Common Gastrointestinal (GI) Problems in Women

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Common GI Problems in Women Overview

It is important to understand how the digestive system tract normally works. It is also important to understand differences between men and women. Women may have unique GI problems or different symptoms than men for the same disease. Hormonal changes across a woman’s life—and differences in anatomy—play a real role in how digestive symptoms develop and persist in women.

• What symptoms might tell a woman that she has a GI problem?

  Women can feel GI symptoms differently than men. This starts with the tongue and goes through the entire digestive tract. More women are “supertasters.” This means they can taste bitter and sweet foods more strongly than men. They need less food to notice these tastes. Women’s GI tracts are more sensitive in other ways. In studies, normal women felt more pain than men when doctors inflated a small balloon in the esophagus (the swallowing tube connecting the mouth and the stomach), small intestine, colon (large intestine) and rectum. For each part of the digestive tract, we will cover symptoms unique to women. We will explain their causes, risk factors, tests, and treatments.

• What are common esophagus problems in women?

  Women’s GI muscles may work differently than men’s. Between the esophagus and the stomach, there is a muscle which acts like a door. When you eat, the door opens so food can slide into the stomach. The door closes quickly, so food does not flow back to the esophagus. In women, especially before menopause, the muscle closes with more force than in men. This keeps food and stomach juices in the stomach.

  There is a similar muscle that protects the windpipe from backflow. Tests show that, after drinking fluids, this muscle tightens more in women than in men. This may be why women feel more “globus,” a feeling of a lump in the throat that is not associated with swallowing food. These strong muscles may give women some extra protection in the esophagus.

  Women may still experience heartburn, but their esophagus usually has less damage than a man’s. Women make less stomach acid than men throughout their lives, so they tend to have fewer ulcers related to acid. The stronger muscles and the lower levels of stomach acid likely explain why women have milder esophagus damage. Because women are more sensitive to irritation, their heartburn can feel worse than a man’s, even with less damage.

  Certain things can trigger heartburn. These include spicy or acidic foods, caffeine, large meals, obesity, and lying down soon after eating. Treatment starts with avoiding triggers. If symptoms continue, an acid-suppression medication may be prescribed. If heartburn doesn’t improve, your doctor may recommend an endoscopy, a test that looks into the esophagus, stomach, and small intestine with a small camera, to better understand the cause of symptoms.

• What are common stomach problems in women?

  Women’s stomachs tend to empty food slower than men’s. This may explain why women feel nausea and bloating more often. Some conditions can damage the nerves that control stomach emptying, including diabetes, prior stomach surgeries, infections, certain medications, and low thyroid levels. When this happens, it can cause a condition called gastroparesis (delayed gastric emptying) which means that the stomach empties too slowly. Women are up to four times more likely to be diagnosed with gastroparesis than men. Common symptoms include abdominal bloating, nausea, fullness and weight loss. Your doctor can run tests to diagnose this condition. Treatment means eating small meals more often and choosing foods that are lower in fat. Doctors can prescribe medications, but there are few effective medication options.

  Another stomach problem in women is gastritis, inflammation of the stomach lining. Many women take aspirin and aspirin-like medications called non-steroidal anti-inflammatory drugs (NSAIDs); ibuprofen is one example. Some NSAIDs are available over-the-counter while others require a prescription. Women, especially older women, use these medications more often than men for many reasons. If used persistently, these medications cause irritation to the stomach lining and ulcers. Always tell your doctor if you are taking.

  Women are more likely to have functional dyspepsia than men. Symptoms include upper belly pain, belly burning, fullness after eating, or feeling full easily. An endoscopy is normal and symptoms are caused by a disorder in signaling between the gut and the brain, leading to pain and discomfort.

• What are common small intestine problems in women?

  Celiac disease is more common in women. Women have higher rates of undetected celiac disease. Osteoporosis (thinning of the bones) and underactive thyroid (hypothyroidism) are more common in women with celiac disease.

• What are common colon problems in women?

  Women’s large intestines empty more slowly than men’s, thought this difference disappears as people age. This may explain why women tend to be more constipated than men. There is also a muscle at the end of the rectum called the anal sphincter. This muscle allows you to hold in a bowel movement until you find a bathroom. When doctors test this muscle, they measure how hard a person can squeeze it shut. Most studies show that women have less squeeze pressure than men. Women also have a shorter anal canal, the passage to the rectum. Men can hold more in their rectum before feeling the urge to go. Because of these differences, men’s bodies are often better at managing diarrhea than women’s bodies.

  Long-term or chronic constipation is common in women and often gets worse with age. Treatment includes at least 20-35 grams of dietary fiber per day, drinking enough fluids, and exercising regularly. Over-the-counter medications may include stool softeners and laxatives. If these do not help, your doctor may order tests or prescribe other medications.

  Irritable Bowel Syndrome (IBS) happens about twice as often in women as men. Symptoms often include diarrhea, constipation or a combination of both. Bloating and belly pain are common and may improve after bowel movements. People with IBS are extra sensitive to intestinal gas. Doctors believe this happens because of how nerves in the intestines send messages to the brain, how the brain reads those messages, and how the brain responds back to the gut. IBS is diagnosed based on specific symptoms and ruling out other problems. Women with IBS are more likely to experience bloating and constipation compared with men. Women also report more fatigue, anxiety, depression, and lower quality of life than men with IBS. The good news is that IBS does not damage the intestinal lining. Stress tends to make IBS symptoms worse. A Mediterranean-style diet, stress management, and physical activity are important lifestyle changes for people with IBS. Healthcare providers may recommend medications to improve the symptoms of IBS.

