Gastrointestinal upset is a common occurrence for many people. Abnormal bowel movements or bloating, abdominal pain, constipation, diarrhoea or bowel irregularity are usually regarded as minor digestive problems or a consequence of unhealthy eating patterns. If these symptoms are chronic and start to interfere with day to day functioning, it may be a sign of Irritable Bowel Syndrome (IBS) which is one of the most common functional gastrointestinal disorders in the world.

Interestingly, research has always revealed that IBS is more common in females than males. The exact cause of this gender difference is still under investigation but now it is thought to be caused by a combination of several biological, hormonal, psychological and environmental factors, rather than any single one.

IBS is a chronic disorder, which involves the way the digestive system works, without any apparent structural damage to the intestines. Typical symptoms of IBS include abdominal pain, bloating, excess gas, constipation, diarrhoea or a combination of both. It's not fatal but it can impact a person's quality of life, impacting work, sleep, social interactions and emotional wellbeing.

Female reproductive hormones play a significant role in the increased incidence of IBS among women, and one of the most compelling explanations is that these hormones can trigger IBS symptoms. Oestrogen and progesterone have a significant influence on a number of functions in the body, including digestion. These hormones can impact the rate at which food passes through the intestines, change the sensitivity of the bowel, and impact the brain's processing of pain signals.

Many women find all the symptoms of IBS change during the course of their lives. Menstrual periods are times when symptoms may be more intense, and there are more hormone changes than at any other time. Also, during pregnancy and menopause, digestive function may change, resulting in a change in bowel movements and abdominal discomfort. These findings strongly indicate the role of hormonal changes in the severity of IBS symptoms.

The gut-brain axis is an important factor, too, as the brain and gut are in close contact. This communication system enables the brain to continuously send and receive messages from the gut. This communication is disrupted in those who have IBS, causing the digestive system to be more sensitive to the normal functioning of the intestines.

Women may respond more physiologically to emotional stress, anxiety and psychological distress, which could directly impact gut function. Stress is not just a mental condition; it can also impact intestinal contractions, raise the pain threshold and make gut upset symptoms worse. That means that women suffering from IBS may experience symptom relapses when they are under stress or experiencing important life changes.

Women with IBS have also been found to be at higher risk for anxiety disorders, depression, sleep problems and chronic fatigue. While these conditions are not needed to trigger IBS, they may intensify symptoms and make them more common and severe via the gut-brain connection. This emphasises the need to take care of your body as well as your mind when dealing with IBS.

Another area of interest that has come to the fore is the gut microbiome. Trillions of healthy bacteria reside in the digestive tract, which are vital to digestion, immunity, metabolism and inflammation. The hypothesis of researchers is that the composition of these gut bacteria is influenced by the difference in levels of hormones between men and women.

Dysbiosis or imbalance in the gut bacteria can lead to changes in bowel movements, low-grade inflammation and heightened sensitivity in the gut. While the research is still ongoing, scientists think that it might be partly because of the differences in the gut microbiome between men and women that IBS is more prevalent and often more severe in women.

The immune system is another possible cause. Research indicates that women with IBS may have an increase in immune activation and low-grade inflammation inside the intestinal lining. IBS isn't an inflammatory bowel disorder itself, but mild changes in the immune system may trigger increased reactions and sensitivity to digestive processes in the intestines. This increased sensitivity can cause pain, bloating and irregular bowel movements even in the absence of an obvious disease.

There are other lifestyle factors that can affect IBS symptoms. Occupied schedules, irregular eating times, insufficient sleep, low physical activity and eating foods high in processed foods can cause and aggravate symptoms. Stress is known to be one of the primary triggers, and keeping the stress level in check is as critical as changing diet.

Fortunately, IBS often can be successfully managed with a personalised treatment plan. Today, IBS treatment is a comprehensive approach, not just about medications. Treatment can involve dietary changes (more soluble fibre or a low FODMAP diet supervised by a medical professional), stress management, regular exercise, rest, probiotics and drugs if necessary, depending on individual symptoms. In many patients, psychological therapies such as cognitive behavioural therapy and mindfulness-based stress management have also been beneficial.

The lesson to be learned is that if digestion is always poor, it should not be ignored and accepted as "normal". If medical evaluation is done early, other gastro-intestinal diseases can be excluded and treatment can be given. Especially women should know that periodic bloating, abdominal discomfort or irregular bowel movements are not necessarily caused by hormonal changes or stress, but can be a symptom of IBS.

Most people with IBS can have a good quality of life when they become more aware of how to deal with their symptoms, are diagnosed early and have a well-rounded management plan that includes treating their gut health, hormonal factors and emotional state.

(By Dr. Harshil Shah, Consultant Gastroenterologist, HPB, and Liver Transplant Surgeon at Bhailal Amin General Hospital)

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