Gender / Hormones
#13955 - 07/14/03 01:57 PM
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Heather
Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA
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All articles that are gender-specific or related to the role hormones in IBS should be posted here.
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Gastroenterology June 2003 • Volume 124 • Number 7
Sex-related differences in IBS patients: Central processing of visceral stimuli
Bruce D. Naliboff*,‡ * [MEDLINE LOOKUP]
Steve Berman*,‡,§ [MEDLINE LOOKUP]
Lin Chang*, § [MEDLINE LOOKUP]
Stuart W.G. Derbyshire* [MEDLINE LOOKUP]
Brandall Suyenobu*,‡ [MEDLINE LOOKUP]
Brent A. Vogt'' [MEDLINE LOOKUP]
Mark Mandelkern¶ [MEDLINE LOOKUP]
Emeran A. Mayer*,‡,§,¶,# [MEDLINE LOOKUP]
Abstract
Background & Aims: Women have a higher prevalence of irritable bowel syndrome (IBS) and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.
Methods: Regional cerebral blood flow measurements using H215O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus (moderate rectal inflation) and a psychological stimulus (anticipation of a visceral stimulus).
Results: In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.
Conclusions: Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.
Publishing and Reprint Information
*Center for Neurovisceral Sciences and Women's Health UCLA School of Medicine, Los Angeles, California, USA
§Department of Medicine, UCLA School of Medicine, Los Angeles, California, USA
‡Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, California, USA
#Department of Physiology, UCLA School of Medicine, Los Angeles, California, USA
''Brain Research Institute, UCLA School of Medicine, and VA GLAHS PET Center, Los Angeles, California, USA
''Cingulum NeuroSciences Institute, Syracuse, New York, USA
Supported by National Institutes of Health grants NR 04881 (to B.D.N.), DK 64539 (to E.A.M.), and AR 46122 (to L.C.). Lin Chang received research support from Astra Zeneca, participates in the Speaker's Bureau for GSK and Novartis, and is on the Advisory Board for GSK and Merck. Dr. Derbyshire's current address is: University of Pittsburgh Medical Center, MR Research Facility, PUH B-804, Pittsburgh, Pennsylvania 15213.
*Address requests for reprints to: Bruce D. Naliboff, Ph.D., GLAVAHS, CURE Building, 115/Room 223, 11301 Wilshire Boulevard, Los Angeles, California 90073, USA; fax: (310) 794-2864; Email: naliboff@ucla.edu
Submitted June 18, 2002.
Accepted on February 27, 2003.
Copyright © 2003 by American Gastroenterological Association
doi:10.1016/S0016-5085(03)00400-1
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Irritable Bowel Syndrome Worse During Periods
By Salynn Boyles
WebMD Medical News
March 14, 2002 -- Women who suffer from irritable bowel syndrome often experience a worsening in symptoms during their periods, suggesting that fluctuations in sex hormones may play a role in the condition, British researchers report.
The findings may help explain why more women than men are afflicted with irritable bowel syndrome (IBS), an intestinal condition characterized by gas, bloating, cramps, and changes in bowel habits. Some people with IBS experience constipation, some have diarrhea, and some have both.
"Women with IBS appear to respond differently to hormonal cycles than women without the syndrome," says lead author Lesley A. Houghton, PhD, of the University Hospital of South Manchester. "The potential role of sex hormones in [development] of IBS needs to be taken into consideration by those working on new medications for the disease."
In their research, Houghton and colleagues used balloon distention of the rectum -- a common tool for studying IBS -- to measure sensitivity changes among women with the disorder during different phases of their menstrual cycle. They showed, for the first time, that rectal sensitivity in women with IBS increases during their periods, compared with all other phases in the cycle. This was not true of women without IBS.
Periods were associated with a worsening of abdominal pain and bloating in those with IBS, and trips to the bathroom were more frequent. In addition, the women tended to report lower general well-being during their periods. The findings were reported in the latest issue of the journal Gut.
It is estimated that from 15-20% of the population suffers from irritable bowel syndrome. Symptoms can range from mildly annoying to disabling. Many people are able to control their symptoms through medications, stress management, and diet, but for some these treatments offer little relief.
Because the cause of IBS is not known, many doctors believe its origins are primarily psychological rather than physiological. Gastroenterologist Brenda Horwitz, MD, of Philadelphia's Temple University Health Sciences Center, says studies like this one add validity to the idea that IBS is truly a disease.
"Many doctors think that it is a psychological disease," she tells WebMD. Clearly it is not, and this is good scientific evidence to show that. These women experienced changes in sensitivity during their menstrual cycles that were different from the normal control population.'
Horwitz agrees that the findings could someday lead to better therapies to treat irritable bowel syndrome. Hopes for better treatments have been dampened over the past several years, as promising new drugs were withdrawn from the market due to unacceptable side effects.
"This is a field that is in desperate need of new treatment strategies," Horwitz says. "The standard treatments we are using have been out there for 15 to 20 years."
© 2002 WebMD Inc. All rights reserved.
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Women Health. 1998;27(4):55-66.
Bowel dysfunction in postmenopausal women.
Triadafilopoulos G, Finlayson M, Grellet C.
Gastroenterology Section, Palo Alto VA Health Care System (111-GI), CA 94304, USA. vagt@leland.stanford.edu
BACKGROUND/AIMS: The perimenopausal and postmenopausal states are frequently accompanied by a variety of symptoms of hormonal imbalance. Although vasomotor, vaginal and genitourinary symptoms prevail, gastrointestinal complaints such as abdominal bloating may occur. In this study, we investigated the nature and prevalence of gastrointestinal and irritable bowel syndrome (IBS)-type complaints in women going through their climacteric and postmenopausal periods. PATIENTS/METHODS: 228 women (170 postmenopausal and 58 premenopausal) who presented for evaluation at a primary care practice limited to women's health were evaluated prospectively by a previously validated gastrointestinal symptoms questionnaire designed to evaluate symptoms suggestive of IBS. At the time of their participation in the study, none of these women was presenting for evaluation of abdominal or genitourinary symptoms. RESULTS: Thirty-eight percent of postmenopausal women reported altered bowel function, in contrast to 14% of premenopausal ones (p < 0.001). Despite this, the two groups did not differ in regards to the occurrence of abdominal pain, diarrhea or constipation, suggestive of IBS. The prevalence of IBS-type complaints peaked to 36% during the climacteric period (40-49 years). Laxative usage (9.4% prevalence), gaseousness/excessive flatulence (48% prevalence) and heart-burn/acid regurgitation (34% prevalence) were also more common among postmenopausal women. Estrogen use did not affect gastrointestinal symptoms in any of the two groups. CONCLUSIONS: Although the possible role of aging on symptom perception-regardless of hormonal status-cannot be ruled out, these results suggest that peri- and postmenopausal women have a high prevalence of altered bowel function and IBS-like gastrointestinal complaints that should be carefully assessed. If the diagnosis of IBS is confirmed, appropriate treatment may improve patients' symptoms, although this approach requires further study.
PMID: 9796084 [PubMed - indexed for MEDLINE]
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Scand J Gastroenterol. 2003 Jan;38(1):36-42.
Gender differences in gut transit shown with a newly developed radiological procedure.
Sadik R, Abrahamsson H, Stotzer PO.
