Special Considerations for Women

Nearly 60% of all GI patients are women.

Women in the United States have a higher number of visits to gastroenterologists annually compared with men.

We take these statistics to heart, which is why women’s health is both a PRIORITY and PASSION of ours at Hunterdon Digestive Health Specialists. We are here for YOU to provide YOU with quality, comprehensive, compassionate GI care close to home, emphasizing your individualized needs.

Over the years many stereotypes and misnomers have existed pertaining to GI disorders in women; for example, the false notion that only men fall victim to colon and rectal cancers (which is grossly untrue).

We’ve come a long way, in part thanks to public health and media campaigns, inaccurately educating individuals on the real statistics and prevalence rates behind GI diseases relating to women, but we still have a long way to go.

The truth is BOTH men and women are affected by GI diseases. Some diseases are more common in men, and others are more common in women. Due to anatomical, physiological, biological, and hormonal differences, diseases can present differently in men and women.

We want YOU to better understand YOUR GI symptoms and healthcare needs, so here are a few differences between men and women (and similarities, too) when it comes to GI disease.

Colorectal cancer is the 3rd leading cause of cancer-related deaths is BOTH men and women in our society today.

Excluding skin cancers, colorectal cancer is the 3rd most commonly diagnosed cancer in BOTH men and women in the United States! COLORECTAL CANCER is the 3rd leading cause of cancer IN WOMEN in the United States.

 

  • Colorectal cancer does NOT discriminate between men and women. Nonetheless, women are screened at lower rates for colorectal cancer compared with men.
  • Colonoscopies can be more difficult to perform AND complete in women due to adhesions from prior abdominal surgeries and c-sections. Women also naturally have longer, more redundant, twisted, colons compared with men. As such, women are MORE likely to have incomplete colonoscopies when they are performed, which can lead to MISSED DIAGNOSES, DELAYED CARE, and POOR OUTCOMES.
  • Screening colonoscopies (meaning colonoscopies used to look for a disease when a person doesn’t have any symptoms) save 1000’s of lives each year by identifying colorectal cancers early on in the disease course and/or before it has started. Removing precancerous polyps during colonoscopy prevents colorectal cancer before it progresses into cancer.

 

Colonoscopies save lives.

According to the Centers for Disease Control and Prevention, roughly 140,000 Americans are diagnosed annually with colorectal cancer, and more than 50,000 people die from it!

 

Colorectal cancer screenings are paramount whether you are male or female!

 

*Women often have longer, more redundant colons, they are more inclined to have adhesions from abdominal surgeries and c-sections, they metabolize medications differently than men, and they can also be more sensitive to gas and bloating than men. Considering these things and more, we at Hunterdon Digestive Health Specialists:

  • Tailor your colonoscopy bowel prep to best meet your needs.
  • We make anesthesia adjustments when necessary.
  • We use CO2 insufflation instead of O2 when possible to allow for less gas discomfort after endoscopy/colonoscopy. Studies show significantly reduced bloating and pain after routine colonoscopy in propofol-sedated patients with carbon dioxide vs. oxygen (i.e. air).
  • We use of pediatric scopes when necessary to minimize complications during your colonoscopy, and allow for a more successful, complete colonoscopy.
  • We practice up-to-date evidence-based medicine, and follow the most current screening and treatment guidelines. 

 

Other common GI conditions and how they relate to women:

 

1. CONSTIPATION

Women are more likely than men to suffer from constipation, with constipation being defined as:

  • 3 or fewer bowel movements per week
  • Having stool that is hard, dry, pebble-like, and/or difficult to pass, or
  • The feeling that you’re unable to completely empty your bowels.

 

Why are women more likely to experience constipation than men?

