A woman’s unique experience of symptoms starts with the tongue and goes through the entire digestive tract. More women can be classified as “supertasters” – they are able to taste both bitter and sweet foods more strongly than men. They don’t need as much of the food to determine if the food is bitter or sweet. This increased sensitivity of the gut to different types of stimulation is seen throughout a woman’s GI tract. Normal women have been shown to be more sensitive to pressure from an inflated balloon placed in the esophagus (swallowing tube between the mouth and the stomach), small intestine, colon or large intestine, and rectum than men. Through each area of the digestive tract, we will talk about symptoms unique to women, their causes, risk factors, testing and treatment.
The GI tract muscles in women may function differently compared with men. Between the end of the esophagus and the beginning of the stomach, there is a muscle which acts like a door. When one eats, the door opens allowing the food to slide into the stomach and then quickly closes again, preventing the food from flowing back up into the esophagus. The muscle in women, especially premenopausal women, squeezes shut with more force than that found in men, making certain that the food and stomach juices stay in the stomach. There is a similar muscle protecting the windpipe from esophageal backflow. In women, tests have shown that after drinking fluids, this muscle tightens more than in men. In part due to this finding, women may have more occurrences of “globus” (the feeling of a “lump in the throat”) that is not necessarily associated with swallowing food. However, overall these strong muscles suggest that women may have some extra protection in the esophagus, normally.
Although women may experience heartburn, they generally have less damage in their esophagus than men. Women secrete less stomach acid than men, throughout their lives and they tend to have fewer ulcers related to acid. The stronger muscles at the end of the esophagus and the lesser amount of stomach acid present in women may help to explain the milder damage to the esophagus. However, because women are more sensitive to irritants, they may experience heartburn more strongly than men. Several things can precipitate heartburn symptoms, including spicy or acidic foods, caffeine, large meals, obesity, or eating prior to lying down. The treatment for heartburn includes modification of any precipitating factors followed by a trial of an acid-suppression medication if symptoms persist. There is data suggesting that prolonged duration of higher-dosed acid-suppressive medication may increase the risk of osteoporosis. This risk can be discussed with your doctor before starting the medication. For refractory cases of heartburn, an endoscopy (a procedure that involves looking into the esophagus and stomach with a small camera) is often indicated to exclude other diagnoses.
Women also seem to have slower emptying of food from the stomach than men. This may be important in explaining why women tend to experience nausea and bloating more frequently than men. Certain conditions including diabetes, prior stomach surgeries, infections, medications, and low thyroid levels can cause damage to nerves that are responsible for gastric emptying, leading to a condition called gastroparesis (delayed gastric emptying). Common symptoms include abdominal bloating, nausea, fullness and weight loss. The diagnosis requires testing by your doctor. The treatment involves eating smaller, more frequent meals that are lower in fat. Although medications may be prescribed by your doctor, options are limited due to drug side effects.
Another stomach problem that may affect women includes inflammation of the stomach (known as gastritis). Many women use aspirin and aspirin-like compounds, known as non-steroidal anti-inflammatory drugs (NSAIDs); ibuprofen is included in this class of medications. Some NSAIDs are available in over-the-counter form while others require a prescription. Women, especially older women, use these medications more often than men for a variety of reasons. These drugs, if used persistently, are known to cause irritation to the stomach lining and may lead to bleeding from ulcers. In recent years, new types of prescription NSAIDs have become available, such as COX-2 inhibitors, which reportedly have less adverse effects on the GI tract, but have been linked to an increase in heart attacks. All patients should discuss with their doctors if the COX-2 inhibitors are right for them. Women should tell their doctors if they are using NSAIDs, whether prescribed or purchased in a drugstore, in order to develop a regimen to help protect their stomach.
Women have slower gallbladder emptying than men normally and are twice as likely to develop gallstones as men. This effect is exaggerated during pregnancy due to unique female hormones, and may be one reason why many women develop gallstones after having a baby. Symptoms of gallbladder disease may include right upper abdominal pain after eating, nausea or vomiting. Gallbladder disease can often be diagnosed by your doctor based upon history and ultrasound results.
Problems During Pregnancy
Pregnancy is associated with nausea, which occurs early in the pregnancy. This effect may result from a slowing of stomach emptying, beyond what is seen normally in women. One of the pregnancy hormones, progesterone, is associated with delaying muscle contraction, and it is believed that this is a major cause of the nausea seen with pregnancy. Women also experience heartburn during pregnancy. This seems to be caused by the increasing levels of progesterone during pregnancy as well as the increasing size of the baby. It is most prominent during the second half of the pregnancy. Constipation is common for similar reasons.
The muscle coordinating moving one’s bowels can be damaged by a tear during childbirth, leading to possible long-term problems. Therefore, it is important for pregnant women to perform the Kegel exercises, which help to strengthen this area, and to discuss any concerns with their obstetrician.