The Menstrual Cycle Affects Rectal Sensitivity in Patients with Irritable Bowel Syndrome but Not Healthy Volunteers

Overview

Journal Gut

Specialty Gastroenterology

Date 2002 Mar 13

PMID 11889064

Citations 66

Authors

L A Houghton

R Lea

N Jackson

P J Whorwell

Affiliations

Soon will be listed here.

Abstract

Background: We have previously shown that the menstrual cycle has no effect on rectal sensitivity of normal healthy women, despite them having looser stools at the time of menses. Patients with irritable bowel syndrome (IBS) often report significant exacerbation of their IBS symptoms with menses, raising the possibility that IBS patients may respond differently to the menstrual cycle.

Aim And Methods: Rectal responses to balloon distension during days 1-4 (menses), 8-10 (follicular phase), 18-20 (luteal phase), and 24-28 (premenstrual phase) of the menstrual cycle were assessed in 29 female IBS patients (aged 21-44 years), diagnosed by the Rome I criteria. During the course of the study patients completed symptom diaries to assess abdominal pain and bloating (visual analogue scale), and frequency and consistency of bowel habits. In addition, levels of anxiety and depression were assessed using the hospital anxiety and depression questionnaire.

Results: Menses was associated with a worsening of abdominal pain and bloating compared with most other phases of the menstrual cycle (p<0.05). Bowel habits also became more frequent (p<0.05) and patients tended to have a lower general well being. Rectal sensitivity increased at menses compared with all other phases of the cycle (p<0.05). There was no associated change in rectal compliance, wall tension, or motility index. Neither was there any difference in resting anal pressure or the distension volumes required to relax the internal anal sphincter during the menstrual cycle.

Conclusion: These data (1) confirm that IBS symptomatology is exacerbated at menses and (2) show for the first time that in contrast with healthy women, rectal sensitivity changes with the menstrual cycle. These cyclical changes in sensitivity suggest that women with IBS respond differently to fluctuations in their sex hormonal environment or its consequences compared with healthy females.

Citing Articles

Reproductive and sexual health concerns in gastrointestinal illness: a narrative review.

Hacker K, Bedell A Transl Gastroenterol Hepatol. 2025; 10:15.

PMID: 39944576 PMC: 11811567. DOI: 10.21037/tgh-24-38.

Rome Foundation Working Team Report on overlap in disorders of gut-brain interaction.

Barbara G, Aziz I, Ballou S, Chang L, Ford A, Fukudo S Nat Rev Gastroenterol Hepatol. 2025; .

PMID: 39870943 DOI: 10.1038/s41575-024-01033-9.

Sex Differences, Menses-Related Symptoms and Menopause in Disorders of Gut-Brain Interaction.

Sarnoff R, Hreinsson J, Kim J, Sperber A, Palsson O, Bangdiwala S Neurogastroenterol Motil. 2025; 37(2):e14977.

PMID: 39748465 PMC: 11748819. DOI: 10.1111/nmo.14977.

Sex differences in zymosan-induced behavioral visceral hypersensitivity and colorectal afferent sensitization.

Guo T, Liu J, Chen L, Bian Z, Zheng G, Feng B Am J Physiol Gastrointest Liver Physiol. 2023; 326(2):G133-G146.

PMID: 38050686 PMC: 11208018. DOI: 10.1152/ajpgi.00081.2023.

Gastrointestinal functioning and menstrual cycle phase in emerging young adult women: a cross-sectional study.

Mendelson S, Anbukkarasu P, Cassisi J, Zaman W BMC Gastroenterol. 2023; 23(1):406.

PMID: 37990300 PMC: 10664285. DOI: 10.1186/s12876-023-03036-3.