Division of Gastroenterology, Institute of Internal Medicine, Sahlgrenska University Hospital, University of Goteborg, Goteborg, Sweden. riadhsadik@hotmail.com
BACKGROUND: Gut transit measurements are essential for understanding the pathophysiology of many gastrointestinal disorders. The ideal bowel transit test should be easy to perform, widely accessible, reproducible, non-invasive and inexpensive and the risks should be minimal. These requirements prompted us to develop a procedure for simultaneous measurement of gastric emptying, small-bowel transit and colonic transit at one visit. We assessed the influence of gender, body mass index, age, menopause and smoking on gastrointestinal transit in healthy subjects. METHODS: Eighty-three healthy subjects (43 women) were included. Colonic transit was based on 10 radiopaque rings given daily for 6 days with fluoroscopy on day 7. Then, the subjects had a test meal containing 20 radiopaque markers. Using fluoroscopy, gastric emptying and small-bowel transit of the markers were followed until they reached the colon. RESULTS: Gastric emptying, small-bowel transit and colonic transit were significantly slower in female healthy subjects compared to males (2.9 (1.6-4.9) h, median and percentile 10-90, versus 2.4 (0.7-3.7) h, P=0.005; 4.4 (2.1-11.1) h versus 3.2 (1.5-6.0) h, P=0.001; 1.5 (1.0-3.7) days versus 1.3 (0.8-1.9) days P=0.002), respectively. Small-bowel transit was significantly faster in women with overweight and in postmenopausal women compared to lean and premenopausal women, respectively. CONCLUSION: This procedure meets most of the requirements of the ideal bowel transit test and is easily performed at one visit. Small-bowel transit as well as gastric emptying and colonic transit were significantly slower for women.
PMID: 12608462 [PubMed - indexed for MEDLINE]
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Int J Fertil Womens Med. 2002 May-Jun;47(3):136-42.
Gender issues in the management of inflammatory bowel disease and irritable bowel syndrome.
Kane S.
Section of Gastroenterology, University of Chicago, Illinois 60637, USA.
Crohn's disease and ulcerative colitis are two chronic inflammatory diseases involving the gastrointestinal tract. While many aspects of the management of these diseases are identical for all patients, there are some issues that are specific to women that are not necessarily part of routine care. Such gender-specific issues as menses, fertility, pregnancy and menopause are often overlooked and mismanaged. Women have different psychological concerns as compared with men with regard to their self-image and impact of disease. Health care providers, regardless of their primary focus, should be aware of these differences and be familiar with general information. Irritable bowel syndrome is a prevalent condition that affects more women than men. Theories as to its underlying pathophysiology are still evolving, but what does appear clear is that women pose specific challenges to the management of this condition.
Publication Types:
Review
Review, Tutorial
PMID: 12081259 [PubMed - indexed for MEDLINE]
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Dig Dis Sci. 2002 Jan;47(1):236-7.
Physician perception of IBS management in women and men.
Borum ML.
Division of Gastroenterology, The George Washington University Medical Center, Washington, DC 20037, USA.
Irritable bowel syndrome is a common gastrointestinal disorder that is manifested by abdominal pain and an alteration in bowel habits. It is estimated to occur in approximately 20% of the US population and is diagnosed more frequently in women compared to men. The principles of management do not differ based upon gender. However, there is not data that has evaluated physician perception of IBS diagnosis and management. This study evaluated internal medicine physicians' perception of IBS in women and men. Sixty internal medicine physicians (30 men, 30 women) completed anonymous surveys evaluating their perception of the ease of diagnosis and management of IBS. A database was created and analyzed using Epi Info. Statistical significance was determined with chi-square tables that generated P values. IBS was more frequently diagnosed in women. There was a statistically significant difference in women with IBS being not easy to diagnose when compared to men with IBS (P = 0.0003). There was also a statistically significant difference in men with IBS being reported to be not easy to manage when compared to women with IBS (P = 0.0014). This study revealed that physicians perceive a difference in the ease of diagnosis and management of IBS based upon gender. Further research is necessary to gain insight into the influence of patient gender upon this disorder.
PMID: 11837728 [PubMed - indexed for MEDL web page INE]
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Gastroenterol Clin North Am. 1992 Dec;21(4):793-802. Related Articles, Links
Diagnosis and management of irritable bowel syndrome, constipation, and diarrhea in pregnancy.
West L, Warren J, Cutts T.
Department of Internal Medicine, University of Tennessee, Memphis.
Irritable bowel syndrome, constipation, and diarrhea may complicate a pregnancy. Complaints of IBS and constipation may be managed by nonpharmaceutical methods. A careful history should be conducted to determine whether these complaints are of an acute or a long-standing nature. Conservative treatment of IBS is recommended and may include stool-bulking agents, a high-fiber diet, elimination of offensive foods, and the behavioral treatment of passive muscle relaxation, biofeedback or supportive psychotherapy. Constipation is generally self-limiting. It also may be treated conservatively with stool-bulking agents, increases in dietary fiber, and the addition of pelvic muscle exercises, preferably using electromyographic biofeedback. Laxatives should be used judiciously (Table 1). Diarrhea is caused most often by infectious agents in pregnancy but may also be from food poisoning or a viral disease. Infectious diarrhea may be treated by mild antidiarrheal agents and safe antibiotics. Fluid replacement is the mainstay of treatment, and care should be taken, remembering that the treatment involves two patients. These complaints can generally be managed conservatively, but persistent cases should be investigated as in a nonpregnant patient.
Publication Types:
Review
Review, Tutorial
PMID: 1478735 [PubMed - indexed for MEDLINE]
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Gut. 1992 Jun;33(6):814-7.
Relation between hysterectomy and the irritable bowel: a prospective study.
Prior A, Stanley KM, Smith AR, Read NW.
Department of Gastrointestinal Physiology and Nutrition, Royal Hallamshire Hospital, Sheffield.
Some women with irritable bowel syndrome date the onset of symptoms to previous hysterectomy. To assess prospectively the incidence of gastrointestinal symptomatology arising de novo after hysterectomy, and to study the effect of surgery on pre-existing symptoms, 205 women completed a symptom questionnaire before and six weeks and six months after surgery. Beforehand, symptoms suggestive of irritable bowel syndrome occurred in 22% of patients. At six months after operation, 60% of these had improved or were symptom free while 20% had increased symptomatology. New gastrointestinal symptoms were present more than once per week in 10% of previously asymptomatic women. Constipation predominant irritable bowel syndrome was the commonest symptom complex seen de novo, occurring more than once per week in 5% of the group. No relation was found between new symptomatology and the type of hysterectomy, oophorectomy, or the administration of perioperative antibiotics. This study suggests that many women with pre-existing gastrointestinal symptomatology improve after hysterectomy. However, symptoms suggestive of irritable bowel syndrome do arise de novo in 10%. As hysterectomy is common, gastroenterologists can expect to see women presenting with post-hysterectomy problems.
PMID: 1624165 [PubMed - indexed for MEDLINE]
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Gastroenterol Nurs. 2001 May-Jun;24(3):129-37.
Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome?
Lustyk MK, Jarrett ME, Bennett JC, Heitkemper MM.
Department of Psychology, Seattle Pacific University, WA 98119, USA. klustyk@spu.edu
It has been proposed that physical activity moderates physiological or psychological responses to chronic conditions. The purpose of this study was to determine if women with a chronic functional gastrointestinal (GI) disorder, irritable bowel syndrome, had less active lifestyles than healthy controls and to test whether active women with irritable bowel syndrome had less severe recalled or daily reports of GI, psychological, and somatic symptoms than inactive women with irritable bowel syndrome. Questionnaires were used to measure GI and psychological distress and somatic symptoms in 89 women who participated in this study. A daily symptom and activity diary was kept for one menstrual cycle. Women with irritable bowel syndrome were significantly less likely to be active (48%) than control women (71%) (X2 = 3.4, p = .05). Within the irritable bowel syndrome group, active women were less likely to report a feeling of incomplete evacuation following a bowel movement than inactive women (p < .04), yet active women did not have less severe recalled psychological or somatic symptoms than inactive women. Active women with irritable bowel syndrome reported less severe daily somatic symptoms, which were accounted for by a lower level of fatigue (p = .003), but not daily GI or psychological symptoms. These results suggest that physical activity may produce select symptom improvement in women with irritable bowel syndrome.