Well, multiple factors contribute:

  1. The female large intestine is 10cm longer than a male’s. This is likely so that women can absorb more water from the large intestine during pregnancy to keep amniotic fluid (the cushion of fluid around a developing fetus) at a desirable level. Keep in mind, the job of the large intestine is to reabsorb salt and water back into our bloodstreams, and condense any remaining indigestible food into stool. So two problems arise. Women have 10cm longer to reabsorb water from the stool, potentially resulting in hardened stools and constipation. This extra length also creates redundancy, or extra twists and turns in the colon, making women more vulnerable to gas, bloating and constipation compared with men.
  2. The large intestine also empties slower in women compared with men. It takes almost 14 hours longer for food to get through the female colon compared with the male colon. That’s 14 hours longer that stool has to sit in a woman’s colon where water can be reabsorbed, stool can become harder and drier, and constipation, gas, and bloating can result.
  3. Alterations in progesterone and estrogen levels related to the menstrual cycle and menopause can affect GI transit time (how fast food moves through your GI tract), and symptoms of constipation. Higher levels of estrogen and progesterone may slow your intestinal movements and cause constipation. Because estrogen and progesterone levels vary throughout the menstrual cycle, women may notice cyclical worsening of their symptoms related to the menstrual cycle.
  4. Constipation tends to worsen with age, and can be associated with other endocrinopathies that are often more common in females AND with age like hypothyroidism. Constipation tends to become more common with menopause also.

 

What causes constipation in women?

Causes of constipation include: pregnancy, dietary factors, like not drinking enough water, or a diet low is fiber and high in processed foods, stress, inactivity, hormonal fluctuations, straining while going to the bathroom (which can result in enlarged hemorrhoids and a weakened pelvic floor both exacerbating underlying constipation and creating a cycle of worsening constipation), and not going to the bathroom when you have the urge to go.

The longer stool is held in the rectum, the more water is reabsorbed from it, making the stool harder, drier, and more difficult to pass. When you consistently hold your bowel movements the rectum becomes desensitized. Over time, the rectum requires more and more feces for the brain to recognize it’s time for you to go to the bathroom. This can become a vicious cycle worsening your constipation.

A common cause of constipation in women is a weakened pelvic floor. This can sometimes play more of a role in the development of your symptoms than diet alone. Please see Pelvic Floor Dysfunction for more information on this condition.

 

What are the complications of constipation in women?

Left untreated, constipation can result in hemorrhoids, anal fissures, ulcerations in the large intestine and rectum, bowel obstruction, rectal prolapse, and pelvic floor dysfunction.

Treating constipation first and foremost involves addressing the underlying cause of the condition.

2. Pelvic Floor Dysfunction

Pelvic floor dysfunction is the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement or to urinate.

The pelvic floor muscles act as structural support to hold your bladder, uterus, cervix, vagina, and rectum in place within your body.

Your pelvic floor muscles stretch from your tailbone in the back to your pubic bone up front, and from one hip to the other side to side. They move up and down like a trampoline supporting your internal organs.

Weakness or other issues with the pelvic floor can result in fecal or urinary incontinence, constipation, the need to strain with bowel movements, pain or pressure felt in the rectum, and muscle spasms in the pelvis.To learn more about Pelvic Floor Dysfunction click here.

Because women are at increased risk for a weakened pelvic floor as a result of pregnancy and childbirth they tend to suffer from more symptoms related to pelvic floor dysfunction than men.

Because constipation can be caused by a weakened pelvic floor this can sometimes play more of a role in the development of your symptoms than diet.

We will comprehensively evaluate your symptoms and work together with you to identify a treatment plan that best meets your personalized needs and improves your quality of life.

 

3. IRRITABLE BOWEL SYNDROME (IBS)

  • IBS is significantly more common in women compared with men.
  • In the United States, more women than men seek healthcare services for IBS symptoms.
  • Symptoms often differ between men and women due to anatomical, physiological, biological, and hormonal differences. Women are more likely to have constipation, bloating, nausea, and lower quality of life associated with IBS.
  • Fluctuations in estrogen and progesterone levels related to the menstrual cycle, and around the time of menopause, will often trigger or exacerbate IBS symptoms in women.
  • A longer, more redundant, and twisted colon, a more relaxed abdominal wall, and the placement of the female reproductive tract within the abdominopelvic cavity all make women more prone to bloating and GI discomfort associated with IBS compared with men.

