For years now, we’ve known that GI disorders can present differently in men and women, and affect men and women in varying ways.
Biological, hormonal, and anatomical differences, as well as pregnancy, menopause, and the natural aging process, all contribute to these differences.
If you think about it, anatomically and physiologically we are different.
- Men and women have different reproductive organs. These organs take up space in the abdominopelvic cavity (or body cavity containing the stomach, liver, pancreas, spleen, gallbladder, kidneys, adrenal glands, small and large intestines, urinary bladder, and reproductive organs: the prostate gland in men, and the uterus, ovaries, and fallopian tubes in women). The extra space that a female’s reproductive tract takes up compared with a man’s affects GI motility (or how fast food moves through your GI tract), and GI symptoms.
- The female colon (or large intestine) is 10cm longer than a male’s. As a result, it can take up to 14 hours longer for food to pass through the female colon compared with the male colon.
These differences alone can start to explain why male and female GI symptoms must be assessed and treated differently.
Understanding some of the differences between male and female anatomy and physiology may help YOU to better understand YOUR symptoms, and why certain treatment options and dietary modifications may or may not work for you.
From the top of our digestive tracts all the way to the bottom you will find differences between male and female anatomy (or structure) and physiology (or functioning).
- Beginning in our mouths, women tend to taste sour and sweet foods more strongly than men.
- Women tend to have increased sensitivity to stimuli throughout the entire GI tract making them more vulnerable to the sensations of pain, discomfort, heartburn, gas, and bloating.
- At the lower end of the esophagus where the esophagus meets the stomach, there is a muscle called the lower esophageal sphincter (or LES). The LES prevents food and acid from refluxing back up from the stomach into the esophagus. This muscle squeezes shut more forcibly in women compared with men. Because of this, women tend to have less damage in the esophagus from acid exposure compared with men. They still experience heartburn, esophagitis, esophageal ulcers, and esophageal cancer, AND they may actually be MORE sensitive to the symptoms of heartburn and reflux, but some research suggests they tend to have less esophageal damage from acid exposure compared with men. Of course, this is not always the case.
- Women tend to secrete less stomach acid (or HCL) than men. Nonetheless, gastritis (or inflammation of the stomach) is MORE common in women. Women are more sensitive to stomach irritants and MORE prone to H. pylori infections and H. pylori-associated ulcers than men. Women may experience increased pain, gas, and bloating secondary to H. pylori infections and gastritis compared with men. As well, women are MORE likely to take non-steroidal anti-inflammatory drugs (or NSAIDs) like Ibuprofen and Naproxen that can increase your risk of developing peptic ulcer disease, inflammation, and irritation in the stomach, esophagus, and small intestines.
- Gastric emptying is slower in women compared with men, meaning food stays in a women’s stomach longer. This contributes to why some women experience nausea and bloating more frequently than men, and maybe more sensitive to larger meals.
- Gallbladder disease is more common in women than men. This is in part because women have more estrogen and progesterone than men. Both estrogen and progesterone change the composition of bile salts (which break down fat molecules into smaller droplets so that your intestines can absorb them better), and affect how fast bile moves through the liver, gallbladder, and bile ducts.
- The gallbladder empties slower in women compared with men, and women are twice as likely to develop gallstones as men. Pregnancy and female sex hormones (estrogen and progesterone) exacerbate gallbladder disease in women.
- Differences in the physiology of the male and female liver (which helps us to “clean” or detoxify our blood), and the activity of the enzymes released from our pancreas into our small intestines that aid with digestion, can affect how women metabolize (or break down) certain medications. Women tend to produce less stomach acid than men. They also digest food more slowly. Drugs that require an empty stomach for absorption may not work as well if women don’t wait long enough after eating a meal before taking their medication. Consequently, women may be more or less sensitive to certain medications compared with men. This becomes a rather important point when you start a new medication or undergo anesthesia.