References

Houghton L, JACKSON N, Whorwell P, Morris J . Do male sex hormones protect from irritable bowel syndrome?. Am J Gastroenterol. 2000; 95(9):2296-300. DOI: 10.1111/j.1572-0241.2000.02314.x. View

Kane S, Sable K, Hanauer S . The menstrual cycle and its effect on inflammatory bowel disease and irritable bowel syndrome: a prevalence study. Am J Gastroenterol. 1998; 93(10):1867-72. DOI: 10.1111/j.1572-0241.1998.540_i.x. View

Drossman D, Powell D, SESSIONS Jr J . The irritable bowel syndrome. Gastroenterology. 1977; 73(4 Pt 1):811-22. View

Rees W, Rhodes J . Altered bowel habit and menstruation. Lancet. 1976; 2(7983):475. DOI: 10.1016/s0140-6736(76)92575-7. View

Wald A, Van Thiel D, Hoechstetter L, Gavaler J, Egler K, Verm R . Gastrointestinal transit: the effect of the menstrual cycle. Gastroenterology. 1981; 80(6):1497-500. View

Narducci F, Bassotti G, Granata M, Pelli M, Gaburri M, Palumbo R . Colonic motility and gastric emptying in patients with irritable bowel syndrome. Effect of pretreatment with octylonium bromide. Dig Dis Sci. 1986; 31(3):241-6. DOI: 10.1007/BF01318114. View

Davies G, Crowder M, Reid B, Dickerson J . Bowel function measurements of individuals with different eating patterns. Gut. 1986; 27(2):164-9. PMC: 1433202. DOI: 10.1136/gut.27.2.164. View

Welgan P, Meshkinpour H, Beeler M . Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Gastroenterology. 1988; 94(5 Pt 1):1150-6. DOI: 10.1016/0016-5085(88)90006-6. View

Rogers J, Henry M, Misiewicz J . Increased segmental activity and intraluminal pressures in the sigmoid colon of patients with the irritable bowel syndrome. Gut. 1989; 30(5):634-41. PMC: 1434217. DOI: 10.1136/gut.30.5.634. View

10.

Whitehead W, Cheskin L, Heller B, Robinson J, Crowell M, Benjamin C . Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology. 1990; 98(6):1485-9. DOI: 10.1016/0016-5085(90)91079-l. View

11.

Cohen R, Perl E . Contributions of arachidonic acid derivatives and substance P to the sensitization of cutaneous nociceptors. J Neurophysiol. 1990; 64(2):457-64. DOI: 10.1152/jn.1990.64.2.457. View

12.

Heaton K, Ghosh S, Braddon F . How bad are the symptoms and bowel dysfunction of patients with the irritable bowel syndrome? A prospective, controlled study with emphasis on stool form. Gut. 1991; 32(1):73-9. PMC: 1379218. DOI: 10.1136/gut.32.1.73. View

13.

Heitkemper M, Jarrett M . Pattern of gastrointestinal and somatic symptoms across the menstrual cycle. Gastroenterology. 1992; 102(2):505-13. DOI: 10.1016/0016-5085(92)90097-i. View

14.

Heaton K, ODonnell L, Braddon F, Mountford R, Hughes A, Cripps P . Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology. 1992; 102(6):1962-7. DOI: 10.1016/0016-5085(92)90320-x. View

15.

Arthur C, Ament M, Song M . Prostaglandin metabolism in relation to the bowel habits of women. Prostaglandins Leukot Essent Fatty Acids. 1992; 46(4):257-9. DOI: 10.1016/0952-3278(92)90031-d. View

16.

Lembo T, Munakata J, Mertz H, Niazi N, Kodner A, Nikas V . Evidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome. Gastroenterology. 1994; 107(6):1686-96. DOI: 10.1016/0016-5085(94)90809-5. View

17.

JACKSON N, Houghton L, Whorwell P, Currer B . Does the menstrual cycle affect anorectal physiology?. Dig Dis Sci. 1994; 39(12):2607-11. DOI: 10.1007/BF02087697. View

18.

Eberhart C, DuBois R . Eicosanoids and the gastrointestinal tract. Gastroenterology. 1995; 109(1):285-301. DOI: 10.1016/0016-5085(95)90296-1. View

19.

Trimble K, Farouk R, PRYDE A, Douglas S, Heading R . Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity. Dig Dis Sci. 1995; 40(8):1607-13. DOI: 10.1007/BF02212678. View

20.

Houghton L, Wych J, Whorwell P . Acute diarrhoea induces rectal sensitivity in women but not men. Gut. 1995; 37(2):270-3. PMC: 1382730. DOI: 10.1136/gut.37.2.270. View