15.AUG.2018 4 MIN READ | 4 MIN READ

Bloating and constipation may be symptoms of irritable bowel syndrome, a common gut disorder among women.

Last updated on 19 March 2021

A healthy gut is an important part of a woman’s overall health. While we often equate women’s health with gynaecology and obstetrics, there are other areas of importance, of which gastroenterology is one of them. Always speak to a gastroenterologist if you have concerns about your digestive health.

There are some gut disorders which are more common in women. These range from autoimmune diseases of the liver to functional and neuro-motility disorders of the gut, such as irritable bowel syndrome (IBS) and bowel disorders.

Many women experience alterations in their bowel habits and abdominal symptoms at various points in their monthly menstrual cycle. Typically they are bloated and constipated pre-menstrual, and have looser stools during their menses. This unto itself is not abnormal, and is a result of hormonal fluctuation. However, in women who suffer from IBS, these symptoms and bowel changes can be much more severe.

What is irritable bowel syndrome (IBS)?

IBS is a condition where there is abdominal pain and/or discomfort which is associated with a change in the frequency, form or nature of stool.

Unlike gastroenteritis, where a patient falls ill and recovers quickly, IBS is a chronic condition that can last for years and longer.

IBS is a condition where there is abdominal pain and/or discomfort which is associated with a change in the frequency, form or nature of stool. Unlike gastroenteritis, where a patient falls ill and recovers quickly, IBS is a chronic condition that can last for years and longer.

What are the causes of irritable bowel syndrome (IBS)?

There are many factors causing IBS, including:

  1. Stress
  2. Genetics
  3. Previous gut infection
  4. An imbalance of the gut microbiota
  5. An over-sensitivity of the nerves in the gut
  6. Diet, especially relating to a group of foods called FODMAPs

There is no single cause, and some or all of these factors interact together to result in the symptoms of IBS. There is also no single test for IBS, and the diagnosis is made by your doctor, based on symptoms.

What are the symptoms of irritable bowel syndrome (IBS)?

Some of the most common signs and symptoms of IBS are as follows:

  • Pain and cramping. Lower abdominal pain that is less severe after bowel movement is the most common IBS symptom.
  • Diarrhoea. Frequent, loose stools are a common symptom in the diarrhoea-predominant type IBS. Stools may also contain mucus.
  • Constipation. In constipation-predominant IBS, which affects nearly 50% of those with IBS, constipation is very common. It also often causes a sensation of incomplete bowel movement, leading to unnecessary straining.
  • Alternating constipation and diarrhoea. This affects about 20% of patients with IBS. They experience alternating periods of diarrhoea and constipation.
  • Changes in bowel movement. These changes include becoming constipated or having loose stools, accumulation of mucus in stools or presence of blood in stools.
  • Gas and bloating. Bloating is one of the most persistent symptoms in IBS. It has also been reported to be more common among women.
  • Food intolerance. People with IBS report that particular foods tend to trigger symptoms. Common trigger foods include gas-producing foods, lactose, gluten and caffeine.
  • Fatigue and trouble sleeping. Many with IBS report fatigue, low stamina, difficulty falling asleep and poor sleep quality. Fatigue and poor sleep quality are also related to more severe digestive symptoms the following day.
  • Anxiety and depression. Digestive symptoms of IBS can lead to increased anxiety, which in turn worsens the digestive symptoms. Many with IBS also report having a mood disorder, such as depression.

How is irritable bowel syndrome (IBS) diagnosed?

Sometimes, endoscopy, scans or blood tests may be necessary to exclude other conditions.

Colonoscopy

A small, flexible tube, with a camera attached to it is used to examine the entire length of the colon. This tube is inserted through the anus. The procedure is done to help your doctor find the cause of your symptoms. Tissue samples may be taken for testing in the lab.

