# women and IBS



## eric (Jul 8, 1999)

FYI"Women without IBS. It is quite common for women to experience GI symptoms before menstruation. Constipation or diarrhea are included as part of the pre-menstrual syndrome. A majority of women describe some change in bowel habits during menstruation such as nausea which may be associated with painful uterine cramping (dysmenorrhea). Women with IBS (see Research Articles). In women with IBS, GI symptoms are even more common around the time of menstruation. Symptoms may include abdominal pain, diarrhea, constipation, flatulence and nausea. It is not yet clear how menstrual cycle hormonal changes result in this increase in IBS symptoms. "http://www.mindbodydigestive.com/Evidence for exacerbation of irritable bowel syndrome during menses. Whitehead W, Cheskin L, Heller B, et al. Gastroenterology 1990;98:1485-1489.Methods: Two groups of women with IBS were studied, one seen at a Planned Parenthood center and the other at a university Gastroenterology Clinic. Excluded from the study were women who had a hysterectomy. (It is noteworthy that 21% of the IBS patients had hysterectomy, far greater than the national average of 5.5%.) The remainder of the IBS patients were compared to a control non-IBS group attending Planned Parenthood. At Planned Parenthood, there were 30 IBS patients and 234 controls. At the Gastroenterology Clinic, there were 42 IBS patients and no controls. All patients received questionnaires regarding their gastro-intestinal symptoms during menses and their psychological state. Psychological tests measured neuroticism, extraversion, openness, agreeableness and conscientiousness. The neuroticism scale included anxiety, hostility, depression, self-consciousness, impulsiveness and vulnerability. Results: Symptoms during menses in IBS patients in Planned Parenthood were similar to those in the Gastroenterology Clinic so these IBS groups were combined and compared to the controls who did not have IBS. All the symptoms studied were significantly greater in IBS patients than in the controls. Menses-related increases were seen in the following symptoms in IBS: gas 48% diarrhea 29% constipation 24% Increased bowel symptoms were unrelated to psychological test scores described above. Also a Menstrual Distress Questionnaire was used to measure negative affect and behavior (such as irritability) during menses. Again, there was no significant correlation between these traits and bowel symptoms Conclusion: Women with IBS have greater exacerbation of gastro-intestinal symptoms during menses than a control population. The menstrual cycle and its effect on inflammatory bowel disease and irritable bowel syndrome: a prevalence study. Kane SV, Sable K, Hanauer S. Amer J Gastroenterology 93: 1867-1872, 1998. Methods: 31 IBS patients seen at a university GI clinic were compared to healthy controls and to patients with inflammatory bowel disease (IBD, which includes ulcerative colitis and Crohn's disease). They were asked about typical premenstrual syndrome symptoms, as well as nausea, vomiting, diarrhea, and constipation during pre-menstrual or menstrual cycles. They were also asked whether they noticed bowel habit changes during pregnancy. Results: a) Pre-menstrual: There was a significant increase in diarrhea and nausea pre-menstrually in both IBS and IBD, compared to controls. There were no significant difference in non-specific symptoms such as irritability, depression or weight gain in IBS patients.







Menstrual: Diarrhea was increased in IBS and IBD while constipation was significantly increased only in IBS, again compared to controls. c) Pregnancy: 291 pregnancies were reported in 139 women. While bowel habits changed during pregnancy, there was no significant difference in those changes among IBS, IBD and control patients. 45% of IBS patients who had been pregnant reported a change in symptoms, the most common being constipation, found in 20%. d) Cyclical patterns: Patients' IBS symptoms occurred in a cyclical pattern. They noted increase in diarrhea, constipation or abdominal pain, in the pre-menstrual or menstrual phase of their monthly hormonal cycle. Conclusion: While most women have gastrointestinal symptoms around the time of menstruation, symptoms are more likely to occur in women with IBS. What is the significance of this? Patients with IBS symptoms such as abdominal pain, diarrhea and constipation may notice and even expect an increase in their symptoms during the menstrual phase of the monthly cycle. Knowing this may help in coping with and managing the treatment of IBS. Menstruation May Worsen Irritable Bowel SyndromeExcerpt By Merritt McKinney, Reuters Healthhttp://preventdisease.com/news/articles/me...ble_bowel.shtml


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## eric (Jul 8, 1999)

Med Hypotheses. 2005;65(1):97-102. Related Articles, Links Will corticosteroids and other anti-inflammatory agents be effective for diarrhea-predominant irritable bowel syndrome?Crentsil V.Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA. crentsil###jhmi.eduIrritable bowel syndrome (IBS) is one of several functional gastrointestinal disorders commonly encountered in both the clinical setting and the general population. The biopsychosocial model is currently believed to be a more complete explanatory mechanism of IBS symptom genesis and propagation. Gut inflammation and immune activation is one of the biological mechanisms for which evidence is emerging. Experimental parasitic infection of mice bowel resulted in elevated substance P levels and increased expression of cyclooxygenase 2 (COX 2) enzyme, prostaglandin E2, IL-4, IL-5, and IL-13. In IBS patients, increased cellularity and proximity of the inflammatory or immune cells to the nerve trunks of the bowel, elevated interleukin-1beta mRNA expression in mucosal biopsies, and increased inducible nitric oxide synthase and nitrotyrosine elaboration (indicative of lymphocyte activation) were observed. Corticosteroids given after the elimination of an experimentally applied parasite from the bowel of mice resulted in the reversal of persistent gut muscle dysfunction. Selective COX-2 inhibitors attenuated the increased bowel smooth muscle contractility resulting from parasite infection of mice gut. In humans, it has been observed that the relative risk of developing IBS in asthma patients was reduced by 60% by the use of oral steroids. Despite such preclinical and human evidence for the role of inflammation and immune activation in IBS, the efficacy of anti-inflammatory and immunomodulatory agents has not been adequately investigated. Budesonide, a corticosteroid with a high mucosal activity and a low bioavailability, is an anti-inflammatory agent that may be worth investigating for its utility in diarrhea-predominant IBS.PMID: 15893125


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