  Inflammatory bowel disease (IBD) includes both Crohn’s and Ulcerative Colitis. Symptoms may include diarrhea, blood in the stool, weight loss, and anemia. IBD is often diagnosed with colonoscopy and review of biopsy samples from the intestine. Over half of women with IBD report worsening of symptoms with their menstrual cycles. Women with IBD have higher rates of anxiety and depression compared to men, with worse quality of life. Over half of patients with IBD report sexual dysfunction due to pain, fear of stool leakage, fatigue, or problems with body image, but very few people discuss these concerns with their healthcare providers. Fecal incontinence or losing control of stools can affect many patients with IBD. These symptoms should be discussed with healthcare providers and can be improved with medications, disease control, and pelvic floor physical therapy.

  Microscopic colitis is 3 times more common in women than men. Microscopic colitis is most commonly diagnosed after age 50 but can be diagnosed at any age. Patients with microscopic colitis have diarrhea which typically continues throughout the night and urgent stools with possible weight loss. This is more common in women with other autoimmune problems.

  Colon cancer is the 3rd most common cancer and 2nd leading cause of cancer death in women. Women are more likely to develop cancer on the right side of the colon. These cancers may be detected due to anemia and fatigue, but they are less likely to cause blood in the stool, so they may be detected later. Women should start colon cancer screening at age 45. If you have a family history of colon cancer, screening may start earlier and screening tests may be done more often. There are inherited colon cancer syndromes that are associated with uterine, ovarian and breast cancers. If these cancers are found within a family, genetic counseling should be offered. All patients, regardless of age, should be evaluated for symptoms of blood in the stool, belly pain, changes in bowel pattern (like new constipation), iron deficiency anemia without an explanation, and weight loss without an explanation.

• What are common gallbladder problems in women?

  Gallbladder disease is 2-3 times more common in women than men. Hormonal differences can cause slower gallbladder emptying and higher risk for forming gallstones. Higher hormone levels in pregnancy can further increase this risk. Symptoms of gallbladder disease may include sudden right upper belly pain after eating, nausea or vomiting. Gallbladder disease can be diagnosed based on talking with your provider and checking an ultrasound of the gallbladder.

• What liver problems are more common in women?

  Autoimmune hepatitis and primary biliary cholangitis are autoimmune diseases that affect the liver. Both of these conditions are more common in women. Metabolic dysfunction-associated steatotic liver disease (MASLD or fatty infiltration of the liver) is less common in women before menopause. After menopause, this disease is equally common in men and women, but women are more likely to have significant scarring in their liver, which can lead to liver transplant. Women are more susceptible to liver injury from alcohol than men who drink the same amount of alcohol. Women have a higher risk of liver injury from medications or drug reactions.

• What are common GI problems women experience during pregnancy?

  The most common GI symptoms in pregnancy are nausea, vomiting, and heartburn. Nausea and vomiting often begin at 4-6 weeks of pregnancy and may improve by week 20 in many women. Heartburn is common later in pregnancy. The hormone progesterone causes relaxation of the muscle at the lower esophagus, making reflux more frequent, and the growing uterus also increases reflux symptoms. Constipation is common later in pregnancy because progesterone slows movement in the GI tract. Iron supplements and reduced activity may also worsen constipation. Sometimes, women may develop itching in the second and third trimester, worst on the palms and soles of the feet. This is caused by an increase in bile acids called intrahepatic cholestasis of pregnancy. Hemorrhoids can become enlarged during pregnancy and delivery.

  Large babies, complicated vaginal deliveries requiring the use of special instruments, or episiotomy can all increase the risk of pelvic floor injury and fecal incontinence – or loss of control over defecation. Many women do not talk to their providers about these symptoms, but treatments including diet changes, fiber supplements, and pelvic floor muscle training can be very helpful.

• What other medical conditions can cause GI symptoms?

  Endometriosis may cause GI symptoms including bloating, diarrhea, constipation, nausea, and painful bowel movements. Symptoms of endometriosis may worsen with menstrual periods. Ovarian cancer can be difficult to diagnose and GI symptoms may be a sign. Bloating, increased belly size, and urgent or frequent urination may be symptoms. Ovarian cancer should be considered, especially in women who have new symptoms of bloating or IBS beginning after 50 years old.

Author(s) and Publication Date(s)

Robyn G. Karlstadt, MD, MACG, Shire Pharmaceuticals, Wayne, PA – Published October 2002, Updated April 2007.

Rebecca Ensley, DO, and Alissa Speziale, MD, FACG, FACP, Naval Medical Center San Diego, San Diego, CA – Updated July 2013.

Ann Flynn, MD, FACG, University of Utah School of Medicine and Saad Javed, MD, Drexel University College of Medicine/Allegheny General Hospital, PA - updated July 2026.

The views expressed in this presentation are that of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

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