# Connecting Menstruation with Digestive Difficulties



## JeanG (Oct 20, 1999)

This article is a year old, but still helpful for us women in understanding IBS and periods! The url is: http://onhealthnetworkcompany.com/women/in...m,39849_1_1.asp May 21, 1999 Connecting Menstruation with Digestive Difficulties By Karin Beuerlein If thereï¿½s a blessing to having survived the ï¿½90s tell-all era, itï¿½s that women have learned to talk freely about the menstrual cycle and how it affects health. At the urging of Oprah and others, women have come out of the closet about cramps, premenstrual syndrome, monthly mood swings and more. But even in this age of menstrual candor, who talks about her bowels? For millions of menstruating women, one notorious week of the month means more than the common discomfort of bleeding and cramps. It also means gastrointestinal trouble that can range from the merely uncomfortable to the debilitating. Potential problems include nausea, vomiting, flatulence, bloating, abdominal pain, constipation and diarrhea. According to William Whitehead, a professor of medicine at the University of North Carolina at Chapel Hill and co-director of the Center for Functional GI and Motility Disorders there, menstruation can also aggravate the symptoms of irritable bowel syndrome, a disorder experienced primarily by women that's characterized by recurring abdominal pain and abnormal bowel movements. "The research we've done indicates a very clear exacerbation of these symptoms during menses," says Whitehead. Symptoms are as individual as the women who have them. "Mine usually appear a day or two before my period begins," says Denise, a 38-year-old writer and mother who remains so embarrassed by her monthly problems that she spoke only on condition that her last name not be revealed. First Denise suffers bloating and flatulence, then constipation, and finally runny stools during her period. "I guess I feel a bit annoyed and embarrassed by it, but to be honest, I've come to just accept it as part of life." Lisa, 39, a public-relations professional, is not so lucky. "I often experience either severe diarrhea or constipation during my period," she says. "It makes life really difficult." Lisa often must use prescription medication or an enema to relieve her discomfort. And then there's her nagging worry: ï¿½Is there going to be a bathroom nearby when I need it?ï¿½ Unfortunately, medical science has not yet pinned the symptoms to a definite physiological cause. Whitehead suspects the culprit may be prostaglandin, a hormone-like substance secreted by the uterus during menses. Prostaglandin is known to affect smooth muscle tissue ï¿½ it's the trigger for monthly cramps. But smooth muscle is also the material the lines the walls of the stomach and intestines, making them sensitive to the monthly cycle. In the early '80s, Margaret Heitkemper, a registered nurse who is chairwoman of the department of biobehavioral nursing and health systems at the University of Washington, set out to study women suffering from dysmenorrhea, pain that's linked to menstruation. She had study participants keep diaries of their symptoms, including GI problems, and what she discovered was this: "It wasn't just women with dysmenorrhea who were suffering from these problems. Lots of women were having digestive troubles related to their periods." Heitkemper says that women typically experience constipation during the luteal phase of the menstrual cycle, roughly the two weeks between ovulation and the first day of bleeding. Then, as the period starts, stools become runny. Heitkemper also cites prostaglandins as an aggravator of symptoms, but she believes the whole range of female hormones that peak and fall throughout the month have an effect. "Progesterone in particular drops during the luteal phase of the cycle," she says. "It really hasn't been studied, though, because women's cycles vary so much that it's hard to conduct a good analysis." Heitkemper emphasizes that most physiological changes accompanying a woman's period are "perfectly natural," and learning to accept this is a key to feeling healthier and stronger when symptoms get you down. However, there is one remedy that can smooth out the digestive peaks and valleys of your cycle. "American women consistently don't get enough fiber," Heitkemper says. She strongly encourages increasing intake of fruits and vegetables to five a day. This does not mean madly bolting down a diet of roughage when you feel constipated, and avoiding vegetables when stools are runny. Both Heitkemper and Whitehead advise against making drastic dietary changes based on temporary symptoms. Instead, increase the amount of fiber in your diet gradually, with the understanding that you may experience some bloating at first. Work up to five vegetables per day and be consistent. If you have particular problems with bloating and flatulence for a few days of your cycle, it's OK to avoid foods famous for causing gas ï¿½ cabbage, beans, cauliflower and onions, for example ï¿½ as long as you don't skip vegetables altogether. If, however, your symptoms are more disruptive and cause you great pain or discomfort, see your doctor. You may want to consider visiting a gastroenterologist in addition to your gynecologist or primary care provider, especially if you're experiencing the abdominal pain and frequent bowel emptying characteristic of irritable bowel syndrome. In addition, Whitehead reports that symptoms of IBS have historically been mistaken for endometriosis and other gynecological problems, which can lead to unnecessary treatments like hysterectomy. Until a specific cause is found for menstruation-related GI woes, treatment is administered on a symptom-by-symptom basis. Oral contraceptives may be prescribed to relieve nausea and vomiting. Some drugs, including low doses of antidepressants that can block pain pathways in the spinal cord, may help with abdominal pain or spasms. Whitehead points out that a particular drug often prescribed for constipation, Chronulac, can increase bowel gas to uncomfortable levels. If you're taking Chronulac and are having problems with bloating, ask your doctor about other alternatives. There is a promising pharmacological note: "Drug companies are developing a new class of compounds to reduce pain sensitivity in the rectum and other parts of the GI tract," says Whitehead. These new drugs should be available sometime in the next two years.


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## Guest (Nov 5, 2000)

Thanks Jean --- as an IBS C type the only time I had "normal" BM's was when I had my period. I'm certaim hormones play a role in IBS. I first started my problems just after the birth of my first child.roz


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## Deana (Dec 12, 2004)

hi , i am 10 times worse at the time of my periods and mine started after the birth of my second child..so as far as i am concerned hormones is deffinitly a factor...Deana!


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## JeanG (Oct 20, 1999)

Bump up to keep with other post.







JeanG


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## cookies4marilyn (Jun 30, 2000)

Good article Jean...before having IBS, I always had IBS like symptoms with periods...then later developed the IBS, which meant the same symptoms all the time...hense a hysterectomy....good to be informed...thanks for posting..------------------Marilyn


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## JeanG (Oct 20, 1999)

Bump up for Beth.


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## Mike NoLomotil (Jun 6, 2000)

Likely magic word: PGE2


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## Guest (Jan 28, 2001)

Thanks ladies! I had searched to try and find answers to my questions you helped the most. I was mainly worried about the small bloodclots with my BM. Now I feel better that I know I'm not alone. It's great to be able to ask questions without embarresment. Sparkett


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