PMID: 11847862 [PubMed - indexed for MEDL web page INE]
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Am J Gastroenterol. 2003 Feb;98(2):420-30.
Symptoms across the menstrual cycle in women with irritable bowel syndrome.
Heitkemper MM, Cain KC, Jarrett ME, Burr RL, Hertig V, Bond EF.
Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle 98195, USA.
OBJECTIVE: The purpose of this study was to describe the patterns of GI, somatic, and psychological symptoms across the menstrual cycle in women with irritable bowel syndrome, and to determine whether symptoms differed by oral contraceptive use or predominant bowel pattern. METHODS: A daily diary was used to assess symptoms across one menstrual cycle. Repeated-measures analysis of covariance, controlling for age and body mass index, was used to compare patterns of symptoms across the menstrual cycle by oral contraceptive use and predominant bowel pattern (diarrhea, constipation, alternating). Data from control women are presented for comparison. RESULTS: For somatic and psychological as well as GI symptoms, women with irritable bowel syndrome had higher symptom severity than did controls. Women with irritable bowel syndrome using oral contraceptives had lower cognitive, anxiety, and depression symptoms (p < 0.05, but not significant after multiple comparison adjustment), but no differences were seen for most symptoms of irritable bowel syndrome. All symptoms except diarrhea were highest in the alternating group and lowest in the diarrhea group, with the constipation group either intermediate or close to the alternating group. This pattern was significant after multiple comparisons adjustment for GI symptoms, and trending toward significance (p < 0.05, but not significant after multiple comparison adjustment) for menstrual, sleep, and cognitive symptoms. The strongest menstrual cycle effect was seen in somatic and menstrual symptoms. The pattern of symptoms over the menstrual cycle did not differ by predominant bowel pattern or by oral contraceptive use. CONCLUSIONS: Many of the symptoms examined differed by predominant bowel pattern and menstrual cycle phase, not just the GI symptoms. The menstrual cycle variation was similar regardless of oral contraceptive use or predominant bowel pattern.
PMID: 12591063 [PubMed - indexed for MEDLINE]
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Dig Dis Sci. 2000 May;45(5):952-9.
Sleep disturbance influences gastrointestinal symptoms in women with irritable bowel syndrome.
Jarrett M, Heitkemper M, Cain KC, Burr RL, Hertig V.
Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle 98195-7266, USA.
This analysis evaluated the association between sleep disturbance and gastrointestinal symptoms in women with and without irritable bowel syndrome (IBS), and examined the role of psychological distress in this relationship. Women with IBS (N = 82) reported considerably higher levels of sleep disturbance compared to controls (N = 35), using both retrospective seven-day recall and daily diary recall for two menstrual cycles (P < 0.05 on 8 of 10 measures). We used daily diary data to estimate the association between sleep disturbance and gastrointestinal symptoms, both across women (ie, whether women with high average sleep disturbance have higher average gastrointestinal symptoms) and within woman (ie, whether poorer than average sleep on one night is associated with higher than average gastrointestinal symptoms the following day). The regression coefficients for the across-women effect are large and highly significant in both groups (IBS, beta +/- SE = 0.46 +/- 0.08, P < 0.001; controls, 0.57 +/- 0.13, P < 0.001). The regression coefficients for the within-woman effect are considerably smaller and statistically significant only in the IBS group (IBS, 0.06 +/- 0.02, P = 0.006; control, 0.01 +/- 0.03, P = 0.691). These regression coefficients showed little change when daily psychological distress or stress was controlled for, the one exception being the coefficient for the across-women effect in the IBS group, which decreased substantially but still remained highly significant. Because it is possible that gastrointestinal symptoms could, in fact, cause poor sleep, we also fitted the temporally reversed model to evaluate the association between gastrointestinal symptoms on one day and sleep disturbance that night. The within-woman regression coefficients were nonsignificant in both the IBS and control groups. In conclusion, these results are consistent with the hypothesis that poor sleep leads to higher gastrointestinal symptoms on the following day among women with IBS.
PMID: 10795760 [PubMed - indexed for MEDLINE]
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Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome?
Maturitas 2003 Feb 25;44(2):133-40 (ISSN: 0378-5122)
Ruigomez A; Garcia Rodriguez LA; Johansson S; Wallander MA
Centro Espanol de Investigacion Farmacoepidemiologica (CEIFE), Madrid, Spain.
OBJECTIVE: Hormonal status could be involved in the occurrence of irritable bowel syndrome (IBS).
The authors examined the risk of developing IBS in women using hormone replacement therapy (HRT).
METHODS: Women 50-69 years old with at least one prescription for HRT during 1994-1999 were
identified from the General Practice Research Database in the UK (n=40, 119). An aged-matched cohort
of 50000 women who never used HRT was sampled from the source population where the HRT cohort
was ascertained. Women in the two cohorts were followed to assess the risk of development of IBS.
Authors performed a nested case-control analysis to assess the role of duration, route and regimen of
HRT use and other risk factors for IBS. The IBS diagnosis was validated by means of a questionnaire
sent to the general practitioners (n=660). RESULTS: The incidence rate of IBS per 1000 person-years
was 1.7 in the cohort of never HRT users and 3.8 among HRT users, respectively. Both current and past
users of HRT presented an increased risk of IBS compared to non-users, after adjusting for co-morbidity
and consultation patterns. This increased risk was observed irrespective of treatment duration, regimen
or route of administration of HRT.
CONCLUSION: The result suggests that HRT use is associated with an increased risk of IBS similar to the one observed among younger premenopausal women with endogenous oestrogenic activity.
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After Menopause, Women Have Same Severity of Irritable Bowel Syndrome As Men
By Maggie Schwarz
BALTIMORE, MD -- October 15, 2003 -- The higher severity of irritable bowel syndrome (IBS) that women experience in comparison with men diminishes after menopause, according to a study of over 800 patients.
Researchers compared severity of IBS symptoms and IBS-specific impairment of quality of life in 826 women and men with the syndrome. Olafur S. Palsson, PsyD, University of North Carolina, Chapel Hill, North Carolina, United States, reported their findings here October 12th at the 68th Annual Scientific Meeting of the American College of Gastroenterology.
Dr. Palsson explained that women have more severe symptoms of IBS, they need more medications, and they go to the doctor more than men with IBS.
To determine whether this greater severity changes with age, the investigators obtained responses to a questionnaire from 638 women and 188 men who were diagnosed with functional bowel disorders and met Rome II criteria for IBS. Their ages ranged from 18 to 76 years (mean 51.9 years). The questionnaires included the IBS Severity Index and the IBS and poorer quality of life (QoL) questionnaire.
Results showed that after the age of 50, the severity of IBS symptoms in women and men is identical. Women in postmenopausal age groups (50+ years of age) had significantly less severity overall for IBS (P<0.0001), abdominal pain (p<0.0001) and bloating (P<0.001), and had higher quality of life scores on the QOL (P<0.05), compared to younger women.
Women younger than 50 had higher IBS severity scores compared to same-age men, but these differences disappeared in older age groups.
Overall IBS-QOL scores were not significantly different between the genders in any age group. However, analysis of the eight content subscales of the IBS-QOL, controlling for IBS severity differences, showed that women differed from men on two scales, with more impaired scores on body image (P<0.05) and food avoidance (P<0.01).