- The female colon (or large intestine) is 10cm longer than a male’s. This is likely so that women can absorb more water from the large intestine during pregnancy to keep amniotic fluid (the cushion of fluid around a developing fetus) at a desirable level. Keep in mind, the job of the large intestine is to reabsorb salt and water back into the bloodstream, and condense any remaining indigestible food into the stool. So two problems arise. Women have 10cm longer to reabsorb water from the stool, potentially resulting in hardened stools and constipation. This extra length also creates redundancy, or extra twists and turns in the colon, making women more vulnerable to gas, bloating and constipation.
- The large intestine also empties slower in women compared with men. It takes almost 14 hours longer for food to get through the female colon compared with the male colon. That’s 14 hours longer that stool has to sit in a woman’s colon where water can be reabsorbed and constipation, gas, and bloating can result.
- A woman’s colon drops into the pelvis, which is shaped differently than a male’s pelvis and has to share space with female reproductive organs and the bladder. The male colon merely sits in the abdomen and doesn’t have to share room with any additional structures. Because men have more room to spare in their abdominal and pelvic cavities, men are less likely to be bothered by symptoms of gas and bloating than women.
- The anal sphincter (or muscle that allows us to hold our stool) is generally weaker in women compared with men. The anal canal (that holds our stool before it exits our bodies) also is shorter in women compared with men. These structurally differences theoretically mean that men can tolerate more stool volume in the rectal area and handle diarrhea better than women.
- Abdominal muscles that surround our abdominal organs and hold our intestines in place tend to be stronger in men compared with women due to hormonal differences (…testosterone in men helps to strengthen the abdominal wall), and pregnancy and childbirth tend to weaken these muscles in women. Our abdominal muscles help to prevent digestive issues like gas and bloating by compressing our abdominal contents, and helping food to move along the digestive tract. Simultaneously, they help us to maintain our postural alignment. Stress, tension in our abdominal muscles, sitting in a slumped position, poor posture, sucking in our guts, central obesity, and excess abdominal fat can all affect digestion. For multiple reasons, women tend to experience more abdominal bloating related to weakened abdominal muscles compared with men.
- Because women are at increased risk for a weakened pelvic floor as a result of pregnancy and childbirth they tend to suffer from more symptoms related to pelvic floor dysfunction than men. The pelvic floor in women consists of the muscles, ligaments, connective tissues, and nerves that support the bladder, uterus, vagina, and rectum. Men also have a pelvic floor consisting of the muscles, connective tissues, and nerves that support the bladder, rectum and prostate. The pelvic floor in BOTH men and women serves the function of holding these structures in place and helping them to function. Your pelvic floor muscles stretch from your tailbone in the back to your pubic bone up front, and from one hip to the other. They move up and down like a trampoline supporting your internal organs. Holes open up in these muscles for your anus, urethra (where urine leaves your body), and vagina. Muscles wrap around these holes and help to keep the anus, vagina, and urethra shut. Weakness in these muscles, or other issues with the pelvic floor, can result in fecal or urinary incontinence, constipation, the need to strain excessively with bowel movements, pain or pressure felt in the rectum, and muscle spasms in the pelvis.
- Hormonal fluctuations related to the menstrual cycle and menopause can cause increased fluid retention, bloating, diarrhea, constipation, and slowed digestion in women compared with men. ***While we do NOT treat gynecological disorders and all gynecological symptoms and disorders should be managed by your OBGYN or another trained professional, estrogen, progesterone, and hormonal imbalances can significantly affect GI symptoms and underlying GI diseases like IBS, which we do treat. We believe that understanding why your symptoms occur, and why they happen when they do, can be empowering to you, allowing you to be a better advocate for your own health, to seek out the appropriate specialty care, and to manage your day-to-day symptoms and overall life better.
- The menstrual cycle has 4 phases. Overall length can vary and typical length is often described as 28 days, although only a portion of the population actually follows a true, consistent, 28-day menstrual cycle. The 4 phases of the menstrual cycle include:
- Menses (roughly days 1-5): If you’re not pregnant, you shed the lining of your uterus during menstruation. Here, estrogen and progesterone levels will typically be at their lowest.
