Do women have more stomach problems than men?
12th October 2017
Is gut health a gendered issue? On the face of things, this may sound like a strange question – you can suffer from GI issues no matter which bathroom you're using. However, there are certain key differences between the sexes that can affect the plumbing problems you're prone to. Here's how:
Women are more likely to have IBS
Irritable bowel syndrome (IBS) is a common condition, affecting around 12 million people in the UK. The name is a blanket term for a collection of otherwise unexplained symptoms that relate to a disturbance in the bowels – abdominal pain, bloating, constipation, cramping or diarrhoea.
According to Dr Adam Farmer, adviser to the charity The IBS Network, the rates of IBS in women are between 1.5 and 3 times higher than those seen in men.
"Internationally, the overall prevalence of IBS in women is 67% higher than in men, although there are some important geographical differences," he says.
Dr Anton Emmanuel, medical director of the digestive diseases charity Core, adds that while women are more likely to present with symptoms of IBS, the actual prevalence in the population may be more even.
"The more specialist the referral the higher the female preponderance. There was also a survey by Core a few years ago suggesting that men are less inclined to present with bowel symptoms, even rectal bleeding," he explains.
Hormones play an important role
Whether women really are more susceptible to IBS – or are just more likely to see the doctor when they have a problem – it is clear the menstrual cycle plays its part.
During the luteal phase (the time after ovulation), women may see a slowing down of transit in their gut, which can lead to constipation and bloating. This is followed by the worst part of the cycle for IBS sufferers – menstruation itself.
"Symptoms such as bloating, abdominal pain and diarrhoea can typically get worse during menstruation. This may be due to increases in prostaglandin levels during menstruation. Prostaglandins are hormone-like substances involved in pain and inflammation, which trigger the uterine muscle contractions," says Dr Farmer.
Another hormone that can affect the gut is testosterone. Since men have high levels of testosterone, they tend to have a well-developed abdominal wall, which in turn means less risk of bloating.
Men and women have differently shaped guts
On average, the female colon is about 10cm longer than the male colon, with more twists and turns – and it also has to compete for space in the pelvis with the reproductive organs. According to gastroenterologist Dr Robynne Chutnik,who was interviewed in The Atlantic, the male and female colon can be described as a "gentle horseshoe" and a "tangled-up Slinky" respectively. This puts women at a greater risk of many GI symptoms.
Gender might affect your gut response to stress
If you've heard the term 'gut-brain axis', you'll be aware that the role of the gut goes far beyond digestion. Rather, your mental health and gut health are closely related – and the precise nature of that relationship may differ for men and women.
"There may be gender differences in the response to stress through the hypothalamic-pituitary-adrenal axis and autonomic nervous system - these systems can influence the sensitivity of the gut. An emerging concept is the 'microgenderome' which relates to the potential influence of sex hormones on modulating the gut microbiota (bugs in the gut)," says Dr Farmer.
The same diet can affect men and women differently
While nutrition is clearly essential to gut health, scientists are only just beginning to explore how gender factors into the mix. In 2014, researchers at the University of Texas at Austin found that when men and women eat identical diets, they see different responses in their gut microbiota. This suggests that, in the future, nutritional advice regarding gut health might be sex-specific.
"Now we can go in with eyes open when we work on therapies for gut microbe problems, as many involve dietary changes. All along we treated diet as if it works the same for men and women. Now we'll be approaching studies of therapies in a different way," said the lead researcher, Daniel Bolnick.
Men are more susceptible to some issues
Although men, on average, have less sensitive guts than women, there are some issues that plague men more frequently. One of these is diarrhoea.
As Dr Farmer explains: "IBS can be sub-divided according to the predominant bowel habit. Evidence suggests that women with IBS are twice as likely to exhibit the constipation-predominant subtype and are approximately half as likely to have the diarrhoea-predominant subtype."
Another is acid reflux. While men are no more prone to heartburn than women, they are more likely to have a weak valve where the oesophagus meets the stomach, increasing their risk of oesophageal damage.
Your gender shouldn't affect your treatment
If you've gone to the doctor with GI issues, you should expect to be treated as an individual, rather than as a member of a group. And while female patients do have one more variable to think about – namely the impact of the menstrual cycle – gender is unlikely to have much bearing on your actual course of treatment.
As Dr Farmer explains, the doctor-patient relationship is central to a successful outcome. What's more, you should keep looking until you find a doctor who takes your complaints seriously.
"Validation of a patient's symptoms in a supportive environment is an absolute cornerstone of treatment. Similarly, treatment options, and their underlying rationale, should be discussed in detail," he says.
Whatever your gender, there's always help available if something's gone awry in your guts. Visit The IBS Network for further information and support.