Dr. Palsson said the reduced severity of IBS symptoms after menopause is due to the drop in sex hormones, which are known to make IBS symptoms worse. "Three-quarters of women with IBS say their IBS symptoms are worse during menses," he said.
The research should help physicians take the effect of the menstrual cycle into account when treating women with IBS, Dr. Palsson said.
The study was supported by Novartis Pharmaceuticals Corporation.
[Study title: IBS Severity and Health-Related Quality of Life Improve With Age in Women But Not in Men. Abstract 81]
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Gender Differences In Brain Response To Pain
Source: University Of California - Los Angeles
Date: 2003-11-05
A new UCLA study shows that different parts of the brain are stimulated in reaction to pain depending on gender. The research, which represents the largest gender-comparison study of its kind, focused on people with irritable bowel syndrome (IBS), one of the nation's most common chronic medical conditions. The findings may help develop and target better treatments for IBS and other illnesses.
"We are finding more scientific differences between men and women as we improve research methods and broaden study populations," said study co-author Dr. Emeran Mayer, UCLA professor of bio-behavioral sciences, and medicine, physiology and psychiatry. "This growing base of research will help us develop more effective treatments based on a new criteria: gender."
Dr. Mayer is the director of the new Center for Neurovisceral Sciences & Women's Health (CNS) at UCLA, which conducted the study.
Published in the June 2003 issue of the journal Gastroenterology, the study examined 26 women and 24 men with IBS. UCLA researchers took positron emission tomography (PET) brain scans of patients during mild pain stimuli.
Although researchers found some overlapping areas of brain activation in men and women, several areas of male and female brains reacted differently when given the same pain stimulus. The female brain showed greater activity in limbic regions, which are emotion-based centers. In men, the cognitive regions, or analytical centers, showed greater activity.
"The reason for the two different brain responses may date back to primitive days, when the roles of men and women were more distinct," said study co-author Dr. Bruce Naliboff, UCLA clinical professor of psychiatry and biobehavioral sciences, and co-director of CNS.
According to Naliboff, these gender differences in brain responses to pain may have evolved as part of a more general difference in stress responses between men and women. Men's cognitive areas may be more highly triggered because of the early male role in defending the homestead, where in response to stress and pain, the brain launched a calculated fight-or-flight reaction.
The female limbic regions may be more responsive under threat because of their importance in triggering a nurturing and protecting response for the young, leading to a more emotion-based response in facing pain and stress.
Naliboff noted that both responses have advantages and neither is better. In fact, under conditions of external threat, the different responses may lead to complementary behaviors between men and women.
In addition, researchers found that the anticipation of pain generated the same brain responses from study volunteers as the actual pain stimulus. "The brain is a powerful force in dictating how the body responds to pain and stress," said study co-author Dr. Lin Chang, UCLA associate professor of medicine and co-director of CNS.
The next step, according to Mayer, is to look at how the results of the study may impact treatment for IBS and other disorders. Mayer adds that one current drug for IBS, Lotronex, affects the limbic system and has worked more successfully in women than men.
UCLA's Center for Neurovisceral Sciences and Women's Health studies how the brain, stress and emotions impact the development of disorders that affect mainly women.
Irritable bowel syndrome affects 15 to 20 percent of Americans and causes discomfort in the abdomen, along with diarrhea and/or constipation.
The National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Nursing Research, both part of the National Institutes of Health, funded the study.
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This story has been adapted from a news release issued by University Of California - Los Angeles.
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Women More Sensitive to Pain Than Men
But study didn't find any racial differences in pain thresholds
THURSDAY, April 1 (HealthDayNews) -- Blacks and whites have about the same sensitivity to pain, but women appear to be more sensitive to it than men.
That's what Duke University researchers report in the April issue of the Journal of Pain.
"Many pain medications are addictive and have unpleasant side effects, so it's important for physicians to be able to understand exactly how much pain their patients are experiencing," lead researcher and psychologist Dr. Tavis Campbell said in a prepared statement.
He conducted the study while at Duke; he's now at the University of Calgary in Canada.
"This research supports well-established findings of slightly higher sensitivity to pain among women compared to men, but revealed no difference between whites and African-Americans," Campbell said.
Previous research and anecdotal evidence have suggested blacks are more sensitive to pain than whites. Campbell suggested pain assessment procedures may be responsible for such racial differences in pain sensitivity.
His study included 76 men and 59 women aged 25 to 45; 72 were black, the rest white. A blood pressure cuff was inflated on the arm of each study participant and left inflated for several minutes. That created an aching sensation. The participants rated their pain according to standard pain rating scales, which gauge both the intensity and the unpleasantness of the pain.
--Robert Preidt
SOURCE: University of Calgary, news release, March 29, 2004
Copyright © 2004 ScoutNews, LLC. All rights reserved.
http://www.healthday.com/view.cfm?id=518151
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Catching Colon Cancer in Women Can Be Tough
They're twice as likely as men to get inadequate sigmoidoscopy, study shows
TUESDAY, Jan. 27 (HealthDayNews) -- Women are up to twice as likely as men to have inadequate sigmoidoscopy exams due to inadequate depth of insertion.
That concern is raised by researchers at the San Francisco VA Medical Center (SFVAMC), who report their finding in the Feb. 1 issue of the American Journal of Medicine.
The study also found that failure to achieve adequate depth of insertion during sigmoidoscopy increases as patients, both men and women, age. The findings suggest a patient's age and sex are important factors when doctors are considering which colorectal cancer screening method to use.
Flexible sigmoidoscopy is one of the most common colorectal cancer screening tools. A sigmoidoscope -- a 60-centimeter-long flexible tube about the thickness of a finger -- is threaded into the patient's rectum and lower third of the colon. The sigmoidoscope has a tiny video camera that lets the doctor to examine the wall of the colon for any abnormalities, such as cancer or polyps.
This study included a review of more than 15,000 sigmoidoscopies. It found the percentage of sigmoidoscopies examinations that failed to reach 50 centimeters into the colon increased from 19 percent in women aged 50 to 59, to 32 percent in women aged 80 or older.
For men, those percentages were 10 percent in the younger group and 22 percent in the older group.
"I had been finding that a lot of my older patients were not getting adequate exams, and I wanted to know whether this was a widespread problem," researcher Dr. Louise Walter, a SFVAMC staff physician in geriatrics and assistant professor of medicine at the University of California, San Francisco, says in a prepared statement.
"I was initially approaching this as an age issue. But then the gender differences popped up. The most disturbing thing this study shows is that women are twice as likely as men to have an inadequate exam," Walter says.
More information
Here's where you can learn more about screening for colorectal cancer. http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_colon_and_rectum_cancer_be_found_early.asp?sitearea=
--Robert Preidt
SOURCE: University of California, San Francisco, news release, Jan. 26, 2004
Copyright © 2004 ScoutNews, LLC. All rights reserved.
http://www.healthday.com/view.cfm?id=517118
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Abdominal Bloating: Relation to Rectal Hypersensitivity and Menstrual Cycle
Lin Chang, MD
Abdominal bloating and visible abdominal distension are commonly reported by patients with IBS.[17] Despite the introduction of tegaserod, which has been shown to relieve symptoms of bloating in female patients with IBS-C,[18] bloating can still be challenging to treat because of the lack of understanding of the pathophysiologic mechanisms underlying these common symptoms.[19] While some patients with bloating have associated abdominal distension, others do not. Although patients with IBS with abdominal bloating, with and without associated visible abdominal distension, are quite similar in the majority of parameters, eg, those with both bloating and distension are more likely to be female, are more likely to report a greater perceived symptom severity, and are more likely to have less diurnal variation in symptoms.[20] In addition, abdominal bloating is reportedly worse in women during the late luteal and early menses phases of the menstrual cycle.[21]
Lea and colleagues[22] performed several studies to further evaluate the impact of these associated factors (ie, diurnal variation, abdominal distension, and menstrual cycle) in patients with IBS with bloating. In one study, they evaluated the diurnal variation of abdominal girth in 16 patients with IBS-C, 21 with IBS-D, and in 20 healthy control subjects. Abdominal distension was measured using a recently validated objective technique of Ambulatory Abdominal Inductance Plethysmography.[23] Abdominal girth was greatest in the early evening in approximately 60% of both IBS-C and IBS-D patients, but only correlated with worsening bloating symptoms in the IBS-C patients.
