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Eur J Gastroenterol Hepatol. 2004 Nov;16(12):1251-2. Related Articles, Links
Irritable bowel syndrome, chronic pelvic inflammatory disease and endometriosis.
Kumar D.
Department of General Surgery, St George's Hospital, Tooting, London, UK.
Irritable bowel syndrome (IBS) is common. The symptom criteria for the diagnosis of IBS remain non specific. Similarly, pelvic inflammatory disease and endometriosis present with symptoms that may be similar to those of IBS. The site of pain, intermenstrual bleeding and exacerbation of symptoms by food may be able to help differentiate the two groups. However, there is still considerable overlap in the symptomatology of the two conditions and to this end both specialties should work together to investigate and manage these patients.
Publication Types:
Comment
PMID: 15618826 [PubMed - in process]
http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&refid=2&id=48DDE4A73E09A969852568880078C249&c=&newsid=8525697700573E1885256F7600368D69&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15618826&ref=/news/content.nsf/SearchResults?openform&Query=ibs&so=date&id=48DDE4A73E09A969852568880078C249
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American Journal of Obstetrics and Gynecology
Volume 192, Issue 3 , March 2005, Pages 761-767
Copyright © 2005 Elsevier Inc. All rights reserved.
General Obstetrics and Gynecology: Gynecology
Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain
Rachel E. Williams PhDa, , , Katherine E. Hartmann MD, PhDa, b, Robert S. Sandler MD, MPHa, c, William C. Miller MD, PhD, MPHa, c, Lucy A. Savitz MBA, PhDd and John F. Steege MDb
aDepartment of Epidemiology, School of Public Health
bDepartments of Obstetrics and Gynecology
cMedicine
dSchool of Medicine, Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Received 15 May 2004; revised 13 October 2004; accepted 29 October 2004. Available online 25 February 2005.
Objective
We sought to describe irritable bowel syndrome (IBS) treatment among women with chronic pelvic pain.
Study design
We performed a cross-sectional study of new chronic pelvic pain patients between 1993 and 2000 (n = 987). IBS was defined by Rome I criteria. IBS treatment was defined as lower gastrointestinal drugs or referral. Analyses were descriptive and multivariable.
Results
IBS occurred in 35% of patients. In the highest quartile of pain, women with IBS were not more likely to have IBS treatment initiated. In the lowest three quarters of pain, women with IBS were 5.08 times more likely to have IBS treatment initiated. IBS was not diagnosed 40% of the time. IBS treatments were not recommended to 67% of patients with IBS. More than 35% of patients were prescribed narcotics.
Conclusion
IBS is not consistently diagnosed and treated even in a pelvic pain clinic. Yet, treatment of IBS may reduce the overall abdominal pain of these patients.
Key words: Irritable bowel syndrome; Chronic pelvic pain; Treatment; Epidemiology; Diagnosis
This research was supported, in part, by an unrestricted educational grant from GlaxoSmithKline and by the Sunshine Lady Foundation.
Reprint requests: Rachel E. Williams, PhD, 1200 Willow Dr, Chapel Hill, NC 27517.
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American Journal of Obstetrics and Gynecology
Volume 192, Issue 3 , March 2005, Pages 761-767
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W9P-4FJVYH8-R&_user=10&_handle=V-WA-A-W-ZW-MsSAYVW-UUW-U-AAABDAVUCA-AAAAWEVYCA-EEABDDBWZ-ZW-U&_fmt=summary&_coverDate=03%2F01%2F2005&_rdoc=21&_orig=browse&_srch=%23toc%236688%232005%23998079996%23575189!&_cdi=6688&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=9e0e5d133e146c96d2a379975bfc3668
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Gastroenterology, March 2005 • Volume 128 • Number 3
Clinical-alimentary Tract
A prospective assessment of bowel habit in irritable bowel syndrome in women: Defining an alternator
Douglas A. Drossman *
Carolyn B. Morris *
Yuming Hu *
Brenda B. Toner ‡ Nicholas Diamant ‡
Jane Leserman * ]
Michael Shetzline §
Christine Dalton *
Shrikant I. Bangdiwala *
Background & Aims: Irritable bowel syndrome (IBS) is subtyped as IBS with diarrhea (IBS-D) or IBS with constipation (IBS-C) based on Rome II guidelines. The remaining group is considered as having mixed IBS (IBS-M). There is no standard definition of an alternator (IBS-A), in which bowel habit changes over time. Our aim was to use Rome II criteria to prospectively assess change in bowel habit for more than 1 year to understand IBS-A. Methods: Female patients (n = 317) with IBS entering a National Institutes of Health treatment trial were studied at baseline with questionnaires and 2-week daily diary cards of pain and stool frequency and consistency. Studies were repeated at the end of treatment (3 months) and at four 3-month intervals for one more year. Algorithms to classify subjects into IBS-D, IBS-C, and IBS-M groups used diary card information and modified Rome II definitions. Changes in bowel habit at 3-month intervals were then assessed using these surrogate diary card measures. Results: At baseline, 36% had IBS-D, 31% IBS-M, and 34% IBS-C. Except for stool frequency, there were no differences between groups. While the proportion of subjects in each subgroup remained the same over the year, most individuals (more than 75%) changed to either of the other 2 subtypes at least once. IBS-M was the least stable (50% changed out by 12 weeks). Patients were more likely to transition between IBS-M and IBS-C than between IBS-D and IBS-M. Notably, only 29% switched between the IBS-D and IBS-C subtypes over the year. Conclusions: While the proportion of subjects in each of the IBS subtypes stays the same, individuals commonly transition between subtypes, particularly between IBS-M and IBS-C. We recommend that IBS-A be defined as at least one change between IBS-D and IBS-C by Rome II criteria over a 1-year period.
