J Korean Med Sci.  2007 Oct;22(5):851-854. 10.3346/jkms.2007.22.5.851.

Irritable Bowel Syndrome Is More Common in Women Regardless of the Menstrual Phase: A Rome II-based Survey

• Lee SY
• Kim JH
• Sung IK
• Park HS
• Jin CJ
• Choe WH
• Kwon SY
• Lee CH
• Choi KW

• KMID: 1713292
• DOI: http://doi.org/10.3346/jkms.2007.22.5.851

Abstract

Functional gastrointestinal disorders are more common in women in relation to the fluctuations of female sex hormones. We tried to know the gender-related differences in the prevalence of irritable bowel syndrome and gastrointestinal symptoms according to the menstrual phase. A total of 253 women before menopause and 252 men below age 50 were examined by a gastroenterologist after completing the questionnaire. Blood tests, endoscopic procedures, and imaging studies were done, if needed. Women were subclassified into three groups according to their menst- ruation period; menstrual phase, proliferative phase, and secretory phase. Finally, 179 men and 193 women were analyzed. Irritable bowel syndrome was more frequently noticed in women than in men (p=0.01). The diarrhea-dominant type was more common in men, while constipation-dominant or alternating types were more common in women (p<0.001). Of 193 women, there was no significant difference in their gastrointestinal symptoms according to their menstrual phase. Regardless of the menstrual phase, gastrointestinal symptoms are more frequent in women. Physicians should consider different symptomatic manifestations between men and women should be considered when evaluating functional gastrointestinal disorders.

Keyword

Gastrointestinal Diseases; Women; Irritable Bowel Syndrome; Menstruation

MeSH Terms

Adult
Diarrhea/pathology
Female
Gastrointestinal Diseases/diagnosis/epidemiology/pathology
Humans
Irritable Bowel Syndrome/*diagnosis/*epidemiology/pathology
Male
*Menstrual Cycle
Menstruation
Middle Aged
Questionnaires
Sex Factors

Figure

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  Fig. 1 Subjects included in the study. Women were subclassified into three groups according to their menstruation; menstrual phase (day 0-6), proliferative phase (day 7-14), and secretory phase (after day 15).

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  Fig. 2 Difference in the prevalence of subtypes of irritable bowel syndrome between men and women. The diarrheadominant type was more common in men while, constipation-dominant or alternating types were more common in women (p<0.001).

Reference

1. Mayer EA, Naliboff B, Lee O, Munakata J, Chang L. Review article: gender-related differences in functional gastrointestinal disorders. Aliment Pharmacol Ther. 1999. 13:Suppl 2. 65–69.

2. Chang L, Heitkemper MM. Gender differences in irritable bowel syndrome. Gastroenterology. 2002. 123:1686–1701.

3. Cho YK, Jung SA, Shim KN, Choi YJ, Kim HS, Lee JS, Kim SE, Kim DY, Yoo K. Relationship between bowel symptom changes and dysmenorrheal in irritable bowel syndrome in women. Korean J Gastrointest Motil. 2003. 9:47–52.

4. Drossman DA, Corazziari E, Talley NJ, editors. Functional bowel disorders and functional abdominal pain. ROME II. The Functional Gastrointestinal Disorders. Diagnosis, Pathophysiology and Treatment: A Multinational Consensus. 2000. 2nd edn. McLean, VA, USA: Degnon Associates.

5. Triadafilopoulos G, Simms RW, Goldenberg DL. Bowel dysfunction in fibromyalgia syndrome. Dig Dis Sci. 1991. 36:59–64.

6. Han SH, Lee OY, Bae SC, Lee SH, Chang YK, Yang SY, Yoon BC, Choi HS, Hahm JS, Lee MH, Lee DH, Kim TH. Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria. J Gastroenterol Hepatol. 2006. 21:1687–1692.

7. Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RA, Updegraff JA. Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev. 2000. 107:411–429.

8. Mayer EA, Berman S, Chang L, Naliboff BD. Sex-based differences in gastrointestinal pain. Eur J Pain. 2004. 8:451–463.

9. Toner BB, Akman D. Gender role and irritable bowel syndrome: literature review and hypothesis. Am J Gastroenterol. 2000. 95:11–16.

10. Soffer EE, Kongara K, Achkar JP, Gannon J. Colonic motor function in humans is not affected by gender. Dig Dis Sci. 2000. 45:1281–1284.

11. Kim HS, Rhee PL, Park J, Lee JH, Kim YH, Kim JJ, Rhee JC. Gender-related differences in visceral perception in health and irritable bowel syndrome. J Gastroenterol Hepatol. 2006. 21:468–473.

12. Talley NJ, Boyce P, Jones M. Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut. 1998. 42:690–695.

13. Corney RH, Stanton R. Physical symptom severity, psychological and social dysfunction in a series of outpatients with irritable bowel syndrome. J Psychosom Res. 1990. 34:483–491.

14. Lee OY, Mayer EA, Schmulson M, Chang L, Naliboff B. Gender-related differences in IBS symptoms. Am J Gastroenterol. 2001. 96:2184–2193.

15. Jun DW, Park HY, Lee OY, Lee HL, Yoon BC, Choi HS, Hahm JS, Lee MH, Lee DH, Kee CS. A population-based study on bowel habits in a Korean community: prevalence of functional constipation and self-reported constipation. Dig Dis Sci. 2006. 51:1471–1477.

16. Heitkemper M, Jarrett M, Bond EF, Chang L. Impact of sex and gender on irritable bowel syndrome. Biol Res Nurs. 2003. 5:56–65.

17. Heitkemper MM, Jarrett M. Pattern of gastrointestinal and somatic symptoms across the menstrual cycle. Gastroenterology. 1992. 102:505–513.

18. Whitehead WE, Cheskin LJ, Heller BR, Robinson JC, Crowell MD, Benjamin C, Schuster MM. Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology. 1990. 98:1485–1489.

19. Heitkemper M, Jarrett M, Cain K, Shaver J, Bond E, Woods NF, Walker E. Increased urine catecholamines and cortisol in women with irritable bowel syndrome. Am J Gastroenterol. 1996. 91:906–913.

20. Houghton LA, Lea R, Jackson N, Whorwell PJ. The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers. Gut. 2002. 50:471–474.

21. Wald A, Van Thiel DH, Hoechstetter L, Gavaler JS, Egler KM, Verm R, Scott L, Lester R. Gastrointestinal transit: the effect of the menstrual cycle. Gastroenterology. 1981. 80:1497–1500.

22. Hinds JP, Stoney B, Wald A. Does gender or the menstrual cycle affect colonic transit? Am J Gastroenterol. 1989. 84:123–126.

23. Jackson NA, Houghton LA, Whorwell PJ, Currer B. Does the menstrual cycle affect anorectal physiology? Dig Dis Sci. 1994. 39:2607–2611.

24. Kamm MA, Farthing MJ, Lennard-Jones JE. Bowel function and transit rate during the menstrual cycle. Gut. 1989. 30:605–608.

25. Caballero-Plasencia AM, Valenzuela-Barranco M, Martin-Ruiz JL, Herrerias-Gutierrez JM, Esteban-Carretero JM. Are there changes in gastric emptying during the menstrual cycle? Scand J Gastroenterol. 1999. 34:772–776.