In a second study,[24] these investigators assessed whether rectal sensitivity differed between female patients with IBS with abdominal bloating, with and without increased abdominal distension (total n = 37). Those patients who did not exhibit physical abdominal distension (compared with healthy controls) had significantly lower rectal pain thresholds than both patients with IBS who were distended and healthy controls. The investigators concluded that the symptom of bloating in the absence of visible abdominal distension may be due to increased visceral sensitivity to gastrointestinal events.
In their third study, Lea and colleagues[25] sought to determine whether perimenstrual bloating is associated with abdominal distension. Abdominal girth was recorded for 24 hours in 12 women with IBS and in 10 healthy female volunteers during the various menstrual cycle phases. Both women with IBS and control females reported more bloating during menses and the premenstrual phase, although bloating was rated as more severe in the patients than in the controls. However, abdominal girth was not different between the different phases of the menstrual cycle in IBS patients or in controls. Taken in conjunction with the results from the first study and with the previous finding that rectal perception is increased during menses compared with the other menstrual cycle phases in women with IBS,[26] these results lend support to the hypothesis that abdominal bloating is related to visceral hypersensitivity in IBS.
Summary. Abdominal bloating is a common symptom reported by patients with IBS, although its pathophysiology is not well understood. Several findings suggest that abdominal bloating may be related to visceral hypersensitivity: (1) bloating without distension is associated with lowered rectal pain thresholds; (2) bloating is reported as worse in the premenstrual and early menses phases of the menstrual cycle; and (3) rectal sensitivity is increased during menses compared with the other phases in women with IBS. If abdominal bloating is related to visceral hypersensitivity, it is not clear whether this is due primarily to visceral hyperalgesia (ie, increased pain perception to noxious visceral events) or to a hypervigilance towards expected aversive events arising from the viscera.
http://www.medscape.com/viewarticle/480232
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Autonomic Cardiovascular Responses Are Impaired in Women With Irritable Bowel Syndrome.
Journal of Clinical Gastroenterology. 38(8):658-663, September 2004.
Waring, W Stephen BMedSci, MB MRCP(UK) *; Chui, Michelle BSc MB ChB +; Japp, Alan BSc, MB ChB +; Nicol, E Fiona BSc, MB FRCP ++; Ford, Mike J MD FRCP +
Abstract:
Goals: This study characterizes cardiovascular autonomic function in women with irritable bowel syndrome (IBS), using standardized techniques.
Background: Autonomic dysfunction is believed to contribute to abnormal gastrointestinal motility and visceral hypersensitivity in IBS. There is mounting evidence of generalized impairment of autonomic activity in patients with IBS.
Study: Thirty women aged 39 years (95% C.I. 25-53 years) diagnosed with IBS, and 30 age-matched healthy women were studied. The ratio of low frequency to high frequency heart rate variability domains (LF:HF ratio) was used to represent cardiac sympathovagal activity, and orthostatic testing and sustained isometric handgrip exercise were used as sympathetic stimuli. Parasympathetic activity was represented by the expiratory to inspiratory R-R interval (E:I) ratio during deep breathing at 6 minutes-1.
Results: LF:HF responses to handgrip exercise (316%, C.I. 134% to 498% vs. 107%, C.I. 15% to 153%; P < 0.05) and orthostatic testing (648%, C.I. 520% to 904% vs. 330%, C.I. 140% to 520%; P < 0.05) were higher in IBS patients than controls, and the E:I ratio was significantly lower (1.47, C.I. 1.33-1.61 vs. 1.20, C.I. 1.14-1.26; P < 0.01).
Conclusions: Autonomic cardiovascular function is impaired in IBS, manifest as attenuated cardio-vagal tone, and relative sympathetic excess during stimulated conditions.
(C) 2004 Lippincott Williams & Wilkins, Inc.
http://www.mdlinx.com/GILinx/thearts.cfm?artid=1041738&specid=13&ok=yes
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Gut 2004;53:1452-1458
© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology
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IRRITABLE BOWEL SYNDROME
Association between a functional polymorphism in the serotonin transporter gene and diarrhoea predominant irritable bowel syndrome in women
A Yeo1, P Boyd2, S Lumsden2, T Saunders2, A Handley1, M Stubbins1, A Knaggs2, S Asquith1, I Taylor2, B Bahari2, N Crocker2, R Rallan2, S Varsani2, D Montgomery2, D H Alpers3, G E Dukes3, I Purvis1 and G A Hicks3
1 Department of Discovery Genetics, GlaxoSmithKline, New Frontiers Science Park, Harlow, Essex, UK
2 Department of Discovery Genetics, GlaxoSmithKline, Stevenage, Hertfordshire, UK
3 Neurology and GI Centre of Excellence for Drug Discovery, GlaxoSmithKline, New Frontiers Science Park, Harlow, Essex, UK
ABSTRACT
Background and aims: Serotonin (5-hydroxtryptamine, 5-HT) is an important factor in gut function, playing key roles in intestinal peristalsis and secretion, and in sensory signalling in the brain-gut axis. Removal from its sites of action is mediated by a specific protein called the serotonin reuptake transporter (SERT or 5-HTT). Polymorphisms in the promoter region of the SERT gene have effects on transcriptional activity, resulting in altered 5-HT reuptake efficiency. It has been speculated that such functional polymorphisms may underlie disturbance in gut function in individuals suffering with disorders such as irritable bowel syndrome (IBS). The aim of this study was to assess the potential association between SERT polymorphisms and the diarrhoea predominant IBS (dIBS) phenotype.
Subjects: A total of 194 North American Caucasian female dIBS patients and 448 female Caucasian controls were subjected to genotyping.
Methods: Leucocyte DNA of all subjects was analysed by polymerase chain reaction based technologies for nine SERT polymorphisms, including the insertion/deletion polymorphism in the promoter (SERT-P) and the variable tandem repeat in intron 2. Statistical analysis was performed to assess association of any SERT polymorphism allele with the dIBS phenotype.
Results: A strong genotypic association was observed between the SERT-P deletion/deletion genotype and the dIBS phenotype (p = 3.07x10–5; n = 194). None of the other polymorphisms analysed was significantly associated with the presence of disease.
Conclusions: Significant association was observed between dIBS and the SERT-P deletion/deletion genotype, suggesting that the serotonin transporter is a potential candidate gene for dIBS in women.
http://gut.bmjjournals.com/cgi/content/abstract/53/10/1452
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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
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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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Clinical Gastroenterology and Hepatology
Volume 5, Issue 9, September 2007, Pages 1059-1064
doi:10.1016/j.cgh.2007.04.028
Copyright © 2007 AGA Institute Published by Elsevier Ltd.
Medical Presentation of Constipation From Childhood to Early Adulthood: A Population-Based Cohort Study
Denesh K. Chitkara, , , Nicholas J. Talley‡, G. Richard Locke III‡, Amy L. Weaver§, Slavica K. Katusic§, Heiko De Schepper‡ and Mary Jo Rucker
Background & Aims: Constipation is a common disorder in children and adults, but the role of gender and early life risk factors remains undefined. The aims of the study were as follows: (1) to estimate the incidence of medical presentation for constipation in a population-based birth cohort, and (2) to examine factors associated with constipation presentation from childhood to adulthood.