http://www2.gastrojournal.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=as0016508504021973&nav=abs
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Overlapping Conditions in Women With Irritable Bowel Syndrome
Margaret Heitkemper; Monica Jarrett
Abstract
Irritable bowel syndrome is a common and often unpredictable disorder with an increased incidence among women. It is characterized by abdominal pain associated with constipation-diarrhea. Recent research, current theories about etiology and pathophysiology, diagnosis, management, and overlapping conditions such as interstitial cystitis and chronic pelvic pain are discussed.
Introduction
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders diagnosed in the United States. IBS is characterized by abdominal pain and alterations in bowel patterns (such as diarrhea, constipation). It is estimated that 10% to 17% of the general population are affected by varying degrees of symptoms. These symptoms account for absences from school, missed work, reduced productivity, diminished quality of life, as well as tremendous costs associated with treating this disorder.
In 2000, the direct and indirect costs of diagnosis and symptom management of IBS were estimated to be $1.66 billion, making it not only costly to the individual but also to the health care system (Levy et al., 2001; Sandler et al., 2002). Leong and colleagues (2003) found that the total health care expenditures per year for the individual with IBS were $4,527 as compared to $3,276 for an age and gender-matched control in 1998. Excess surgeries are among the undesirable health care events related to an IBS diagnosis (Feld et al., 2003). In addition to health care utilization, the impact of IBS has been measured in the poorer quality of life of patients as well as missed work/school and reduced productivity (Motzer, Hertig, Jarrett, & Heitkemper, 2003; Whitehead, Burnett, Cook, & Taub, 1996).
In most countries, including the United States, the prevalence of IBS is approximately 2 to 2.5 times greater in women than men (Camilleri & Choi, 1997). This imbalance has prompted clinicians and investigators to examine factors that account for gender differences in IBS (for review see Chang & Heitkemper, 2002). Such studies have demonstrated that women with IBS are more likely to report a history of constipation whereas men are more likely to report diarrhea. In addition, women with IBS are more likely than men to report extra-intestinal disorders including migraine headaches, bladder discomfort, dyspaurenia, and chronic pelvic pain (Lee, Mayer, Schmulson, Chang, & Naliboff, 2001). The focus of this article is to explore current thinking related to the etiology and pathophysiology of IBS along with its relation to other pelvic organ conditions especially chronic pelvic pain (CPP) and interstitial cystitis (IC). Finally, diagnosis and management of IBS will be discussed.
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Section 1 of 6 Next Page: Etiology and Pathophysiology
Margaret Heitkemper, PhD, RN , is a Professor and Chairperson, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA.
Monica Jarrett, PhD, RN , is an Associate Professor, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA.
Urol Nurs. 2005; 25 (1): 25-31. ©2005 Society of Urologic Nurses and Associates
To continue this article, click here http://www.medscape.com/viewarticle/499502
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Women and Men Perceive Pain Differently
Jennifer Wider, M.D.
Society for Women's Health Research
August 25, 2005
Pain seems to affect women and men differently, even at early ages. Studies have shown that women report pain more often than men. Certain studies even suggest that women can handle and cope with pain better than their male counterparts.
