Irritable bowel syndrome (IBS) is a complex clinical process with multiple pathophysiologic mechanisms. There has recently been a shift in the treatment of patients with severe IBS symptoms to disease-modifying therapies as opposed to symptomatic treatment. Because pathophysiologic differences exist between men and women, so does the efficacy of treatment options. These differences could further explain gender-related differences in disease prevalence and treatment response. A brief discussion of the definition, epidemiology, and diagnostic criteria of IBS is followed by a comprehensive review of the current treatment choices and potential future therapeutic options of IBS in women.
Irritable bowel syndrome (IBS) has been defined as a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habits, along with features of unsatisfactory defecation. Characterized by cramping, abdominal pain, bloating, constipation, or diarrhea, IBS affects an estimated 58 million individuals in the United States. It is considered among the most frequent causes of outpatient gastroenterology consultations in the Western world and statistically one of the most common functional gastrointestinal (GI) disorders worldwide.
Epidemiology and prevalence
It has been frequently noted that women bear much of the burden of IBS, with twice as many women as men seeking treatment for IBS in the United States. Whether the increased prevalence in female patients means that women are more willing than men to report IBS-related symptoms, or if it means that women are biologically predisposed to IBS is still not clear. However, there are associations between the diagnosis of IBS and psychiatric diagnoses, such as anxiety and depression, and pain syndromes, such as fibromyalgia, chronic fatigue syndrome, and migraine headaches, all of which are seen more frequently women. A population-based study evaluating the prevalence of IBS symptoms among healthy university students supported this increased prevalence seen in the general public, with 15.7% prevalence in women compared with 7.7% prevalence in men (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7–2.9; P <.0001). In particular, constipation-predominant IBS (IBS-C) was more frequently associated with women than with men (OR, 6.4; 95% CI, 4.1–9.7; P <.001). Subsequent studies have also reported that women with IBS had a lower quality of life (QoL) score and reported more fatigue, depressed mood, and levels of anxiety, and less positive self-esteem and well-being compared with men with IBS, underlying the need for further review of the impact of IBS in the female population.
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