Methods: A birth cohort of all children born between 1976 and 1982 to mothers who were residents of Rochester, Minnesota, and who remained in the community until age 5 was used for this study. Medical visits for constipation were identified by diagnoses codes and chart review. Subjects were followed up based on their diagnoses accumulated while younger than 21 years old, and 80% of subjects remained in the area until 18 years of age.
Results: Of 5299 birth cohort members without constipation presentation before age 5, the overall age- and sex-adjusted incidence was 3.9 per 1000 person-years. A higher incidence for constipation in females occurred beginning at 13 years to early adulthood (rate ratio, 2.6 for 13–16 y and 4.2 for 17 to <21 y). Children with a diagnosis for constipation at younger than 5 years of age had a significantly higher incidence for subsequent medical visits for constipation through adolescence and early adulthood compared with the incidence rate of children without an early medical presentation (rate ratio, 4.5 for 5–8 y, 2.5 for 9–12 y, and 3.9 for 17–20 y).
Conclusions: Early medical presentation and female sex influence incident and repeat medical visits for constipation from childhood to early adulthood.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7GGW-4P5YK6F-1&_user=10&_coverDate=09%2F30%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=317be6cbdd8c8dfa61789a841cbe1ce3
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Hepatogastroenterology. 2007 Jul-Aug;54(77):1403-6.
Factors affecting the technical difficulty of colonoscopy.
Oh SY, Sohn CI, Sung IK, Park DI, Kang MS, Yoo TW, Park JH, Kim HJ, Cho YK, Jeon WK, Kim BI.
Department of Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, Korea.
BACKGROUND/AIMS: Colonoscopy is a standard diagnostic tool for screening and surveillance of diseases affecting the colon. Colonoscopy may be painful for patients and difficult for the endoscopist. The aim of this study was to identify the factors affecting the technical difficulty of a colonoscopic examination and to predict potential difficult patients who will undergo colonoscopy.
METHODOLOGY: A total of 646 outpatients were consecutively included in this study. Patient's age and gender, body mass index (BMI), prior surgical history, and the duration and symptoms of irritable bowel syndrome (IBS) were recorded before the procedure. The quality of bowel preparation, the difficulty of examination reported by the colonoscopist, the degree of patient pain, the degree of pain as reported by an observer, cecal intubation time andcolonoscopic findings were assessed after the procedure.
RESULTS: We evaluated the difficulty of colonoscopy by cecal intubation time. Advanced age (>50 years), female gender, low BMI (< or = 23 Kg/m2), poor bowel preparation, prior surgical history, patient pain and the presence of IBS were associated with prolonged cecal intubation time. A multivariate logistic regression analysis demonstrated that advanced age, female gender, low BMI, poor bowel preparation and patient pain were independent factors related to prolonged cecal intubation time.
CONCLUSIONS: In patients with advanced age, female gender and low BMI, information that colonoscopy may be difficult and painful should be provided. If a colonoscopy is not absolutely indicated, barium enema or CT colonography may be performed as alternative diagnostic modalities.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17708264&ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Rev Gastroenterol Mex. 2007 Jan-Mar;72(1):29-33.
Association of depression and anxiety in patients with irritable bowel syndrome
Cruz Ruíz MA, Ortíz Herrera RB, Muñiz Jurado D, Padierna Luna JL.
Gastroenterólogo adscrito Hospital General de Zona 4 IMSS, Celaya, Gto.
INTRODUCTION: The irritable bowel syndrome (SII) is characterized by alterations of intestinal motility and visceral sensibility, without organic cause. Is associated a psychiatric alterations and somatic symptoms in 80%, the anxiety or depression precede or is concomitants with gastrointestinal symptoms.
OBJECTIVE: To determine association between depression or anxiety on the basis of DSM-IV criteria and Scale of Hamilton in patients with criteria of Rome II.
DESIGN: A total one hundred patients were randomized in two groups: Hamilton for anxiety (n = 50) and DSM-IV for depression (n = 50), is correlated bi-variables (Pearson) in a descriptive and transversal study.
RESULTS: The female gender represented 76% (n = 76), the relation F/ M; 4:1, the age average 49.7 years (R 18-89). Group DSM-IV in 62% (n = 31) had depression and 54% (n = 27) were women. The group Hamilton in 58% (n = 29) presented anxiety and 50% were women (n = 25). The correlation of Pearson (P < 0.1) for the female with anxiety was of P < 0.05 and in depression of P < 0.01, using an IC 95%.
CONCLUSIONS: The manifestation of anxiety or depression appears in more of 50%, affects in greater proportion the female, reason why antidepressing therapy must be contemplated in the handling of the SII.
PMID: 17685197 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17685197&ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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World J Gastroenterol. 2007 Jul 21;13(27):3699-704.
Abnormal endogenous pain modulation and somatic and visceral hypersensitivity in female patients with irritable bowel syndrome.
Wilder-Smith CH, Robert-Yap J.
Brain-Gut Research Group, Bubenbergplatz 11, CH-3011 Berne, Switzerland.
AIM: To investigate the role of endogenous pain modulatory mechanisms in the central sensitization implicated by the visceral hypersensitivity demonstrated in patients with irritable bowel syndrome (IBS). Dysfunction of modulatory mechanisms would be expected to also result in changes of somatic sensory function.
METHODS: Endogenous pain modulatory mechanisms were assessed using heterotopic stimulation and somatic and visceral sensory testing in IBS. Pain intensities (visual analogue scale, VAS 0-100) during suprathreshold rectal distension with a barostat, cold pressor stimulation of the foot and during both stimuli simultaneously (heterotopic stimulation) were recorded in 40 female patients with IBS and 20 female healthy controls.
RESULTS: Rectal hypersensitivity (defined by 95% CI of controls) was seen in 21 (53%), somatic hypersensitivity in 22 (55%) and both rectal and somatic hypersensitivity in 14 of these IBS patients. Heterotopic stimulation decreased rectal pain intensity by 6 (-11 to -1) in controls, but increased rectal pain by 2 (-3 to +6) in all IBS patients (P < 0.05) and by 8 (-2 to +19) in IBS patients with somatic and visceral hypersensitivity (P < 0.02).
CONCLUSION: A majority of IBS patients had abnormal endogenous pain modulation and somatic hypersensitivity as evidence of central sensitization.
PMID: 17659729 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17659729&ordinalpos=23&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Urology. 2007 Jul;70(1):16-8.
Prevalence of pelvic floor dysfunction in patients with interstitial cystitis.
Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC.
Ministrelli Program for Urology Research and Education, Department of Urology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
OBJECTIVES: To evaluate the prevalence of pelvic floor dysfunction in women with interstitial cystitis (IC).
METHODS: Women with IC and pelvic pain were referred to the Beaumont Women's Initiative for Pelvic Pain and Sexual Health program. A comprehensive patient history and pelvic examination were completed by a certified women's health nurse practitioner.
RESULTS: Seventy women with a mean age of 45 years were evaluated. Of these 70 women 87% had levator pain consistent with pelvic floor dysfunction. The mean levator pain score was 4.48 out of 10. Nearly two thirds of these women (64%) had their pain for 5 years or more, whereas one quarter (24%) had their pain for 1 to 3 years. Half of the women reported irritable bowel syndrome, and more than one third (36%) reported urge urinary incontinence.