*Women with IBS symptoms should always be evaluated by an OBGYN to rule out gynecological causes of their symptoms including endometriosis, PCOS, and ovarian cancer.

Ovarian cancer can and often presents with vague symptoms such as gas, bloating and indigestion. These symptoms should NEVER be overlooked or blamed on IBS until all other organic causes are ruled out.

While we at Hunterdon Digestive Health Specialists will carefully evaluate you and rule out GI causes of your symptoms, we may need to refer you to another specialist such as an OBGYN to rule out other causes to your symptoms and to ensure that your symptoms are comprehensively addressed, worked-up, and evaluated properly before making a definitive diagnosis of IBS.

 

4. Gas and Bloating I

Again, due to anatomical, physiological, biological, and hormonal differences between men and women, women are MORE likely to be affected by gas and bloating compared with men.

Women tend to be MORE affected by gas and bloating compared with men for a number of reasons including:

  • Food moves more slowly through the female GI tract (up to 14 hours longer).
  • Gastric emptying is delayed in women (meaning food stays in a women’s stomach longer), and
  • Women have a longer, more redundant colon compared with men making them more susceptible to constipation, gas, and bloating.

 

How does gas end up in the GI tract?

  • In general, gas ends up in your STOMACH when you swallow air while eating or drinking. It’s a normal occurrence but can be worsened by:
    • Eating too quickly
    • Drinking through a straw
    • Chewing gum
    • Sucking on candies or mints, and
    • Talking while eating
  • Gas in your LARGE INTESTINE comes from bacteria fermenting carbohydrates that weren’t previously digested in your small intestine and arrived in your large intestine undigested.

What causes SYMPTOMS of gas and bloating?

Gas and Bloating can be caused by any number of conditions, and these symptoms can mask very serious underlying conditions like ovarian or pancreatic cancer.

*In addition to a comprehensive GI evaluation, women with gas and bloating should ALWAYS be evaluated by an OBGYN to rule out gynecological causes of their symptoms including endometriosis, PCOS, and ovarian cancer.

Ovarian cancer can and often presents with vague symptoms such as gas, bloating and indigestion. These symptoms should NEVER be overlooked or blamed on IBS until all other organic causes are ruled out.

While we will carefully evaluate you and rule out GI causes of your symptoms, we may need to refer you to another specialist such as an OBGYN to rule out other causes to your symptoms and to ensure that your symptoms are comprehensively addressed, worked-up, and evaluated properly before making a definitive diagnosis of IBS.

 

Common causes of gas and bloating include:

  • Certain high-fiber foods such as legumes, beans, peas, fruits, vegetables, especially those in the cabbage family, whole grains, carbonated beverages, and sugar substitutes or artificial sweeteners
  • Certain fiber supplements
  • Hormonal fluctuations or imbalances related to the menstrual cycle and menopause
  • Medical conditions like: Inflammatory Bowel Disease, Ulcerative Colitis and Crohn's disease, Celiac Disease, Small Intestinal Bacterial Overgrowth or SIBO (an increase or change in the bacteria present in your small intestine), Food intolerances like lactose intolerance, fructose intolerance, and gluten intolerance, Constipation, Giardia and other infectious causes, and Diverticulitis.
  • Serious causes may include: ovarian cancer, pancreatic cancer, liver disease, ascites, kidney disease, congestive heart failure, GI perforation, and others.

 

5. INFLAMMATORY BOWEL DISEASE (IBD)

Inflammatory Bowel Diseases, including Crohn’s disease and Ulcerative Colitis, occur more frequently in women compared with men. IBD is twice as common in women compared with men.

Additionally, women who are smokers, are Hispanic or non-Hispanic white, are Jewish of European descent, or have a family history of IBD may be at increased risk for IBD comparatively. Some studies suggest that using antibiotics, taking oral contraceptives, or NSAIDs may also increase a women’s risk for developing IBD.

What causes Inflammatory Bowel Disease?

Regardless of biological sex, the exact cause of the disease is unknown.

It’s thought that our immune system may contribute to the development of IBD. Usually, our immune system protects us from infections agents like bacteria and viruses. In the case of IBD, our immune system may overreact to normal bacteria in the gut resulting in inflammation and damage to the GI tract over time.