Upper endoscopy

Endoscopy is a procedure where a long, flexible tube is inserted down your through into the food pipe. A camera is fixed to the end of the tube to allow your doctor to have a close view of your upper digestive tract and small intestine. Fluids and tissue samples may also be taken to be tested in the lab.

Scans

X-ray or CT scans produce images of your abdomen and pelvis that can help with the diagnosis of IBS. The images from the scans can be used to rule out other causes of your symptoms, especially if you have abdominal pain.

Laboratory tests

Specific tests may sometimes be needed to confirm a specific cause, for example, breath testing, to check for bacterial overgrowth in the intestines, or lactose intolerance test to test intolerance towards dairy products. Stool tests may also be done if you have chronic diarrhoea.

How is irritable bowel syndrome (IBS) treated?

Treatment will depend on the severity and often include the use of medication and approaches to address and correct the underlying factors.

These can range from lifestyle changes to help control stress and regulate the diet, to medication to control the symptoms and reduce the sensitivity of the nerve endings.

Probiotics are also useful in restoring the balance of microflora in the gut, and have been shown to improve symptoms of abdominal pain and bloating in IBS patients.

Medications to treat IBS

  • Antispasmodic medicines. The medicines relax the muscles in the wall of the large intestine and improve pain.
  • Antibiotics. These help to address the growth of harmful bacteria in the intestines.
  • Laxatives. These are advised for short periods if increasing fibre does not improve constipation.
  • Antidiarrhoeal medicines. For those with diarrhoea as their main symptom, antidiarrhoeals such as loperamide is helpful to control the symptoms.
  • Antidepressant medicines. Certain types of antidepressants such as amitriptyline and fluoxetine can be used to treat pain in IBS.
  • Probiotics. Some probiotics may help ease symptoms in some patients. However, more research is needed on the form, dose, and strains that are effective.

Lifestyle and dietary changes to treat IBS

Certain diets can help improve IBS symptoms:

  • Low-fibre diet. For those who frequently have gas and diarrhoea, opt instead for a low-fibre diet. However, before eliminating fibre from your diet, explore consuming small amounts of soluble fibre.
  • Increasing soluble fibre. A diet rich in soluble fibre helps with bowel movement in those who experience constipation. However, caution is warranted as some patients may experience worsened bloating. Fibre should be gradually increased to help your body get used to it.
  • Gluten-free diet. A gluten-free diet may help those who are gluten-intolerant. The protein, found in most grain products, can damage the intestines of those who are gluten-intolerant.
  • Avoiding fatty foods. Cutting down on high-fat foods can help to improve IBS symptoms. Fatty foods are especially bad for those with mixed IBS (both constipation and diarrhoea are present).
  • Low FODMAP diet. A low FODMAP diet is helpful in reducing gas, bloating, and diarrhoea. This involves avoiding foods such as certain fruits and vegetables, legumes, wheat and dairy products. Keep track of the foods that induce your symptoms and eliminate them from your diet.

Lifestyle changes that are helpful include:

  • Exercising regularly
  • Keeping your stress levels in check
  • Getting sufficient sleep
  • Keeping a symptom diary. Keeping a food and lifestyle diary for 2 to 4 weeks may help in monitoring symptoms and identify factors that trigger them.

Constipation in women

IBS

Studies have also shown that women tend to have a slightly slower colon transit time than men, resulting in a higher chance of developing constipation.

Constipation is generally described as having fewer than 3 bowel movements a week. However, it not only refers to a decreased frequency of defecation, but it can also present as hard stools and having to strain to pass stool.

How is constipation treated?

Whilst in most cases constipation can be addressed by dietary changes and drinking more water, there are cases when further intervention is necessary.

These may involve the need for endoscopy or scans to exclude structural lesions or tests to determine the rate of transit in the colon.

Treatment may involve the use of laxatives, or some of the newer medications, to speed up the rate of transit of digested food in the colon.