CONCLUSIONS: Women with IC may have pelvic floor dysfunction, as noted in this population in which 87% had levator pain upon examination. If pelvic floor dysfunction is diagnosed in IC patients, then therapy targeting the pelvic floor musculature may be considered as part of a multimodality approach to treating IC.
PMID: 17656199 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17656199&ordinalpos=24&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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J Korean Med Sci. 2007 Oct;22(5):851-4.
Irritable Bowel Syndrome Is More Common in Women Regardless of the Menstrual Phase: A Rome II-based Survey.
Lee SY, Kim JH, Sung IK, Park HS, Jin CJ, Choe WH, Kwon SY, Lee CH, Choi KW.
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Functional gastrointestinal disorders are more common in women in relation to the fluctuations of female sex hormones. We tried to know the gender-related differences in the prevalence of irritable bowel syndrome and gastrointestinal symptoms according to the menstrual phase.
A total of 253 women before menopause and 252 men below age 50 were examined by a gastroenterologist after completing the questionnaire. Blood tests, endoscopic procedures, and imaging studies were done, if needed. Women were subclassified into three groups according to their menst- ruation period; menstrual phase, proliferative phase, and secretory phase.
Finally, 179 men and 193 women were analyzed. Irritable bowel syndrome was more frequently noticed in women than in men (p=0.01). The diarrhea-dominant type was more common in men, while constipation-dominant or alternating types were more common in women (p<0.001). Of 193 women, there was no significant difference in their gastrointestinal symptoms according to their menstrual phase.
Regardless of the menstrual phase, gastrointestinal symptoms are more frequent in women. Physicians should consider different symptomatic manifestations between men and women should be considered when evaluating functional gastrointestinal disorders.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17982234&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Am J Gastroenterol. 1998 Oct;93(10):1867-72.
The menstrual cycle and its effect on inflammatory bowel disease and irritable bowel syndrome: a prevalence study.
Kane SV, Sable K, Hanauer SB.
Department of Medicine, University of Chicago, Illinois 60637, USA.
OBJECTIVE: Female patients with bowel disease commonly report worsening symptoms in relation to the menstrual cycle. Our aim was to determine the nature of gastrointestinal symptoms correlating with the menstrual cycle in women with inflammatory and irritable bowel disease.
METHODS: This was a retrospective study involving 49 women with ulcerative colitis (UC), 49 women with Crohn's disease (CD), 46 women with irritable bowel syndrome (IBS), and 90 healthy community controls. Participants were interviewed using a questionnaire including information regarding general health, medication history, pregnancy, as well as premenstrual and menstrual symptoms. Chi2 testing and logistic regression modeling were used to test for differences in frequencies between groups and for risk analysis.
RESULTS: Premenstrual symptoms were reported by 93% of all women but statistically more often by patients with CD (p < 0.01). CD patients were also more likely to report increased gastrointestinal symptoms during menstruation ( < 0.01), diarrhea being the symptom reported most often. All disease groups had a cyclical pattern to their bowel habits significantly more than controls (p=0.01). Cyclical symptoms included diarrhea, abdominal pain, and constipation. Logistic regression revealed an odds ratio (OR) of 1.1 (95% CI 0.9-1.2) for experiencing bowel symptoms during the premenstrual and menstrual phases and an OR of 2.0 (95% CI 1.2-3.2) for experiencing a cyclical pattern in bowel habit changes in women with bowel disease.
CONCLUSION: The prevalence of menstrually related symptoms is high, and appears to affect bowel patterns. The physiological and clinical effects of the menstrual cycle should be taken into consideration when assessing for disease activity.
PMID: 9772046 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9772046&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
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Acupunct Med. 2008 Mar;26(1):33-45.
Is it all about sex? Acupuncture for the treatment of pain from a biological and gender perspective.
Lund I, Lundeberg T.
Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects.
In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men.
Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences.
Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women. When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ.
Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.
PMID: 18356797 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18356797?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Twin Res Hum Genet. 2008 Apr;11(2):197-203.
No evidence of sex differences in heritability of irritable bowel syndrome in Swedish twins.
Svedberg P, Johansson S, Wallander MA, Pedersen NL.
1 Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Abstract Studies have shown that familial aggregation is of importance for abdominal symptoms including irritable bowel syndrome and there are a few reports of a moderate heritability for irritable bowel syndrome.
Sex differences in prevalence and incidence of irritable bowel syndrome have been demonstrated however less is known about sex differences in heritability. The objective was to investigate whether there were sex differences in heritability of irritable bowel syndrome while accounting for different prevalences among women and men in different age groups.
A sample of 45,750 Swedish twins, whereof 16,961 were complete twin pairs, participated in a telephone interview. The sample was divided into three age groups (40-54, 55-64 and 65 years and older) and the diagnosis of irritable bowel syndrome was operationally defined with a number of disorder specific symptoms.
Standard biometrical model fitting analyses were conducted using raw ordinal data from same-sex and opposite-sex twins. The prevalence of irritable bowel syndrome was greater among women than men and more prevalent at younger ages (e.g., women 10.3%, men 6.3% at ages 40-54 years vs. women 6.1%, men 4% at ages over 65 years).
The heritability of the disorder was approximately 25% in all age groups. We found no evidence for sex differences in heritability in any of the age groups, however, models allowing prevalences of irritable bowel syndrome to differ between sexes and age groups fitted best.
PMID: 18361721 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18361721?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Biol Psychol. 2010 Mar 1.
Gender-related differences in prepulse inhibition of startle in irritable bowel syndrome (IBS).
Kilpatrick LA, Ornitz E, Ibrahimovic H, Treanor M, Craske M, Nazarian M, Mayer EA, Naliboff BD.
Center for Neurobiology of Stress, David Geffen School of Medicine, UCLA, United States; Department of Medicine and Physiology, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, United States.
Alterations in central networks involved in the regulation of arousal, attention, and cognition may be critical for irritable bowel syndrome (IBS) symptom maintenance and exacerbation.
Differential sensitivities in these networks may underlie sex differences noted in IBS. The current study examined prepulse inhibition (PPI), a measure of sensorimotor gating, in male and female IBS patients.
Relationships between PPI and symptom severity were examined, as well as potential menstrual status effects.
Compared to healthy controls, male IBS patients had significantly reduced PPI; whereas female IBS patients (particularly naturally cycling women) had significantly enhanced PPI suggesting hypervigilance.
Considering previously demonstrated sex-related differences in perceptual and brain imaging findings in IBS patients, the current findings suggest that different neurobiological mechanisms underlie symptom presentation in male and female IBS patients.
Compromised filtering of information in male IBS patients may be due to compromised top down (prefrontal, midcingulate) control mechanisms while increased attention to threat due to increased limbic and paralimbic circuits may be characteristic of female IBS patients. Copyright © 2010. Published by Elsevier B.V.
PMID: 20193731 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20193731
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Am J Gastroenterol. 2010 Feb 23.
Differences in Gastrointestinal Symptoms According to Gender in Rome II Positive IBS and Dyspepsia in a Latin American Population.
Schmulson M, Adeyemo M, Gutiérrez-Reyes G, Charúa-Guindic L, Farfán-Labonne B, Ostrosky-Solis F, Díaz-Anzaldúa A, Medina L, Chang L.
Laboratory of Liver, Pancreas and Motility (HIPAM), Department of Experimental Medicine-Faculty of Medicine, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.
OBJECTIVES:Irritable bowel syndrome (IBS), constipation, and bloating are more prevalent in women than men, but gender differences associated with dyspepsia are inconsistent.The aim of this study was to determine gender differences in the prevalence of symptoms diagnostic for functional gastrointestinal disorders (FGIDs) in subjects with IBS and dyspepsia, as well as in controls in Mexico.
