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Suffering in Silence: Why Women’s Gut Health Issues Often Go Unreported

Suffering in Silence: Why Women’s Gut Health Issues Often Go Unreported

Written by Jonathan Bailor, CEO SANESolution & Reviewed by Dr. Matthew Olesiak, MD Chief Medical Director, SANESolution

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It’s no secret that women tend to avoid talking about their gut health. Most won’t even discuss this subject with their closest girlfriends. This is especially true when it comes to bowel movements. Even in this enlightened age, many women think that doing #2 is considered “unfeminine,” something to be ashamed of…and they don’t want anyone knowing they do it.

Case in point…

In a 2013 survey, 1,002 adult women in Canada were asked about this subject. While a whopping 97% admitted that proper bowel function is an important factor in overall health, nearly half said they were too embarrassed to do #2 in a public restroom.(1)

Women Seldom Discuss It With their Doctors

Research shows that most women are even ashamed to discuss their bowel and digestive health issues with their doctors.

In one study, researchers reviewed the medical charts of 463 consecutive new patients of a urogynecologic clinic. They also reviewed questionnaires these women completed regarding their bowel movements.

In reviewing the medical charts, researchers noted that only 3% of these patients listed a bowel symptom as their primary complaint. But 76% reported at least one bowel symptom on their questionnaires.(2)

It is clear that shame and embarrassment over bowel habits and poor gut health is pervasive among women. This shame leads many women to suffer in silence with gastrointestinal issues that could easily be treated — if only they’d speak up.

Plus, NOT reporting bowel symptoms or digestive issues can lead to a potentially serious condition going undiagnosed for years, ultimately making it more difficult or impossible to treat. 

This is important because due to differences in the male and female digestive systems, women are at higher risk of developing several gastrointestinal conditions and diseases.

Women’s Unique Digestive System

There are at least 4 key differences between the male and female digestive system.

Female hormones

Many women experience bloating, diarrhea, abdominal pain, constipation, and other digestive issues at various stages of their menstrual cycle. This usually occurs around the start of their period and/or ovulation because of wildly fluctuating hormones.

This is not a coincidence. Receptor cells for estrogen and progesterone reside throughout our gastrointestinal tract(3), (4),  making the gut responsive to hormonal fluctuations.

Gut Microbiota

Emerging research shows that gut microbes may differ between men and women. Specifically, women  have been shown to have a more diverse microbiome than men. Researchers believe that hormonal fluctuations may create this microbial diversity, as microbial differences don’t appear until the hormonal changes of puberty begin.(5)

The exact effect of sex differences in gut microbiota is largely unknown, but it could be one of the factors that increases women’s risk of developing inflammatory bowel disease and irritable bowel syndrome.(6)

Colon Size

A woman’s colon is 10 centimeters longer than a man’s. The increased length means that the female colon drops deep into her pelvis where all her reproductive organs and the bladder are housed. This makes for a cramped “living space.”(7) In addition, her colon is more “tangled” than a man’s, full of twists and turns that makes elimination a more complicated process.

This may explain why, according to research, women are slower at emptying their colons and experience constipation more often than men.(8)

Food Transit Time

Transit time — the time it takes for food to move through the digestive system and be eliminated — is significantly longer in women compared to men.

In a Mayo Clinic study, researchers discovered that the average time it took 21 healthy people to digest food was 33 hours for men and 47 hours for women!(9)

Transit time is a key factor in digestive health. Research shows that the longer it takes for food to pass through the colon, the more time bacteria have to break it down. This not only causes excessive gas and bloating, but when bacteria run out of carbohydrates — their preferred food source — they will start breaking down proteins and other nutrients.(10)

This creates toxic substances in the colon that may lead to the development of colon cancer and other diseases. 

5 Most Common Digestive Problems in Women

The female’s unique digestive system can increase the risk of many gastrointestinal diseases and disorders. Here are 5 conditions most common in women.

Constipation

According to epidemiology surveys, an estimated 4 million people in the U.S. experience frequent constipation. It is the most common digestive issue in America, and for many, it is a chronic condition.(11)

Symptoms of constipation include infrequent bowel movements, i.e. fewer than 3 per week, hard  dry stool that is difficult to pass, and pain in the abdomen.

Research indicates females suffer constipation 3 times more often than men.  They are also more likely than men to experience chronic constipation.

