IBS symptoms in women: what to track and when to see a doctor

The core symptoms

NIDDK, part of the US National Institutes of Health, says the most common symptoms of irritable bowel syndrome (IBS) are pain in the abdomen, often related to bowel movements, and changes in bowel movements: diarrhea, constipation or both. Other symptoms can be bloating, the feeling that you have not finished a bowel movement, and whitish mucus in the stool.

The NHS describes stomach pain or cramps that are usually worse after eating and better after a bowel movement, plus bloating, diarrhea and constipation. Symptoms can come and go, with better days and flare-ups, and can be set off by food or drink. The NHS also lists wind, nausea, tiredness, backache, bladder problems and pelvic pain as other possible symptoms.

Do women have different symptoms?

NIDDK says women are up to two times more likely than men to develop IBS. A 2010 meta-analysis in Alimentary Pharmacology and Therapeutics pooled 22 studies. Women were more likely to report abdominal pain and constipation-related symptoms (relative risk 1.12 for each), and men with IBS were more likely to report diarrhea-related symptoms. The authors call the differences modest.

In practice, that means the list of symptoms is the same, and the mix may lean toward pain and constipation in women. Your own pattern matters more than an average.

Periods and hormones

NIDDK says women with IBS often have more symptoms during their periods. The same meta-analysis reviewed 13 studies and found that both women with IBS and healthy women reported more IBS-type symptoms during menses than in other phases of the cycle.

The authors say studies suggest that female sex hormones influence the severity of symptoms, but that more studies are needed, and they found too little data to say what menopause or hormone supplements do. Our advice is to mark your period dates next to your symptoms, so that you and your doctor can see whether a cycle pattern exists for you.

Conditions that look alike

The NHS says endometriosis symptoms can be similar to other conditions, including irritable bowel syndrome, and that diagnosis can take a long time. Its symptoms include severe period pain, heavy periods, pelvic pain, pain when you poo or pee, pain during or after sex and extreme tiredness.

The NHS lists ovarian cancer symptoms of frequently, roughly 12 or more times a month, having a swollen tummy or bloating, pelvic pain, feeling full quickly after eating, or needing to pee more often. It says these symptoms are very common and caused by many conditions, but that they should still be checked by a doctor because early finding makes cancer more treatable. Our advice: bloating that is new, frequent and does not settle deserves that check, even if you have always had a sensitive gut.

Signs that need a doctor

NIDDK says certain symptoms may suggest another health problem instead of IBS: anemia, bleeding from the rectum, bloody or black tarry stools, and weight loss. The NHS advises urgent help for losing a lot of weight for no reason, bleeding from the bottom or bloody diarrhea, a hard lump or swelling in the tummy, or shortness of breath with palpitations and unusually pale skin. Our advice: in the US, call your clinician the same day or use urgent care for these, and call 911 for heavy bleeding, fainting or severe pain. The details are in our guide to IBS red flags.

The NHS also advises seeing a doctor if you think you have IBS and symptoms have lasted over 4 weeks. There is no single test for IBS: NIDDK says doctors look for a pattern of pain with two or more of three features (relation to bowel movements, change in how often you go, change in how stools look), and the NHS says blood and stool tests may be used to rule out conditions such as celiac disease and inflammatory bowel disease. The American College of Gastroenterology guideline suggests a celiac blood test for people with IBS and diarrhea symptoms, and a fecal calprotectin test to rule out inflammatory bowel disease.

What to track

The NHS suggests writing down details of your symptoms before your appointment, including when you get them, how often, how long, and whether they follow certain foods. The fields below are our own suggestions built on that advice.

• Date and time of each episode, and how long it lasted.
• Pain on a 0 to 10 scale and where it was: upper, lower or one side.
• Bloating, and whether it eased after a bowel movement.
• Stool type, using the Bristol chart, and how many times you went.
• Meals and drinks in the hours before, including alcohol and caffeine.
• Period start and end dates, and any heavy bleeding or pain during sex.
• Stress, sleep and any new medicines or antibiotics.