Aron. "At California Pacific Medical Center, with our emphasis on stress reduction and nutrition, we are in a very good position to help provide it."