Diet and lifestyle changes

The following diet and lifestyle changes may help to relieve constipation:

  • Increasing fibre intake. Slowly increase your intake of fibre by adding fruits, vegetables, whole-grain breads and cereals to your daily diet.
  • Exercise often. Try to exercise at least 4 days a week. Physical activity increases muscle activity in your intestines.
  • Use the toilet when you feel the urge. Don’t ignore the urge to have a bowel movement. Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions or feeling rushed.

Laxatives

Laxatives can help to relieve constipation temporarily. They are available over-the-counter and can be found in several types. Each works differently. These include:

  • Fibre supplements
  • Stimulants
  • Osmotics
  • Lubricants
  • Stool softeners
  • Enemas and suppositories

Other medications

Sometimes prescription medications may be needed for chronic constipation. There may include:

  • Medications that draw water into your intestines
  • Serotonin 5-hydroxytryptamine 4 receptors
  • Peripherally acting mu-opioid receptor antagonists (PAMORAs)

Defaecation disorders

Disorders of defecation are also markedly more common in women, such as dys-synergic defaecation or faecal incontinence.

Passing stool requires coordination of the muscles in the abdomen and pelvic floor, so that stool can be easily squeezed out of the colon, almost like how toothpaste is gently squeezed out of a tube.

Dys-synergic defaecation

Dys-synergic defaecation occurs when this coordination is disrupted due to weakness of the pelvic floor muscles or a disruption of the coordination.

Faecal incontinence

Faecal incontinence, on the other hand, is an inability to control the bowels and stool may leak out. This is common in women who have had a difficult vaginal delivery, with damage to the sphincters (rings of muscles that constrict to close an opening in the body) during childbirth and delivery. Tests such as special pressure testing, called anorectal manometry, and scans, will help determine this condition. It is best diagnosed and treated by your gastroenterologist working together with your gynaecologist.

Finally, it must also be recognised that women, like men, can also develop cancers of the gastrointestinal tract. These include stomach, liver, pancreas, gall bladder, bile duct and colon tumours.

Prominent among these is colorectal cancer, which is the 2nd most common cancer in women after breast cancer. Like breast and cervical cancer, colon cancer is preventable through early detection by screening. Screening involves testing the stool for the presence of occult blood, or performing a colonoscopy using a video endoscope. Stool occult blood testing is painless and simple, but it’s not very sensitive, so the testing needs to be done annually. A colonoscopy is more invasive, but it allows detection of small tumours and polyps that may be missed by stool occult blood testing. Polyps, the precursor to colon cancer, can also be removed during endoscopy without the need for surgery. Screening by colonoscopy needs to be performed only once every 10 years, but if there is a family history of colorectal cancer or a personal history of polyps, then it means the woman has a higher risk and the colonoscopy should be performed once every 5 years.

In summary, these are some of the gut disorders that are faced more commonly by women than by men, but if addressed promptly by accurate diagnosis and given appropriate treatment, they can prevent unnecessary suffering and afford every woman a good quality of life.

If you’re concerned about a digestive condition, speak to a specialist.

 

Article contributed by Dr Reuben Wong, gastroenterologist at Gleneagles Hospital

References

9 Signs and Symptoms of Irritable Bowel Syndrome (IBS). (2019, July 19) Retrieved January 25, 2021, from https://www.healthline.com/nutrition/9-signs-and-symptoms-of-ibs

Irritable Bowel Syndrome. (2020, October 15) Retrieved January 25, 2021, from https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064

Constipation. (2019, June 29) Retrieved January 25, 2021, from https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

15.AUG.2018
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Wong Kong Min Reuben
Gastroenterologist
Gleneagles Hospital

Dr Reuben Wong is a gastroenterologist practising at Gleneagles Hospital, Mount Elizabeth Novena Hospital and Parkway East Hospital, Singapore. His clinical expertise includes the treatment of reflux and swallowing disorders, irritable bowel syndrome (IBS), gut microorganism, chronic constipation and diarrhoea.