As previously mentioned, one reason for women’s higher risk of constipation is their longer, more complicated colon. But women’s shame of having  bowel movements in public restrooms may also play a role, as holding in stools can contribute to constipation.

Solution? Eat a high-fiber diet with a moderate amount of healthy fats and drink plenty of water. This helps bulk up and soften your stool, leading to quicker transit time and easier elimination.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic digestive health condition affecting the colon. It is considered a functional disorder in that the bowel is not functioning normally. But it doesn’t damage the intestinal lining.

IBS is the most common functional digestive disorder affecting  10% to 15% of the world’s population.(12)

Symptoms range from mild to severe and can include abdominal pain, cramping, bloating, gas, nausea, diarrhea and/or constipation.

IBS occurs 2-6 times more often in women than men.(13) The aforementioned female hormone receptors in the digestive tract may be one reason women experience this condition more often than their male counterparts.

The symptoms of irritable bowel syndrome are typically managed with lifestyle and dietary modifications. The Mayo Clinic recommends that you eat high fiber foods, drink plenty of liquids, exercise regularly, get adequate sleep, and avoid “trigger foods”.(14)

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a general term for intestinal disorders characterized by chronic inflammation of the digestive tract.  It is considered to be an autoimmune disease. Unlike IBS, inflammatory bowel disease damages the gastrointestinal tract. It can be extremely painful with sometimes life-threatening complications. It also increases the risk of developing colon cancer.

The two main types of IBD are ulcerative colitis (UC) and Crohn’s disease. Over 3 million adults in the U.S. have been diagnosed with one of these types.(15) Further, roughly twice as many women as men have been diagnosed with IBD.(16)

Female hormones are thought to play a role in the increased prevalence of IBD among women. In addition, the autoimmune nature of this disease could increase their risk. According to research, roughly twice as many women as men get autoimmune diseases.(17)

Symptoms of IBD vary in type and severity and may include flatulence, diarrhea, bloating, stomach cramps, fever, fatigue, weight loss, and blood in stool.

There is no known cure for this disease. It is usually treated with anti-inflammatory medications, dietary changes, and sometimes surgery.

Gallstones

Gallstones are another common gut health issue among women.

Gallstones are hardened deposits of cholesterol that form in your gallbladder. The gallbladder, a small pear-shaped organ on the right side of the abdomen, releases a yellow green fluid (bile) into your small intestine to help digest dietary fat.

According to statistics, women are twice as likely as men to develop gallstones. Why? The main reason is that the female hormone estrogen increases cholesterol levels in the bile which slows gallbladder movement. This gives a gallstone the material and the time it needs to form.(18)

Symptoms include sudden severe pain in the middle to upper right part of the abdomen, fever, nausea/vomiting.

Treatments typically include medication to dissolve the gallstone. If gallstones are a recurring issue, your doctor may recommend surgery to remove your gallbladder. You can also reduce your risk of gallstones by losing weight or maintaining a healthy weight, eating a balanced mix of plant-based foods, reducing red meat consumption, and getting regular exercise.

Colon Cancer

According to the American Cancer Society, colon cancer is the third most diagnosed cancer in men and women in the U.S., not including skin cancer.(19) But women have a greater risk than men of developing this disease.

In its early stages, colon cancer typically has no obvious symptoms. In later stages, symptoms may include changes in bowel habits, diarrhea, constipation, abdominal pain/cramps, blood in stool, fatigue, and unexplained weight loss.

Treatment for colon cancer typically includes a combination of surgery, medication, and chemotherapy/radiation. You may also reduce your risk of developing this disease by eating a diet low in animal fats and high in vegetables and other high-fiber foods.

To adequately treat this disease, regular colorectal cancer screenings are essential. Early diagnosis makes colon cancer easier to treat and improves your chances of survival.

It’s Time for Women to Drop the Shame

Though these represent the 5 most common digestive problems in women, they’re only the tip of the iceberg. 

Every day, hundreds of thousands of women live with excessive gas, bloating, heartburn, stomach pain, and other digestive health issues. That’s bad enough, but gut dysfunction also affects all areas of your health — skin, energy, mood, immune system, joints etc. — which can prevent you from living your best life.

Don’t let shame do that to you. There are easy solutions to many of the most common gut health issues. To experience the relief you deserve, talk to your doctor and a trusted friend. Your health and happiness are worth it.

