Copyright independent
For a while, the “hot girls have stomach problems” trend on social media has been a way for women to destigmatise irritable bowel syndrome (IBS). By sharing content about bloating, farting, diarrhoea and constipation, users normalise talking about some of the condition’s unpleasant symptoms. But why does IBS affect women more than men? Studies show women are twice as likely as men to have this condition, and symptoms are most common among those aged 18 to 39. The reasons are complex, but sex hormones seem to play an important role. Here’s what we know. IBS is more than just stomach pain – it’s a complex disorder affecting messages sent by the nerve network known as the gut-brain axis. IBS is considered a syndrome because it is characterised by a collection of symptoms, rather than a structural abnormality in the gut or a particular disease. People with this condition experience unpredictable and uncomfortable bowel motions such as diarrhoea and constipation. Other symptoms can include pelvic pain, headaches and fatigue and significantly affect quality of life. There is also significant overlap between IBS and depression and anxiety. The definitive reason people develop IBS remains unclear. But we do know that messaging between the brain and gut is thrown off track. In both men and women, everyday factors – including stress, exercise, diet, socialising and thought patterns, such as the anxiety someone may develop about symptoms – can speed up or slow down the messages sent via the gut-brain axis. The result is heightened reactivity: the gut becomes very sensitive to food, stress and anxiety, leading to unpredictable bowel motions. Differences in men's and women’s IBS symptoms – and how bad they are – may be due to differences in hormones. Men have more testosterone than women, and this hormone is thought to help protect against developing IBS. But for women, fluctuations in oestrogen and progesterone – which they have more of – can worsen symptoms. These hormones influence how quickly food moves through the gut, speeding up or slowing down the number of times the gut contracts, leading to pain and other symptoms like constipation and diarrhoea. Women are more likely to have worse symptoms during their reproductive years. Symptoms are also often worse during a woman’s period, which is when oestrogen and progesterone decrease. There is also emerging evidence about the overlap between IBS and conditions such as endometriosis and polycystic ovary syndrome. Recent studies suggest people with endometriosis are three times more likely to have IBS, while those with polycystic ovary syndrome are twice as likely to have it. These conditions seem to be connected by hormone fluctuations and pain, although we don’t know what causes what. Factors such as mild inflammation from an overactive immune system, a weak gut lining, unbalanced gut bacteria and sensitive nerves in the gut may explain why these conditions happen together. Women are also more likely to seek support for IBS than men, which may explain why we have better reporting on their diagnosis and the overlap of other conditions that affect women. There is no cure for IBS. But the syndrome can be managed with lifestyle changes and medication. Evidence suggests that reducing gut irritants in your diet can reduce discomfort. These include caffeine, spicy food, alcohol, fizzy drinks and high-fat food. For some people with ongoing symptoms, a dietitian may prescribe restricting and then reintroducing certain food groups known as fermentable carbohydrates, or FODMAPs. FODMAPs are found in common foods such as dairy products (lactose), grain and cereals (fructans) and certain fruits such as apples, watermelon and stone fruit (polyols). The purpose of this diet is to first relieve symptoms and then systematically identify irritants, so that if they’re reintroduced, it’s at a level that the gut can tolerate. For some people, cognitive behavioural therapy also helps. This talk therapy – which focuses on reframing unhelpful thinking and behaviour – is used to get messages between the gut-brain axis back on track. For example, by reducing emotional stress (the “fight or flight” response), improving how your brain interprets pain, and addressing negative thoughts about symptoms, such as shame and anxiety. Others may benefit from hypnotherapy, which helps reduce gut sensitivity and promotes deep relaxation. This teaches the body to respond more calmly to stress, which helps to regulate the gut-brain messaging system. Doctors can also recommend medications that act on receptors in the gut and regulate the speed of digestion, which can reduce diarrhoea and constipation. Otherwise, low-dose antidepressants (prescribed at a much lower dose than what would be used to treat clinical depression) can help to reduce sensitivity to pain in the gut. People living with IBS often feel their condition isn’t taken seriously. Research shows they face dismissive attitudes – including from doctors – which suggest the symptoms are just in their head, and are more likely to experience shame about their condition. For some women, sharing experiences online can help them shed the shame and find out more about IBS. But social media communities, and influencers trying to sell products, can also encourage women to try expensive strategies that don’t have evidence to back them. Given the complexity of IBS, individual, tailored care is key. Your symptoms are not just a “vibe”. If you’re concerned, you should speak to a trained health-care professional, such as a GP, psychologist or dietitian, who can help you find the right treatment for you.
