There’s a hidden gender gap when it comes to digestive problems, with women taking the lead in this unpleasant contest. While men are hardly immune to gastrointestinal woes, certain digestive problems are considerably more common in women. “Women aren’t broken—they’re just different,” says Dr. Jeanetta Frye, a gastroenterologist at the University of Virginia in Charlottesville. For one thing, she says, “women have more visceral hypersensitivity so they may feel gastrointestinal symptoms more intensely.”
Symptom sensitivity aside, there’s clear evidence that certain digestive disorders are more likely to affect women than men. Irritable bowel syndrome (IBS)—a disorder that involves repeated bouts of abdominal pain and changes in bowel movements (diarrhea, constipation, or alternating bouts of the two)—is two to six times more common among women than men. Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, affects twice as many women as men, according to the American College of Gastroenterology.
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In addition, celiac disease—an autoimmune disorder that causes bloating, chronic diarrhea, constipation, gas, and other GI symptoms and is triggered by eating gluten—is diagnosed nearly twice as often in women as in men. And functional dyspepsia (a.k.a. chronic indigestion) is also more common in women. So is a lesser known brain-gut disorder called cyclic vomiting syndrome—characterized by recurrent episodes of nausea, vomiting, and dry heaving, separated by symptom-free periods in between, says Dr. David Levinthal, a gastroenterologist and director of the Neurogastroenterology and Motility Center at the University of Pittsburgh Medical Center.
Across the board, “disorders of gut-brain interaction are more prevalent in women than men,” Levinthal says, and the same is true of motility disorders like gastroparesis (delayed emptying of the stomach) and chronic constipation.
A mysterious gender gap
Why are women more susceptible to GI disorders? What is it about being born female that puts their digestive systems at risk? The answer is complicated and not completely understood.
This much is known: Reproductive hormones may play a role. “The female hormones estrogen and progesterone have a profound effect on the GI tract in terms of motility, pain sensitization, and how the brain delivers messages to the GI tract,” explains Dr. David Johnson, chief of gastroenterology at Eastern Virginia Medical School in Norfolk and past president of the American College of Gastroenterology. As a result, women may experience flare-ups of GI disorders at certain times of the month (such as during menstruation) or during pregnancy.
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For another thing, “women have a more easily activated immune system than men do,” says Levinthal. This is significant because immune function, including inflammatory processes, plays a role in celiac disease and inflammatory bowel disease.
What’s more, the gastrointestinal tract itself is longer in women, and that difference in length can affect transit time through the GI tract, Johnson says. In addition, women’s stomachs empty slightly more slowly than men’s do—“why that is isn’t known,” says Levinthal, but it may explain women’s greater susceptibility to gastroparesis. Research also suggests that the intestine’s nerve cells are more sluggish in women, which may be why IBS and gastroparesis are more common in women.
Another possible contributing factor has to do with psychological issues. “Anxiety and depression, which are more common in women than men, can worsen the severity of disordered gut function,” Levinthal says. “Feeling stressed or depressed or anxious is linked with how our guts work.” When you’re stressed out or anxious, you may be more likely to experience flare-ups of these GI disorders.
Giving your gut the right TLC
Regardless of gender, it’s important to “do everything you can to be proactive about your digestive health rather than just reactive,” Johnson says. That means staying well hydrated and consuming a healthy diet rich in plant-based foods (like fruits, vegetables, whole grains, legumes, nuts, and seeds), and lean protein, and avoiding sugary, highly processed foods.
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In particular, “fiber helps good bacteria flourish in the gut,” Johnson says, which contributes to the health of the gut microbiome, the community of bacteria and other microbes that naturally live in the GI tract. Research has found a strong correlation between gut bacteria and the risk of GI disorders such as IBS, IBD, and others.
Being proactive about your gut health also means taking steps to manage stress, get plenty of sleep, and exercise regularly. “The more you move your body, the more your gut is moving, too,” says Dr. Samuel Akinyeye, a gastroenterologist at the Ohio State University Wexner Medical Center. That movement is likely to help with many of these disorders.
If these measures don’t help sufficiently, there’s no reason to suffer alone. Medications and other treatments are available for all of these digestive disorders. “If you have symptoms you don’t understand, talk to a gastroenterologist,” Frye advises. “A lot of women are embarrassed to talk about their GI symptoms—I want them to feel empowered to discuss them. I tell my patients that it’s a safe space, and I’m not embarrassed to hear anything. This is why I’m here.”
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