As young children, boys are socialized to cope with pain differently than girls. Boys are expected to internalize their feelings when they get hurt, while girls aren't expected to hide their emotions when they're injured. But research has shown that male and female babies exhibit different responses to pain only hours after birth. Therefore, other factors must be at play.
Past studies suggest that men and women use different pathways in the brain when it comes to pain.
"Men and women both have pain and both can inhibit pain, but may do so by the activation of neural mechanisms that are different in each sex," said Jeffrey Mogil, Ph.D., who serves as the E.P. Taylor Professor of Pain Studies at McGill University in Montreal.
While social expectations and the brain definitely play a role in pain perception, there are other factors involved. It has been shown that a woman's pain threshold varies throughout her menstrual cycle, suggesting a potential role for estrogen and progesterone. For example, some women with migraine headaches complain that the pain gets worse during menstruation.
Chronic pain conditions including osteoarthritis, temporomandibular joint disorder, fibromyalgia and migraines affect women more frequently than men. "Women feel more pain, seek help more aggressively, and make more active attempts to cope with pain than men," said Mark Young, M.D., of John Hopkins University in Baltimore, in his book "Women and Pain." Pain conditions often hit women harder during their childbearing years, further suggesting that hormones play a role.
Examining the way pain medications work may hold the key in understanding the differences between the sexes. Mogil and colleagues have conducted many studies in the field of pain genetics, thoroughly researching gender differences in pain perception. They discovered that certain pain medications actually work better in women than in men.
Researchers at the University of California in San Francisco discovered that female patients achieved better pain control than male patients from kappa opioids, a well-known class of pain relievers, after surgery to remove their wisdom teeth. In 2000, Australian researchers at the University of New South Wales showed in a randomized controlled trial that ibuprofen, the active ingredient in several over-the-counter medications, works more effectively in men.
It is obvious that the perception and modulation of pain among women and men differ. But, "we aren't doing enough to understand and close this gender gap," Young said. More research is needed to further understand the role that gender plays in the response to pain and pain relief.
August is National Pain Awareness Month. The observance is sponsored by the National Pain Foundation and the American Academy of Pain Medicine. You can learn more by visiting the pain foundation's Web site at www.painconnection.org.
Sources
Moir, Anne, and David Jessel. Brain Sex: The real difference between men and women. Dell, New York, 1992.
Young, Mark. Women and Pain: Why It Hurts and What You Can Do. Hyperion, New York, 2001.
© August 25, 2005 Society for Women's Health Research
http://www.womenshealthresearch.org/press/newsservice/082505.htm
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Women With Interstitial Cystitis at Risk for Irritable Bowel Syndrome and Depression
NEW YORK (Reuters Health) Sept 01 - Compared to women without bladder problems, women with interstitial cystitis are more likely to have irritable bowel syndrome and depression, researchers report. They hypothesize that bladder and bowel pain may cause depression in this population.
Dr. Joseph M. Novi, of the University of Pennsylvania, Philadelphia, and colleagues conducted a case-control study comparing 46 women with newly diagnosed interstitial cystitis and 46 similar but unaffected women presenting for annual gynecologic examination. Standardized, validated questionnaires were used to collect data.
Among the women with interstitial cystitis, 20 (43%) were diagnosed with irritable bowel syndrome, the team reports in the September issue of the Journal of Urology. Five of the control women (11%) were diagnosed with irritable bowel syndrome.
The odds ratio for irritable bowel syndrome associated with interstitial cystitis was11 (p < 0.001). No significant difference in the frequency of irritable bowel syndrome was observed between women with severe interstitial cystitis and those with mild interstitial cystitis.
A total of 19 cases (41%) and five controls (11%) had symptoms of major depression, for an odds ratio of 4 (p = 0.01). The association with depression was significantly higher among women with severe interstitial cystitis than among those with mild interstitial cystitis (OR 10.1).
The investigators found that in the interstitial cystitis group, women with depression were significantly more likely to complain of bladder pain, nocturia, abdominal pain, and other bowel symptoms than those without depression.
"A common pathogenesis, that is the interaction of mast cells with nerve cells to produce neurogenic inflammation and pain, has been proposed for interstitial cystitis and irritable bowel syndrome," Dr. Novi and colleagues comment.
"We hypothesize that pain associated with irritable bowel syndrome and interstitial cystitis is a causal factor in depression in these women," they write. They suggest that appropriate pain management techniques may improve depression symptoms.