- Follicular Phase: This is the first half of your menstrual cycle, roughly days 1-14, up until ovulation. During this phase estrogen is produced from sacs that contain your eggs, called follicles. Estrogen levels rise during the follicular phases causing the lining of your uterus (or endometrium) to thicken in preparation for pregnancy. About halfway through this phase (just as your period is ending) one follicle in one of your ovaries will be the largest of all of the follicles. This follicle becomes the “dominant follicle” and prepares to be released at ovulation. Near the end of this phase, your estrogen levels peak, triggering the anterior pituitary gland in your brain to release two hormones: a large surge of luteinizing hormone (LH), and a smaller surge of follicle stimulating hormone (FSH). The surge of these hormones is what triggers ovulation. Just before ovulation the dominant follicle stops producing estrogen and estrogen levels drop off.
- Ovulation (roughly day 14): This is when the egg is released from the dominant follicle, and pregnancy can occur if sperm is present in the female reproductive tract.
- Luteal Phase (roughly days 15-28): Where the dominant follicle was, now a new hormone-producing structure called the corpus luteum forms from the walls of the follicle. The main function of the corpus luteum is to produce hormones (lots of progesterone, and some estrogen, too), in order to prepare the uterus for pregnancy. If an egg is not fertilized and implanted, the corpus luteum will stop producing progesterone and estrogen roughly around days 24-28, and the levels of both of these hormones will quickly drop off, triggering the start of menstruation. During the late luteal phase, you’re most likely to experience bloating, constipation and/or diarrhea due to hormonal changes.
- A few notes about the menstrual cycle:
- When estrogen levels are high, women tend to retain more water resulting in bloating.
- When progesterone levels are high, like during the 2nd half of your menstrual cycle, GI transit time can be delayed, resulting in food moving more slowly through your GI tract, causing symptoms of constipation and bloating.
- When progesterone levels drop and menstrual bleeding begins, many women notice an increase in bowel activity resulting in diarrhea, increased gas, and bloating.
- Women are more susceptible to the damaging effects of alcohol compared with men because they are generally smaller in stature, and proportionately have more body fat and less body water than men. Water dilutes alcohol, and fat retains alcohol. Women also have less alcohol dehydrogenase, an enzyme released in the liver that breaks down alcohol before it reaches the bloodstream.
- Due to these differences, women tend to experience a more dramatic physiological response to alcohol compared with men.
- Compared with men, women develop alcohol-induced liver disease over a shorter period of time and after consuming less alcohol.
- Women are more likely than men to develop alcoholic hepatitis than men.
- In BOTH men and women, moderate to heavy alcohol consumption is associated with an increase in colorectal cancer compared with no alcohol consumption.
- Heavy alcohol consumption is associated with a 2 fold increased risk of liver cancer.
- Alcohol consumption at any level is associated with an increased risk of squamous cell esophageal cancer.
Due to these anatomical and physiological differences and more, GI symptoms must be assessed and treated differently in male and female patients.
We at Hunterdon Digestive Health Specialists pride ourselves in treating ALL of our patients as individuals. We emphasize informed, patient-centered, shared, decision-making. We firmly believe that you get the most out of your medical care when you are an active participant in your treatment plan and disease management. Dr. Sinha will actively listen to you and thoroughly answer your questions visit after visit. Together we will develop a treatment plan specific to your healthcare needs and personalized to you. We pride ourselves in quality, comprehensive, patient-centered care close to home. Please consult our office for a comprehensive medical evaluation. This information is only intended for educational purposes and is NOT meant to be a substitute for quality medical care.
NOTE: This discussion pertains to the biological and physiological differences between the male and female GI tract based on biological sex. Biological sex is differentiated from gender, which interacts with, but is defined differently from, biological sex. Gender is based on an internal awareness of one’s own identity relating to a complex range of psychological and social perceptions of oneself.