The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers

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.

Estrogenic influences in pain processing

“…Genetic variants and polymorphisms as well as environmental factors have been shown to affect the susceptibility to different pain conditions (Diatchenko et al, 2007). Still, pain symptoms in women with IBS, TMD, and migraine fluctuate with the menstrual cycle (Houghton et al, 2002;Johannes et al, 1995;LeResche et al, 2003) and increased estrogen levels also correlate with a higher risk of chronic lower back pain (Wijnhoven et al, 2006) and temporomandibular disorders (LeResche et al, 1997). The incidence of less well-defined pain disorders such as fibromyalgia and its equivalents peaks around menopause (Pamuk and Cakir, 2005;Waxman and Zatzkis, 1986;Wolfe, 1990) and postmenopausal women have been reported to be twice as likely to experience joint pain or stiffness as premenopausal women (Szoeke et al, 2008).…”

Differential Activation of the Periaqueductal Gray by Mild Anxiogenic Stress at Different Stages of the Estrous Cycle in Female Rats

“…In women, one factor that appears to affect the pain experience is the cyclical variations in sex hormones that occur during the menstrual cycle. Women with existing painful disease states consistently report worsening of their pain during the late luteal phase of the cycle (premenstrual period) (Bajaj et al, 2001;Houghton et al, 2002;Powell-Boone et al, 2005). Cycle-related changes in pain threshold have also been reported in normal healthy women (Riley et al, 1999;Fillingim and Ness, 2000), although a more recent study has challenged this finding (Tousignant-Laflamme and Marchand, 2009).…”

Hormones and Their Interaction with the Pain Experience

“…For example, although no difference in rectal sensitivity to balloon distension across the cycle is seen in healthy women, in those with IBS an increased sensitivity is seen during the menstrual phase 14 . Similarly, variations in pain sensitivity have also been demonstrated in women with IC, dysmenorrhoea and fibromyalgia.…”