Women with Gastrointestinal Symptoms: Implications for Nursing Research and Practice

Abstract

Irritable bowel syndrome and functional bowel disorder are diagnoses used to describe chronic GI symptoms for which no overt pathological condition can be identified. Symptoms are more common in women and are frequently followed in gastroenterology clinics. The purpose of this article is to provide an overview of the research linking GI symptoms and reproductive cycling and to discuss implications for practice. GIGl symptoms such as stomach pain and nausea are highest during menses compared with other cycle phases; also, stool consistency is loosest at menses. This pattern is present in control subjects. In women with irritable bowel syndrome the same pattern is seen but with higher symptom intensity. Although animal studies have demonstrated that estrogen and progesterone modulate contractile function of some GI segments. In humans, symptoms are highest when these hormones are at the lowest levels. Thus, symptoms in women may be related to decreasing ovarian hormone levels or to other circulating hormones or factors which vary with the menstrual cycle. Additionally, other factors such as stress aggravate symptoms. Therapeutics directed toward increasing patient awareness of cyclic patterns in symptom complaints, for example, via the use of daily symptom diaries may be a useful adjunct to dietary, pharmacological, and other therapies.

The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers

“…In addition, stool consistency was firmer during the luteal phase. Similar observations have been made in other studies [8][9][10][11] although one study reported no change in stool form or frequency with the menstrual cycle. 10 Furthermore, although general well being was reduced at menses, anxiety and depression remained unaltered throughout the menstrual cycle.…”

“…3 5 Sex hormones may also play a role in the pathogenesis of irritable bowel syndrome (IBS). This is supported by observations that more women suffer from IBS than men, 6 7 and that premenopausal female patients often report exacerbation of their symptoms at the time of menses [8][9][10][11] and have fewer episodes of abdominal bloating than postmenopausal women. 12 Furthermore, postmenopausal women taking hormone replacement therapy (HRT) experience less bloating than those not taking HRT.…”

“…[8][9][10][11] Analysis was carried out using repeated measures analysis of variance (two tailed). Data were logged for physiological measurements to produce an adequate approximation to normal distribution.…”

“…Menses is also associated with a significant worsening of IBS symptomatology, which is in accordance with previous studies. [8][9][10][11] Both abdominal pain and bloating were worse and bowel habits more frequent during menstruation. In addition, stool consistency was firmer during the luteal phase.…”

Irritable Bowel Syndrome and Gastroesophageal Reflux Disease in Primary Care: Is There a Link?

“…HRT use has previously been associated with an increased risk of IBS in postmenopausal women, similar to the increased risk in younger women associated with endogenous oestrogenic activity [34]. Patterns of IBS symptoms are known to vary during the menstrual cycle [35,36], and ovarian hormones are known a Odds ratio (OR) estimates with 95% confidence intervals (CI) were adjusted by age, sex, smoking, body mass index, alcohol use and healthcare utilization using logistic regression b Current/recent use was defined as a supply of the most recent prescription lasting until the index date or ending in the previous 365 days. Past use was defined as a prescription ending more than 365 days before the index date.…”