 

How does IBD affect women differently than men?

  • Women with IBD are more likely to experience symptoms of PMS, like headaches, menstrual pain, and cramping.
  • Hormonal fluctuations associated with the menstrual cycle may exacerbate diarrhea, abdominal pain, and other IBD symptoms particularly right before or during menstruation.
  • Women with IBD have a greater risk of developing iron-deficiency anemia than women without IBD. Women with heavy menstrual periods also have an increased risk of developing iron-deficiency anemia. Being a woman with IBD increases your risk for iron-deficiency.
  • Some women with IBD may have fertility issues, especially during a flare-up. This is not always the case, but should be discussed with your OBGYN and our staff when planning pregnancy.
  • Additionally, pregnant women with IBD may have a high-risk pregnancy. Having a flare-up during pregnancy may increase your risk of premature birth, low birth weight, and cesarean section. All pregnant IBD patients should be followed closely and monitored for disease recurrence or flare-ups.
  • Hormonal fluctuations during pregnancy may improve or worsen disease activity.
  • Some medicines, like methotrexate, cause birth defects and should NOT be taken before getting pregnant, while you are pregnant, or while you are breastfeeding. All of your medications should be discussed in detail with your OBGYN and our staff prior to planning pregnancy to avoid the risk of birth defects.

 

6. Familial Cancer Syndromes

Between 2-5% of all colorectal cancers arise as a result of inherited syndromes such as Lynch Syndrome and Familial Adenomatous Polyposis (FAP). These conditions are associated with a high risk of not just colorectal cancer but also uterine, ovarian, breast, stomach, biliary (gallbladder and bile duct), urinary tract, small bowel, brain, and pancreatic cancers.

Endometrial (or uterine) cancer is the most common cancer outside of colorectal cancer associated with Lynch syndrome.

If several cancers are found within a family, or a woman has a history of gynecological cancer herself or in her family, genetic counseling should be strongly considered. Please be sure to provide us with a comprehensive and up-to-date family history so that we can better assess your risk for these syndromes.

7. Barrett’s Esophagus

Sex hormones can play a major role in the development of Barrett’s esophagus and Gastroesophageal Reflux Disorder (or GERD). Estrogen tends to be somewhat protective against Barrett’s esophagus until the protective effects of estrogen wear off with menopause.

After menopause, women and men show SIMILAR rates of Barrett’s esophagus. Barrett’s esophagus affects BOTH men and women!!!

Barrett’s esophagus increases your risk of esophageal cancer. All reflux symptoms should be discussed in depth with our staff to avoid missed diagnoses, delayed care, and poor outcomes, and to ensure appropriate surveillance guidelines are being followed.

8. Other Special Considerations for Women:

  • Certain autoimmune LIVER diseases (such as autoimmune hepatitis, and primary biliary cirrhosis) are more common in women.
  • Women have an increased risk of other autoimmune conditions like Hashimoto’s thyroiditis, which the most common cause of hypothyroidism in the United States. Having one autoimmune condition increases your risk of developing others. SIBO is commonly seen in patients with autoimmune diseases, like IBD, celiac disease, and Hashimoto's. The exact association between these diseases is not well understood; however, because women are at increased risk of autoimmune conditions they may be at increased risk for SIBO as well. 
  • Gallstones and gallbladder disease are more common in women.
  • GI cancers including STOMACH, GALLBLADDER, BILE DUCT, LIVER and PANCREATIC cancers occur in BOTH men and women!
  • Due to physiological differences between men and women, some medications used to treat GI disorders or other disorders will be absorbed and metabolized differently between men and women. This is due in part to lower body weight, differences in fat and muscle percentages, slower GI motility, delayed gastric emptying, and less intestinal enzymatic activity. Women tend to produce less stomach acid than men. They also digest food more slowly. Drugs that require an empty stomach for absorption may not work as well if women don’t wait long enough after eating a meal before taking their medication. We take this into consideration when prescribing medications and when administering anesthesia!

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