Women suffer from a number of different gastrointestinal (GI) issues that can not only cause troublesome and embarrassing symptoms, but can also negatively impact their quality of life. Over the last decade, research on GI conditions in women has increased, including the impact of gender on diagnosis, treatment and outcomes. In fact, the March 2021 issue of the American Journal of Gastroenterology focused entirely on understanding and addressing sex-related disparities in gastroenterology and hepatology as well as how to encourage and support more female physicians entering these medical specialties.
Women have inherent physiological differences that impact both the approach to care and the response to treatment for a number of GI conditions. Females break down medications differently, and there are also distinctions in the type and degree of symptoms they experience. Some of the specific differences that have been identified in women include the following:
- Unique GI challenges that arise during pregnancy and postpartum
- More significant decline in quality of life due to GI conditions
- Increased gut sensitivity, including more frequent nausea, bloating and constipation
- Higher incidence of functional GI disorders such as heartburn
- Increased incidence of rheumatic diseases such as systemic sclerosis that impact the GI system
In addition, as with a heart attack, many female patients with GI conditions present differently from men, requiring a tailored approach to both diagnosis and treatment to ensure timely, proper care is delivered. The good news is women are more likely to seek treatment sooner for GI concerns which can help prevent complications.
Most Common GI Conditions in Women
Some of the most common GI conditions affecting women include the following:
- Chronic constipation — This especially impacts post-menopausal women and can be exacerbated by declining hormone levels or weakened pelvic floor muscles.
- Reflux — Pregnancy increases incidence of heartburn and acid reflux.
- Irritable bowel syndrome (IBS) — Often triggered by stress, IBS occurs two to six times more often in women than in men according to the American College of Gastroenterology (link to the DHSI IBS article by Dr. Gomez-Dorati). In addition, a large proportion of women affected with IBS are of childbearing age, and researchers have identified management of IBS in pregnancy as a key topic for further study.
- Irritable bowel disease (IBD) — This includes both Crohn’s and ulcerative colitis which are characterized by chronic inflammation of the GI tract. (can link to DHSI chronic Crohn’s article)
- Gallbladder problems — These issues, including gallstones, occur more often in pregnancy and postpartum. Weight gain can also increase risk.
- Pelvic floor weakness/dysfunction — The inability to coordinate and control pelvic floor muscles to have a bowel movement, pelvic floor weakness can be caused by childbirth as well as the decline in estrogen as women age.
- Liver inflammation/disease — Autoimmune hepatitis, when the body’s immune system attacks the liver cells, occurs more commonly in women. In addition, acute fatty liver of pregnancy (AFLP) is a rare and dangerous complication that can arise in the third trimester or early postpartum period.
- Colon cancer — According to the American College of Gastroenterology, colon cancer is the number three cancer for women in the United States. Screening is important and should begin at age 50 or earlier if you are African American or have a family history. In addition, research has revealed that the BRCA1 and BRCA2 genetic mutations, known to increase breast cancer risk, also increase colon cancer risk.
AdventHealth Offers Specialized GI Care for Women
AdventHealth’s Digestive Health and Surgery Institute (DHSI) provides comprehensive care for a full range of women’s GI conditions, developing coordinated, multidisciplinary treatment plans that are customized for each patient. A couple of specialized services DHSI offers include the following:
- Pelvic Floor Clinic — offering pelvic floor rehabilitation, a noninvasive treatment option that has been found to be up to 80 percent successful in restoring functionality to the pelvic muscles when age, childbirth or disease has compromised their strength
- InterStim Therapy — a minimally invasive method of addressing chronic fecal incontinence by implanting a small pacemaker-like device under the skin to deliver mild electrical pulses to the sacral nerves that are responsible for transmitting neurological messages between the brain and bowels
Women Caring for Women
AdventHealth believes in the power of the physician-patient relationship to deliver the highest quality care and achieve the best possible outcomes. Because of the sensitive nature of the symptoms experienced, many female GI patients prefer to see a female provider. They may have concerns they find embarrassing and have an increased comfort level speaking to a female provider about them. While gastroenterology tends to be a male-dominated field, AdventHealth offers patients access to a number of female GI providers, including sub-specialists, who care for a range of GI conditions.
To schedule an appointment or refer a patient to the AdventHealth Digestive Health and Surgical Institute.
Mariam Naveed, MD, is a board-certified gastroenterologist with advanced fellowship training in gastroenterology and hepatology. She is an active researcher in her field and has co-authored numerous publications in peer-reviewed medical journals, including a book chapter on risk factors for esophageal adenocarcinoma. A graduate of the University of Kentucky and its medical school, Dr. Naveed completed her internship and residency in internal medicine at Duke University in North Carolina, and her fellowship training at the University of Texas Southwestern Medical Center in Dallas.
Bria Strada, PA-C, is a certified physician assistant who specializes in gastroenterology and hepatology. She earned her Bachelor of Science degree from the University of Florida College and her Master of Medical Science in Physician Assistant Studies from Nova Southeastern University.