Women with Gastrointestinal Symptoms: Implications for Nursing Research and Practice

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Irritable bowel syndrome and functional bowel disorder are diagnoses used to describe chronic GI symptoms for which no overt pathological condition can be identified. Symptoms are more common in women and are frequently followed in gastroenterology clinics. The purpose of this article is to provide an overview of the research linking GI symptoms and reproductive cycling and to discuss implications for practice. GI symptoms such as stomach pain and nausea are highest during menses compared with other cycle phases; also, stool consistency is loosest at menses. This pattern is present in control subjects. In women with irritable bowel syndrome the same pattern is seen but with higher symptom intensity. Although animal studies have demonstrated that estrogen and progesterone modulate contractile function of some GI segments, in humans, symptoms are highest when these hormones are at the lowest levels. Thus symptoms in women may be related to decreasing ovarian hormone levels or to other circulating hormones or factors which vary with the menstrual cycle. Additionally, other factors such as stress aggravate symptoms. Therapeutics directed toward increasing patient awareness of cyclic patterns in symptom complaints, for example, via the use of daily symptom diaries may be a useful adjunct to dietary, pharmacological, and other therapies. In individuals with chronic gastrointestinal symptoms for which there is no overt pathological condition the diagnosis of irritable bowel syndrome (IBS) is frequently given or they are said to have functional bowel distress (FBD). One report estimated that up to one-half of patients seen by gastroenterologists have IBS (Harvey, Salih, & Read, 1983). In the United States, IBS and FBD are reported more frequently by women as compared to men(Crouch, 1988). Despite the link between the report of chronic gastrointestinal (GI) symptoms and gender, little systematic study of this relationship has been made. The authors' research has focused on probing the interaction between reproductive cycling and GI symptoms and on identification of potential mechanisms accounting for symptoms in women. Nurses who counsel and manage women with regard to their symptoms need to understand the links between reproductive and GI physiology so that appropriate interventions can be planned. This article provides an overview of the current state and future directions for research linking GI symptoms and the menstrual cycle and then gives implications for nursing practice and additional nursing research.

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