WOMEN'S GI
Women are twice as likely to develop gallstones as men because of the effects of estrogen and progesterone. Gallbladder emptying may be slowed by progesterone, a normal hormone secreted during the second half of the menstrual cycle and during pregnancy. Estrogen and progesterone affect the handling of cholesterol in the body. Because of the slowed emptying of the gallbladder as well as an increase of cholesterol in the gallbladder, there is a greater chance for the development of gallstones.
Irritable Bowel Syndrome occurs 2 to 6 times more often in women than in men. One reason for this observation may be that women normally are more sensitive to irritants of the GI tract. In IBS, the patient is super sensitive to irritants that would not be bothersome to other people, such as increased gas in the gut.
The basis is believed to be a problem with how the nerves send the message to the brain, the interpretation that the brain makes, and it's a response back to the gut. In fact, if a person with IBS puts her hand in ice water, she can keep it in the bucket longer than someone who does not have this syndrome - she doesn't feel the pain/discomfort of the ice water as rapidly as a non-IBS sufferer. The problem lies within the sending of the message by the nerves.
If a person has some emotional stress, the IBS response appears to be amplified. Additionally, the gut becomes somewhat hyperactive and the patient may experience either diarrhea, constipation, or forms of both.
The good news is that there is no damage to the intestinal lining. This is a "functional" problem - that is, the bowel is not functioning at a normal level, but at a super- or suboptimal level.
Currently, there is no one treatment for this disorder. However, research is ongoing and new therapies will be forthcoming. In the meantime, lifestyle changes are recommended including the development of coping strategies for life stresses. This is a chronic condition and many patients have reached a satisfactory result working with their physicians as a team.
Inflammatory Bowel Disease (IBD) is a serious problem and is made up of predominantly two disorders: Crohn's Disease (inflammation through the intestinal wall) and Ulcerative Colitis(inflammation of the colon lining). IBD is more frequent in women with a ratio of about 2:1. Women may have a milder course of Crohn's Disease, especially if they have given birth to several children. Although older literature suggested that more women developed ulcerative colitis, the more recent work does not support this.
The main problem for women in IBD is when they become pregnant. Women may either get better, get worse, or remain unchanged when they become pregnant. The response seems to be triggered by the hormones associated with pregnancy and is expected to be similar for all subsequent pregnancies in the same individual.
Colon cancer in women can be associated with breast cancer, lack of giving birth to children, and the appearance of cancer on the right side of the colon. Some investigators have also suggested a correlation with surgical removal of the gallbladder, although this occurs many years after the surgery.
Of interest, although women aged 55 or younger seem to have higher frequencies of colon cancer than men, Hormonal Replacement Therapy (HRT) with estrone and not estradiol as the major component, seems to protect against colon cancer.
Colon cancer is the number 3 cancer for women in the United States. Women should be advised to follow current guidelines to be screened at age 50, and talk to their doctors if they have a family history of the disease, which means they should be screened at an earlier age.
Nausea may occur more often in women. Other symptoms, such as a feeling of fullness or bloating, pain in the belly, feeling full soon after eating, belching or burping that is annoying have also been reported more often in women. If these symptoms persist, women should see their physician to make sure that there is no serious underlying problem.
Many women use aspirin and aspirin-like compounds, known as NSAIDs (non-steroidal anti-inflammatory drugs.) Medications such as ibuprofen make up this class of medication. Some NSAIDs are available in over-the-counter form while others require a prescription. Women, especially older women, use these medications more than men for a variety of reasons. These drugs, used for a long time, are known to cause irritation to the stomach lining and may lead to bleeding from the stomach. Women who use NSAIDs chronically are at higher risk for developing stomach ulcers as well as gastritis. NSAIDs can decrease the level of mucus that the stomach normally makes to protect itself, and this may also increase the possibility that a patient will be likely to develop damage from the medication. In recent years new types of prescription NSAIDs have become available, such as COX-II inhibitors, which reportedly have a less adverse impact on the GI tract. Women should tell their doctors if they are using NSAIDs, whether it is prescribed or purchased in a drugstore. This way they can work with their physician to develop a regimen to help protect their stomach, should continued NSAID use be needed.
The muscle coordinating moving one's bowels is the same length in men and women. However, perhaps because women are smaller, it makes up more of the anal canal in women. This is important because it can be more easily damaged by a tear during childbirth, leading to possible long-term problems. Therefore, it is important for pregnant women to perform the Kegel exercises, which help to strengthen this area, and to discuss any concerns with their obstetrician.