J Urol 2005;174:937-940.
http://www.medscape.com/viewarticle/512005
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Gut 2005;54:1396-1401; doi:10.1136/gut.2004.058685
© 2005 by BMJ Publishing Group Ltd & British Society of Gastroenterology
gut.2004.058685v1
54/10/1396
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Sex specific alterations in autonomic function among patients with irritable bowel syndrome
K Tillisch1, E A Mayer2, J S Labus3, J Stains3, L Chang4 and B D Naliboff5
1 CNS/WH: Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
2 CNS/WH: Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Departments of Medicine, Physiology, and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
3 CNS/WH: Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
4 CNS/WH: Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
5 CNS/WH: Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
Correspondence to:
Dr K Tillisch
CNS/WH: Center for Neurovisceral Sciences and Women's Health, CURE Building 115, Room 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA;
ABSTRACT
Background: Irritable bowel syndrome (IBS) is associated with increased psychological symptoms, early life stressors, and alterations in visceral perception and brain responses to noxious visceral stimuli. The autonomic nervous system (ANS) is a likely mediator for these brain-gut interactions. The few studies directly examining ANS measures have been suggestive of alterations in some IBS patients, but no studies to date have examined the potentially critical variables of sex differences or response to visceral stimulation.
Aims: (1) To test differences in ANS function during rest and during a visceral stressor (rectosigmoid balloon distension) between IBS patients and healthy control subjects. (2) To examine the role of sex on the autonomic responses of IBS patients.
Methods: Baseline autonomic measures were evaluated from 130 Rome I positive IBS patients and 55 healthy control subjects. Data were also collected from a subset of 46 IBS patients and 16 healthy control subjects during a sigmoid balloon distension study. Heart rate variability measures of peak power ratio (PPR) and peak power high frequency (PPHF) were analysed to assess sympathetic balance and parasympathetic response, respectively. Peripheral sympathetic response was measured by skin conductance.
Results: IBS patients showed a greater skin conductance response to visceral distension than controls. IBS patients had higher PPR and lower PPHF across conditions. Male IBS patients had higher skin conductance and PPR than females and lower PPHF.
Conclusions: IBS patients have altered autonomic responsiveness to a visceral stressor, with increased sympathetic and decreased parasympathetic activity. These differences are predominantly seen in males.
http://gut.bmjjournals.com/cgi/content/abstract/54/10/1396
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American Journal of Obstetrics and Gynecology
Volume 193, Issue 6 , December 2005, Pages 2105-2111
doi:10.1016/j.ajog.2005.07.016
Copyright © 2005 Mosby, Inc. All rights reserved.
Transactions from the 31st Annual Scientific Meeting of the Society of Gynecologic Surgeons
Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence
John E. Jelovsek MD, , Matthew D. Barber MD, MHS, Marie Fidela R. Paraiso MD and Mark D. Walters MD
Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, The Cleveland Clinic Foundation, Cleveland, OH
Objective
The purpose of this study was 1) to determine the prevalence of functional bowel and anorectal disorders as defined by the Rome II criteria in patients with advanced pelvic organ prolapse (POP) and urinary incontinence (UI), and (2) to determine if the extent of prolapse on gynecologic examination is related to the subtypes of constipation or any functional anorectal pain disorder.
Study design
Three hundred and two consecutive female subjects presenting to a tertiary urogynecology clinic were enrolled. Demographic, general medical, and physical examination information, including POPQ measurements and a standardized sacral neurologic evaluation, were collected. The prevalence of functional disorders of the bowel, rectum, and anus as defined by the Rome II criteria were collected using the Rome II Modular questionnaire. Relationships of functional disorders to various components of the vaginal examination were reviewed.
Results
Thirty-six percent (108/302) met the criteria for constipation, including the following subtypes: 19% outlet constipation, 5% functional constipation, 5% constipation predominant irritable bowel syndrome (IBS), and 7% IBS-outlet. Nineteen percent (56/302) of subjects had IBS or 1 of its subtypes. Functional diarrhea was seen in 6% (17/302), fecal incontinence in 19% (58/302), and anorectal pain disorders in 25% (77/302). After controlling for age, parity, diabetes, constipating medications, and previous pelvic surgery, there were no differences in the prevalence of constipation or any of its subtypes between patients with UI and those with stage 3 or 4 POP. Fecal incontinence was independently associated with UI (adjusted odds ratio [OR] 6.3; 95% CI 2.6–19.1), but not advanced POP. Neither overall stage of POP nor stage of posterior vaginal prolapse was significantly associated with any of the functional bowel disorders, including constipation and its subtypes. Perineal body measurement was significantly longer in patients with outlet type constipation (mean 3.5 ± 0.6 cm vs 3.1 ± 0.9 cm, P < .01) and in those with proctalgia fugax (mean 3.4 ± 1.0 vs 3.1 ± 0.8, P < .05).
