Can irritable bowel syndrome be mistaken for gynaecological problems?

A study inSouth Manchester in 1989 found that 52% of women presenting to a gynaecological clinic with pelvic pain had symptoms suggestive of irritable bowel syndrome. Only 8% of those with symptoms suggestive of IBS had a proven gynaecological disorder. One cause of pain associated with intercourse (dyspareunia) is IBS.

There may be a relationship between hysterectomy and IBS. A study inSheffield found that 22% of women had symptoms of IBS before surgery (this is no different from the general population). Following hysterectomy, 60% of those with IBS symptoms had improved or were symptom free.

The bowel is sensitive to progesterone, which is secreted from the ovary after egg release during the second half of the menstrual cycle (luteal phase -Q 2.13). Progesterone levels increase in pregnancy and this plays a part in the sluggishness of the bowel. Many women are aware of a change in bowel habit during the second half of the menstrual cycle or during their periods. Some studies, but not all, confirm that during the luteal phase the transit time for food to pass through the bowel increases leading to abdominal distension and constipation.

 

A 45 year old secretary was referred for treatment of pelvic pain before her periods. At laparoscopy the pelvic organs appeared perfectly healthy. It became apparent that her bowels became sluggish before her periods. Regulan ( 40) was commenced before her periods and her pain improved quickly.

A nineteen year old young lady was referred to me for a third opinion and for hysterectomy! She had chronic pelvic pain which was very severe around the time of her periods. When I saw her on the first occasion she was accompanied by her family who stressed the devastating pain that she was experiencing and that the only humane option was for me to remove her womb.

At the age of seventeen she had a laparoscopy and was found to have spots of endometriosis. The endometriosis had been treated by laser, danazol and the pill and she had also received antibiotics. None of these treatments had any effect on her pain. When we reviewed the story, it became apparent that she was having increased Frequency of bowel actions at the time of her periods and she had pain on opening her bowel.

Whilst we felt every sympathy for this young lady’s pain, we felt that other avenues to hysterectomy should be pursued. Colpermin and Regulan were prescribed to be taken as required and particularly from a few days before menstruation and continued through the period. When she attended for her first review, the problem had resolved. Clearly the pain had been from her bowel which is sensitive to the hormone changes that occur around the time of menstruation.

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Women's Health



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