Most of my final year of university was spent crying in the library toilets. Not because of the workload, but because I spent it in a never-ending IBS flare-up. Most days, my stomach would be cramping on top of being so distended I looked pregnant. Acid reflux was a daily feature of my life too, with the burning sensation running from my belly button to my throat as I tried to type out my dissertation project.
I had been diagnosed with a “funny tummy” when I was just five, but I didn’t get a diagnosis of irritable bowel syndrome until well into my teenage years (most cases are thought to start between 20 to 30 years old).
Diagnosing IBS is hard, as it is a classification of multiple symptoms that go on for six or more months. “Often your own symptoms may not be linear and it can be hard to explain and monitor them to receive a diagnosis,” says dietitian and functional gut expert Catherine Rabess.
Plus, talking about IBS is embarrassing. No one, particularly young girls, wants to talk about their poo. “There’s a stigma around toilet talk that often causes a barrier for women to seek help,” agrees Rabess.
My diagnosis didn’t change much. There is no cure for IBS but I was sent away by GPs when searching for management tools, being told there was nothing wrong or that the symptoms would sort themselves out.
A nutritionist put me on the famous FODMAP diet, in which you exclude fermentable foods that can trigger IBS before slowly reintroducing them to find your tolerable limits. It did seem to help: I found triggers in gluten, aubergines and mushrooms among other foods, but I never managed to book a follow-up appointment to help reintroduce these foods to my diet.
Two-thirds of people diagnosed with the condition are women, and the lack of care and understanding around the condition is undeniably a feminist issue. IBS is a victim of the gender pain gap, as “women score higher on the visceral hypersensitivity scale, meaning they tend to experience bloating or gas in more painful and difficult sensations compared to men who present with the same symptoms,” says Rabess.
Last year, researchers in Sweden found that compared with women with IBS, men with IBS had fewer contacts with the healthcare system and less chronic pain.
They were also less likely to have sleep issues and to have a mental health diagnosis. We know that, in general, men are less likely to report health symptoms to their doctors, often due to stoic stereotypes, which is a call for equal and inclusive treatment in itself. But there are physiological differences that mean women are at a higher risk of the syndrome too.
“Women have a different gastrointestinal tract to men,” explains Rabess. “Their colon is 10 centimetres longer than a man’s, which can lead to slower emptying.”
This explains why 40 per cent of women with IBS present with constipation, compared to just 20 per cent of men, as does the fact that “women are more prone to developing thyroid problems, in particular hypothyroidism which is associated with slower gut transit and constipation,” says Marilia Chamon, registered nutritional therapist and IBS specialist.
But the longer colon also means our digestive system runs deeper into the pelvis, rubbing up against our reproductive organs. “The proximity of our digestive and reproductive organs can mean symptoms are interchangeable. Your period can often trigger a change in your bowel movements or cause bloating or pain,” says Rabess.
Yep, the period poo phenomenon is real – one study from BMC Women’s Health reported that 73 percent of women reported at least one digestive symptom during their period, from abdominal pain to diarrhoea. And, with research showing that there are sex hormone receptors along our GI wall, women often report changing, irritating and painful bowel movements around their menstrual cycle.
It’s not all biology. Women are more prone to suffer from the mental and social triggers of IBS. “The gut-brain axis is the two-way communication that goes on between your gut and your brain,” explains Dr Sammie Gill, a specialist gastroenterology dietitian at Symprove. “They are connected through a network of nerves that runs from the brain to the gut. If we are mentally stressed, the gut feels physically stressed, and this impacts the way the gut functions.”
There’s lots of data suggesting that women suffer from stress more than men: in research by LinkedIn in 2021, 74 percent of women reported being very or somewhat stressed for work-related reasons, compared with just 61 percent of men, while a 2018 study found that women are more vulnerable to burnout than men.
“Women are more likely to experience continuous exposure to stress which may be related to the multiple roles that many women are expected to juggle, such as caregiving, work, and household responsibilities,” adds Chamon.
One of the most prolific triggers for IBS is under-eating, and women are much more likely to restrict food and be influenced by diet and wellness cultures that encourage orthorexic or disordered eating tendencies.
In 2017, a report from the International Journal of Public Health found that every study they looked at of eating habits in both genders showed women had a higher prevalence for dieting. In the same year, a study reported that people who had irregular eating habits – regularly skipping meals or leaving long periods between eating – were over three times more likely to suffer from IBS.
It is a classic story that Rabess sees in clinic, with women who frequently diet or restrict calories or food groups developing digestive issues, then restricting further in an attempt to heal. “All those years of restrictive eating and crash diets can wreak havoc on your digestion,” she says. “I particularly see patients in clinic who have been following low-carb diets or doing intermittent fasting for a long time which can cause the beneficial gut microbes to starve and cause dysbiosis – which is an imbalance of healthy bacteria versus good bacteria – in the gut. That of course can then lead to potential problems with functional gut symptoms, including IBS.”
Chamon adds: “Diets like low FODMAP are effective for people with IBS but should not be done without the assistance of a trained nutritionist, as it could trigger disordered eating habits in some individuals, particularly because it involves restriction or avoidance of certain foods for a limited amount of time.”
For so many women with IBS – including myself – who are left to their own devices with restrictive eating plans, food becomes a source of anxiety, meaning they eat less, stress more and suffer worse symptoms. It was ironic then that increasing my food intake, in terms of quantity and variety, was the unsung hero of my IBS management.
It meant going against the ingrained messages of small portions, restricting food groups and exercising more as routes to health. It was a decision born out of necessity – I had lost a lot of weight and felt anxious about going out for dinners or letting friends and family cook for me.
The timing was also right; it was 2018, when honest experts were finally gaining the same traction as the faux wellness influencers, and I luckily found myself on the corner of the internet where health was finally being put before aesthetics.
Simultaneously, there was a boom in gut health research and discussion. I read up about the latest reports, which seemed to suggest the same thing: diversity not restriction is the best way to better digestion. “Maintaining good gut health is all about adding things in. A higher diversity equals a healthier gut microbiome,” adds Dr Emily Leeming, senior nutrition scientist at personalised nutrition company ZOE, where some of the leading research in the field of gut health is being done.
“I often see clients who are really desperate because they’ve not been able to get the help that they need,” says Rabess. “Not being taken seriously causes quite a barrier for women wanting to seek out help.”
Until we close the gender health gap, which is responsible for the underfunding and lack of respect for health conditions that are dominated by women, we probably won’t have better help for IBS. But for now, we need to talk about it.
“Having IBS can have a huge impact on your quality of life, and is linked to higher levels of depression,” acknowledges Dr Leeming. “You might have to think about where the nearest public loo is when you’re out and about, or you might be worried about even leaving the house in the first place. It’s something that isn’t talked about enough, and the more we talk about our bodies, the more we normalise our experiences.”
The reassurance from other women – and some understanding medical staff – I’ve spoken to that this isn’t in my head has been a lifeline on my IBS journey, and other women need that support too.