METHODS:A database of 1,021 subjects (61% women) who completed the Rome II Modular Questionnaire (RIIMQ) in Spanish Mexico was analyzed. Gender differences in the frequency of all symptoms included in the RIIMQ between those fulfilling criteria for IBS (28.9%), dyspepsia (4.0%) and controls without any FGIDs (38.2%) were studied. Subjects fulfilling criteria only for other FGIDs were excluded.
RESULTS:There were higher proportions of women with IBS (67.8%) and dyspepsia (85.4%) compared with the control group (55.9%) (P<0.001). In IBS, women more frequently reported changes in the number of bowel movements (BMs) associated with the onset of abdominal discomfort/pain, fewer than three BMs/week and abdominal fullness/bloating/swelling than men. Men with IBS more frequently reported swallowing air to belch and abdominal pain that improved after a BM than women. In controls, burping and hard or lumpy stools were both more frequent in men.
CONCLUSIONS:In Mexico, gender differences in FGIDs exist, with both IBS and dyspepsia being more common in women than men. In IBS, symptoms related to constipation and bloating were more common in women, but the dyspepsia group was too small to draw any conclusions. Finally, this is the first study to report that belching is more common in men than women controls not fulfilling criteria for any FGID.
Am J Gastroenterol advance online publication, 23 February 2010; doi:10.1038/ajg.2010.58.
PMID: 20179693 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20179693
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Constipation and Risk of Cardiovascular Disease among Postmenopausal Women
Elena Salmoirago-Blotcher, MDemail address
,
Sybil Crawford, PhD
,
Elizabeth Jackson, MD
,
Judith Ockene, PhD
,
Ira Ockene, MD
published online 10 June 2011.
Background
Constipation is common in Western societies, accounting for 2.5 million physician visits/year in the US. Because many factors predisposing to constipation also are risk factors for cardiovascular disease, we hypothesized that constipation may be associated with increased risk of cardiovascular events.
Methods
We conducted a secondary analysis in 93,676 women enrolled in the observational arm of the Women's Health Initiative. Constipation was evaluated at baseline by a self-administered questionnaire. Estimates of the risk of cardiovascular events (cumulative end point including mortality from coronary heart disease, myocardial infarction, angina, coronary revascularization, stroke, and transient ischemic attack) were derived from Cox proportional hazards models adjusted for demographics, risk factors, and other clinical variables (median follow-up 6.9 years).
Results
The analysis included 73,047 women. Constipation was associated with increased age, African American and Hispanic descent, smoking, diabetes, high cholesterol, family history of myocardial infarction, hypertension, obesity, lower physical activity levels, lower fiber intake, and depression. Women with moderate and severe constipation experienced more cardiovascular events (14.2 and 19.1 events/1000 person-years, respectively) compared with women with no constipation (9.6/1000 person-years). After adjustment for demographics, risk factors, dietary factors, medications, frailty, and other psychological variables, constipation was no longer associated with an increased risk of cardiovascular events except for the severe constipation group, which had a 23% higher risk of cardiovascular events.
Conclusion
In postmenopausal women, constipation is a marker for cardiovascular risk factors and increased cardiovascular risk. Because constipation is easily assessed, it may be a helpful tool to identify women with increased cardiovascular risk.
http://www.amjmed.com/article/PIIS0002934311002920/abstract?rss=yes
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Ayu. 2012 Apr;33(2):311-3. doi: 10.4103/0974-8520.105259.
Effect of fennel on pain intensity in dysmenorrhoea: A placebo-controlled trial.
Omidvar S, Esmailzadeh S, Baradaran M, Basirat Z.
Source
Research Scholar, Maternal and Child Health, Babol University of Medical Sciences and Health Services, Iran.
Abstract
The aim of this study was to determine the clinical effect of Foeniculum vulgare on primary dysmenorrhoea. Sixty virgin girls with complaints of dysmenorrhoea were enrolled in this study, out of which 50 cases were completed the course of treatment and were divided in two groups (study and placebo) and were under treatment for two cycles. In study group a capsule of 30 mg fennel extract, four times a day for three days from start of their menstrual period and in placebo a capsule containing wheat flour in same dose was administered. Intensity of pain was reported by using a 10 - point linear analogue technique. In study group the mean age of menarche was 13.1 ± 0.1 and onset age of dysmenorrhoea was 14.5 ± 0.1 years. Both groups were relieved but there was significant difference between study and placebo group. Study group shown more effective results than placebo in pain relief (P`0.05). Based on the observations, it can be concluded that, fennel is an effective herbal drug for menstrual pain.
KEYWORDS:
Fennel, Foeniculum vulgare, pain, primary dysmenorrhoea
PMID:
23559811
[PubMed]
PMCID:
PMC3611645
http://www.ncbi.nlm.nih.gov/pubmed/23559811
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Women, hormones, and IBS
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ASA Releases Women's Pain Update To Raise Awareness
Pain management in women is often overlooked and ineffective for a variety of conditions ranging from back pain to postsurgery cancer pain, according to the American Society of Anesthesiologists (ASA). In response, the ASA has issued the Women's Pain Update, in the hopes of raising awareness of available treatment options, as well as the role a pain medicine specialist can play in treating chronic and acute pain.
The ASA conducted a literature review of peer-reviewed studies related to women and pain that were published in 2014. According to Donna-Ann Thomas, MD, a member of ASA's Committee on Pain Medicine, many women have been suffering in silence for years.
"I can't tell you the number of women I see who have been told they just have to live with the pain," said Dr. Thomas in a press release, regarding women who come to her with sciatica pain. "It's just heart breaking because many of these women have been suffering a long time. Women—especially older women—are less likely to speak up and seek treatment for their pain."
The ASA suggests that patients who plan on seeking treatment from a specialist find physicians who are certified in a pain medicine subspecialty by the American Board of Medical Specialties.
Key findings from the ASA study report included the following:
• Women who received a nerve block with regional anesthesia during breast cancer surgery reported less postsurgery pain nausea and vomiting, and less morphine use than women who had general anesthesia.
• Women reported more postsurgery pain than men for 30 different types of surgery, ranging from appendectomy to knee replacement.
• There are no sex differences in the amount of fibromyalgia pain reported, but men are more likely to avoid activity to avoid pain.
• One in seven women are prescribed opioids while pregnant.
• Music eases labor pains, yoga relieves back pain and rose oil eases menstrual pain.
—AN Staff
Based on a press release from the ASA.
Studies Reviewed by the ASA
Maeda A, Bateman BT, Clancy CR, et al. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology. 2014;121(6):1158-1165.
Simavli S, Gumus I, Kaygusuz I, et al. Effect of music on labor pain relief, anxiety level and postpartum analgesic requirement: a randomized controlled clinical trial. Gynecol Obstet Invest. 2014;78(4):244-250.
Abdallah FW, Morgan PJ, Cil T, et al. Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection. Anesthesiology. 2014;120(3):703-713.
Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237-1245.
Sadeghi Aval Shahr H, Saadat M, et al. The effect of self-aromatherapy massage of the abdomen on the primary dysmenorrhoea. J Obstet Gynaecol. 2014 Sept 25. [Epub ahead of print]
Lee M, Moon W, Kim J. Effect of yoga on pain, brain-derived neurotrophic factor, and serotonin in premenopausal women with chronic low back pain. Evid Based Complement Alternat Med. 2014;2014:203173.
Racine M, Castarlenas E, de la Vega R, et al. Sex differences in psychological response to pain in patients with fibromyalgia syndrome. Clin J Pain. 2014 Oct 17. [Epub
http://www.anesthesiologynews.com/ViewArticle.aspx?d=Web%2bExclusives&d_id=175&i=January+2015&i_id=1138&a_id=29310
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