Earlier this month National Geographic published an article headlined “Why women are more likely to have IBS”. I love that big publications such as National Geographic are paying attention to irritable bowel syndrome, as it is so common, and as there is so much misleading information out there. Big publications could help bust some of that misinformation.

The article aimed to explore why more women than men have IBS, and to discuss some of the treatment options. Since the comments below the original Instagram post, where I first spotted the article, seemed to point out some discrepancies, I thought I’d chime in and expand on some of the unclear points. Here are some of my thoughts:

According to Dr. Raj, a gastroenterologist, IBS is a diagnosis of exclusion – more severe illnesses with overlapping symptoms need to be ruled out before an IBS diagnosis can be made. My experience: not all doctors test for everything, like cancer and IBD. This is probably to save resources, especially in a public healthcare setting, where money is tight. However, this leads to patients feeling unsure of their diagnosis. It's one of the reasons why it's so important to be able to advocate for yourself when talking to doctors. When you know a bit about what to expect, you will feel more empowered to ask the right questions and get the help you need (one of the reasons I created IBSwise). Here’s my wish to doctors seeing patients with IBS and these kinds of gut issues: spend time explaining your decisions on testing and recommendations so that people feel heard, and can understand and accept their diagnosis and thus go for correct treatments, instead of wasting time and money looking in the wrong places.
The reason why women are more likely to have IBS is hormones. This I can agree with. I wrote a blogpost about it.
Another reason for women being more susceptible to IBS: sensitivity to stress. Yes, seems true. I was also glad to see stress mentioned early in the article, as this is also what I have found in my IBS research. Stress is a real culprit in IBS, for both women and men. Even so, it seems that both doctors and patients resist this fact. Maybe blaming stress feels like it belittles the problem, which is not true. The effect of stress on gut function is a real physical response triggered by our thoughts, beliefs and feelings. So, IBS is not just in our head, but the brain has a lot to do with it in a real, physical way.

A stressed out woman with her eyes closed

IBS treatments: proper sleep and stress reduction. Yes, 100% agreement. Poor sleep affects everything, including gut health and stress sensitivity. The article also mentions that “finding your stress management technique, whether it’s meditation, cognitive behavioral therapy or exercise is key for keeping symptoms at bay.” This is correct, but I’d add that you don’t have to choose just one stress management or release method, you can utilize multiple of them. Combining meditation with exercise for example is more effective than doing one or the other. Not to mention there are many other methods to try, too.
Antidepressants in low doses can help. Yes, true. However, science is showing that dietary changes can be as effective as medication. For this reason experts consider diet to be a first line therapy as compared to meds.
Low FODMAP diet is considered to be an effective approach. Yes, studies show that the low FODMAP diet helps reduce symptoms in 2/3 of cases or so. However, the article is not mentioning any risks involved with the diet. Like reduced enjoyment of eating, increased cost, food relationship changes (like food fears) and that the diet can cause stress, which is not helpful when stress is a major IBS trigger. To me, deciding on whether or not to follow the low FODMAP diet should be given thorough consideration. It shouldn’t be something automatic for every IBS patient. This even though it is one of the more natural approaches to managing IBS. Other, more simple, diet changes may be all that is needed.
Proper hydration is key. Someone commented below the article on Instagram that they drink a lot of water, and increasing water intake doesn’t help them (this person even seemed frustrated by this advice). Both the article and the commenter are correct: drinking enough fluids is important, but if you already are drinking a lot, at least 2 liters (8 cups) a day, then drinking more is not going to help. The point is that dehydration dries out stool in the gut, predisposing us to constipation.

Fiber is needed. It’s true that most people in the Western world don’t get enough of it, not even close. However, the article doesn’t go into any detail here, they only mention that many brands are adding fiber into their products. Fiber is critically important for gut function, and it’s important to note that there are different types of fiber that are handled differently in the gut. This is where speaking with a dietitian is helpful for making sure increasing fiber intake is done right – something the article could’ve mentioned.
If you have persistent digestive issues, get tested. Yes, absolutely. It’s important to know your gut symptoms are not a sign of something more serious. IBS isn’t serious in the eyes of health care practitioners in that it doesn’t shorten life span, but it’s serious in a different way - it dramatically reduces quality of life. I know it can feel embarrassing to talk to a doctor about your gut function, but taking that step also brings you closer to symptom management and improving your quality of life. Remember that 10% of the global population have IBS, so it’s very common and nothing to be embarrassed about. What’s important is your health and wellbeing.

Thanks for reading! I’m glad we are talking more about IBS publicly, but much more is needed! More publications should write about IBS in an easy-to-understand way. In the meantime you can ask me. I’m here to help!

