Treating IBS in Women

Irritable bowel syndrome (IBS) affects millions of people in the U.S., more often women than men. While this condition can be uncomfortable and frustrating to deal with, our providers at Rochester Regional Health work with patients to find a treatment that reduces their symptoms and improves their quality of life.

Our gastroenterology specialists with Rochester Regional Health regularly treat women with IBS and other gastrointestinal disorders and explain how the conditions are diagnosed, treated, and how to prevent symptoms from recurring.

What is IBS?

Irritable bowel syndrome (IBS) is a disorder that affects a patient’s gastrointestinal system and is characterized by recurrent abdominal pain, bloating, diarrhea, constipation or a mixture of all of these symptoms.

IBS is now understood as a disorder of gut-brain interaction. This means that the gut and brain do not communicate normally. The result can be a more sensitive gut (pain felt more easily), changes in how quickly food moves through the intestines, and other changes involving the gut bacteria.

IBS does not cause visible damage to the GI tract that would show up on endoscopy or colonoscopy. It also does not cause changes that would be identified by blood work. IBS does not raise the risk of colon cancer or other serious diseases.

Researchers have examined patients using endoscopies, bloodwork, stool tests, abdominal imaging and other methods, but not yet determined an organic cause of IBS.

Potential risk factors for IBS

Many in the healthcare community, including the International Foundation for Gastrointestinal Disorders, acknowledge that IBS is more common in women than men. The exact reason is not known, but there are some correlations that may explain the increased risk.

Higher levels of estrogen and progesterone are one potential link between women and IBS. These hormones tend to slow down gut motility and can predispose women to more pain and altered bowel movements.

Menstrual cycles and endometriosis can cause women to exhibit symptoms similar to IBS, as well. Studies have found that more 50 percent of patients seeing a gynecologist for lower abdominal pain have IBS.

Pregnancy also increases the prevalence of GI symptoms. Changes in hormones and the physical pressure of the baby pushing on the bowel wall may both contribute to GI symptoms. Research has shown that nearly a third of pregnant women experience increased constipation, particularly during the last trimester.

Stress and anxiety may also pose an increased risk of IBS. As levels of stress and/or anxiety rise, that may manifest through IBS-related symptoms.

Stomach infections can sometimes start IBS after a bout of food poisoning or another gut infection. Women are about twice as likely to develop IBS this way. 

Slower gastrointestinal (GI) transit for women means, on average, food moves through the digestive tract more slowly in women than in men. This may help explain why constipation is more common in women with IBS. 

Symptoms of IBS in women

For both men and women, symptoms of IBS vary but are similar across the board. They include:

• Recurrent abdominal pain associated with bowel movements
  • At least 1 day per week for the last 3 months
  • Pain associated with stool consistency or frequency
• Diarrhea
• Constipation
• Bloating

Studies show women are more likely to IBS with constipation (IBS-C) or mixed symptoms (IBS-M), and to report more belly pain and bloating. IBS with diarrhea (IBS-D) is more evenly split between men and women.

How IBS is diagnosed

IBS is diagnosed mainly from your symptoms and physical exam. Your provider may also order a few targeted tests, such as blood or stool tests, to check for conditions with similar symptoms like celiac disease or inflammatory bowel disease (IBD).

Occasionally, but not always, a colonoscopy and stool sample may be recommended for those with diarrhea.

See a provider if you have:

• blood in your stool
• unexplained weight loss
• new symptoms starting after age 50
• a family history of colon cancer, inflammatory bowel disease (Crohn's or Ulcerative Colitis), or Celiac disease

Treatments to reduce IBS symptoms

No two patients with IBS are the same, treatment is tailored to each person's main symptoms and preferences. Treatment often combines several approaches.

Lifestyle changes

Regular exercise, good sleep, regular meals, and stress management can all help reduce IBS symptoms.

Providers may try several options to treat IBS in a patient.

Fiber

Psyllium fiber (soluble fiber) can help regulate bowel movements and improve overall symptoms. Increase fiber slowly to avoid extra gas and bloating. Insoluble fiber, such as wheat bran, generally does not help IBS and may make bloating worse.

Diet

Providers will have patients adopt a low-FODMAP diet to help with symptoms. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols – which are carbohydrates and sugars that are not easily broken down and absorbed by the small intestine.

FODMAPs can range from certain fruits, vegetables, legumes to cereals, grains, and bread.

Finding a registered dietician to help implement this diet can help to make sure you are not making the diet too restrictive. It is not meant to be followed forever. It works best in three steps:

1. Cut out high-FODMAP foods for a short time (usually 2-6 weeks).
2. Slowly add foods back to find out which ones trigger your symptoms
3. Build a long-term, balanced diet that avoids only your personal triggers.

Prescription medications

These are prescribed to patients after a combination of fiber, diet, and lifestyle modifications do not yield any change. The choice depends on your main symptoms.

For IBS with constipation: Options include linaclotide, plecanatide, lubiprostone, and tenapanor. Over the counter, polyethylene glycol (Miralax) can be very effective for constipation and is usually first line therapy.

For IBS with diarrhea: Options include rifaximin (an antibiotic that acts mainly on the gut), loperamide or lomotil.

Peppermint oil

Using peppermint oil can help reduce bloating and overall IBS symptoms. Studies have shown this can sometimes be more effective than some medications prescribed for abdominal pain and bloating.

Certain anti-depressants (neuromodulators)

The use of nortriptyline or amitriptyline has been shown to reduce bloating and abdominal pain for some patients. Lower doses are typically used for IBS. The medications work by calming the nerves between the gut and brain and, at these doses, are not used to treat depression.

Common side effects include drowsiness, dry mouth, and constipation, so they are often a better fit for people with diarrhea-predominant symptoms.

Your provider will start with a low dose and monitor how you respond.

Journaling

Writing down what foods a patient is eating can help to determine if something may be triggering IBS symptoms. Traditional journaling about experiences of stress or anxiety can also help to determine if a person may need to be referred to a specialist for cognitive behavioral therapy (CBT) or hypnotherapy

 The most important thing is a willingness to work with your physician and try different treatments to see what works best for you. That may require a lot of patience. But IBS is something that can be controlled. With the right course of treatment, you can lead a normal life and not be overwhelmed by your symptoms.