Are the symptoms of IBS in men and women different?

For the purpose of this article 'girls, females, or women' are those individuals assigned as female at birth. "Boys, males or men" are those individuals assigned as male at birth. It is not intended to exclude or dismiss individuals who do not identify as female or male.

Symptoms of IBS in women and men

Irritable bowel syndrome (IBS) is a common digestive disorder among women and men. It's a long-term condition that can't be cured, but symptoms can usually be improved through a combination of diet, other lifestyle changes, and medication. There will be times when people do not have any symptoms at all.

Both men and women can experience these common symptoms of IBS:

• Constipation, diarrhoea, or alternating between the two at different times.
• More frequent bowel movements and urgent bathroom trips.
• Changes in poo (stool) consistency - for example, hard or watery poos.
• Feeling unable to fully empty your bowels.
• Tummy (abdominal pain), cramps, gas, or bloating.
• Heartburn.
• Lower back pain.
• Symptoms getting worse after meals and certain foods that trigger the symptoms.

Sex, gender, and IBS

Evidence suggests that your experience of IBS can be different as a man or a woman, because of sex and gender differences.

Symptoms of IBS in women

IBS with constipation

If you have IBS, you may experience constipation, diarrhoea, or both. Studies show that women with IBS are more likely to experience constipation than men with IBS². This means they're also more prone to constipation-related symptoms, which includes infrequent bathroom trips, hard poos, tummy pain, bloating, and trapped gas.

Constipation is less common during a woman's menstrual period, which suggests that IBS with constipation is linked to hormone levels during the rest of the month¹.

IBS with more severe pain

Constipation is often accompanied with tummy pain, which may partly explain why more women report more severe IBS pain than men. Long-term pain disorders that often overlap with IBS - for example chronic pelvic pain, fibromyalgia, and migraine - are also more common in women with IBS.

This suggests that the female sex hormone oestrogen plays a key role in the experience of pain³. It's thought that oestrogen stimulates the central nervous system, which may increase pain sensitivity. Biological differences in the gut and brain may also account for different experiences of pain between women and men¹.

IBS and the menstrual cycle

There's strong evidence that IBS symptoms can become worse during a woman's period. However, constipation pain can improve but is often replaced with another inconvenient and uncomfortable IBS symptom - diarrhoea.

Other symptoms which are reportedly worse around the menstrual cycle²:

• Loose stools.
• Abdominal pain.
• Bloating.
• Needing the bathroom more often.
• Other changes in your usual bowel habits.

Even women who don't have IBS can experience these digestive issues around their period. There are several biological theories on how the menstrual cycle affects the digestive system, for example:

• During your period, oestrogen and progesterone drop, and this can trigger or worsen digestive symptoms.
• Serotonin also decreases, a hormone that can be found in the gut that's thought to directly influence IBS symptoms⁴.

IBS and female conditions

The symptoms of IBS in women may also be influenced by female-specific health conditions. For example:

• Pregnancy - for some, pregnancy can actually improve IBS symptoms; for others, it makes IBS flare-ups worse. More research is needed to understand the interactions between pregnancy and IBS, but hormonal changes during pregnancy are likely responsible for changes in digestive health.
• Endometriosis - women with endometriosis are three times more likely to develop IBS⁵.
• Menopause - some studies suggest that women with IBS who have been through menopause report more frequent IBS symptoms, such as having excess gas. However, more research is needed.

Symptoms of IBS in men

IBS with diarrhoea

While women with IBS are more likely to suffer with constipation, being a man increases your chances of the opposite digestive issue - IBS diarrhoea. Half of men with IBS report needing more frequent and urgent trips to the bathroom and runny stools. This is compared to around one third of women with IBS².

Several biological factors might explain why diarrhoea is a more common IBS symptom in men. This includes differences in digestive function and brain activation patterns. For example, studies of healthy people have found that women generally have slower bowel movements than men.

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Less severe or reported IBS

One person's experience of IBS can be very different to another's. However, generally speaking, IBS symptoms in men appear to cause less pain than in women - and hormonal differences may account for why this is.

Evidence suggests that having more testosterone - the sex hormone more abundant in men - is linked to improved IBS symptoms⁶. It's also possible that the male gut is less sensitive to IBS and painful symptoms, which could be due to lower oestrogen levels, as well as other biological interactions.

It can be hard for scientists to predict the extent of milder symptoms caused by biological differences because gender roles also come into play. For example, with both IBS and other health problems, men are generally less likely to report symptoms to healthcare professionals.

IBS, quality of life, and gender roles

For both men and women, living with IBS can take its toll. Pain, frequent bathroom trips, and general discomfort can interrupt home, work, and social life. Yet, studies have observed some differences in how genders experience the impact of IBS on their mental health and quality of life.

Women living with IBS:

• Report more depression, anxiety, fatigue, and a lower quality of life¹.
• Report feeling more stressed about the effects of IBS on looking bloated, being slim, feeling clean, and smelling good¹.
• Are particularly concerned with how IBS affects their work life and relationship responsibilities as mothers and romantic partners⁷.
• Score lower for body image, sexual relationships, and health worries⁸.

Men living with IBS:

• Report less depression, anxiety, and fatigue compared to women with IBS.
• Report a higher quality of life compared to women with IBS.
• Are particularly concerned with how IBS interrupts their perception of masculinity, due to the social labelling of IBS as a female health concern, as well as the ways in which IBS symptoms can make them feel weak, helpless, and less able to support their families⁷.
• Have more similar attitudes to women with IBS if they score higher on gender characteristics traditionally thought of as female - such as self-blame and self-silencing⁹.

This general IBS/quality of life experience gap between women and men can be explained by psychological factors. These factors have been influenced by learned constructions of gender identities, differing societal expectations, and how these have influenced a person's upbringing and life experiences.

Further reading

1. Sun Kim and Kim: Sex-gender differences in irritable bowel syndrome.
2. Adeyemo et al: Meta-analysis: do irritable bowel syndrome symptoms vary between men and women?
3. Mulak and Taché: Sex difference in irritable bowel syndrome: do gonadal hormones play a role?
4. Vahora et al: How serotonin level fluctuation affects the effectiveness of treatment in irritable bowel syndrome.
5. Nabi et al: Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses.
6. Houghton et al: Do male sex hormones protect from irritable bowel syndrome?
7. Björkman et al: The gendered impact of irritable bowel syndrome: a qualitative study of patients' experiences.
8. Choghakhori et al: Sex-related differences in clinical symptoms, quality of life, and biochemical factors in irritable bowel syndrome.
9. Ali et al: Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome.