Gender Differences in IBS

Why do more women than men suffer from IBS?

In the United States and other western countries, twice as many women as men seek treatment for Irritable Bowel Syndrome (IBS). In fact, IBS is largely perceived as a women’s health issue even though there are men who suffer from it as well. Why are more women diagnosed as men? Does the answer lie in the physical, chemical, social or emotional differences between the genders?

Physical differences. Some research indicates that the large discrepency between men and women with IBS may lie in physiological differences, such as response to pain.¹ In general, women have been shown to be more sensitive to certain types of pain (such as pain from internal organs) than men. Therefore, IBS pain that might be considered debilitating to a woman may be only an annoyance to a man.

Chemical differences. Many women report that their IBS symptoms are worse during certain phases of their menstrual cycle (such as pre-menstrual or ovulation periods).² This association led researchers to speculate that if female hormones exacerbate IBS, male hormones may be responsible for “protecting” men from IBS. In one study, men with IBS were found to have lower hormone levels than men without IBS. This could mean that higher levels of male hormones in the body somehow prevent IBS symptoms, but researchers are unsure why. Additionally, another study showed that men who had a lower testosterone level in particular experienced worse IBS symptoms.³

Social differences. Another reason for the low amount of men reporting IBS symptoms is that they may not seek medical treatment as readily as women. Men tend to have a higher pain threshold and might not consider seeing a medical professional for the pain experienced from IBS.¹

Women may also seek treatment for IBS more often because they are already accustomed to seeing a doctor (usually a gynecologist) for a Pap screen on a yearly basis. Reporting abdominal pain or changes in bowel habits on these visits might lead to a referral for a follow-up with a general practitioner or a gastroenterologist. Younger and otherwise healthy men may not see a physician on a regular basis, and would therefore not be in a position to report pain or changes in bowel habits.

Emotional differences. There appears to be a connection between psychological conditions and IBS, though researchers are still unsure about what causes the link. Depression and anxiety are generally more common in women than men⁴ which may partly explain the prevalence of IBS in women. Women with IBS are also more likely to have a history of sexual abuse.⁵

It appears that all these factors play a role in explaining the low rate of reported IBS in men when compared to women. Studies about IBS have increased in recent years, and researchers conclude that more are needed to understand the gender differences in IBS.

1. Chang L, Heitkemper MM. Gender differences in irritable bowel syndrome. Gastroenterology 2002;123:1686-1701.
2. 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.
3. Houghton LA, Jackson NA, Whorwell PJ, Morris J. Do male sex hormones protect from irritable bowel syndrome? Am J Gastroenterol 2000;95:2296-2300.
4. Blanchard EB, Keefer L, Galovski TE, Taylor AE, Turner SM. Gender differences in psychological distress among patients with irritable bowel syndrome. J Psychosom Res 2001;50:271-275.
5. Fass R, Fullerton S, Naliboff B, Hirsh T, Mayer EA. Sexual dysfunction in patients with irritable bowel syndrome and non-ulcer dyspepsia. Digestion 1998;59:79-85.