Love,

Anna-Kaisa

PS: If you have questions about this, or any other gut health or stress topic, get in touch!

PPS: Did you download my free guide “Beat Stress and Boost Your Mood” yet?

Link to the original NatGeo article here.

bloating, constipation, diarrhea, dietitian, disorder of gut-brain interaction, female hormones, gut symptoms, IBS, IBSwise, irritable bowel syndrome

Have you noticed that your gut functions differently depending on where you are in your cycle? That every time you are about to have your period, your gut gets messed up, or your already loose stools become worse?

You are not imagining it – female hormones do affect the gut, especially through pain sensitivity, how fast the gut contents move (motility), and indirectly through greater stress sensitivity (1-4). Female hormones could explain why women tend to have more IBS than men in general, and more IBS-C than men (1,2). In this article, I briefly go over what this means in terms of gut symptoms.

Menstrual cycle

First, let’s briefly discuss the menstrual cycle. There are three phases:

Phase	Days	Estrogen and progesterone	Gut impact
Menstruation phase	1-7	Both are low	Faster motility, higher risk of diarrhea, urgency Increased pain sensitivity
Follicular phase	8-14 (until ovulation)	Estrogen: Increases until peaks at ovulation Progesterone: low	Slower motility
Luteal phase	15-28	Estrogen: high, drops quickly Progesterone: high	Slower motility

Female hormones and the gut

Now, let’s dive into how female hormones can change how the gut functions.

Motility

Very simply put (I discuss this subject in more detail in my IBSwise course), estrogen affects the gut by lengthening gut transit time, which means that gut contents move slower through the intestines. When estrogen levels are high, gut moves slower, and when estrogen levels drop, gut motility increases. This is probably why women tend to be more prone to IBS-C, and have constipation especially during follicular and early luteal phases, and higher chance of diarrhea around menstruation. During pregnancy, estrogen levels are high, which could at least partially explain why constipation is so common in pregnant women, especially during the third trimester. (1,2)

On the other hand, progesterone’s effect on gut motility is not as clear, as it affects serotonin mechanisms also, but the overall effect seems to be similar to estrogen: higher levels are associated with slower gut movements (1).

Pain sensitivity

It’s unclear how estrogen affects pain sensitivity, but it looks like changes in estrogen predispose to pain, such as a few days after ovulation when estrogen levels drop quickly (6). Pain sensitivity has also been found to be higher around menstruation when there is an increased number of serotonin receptors due to low estrogen, which leads to detecting pain and sensations more easily. Estrogen affects inflammatory pathways as well, which can lead to higher sensitivity – in IBS it has been noted that the number of a certain estrogen receptor is often high, which increases inflammation and therefore pain sensitivity (1,3,4).

Girl with abdominal pain clutching her stomach

Stress

Another mechanism that can increase gut symptoms in women is that women are naturally more reactive to stress than men. Female sex hormones have been connected to HPA-axis activity, and to a higher limbic system activity (1-3). This all lowers the threshold for a stress response to be triggered in the body, which leads to gut issues, especially in IBS.

Birth control?

What about women on birth control? According to Dr. Liao (5), birth control that allows for menstruation doesn’t protect from hormonal gut changes, but ones that skip menstruation could. Discuss with your doctor if you feel that at different phases of your cycle you experience difficult symptoms, whether it’s constipation during follicular and early luteal phase, or diarrhea and pain around menstruation phase. Still, even though female hormones seem to affect gut symptoms, data doesn’t support utilizing hormone therapies for women with IBS (3).

What can you do about it?

If your gut behaves differently during different phases of the menstrual cycle, it’s nice to know it is caused by your hormones. While I don’t recommend observing gut symptoms too closely, knowing when you are more likely to have diarrhea vs constipation could help you anticipate these changes.

Perhaps you can prepare a bit, also – if you are often constipated outside of menstruation, you could increase the amount of fiber you eat at that time of the month, whereas if you experience diarrhea during and close to menstruation, you could utilize soluble fiber from chia seeds, flaxseed and oatmeal. Additionally, focusing on anti-inflammatory foods during menstruation may be useful, like eating lots of colorful fruits and vegetables, and omega-3 rich foods, like walnuts, hempseed, and salmon, although these are important foods to eat every day.

So, female hormones and gut function are connected. Knowing how is useful, as you won’t be surprised by the changes, nor will there be a need to be worried. And you can make better food choices according to your cycle too.

Have a great summer!

Love,

Anna-Kaisa from AKWise

PS: Check out all the free giveaways on my home page!