Conclusion
There is a high prevalence of constipation and anorectal pain disorders in women with urinary incontinence and pelvic organ prolapse. However, patients with stage 3 or 4 pelvic organ prolapse have similar rates of constipation compared with those with urinary incontinence. Constipation and its subtypes are not related to the stage of pelvic organ prolapse. It appears that either constipation is not a significant contributor to prolapse, or constipation contributes equally to the development of both urinary incontinence and pelvic organ prolapse.
Key words: Pelvic organ prolapse; Urinary incontinence; Constipation; Functional bowel disorders
Presented at the 31st Annual Meeting of the Society of Gynecologic Surgeons, April 4-6, 2005, Rancho Mirage, CA.
Reprint requests: John E. Jelovsek, MD, The Cleveland Clinic Foundation, Department of Gynecology and Obstetrics, 9500 Euclid Avenue/A81, Cleveland, OH 44195.
American Journal of Obstetrics and Gynecology
Volume 193, Issue 6 , December 2005, Pages 2105-2111
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W9P-4HPHP0W-1H&_user=10&_handle=V-WA-A-W-ZE-MsSAYVW-UUA-U-AABZBCUYWV-AABBEBAZWV-CAYVDDUYD-ZE-U&_fmt=summary&_coverDate=12%2F31%2F2005&_rdoc=43&_orig=browse&_srch=%23toc%236688%232005%23998069993%23612735!&_cdi=6688&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1ccf1c0d7e537286309144d801f02208
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Nat Clin Pract Gastroenterol Hepatol. 2006 May;3(5):256-266.
Therapy Insight: drugs for gastrointestinal disorders in pregnant women.
Thukral C, Wolf JL.
JL Wolf is an Attending Physician in the Division of Gastroenterology, Beth Israel Deaconess Medical Center, and an Associate Professor of Medicine, Harvard Medical School; C Thukral is a Fellow in the Division of Gastroenterology, Beth Israel Deaconess Medical Center and a Clinical Teaching Fellow, Harvard Medical School, Boston, MA, USA.
The management and treatment of gastrointestinal ailments in pregnant women requires special attention and expertise, since the safety of the mother, fetus and neonate remains the primary focus. Nausea and vomiting during pregnancy is common, as is symptomatic gastroesophageal reflux disease. Peptic ulcer disease occurs less frequently and with fewer complications. Gastroenterologists and obstetricians should be familiar with safe treatment options for these conditions, because they can profoundly impair the quality of life of pregnant women. During pregnancy, constipation can develop de novo, or chronic constipation can increase in severity. Given the array of therapies for constipation, physicians must apprise themselves of drugs that are safe for both mother and fetus. Management of acute, self-limited diarrhea should focus on supportive therapy, dietary changes and maintenance of hydration. Treatment of chronic diarrhea should be considered in the context of therapy for the underlying disorder. Inflammatory bowel disease and irritable bowel syndrome present a unique therapeutic challenge-to control the disease while minimizing toxicity to the fetus and mother. Initiation and alteration of medical therapy for gastrointestinal disorders during pregnancy must be undertaken after discussion with the patient's obstetrician.
PMID: 16673005 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16673005&query_hl=7&itool=pubmed_docsum
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Changes in Bowel Function: Pregnancy and the Puerperium
Authors: Derbyshire, Emma1; Davies, Jill; Detmar, Peter
Source: Digestive Diseases and Sciences, Volume 52, Number 2, February 2007, pp. 324-328(5)
Abstract:
Pregnancy is a time when women are susceptible to bowel habit perturbations. The purpose of this study was to provide new baseline data for a range of bowel habit parameters. Prospective 7-day bowel habit diaries were completed during each of the three trimesters of pregnancy and after birth. Sensations of incomplete evacuation and time spent defecating were significantly increased during all three trimesters of pregnancy compared with after birth (P < 0.05). Symptoms of urgency were higher in nonlactating mothers (41% of occasions) compared with lactating women (17% pf occasions) (P=0.07). This study has confirmed the importance of investigating a range of bowel habit parameters during and after pregnancy—investigation of constipation per se may obscure changes in individual bowel habit parameters.
http://www.ingentaconnect.com/content/klu/ddas/2007/00000052/00000002/00009538;jsessionid=1rok0j96gkkeg.victoria
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