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References

1- Linton M. It’s Time for Women to Talk About Constipation. HuffPost Canada Archives. Nov 3, 2013. Accessed Jul 13, 2021. https://www.huffingtonpost.ca/marilyn-linton/women-constipation_b_3837007.html

2- Urogyn. patients underreport bowel symptoms.. (n.d.) >The Free Library. (2014). Retrieved Jul 13 2021 from https://www.thefreelibrary.com/Urogyn.+patients+underreport+bowel+symptoms.-a0218591289

3- Schoenfeld L. Is Your Period Causing Digestive Issues? Here’s Why. Accessed Jul 14, 2021. https://lauraschoenfeldrd.com/digestive-issues-period-ovulation/

4- Heitkemper MM, Jarrett ME. Pattern of Gastrointestinal and Somatic Symptoms Across the Menstrual Cycle. Gastroenterol. 2. 1992;102:505-13

5- Anderson SC. Sex and the Microbiome. Psychology Today. Feb 11, 2020. Accessed Jul 14, 2021. https://www.psychologytoday.com/us/blog/mood-microbe/202002/sex-and-the-microbiome

6- Haro C, Rangel-Zúñiga OA, Alcalá-Díaz JF, et al. Intestinal Microbiota Is Influenced by Gender and Body Mass Index. PLoS One. 2016;11(5):e0154090. Published 2016 May 26. doi:10.1371/journal.pone.0154090

7- Potter A. How a Female’s Digestive System Differs From a Male’s. Newsmax. Apr 27, 2016. Accessed Jul 14, 2021. https://www.newsmax.com/FastFeatures/female-digestive-system-differ-male/2016/04/27/id/726146/

8- Ensley R, Speziale A, Karlstadt RG. Common GI Problems in Women. American College of Gastroenterology. Accessed Jul 14, 2021. https://gi.org/topics/common-gi-problems-in-women/

9- Caroline Digestive Health Associates. Women vs Men When it Comes to Digestion. Accessed https://carolinadigestive.com/about-us/news/women-vs-men-digestion

10- Henrik M. Roager, Lea B. S. Hansen, Martin I. Bahl, Henrik L. Frandsen, Vera Carvalho, Rikke J. Gøbel, Marlene D. Dalgaard, Damian R. Plichta, Morten H. Sparholt, Henrik Vestergaard, Torben Hansen, Thomas Sicheritz-Pontén, H. Bjørn Nielsen, Oluf Pedersen, Lotte Lauritzen, Mette Kristensen, Ramneek Gupta, Tine R. Licht. Colonic transit time is related to bacterial metabolism and mucosal turnover in the gut. Nature Microbiology, 2016; 1: 16093 DOI: 10.1038/nmicrobiol.2016.93

11- Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. 1989 Jan;32(1):1-8. doi: 10.1007/BF02554713. PMID: 2910654.

12- Facts About IBS. Accessed Jul 14, 2021. https://aboutibs.org/what-is-ibs/facts-about-ibs/

13-  Ensley R, Speziale A, Karlstadt RG. Common GI Problems in Women. American College of Gastroenterology. Accessed Jul 14, 2021. https://gi.org/topics/common-gi-problems-in-women/

14- Mayo Clinic Staff. Irritable Bowel Syndrome. Mayo Clinic. Oct 15, 2020. Accessed Jul 14, 2021. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064

15- Statista. Number of adults with Crohn’s disease or ulcerative colitis in the U.S. in 2015-2016, by gender. Feb 26, 2018. Accessed Jul 15, 2021. https://www.statista.com/statistics/772769/inflammatory-bowel-disease-prevalence-us-by-gender/

16- Ensley R, Speziale A, Karlstadt RG. Common GI Problems in Women. American College of Gastroenterology. Accessed Jul 14, 2021. https://gi.org/topics/common-gi-problems-in-women/

17- Hayter SM, Cook MC. Updated assessment of the prevalence, spectrum and case definition of autoimmune disease, Autoimmunity Reviews, Volume 11, Issue 10, 2012, Pages 754-765, ISSN 1568-9972, https://doi.org/10.1016/j.autrev.2012.02.001. (https://www.sciencedirect.com/science/article/pii/S1568997212000225)

18- International Surgery Rome. How to Get Rid of Gallstones. Accessed Jul 15, 2021. https://www.surgeryrome.com/why-is-gallstone-common-in-women-and-at-what-age-is-it-most-likely/