The Connection Between PCOS and IBS 

Recent research has delved into the connection between PCOS and IBS, and if there is a positive correlation between these two disorders. Though much work is yet to be done exploring the ‘why’ and ‘how’ behind the ways IBS and PCOS may be connected, there is emerging research to show that women with a positive PCOS diagnosis may be more likely to display symptoms of IBS, compared to women who do not have PCOS. In this article, we’ll discuss what IBS entails, what the data suggests regarding the connection between IBS and PCOS, as well as what steps you may be able to take to reduce your symptoms. 

  • What Is IBS? 
  • What the data says about PCOS and IBS 
  • How to reduce symptoms of IBS

What is IBS? 

IBS stands for irritable bowel syndrome, and it is a common disorder that affects the large intestine. Signs and symptoms include “cramping, abdominal pain, bloating, gas, diarrhea, and constipation.” Unfortunately, IBS is chronic and there is no known cure for it, although some people find that they are better able to manage symptoms through diet, reducing stress, and lifestyle changes.

So what causes IBS? The driving force isn’t exactly known, although multiple potential factors are thought to play a role, including: 

  • Muscle contractions 
    • The walls of the intestines are lined with layers of muscle; these muscles contract as food moves through your digestive tract. If contractions are consistently stronger, or last longer, than normal then this can trigger cramping, gas, bloating, and diarrhea. On the other hand, weak intestinal contractions may be behind constipation (and related bloating), as food passage through the tract is slowed. 
  • Nervous system abnormalities
    • Conditions affecting the nervous system can impact the functioning and communication of the gastrointestinal system. Some people with IBS may have abnormalities in the nerves in the digestive system that cause them to experience discomfort when the abdomen stretches from gas or stool. 
  • Severe infection 
    • IBS can be the response to diarrhea caused by bacteria or a virus; alternatively, it can be associated with a surplus of bacteria (otherwise known as “bacterial overgrowth”) in the intestines. 
  • External stressors
    • Stress and anxiety can both trigger an ‘overreactivity’ or ‘under reactivity’ of your gut, according to a review published in the World Journal of Gastroenterology; this originates from disturbances in the balance between your brain and stomach, and the signals that pass between the two. They point out that since IBS is a “stress-sensitive disorder,” reducing stress shows promise in its ability to mitigate symptoms. 

What the data says about PCOS and IBS 

One study conducted in 2020 that followed 200 women (approximately 100 with PCOS, and 100 without) found that women with PCOS were more likely to experience symptoms of PCOS. The study lasted for 6 months and found that the prevalence of IBS in women with PCOS hovered around 20%, while women without PCOS hovered around 11%. Researchers aren’t sure on why there seems to be a positive association between these two chronic conditions, but they hypothesize that PCOS-induced stress may have something to do with it. Specifically, they point out that “previous studies have reported that women with PCOS have more anxiety and stress” than women without. 

As mentioned earlier, IBS is a stress-sensitive condition. A review from 2014 found that evidence from both clinical and experimental studies have demonstrated stress impacts the following: intestinal sensitivity, motility, and secretion and permeability, which all yield alternations in the “central nervous system, peripheral neurons, and gastrointestinal microbiota.” Stress also goes on to trigger changes in the gut-brain axis and the microbiota-gut-brain-axis, which can cause symptom flare ups that correlate with periods of stress. Another study published in Digestive Diseases and Sciences found that in a small cohort of 65 women (36 of who had PCOS), women with PCOS seem to “have a higher prevalence of IBS compared to healthy control [subjects],” and this finding was true even after correcting for BMI and age.   

So we know from the review discussed above that stress is antagonistic toward IBS, and we already know that PCOS can be extremely stressful. In that sense, the connection between these two conditions may not be entirely surprising. However, researchers studying the impact of stress on PCOS patients also found that women with PCOS – on a physiological level – may respond differently to stressful events than women without PCOS. 

Using cardiovascular responses, cortisol levels, ACTH, and circulating leukocytes (white blood cells) as proxies for stress, researchers in the study found that women with PCOS had a “significant increase in anxiety” and blood pressure, as well as enhanced HPA-axis and heart-rate reactivity in response to a stressful event compared to women without PCOS. They conclude that there is “altered stress reactivity” in PCOS patients, which may “constitute a link between depression, overweight, and cardiovascular and diabetes risks” associated with a positive PCOS diagnosis. This increased stress and anxiety that is well documented among women with PCOS experience may in turn promote and exacerbate IBS symptoms. 

How to control IBS symptoms 

Unfortunately, since IBS has no cure (similar to PCOS), the best strategy is to calibrate your expectations and focus on reducing IBS symptoms, as opposed to doing away with them altogether. In order to find out how best to combat IBS, we can look to the potential triggers we can control: stress and lifestyle. 

This is easier said than done, we know! However, there are research-backed ways to try and eliminate stress from your life; you can try to work the following methods into your everyday routine. Try out one or more of the suggestions below at a time, and see how it impacts your life. 

  1. Exercise (preferably aerobic!)

Even though exercise is a form of ‘physical stress,’ it is proven to help with neurological stress. Harvard Health reports, “the mental benefits of aerobic exercise have a neurochemical basis;” this is because exercise reduces your body’s levels of stress hormones (such as adrenaline and cortisol), and stimulates the production of endorphins (known to be natural painkillers and mood elevators.” They explain this is why ‘runner’s high’ is such a well-documented phenomenon: endorphins trigger feelings of relaxation and optimism that follow exerting yourself physically. 

Great examples of aerobic exercise include anything that gets your heart pumping: think bicycling, running, water aerobics, swimming, and circuit training. A common myth regarding PCOS is that those with the condition should not engage in vigorous or aerobic activity. However, as long as you don’t push yourself too hard, this type of exercise is healthy for PCOS as well. Symptoms of ‘overdoing it’ include extreme fatigue, feeling like taking a nap, sleep disturbances, etc. 

  1. Find time for self care  

This will mean different things to different people, but the key part to quality self care is as follows: it is time alone to think solely about yourself, be in the moment, or do something you enjoy. No worrying about things to complete in the future, obligations to fulfill, or past worries to rehash: just be in the moment and take time to do something for yourself. There doesn’t necessarily need to be something inherently ‘productive’ to this – you don’t need to walk away having completed something. You just need to focus on yourself, honoring your own wants and needs in the space and time you have set aside. 

Here are some ideas that are popular: taking a relaxing bath (consider doing a spa day at home!), meditating for 10 minutes in the morning before getting on your phone, journaling, cooking, baking, gardening, going for a long walk, reading a good book, and so on. 

Find joy in the small things, and consciously put time on your calendar to do this small thing for yourself. Treat it as importantly as you would a business meeting or a meeting with a friend. 

  1. Work with a trusted healthcare teamdoctor 

Holistic medicine involves focusing on more than just tackling the symptoms. It’s about getting to the root cause of a health problem, and incorporating multiple methods by which you can remedy the underlying issue. In the case of PCOS, stress, hormonal imbalances, and insulin resistance can all play a role in exacerbating symptoms. As such, creating a holistic care plan which focuses on exercise, nutrition, lifestyle, and community can all have a place in tackling challenging symptoms from multiple angles. Similarly, for IBS, researchers believe it is a stress-sensitive disease, so taking time to not only explore medications (which can be useful in managing symptoms), but also prioritizing foods that calm your gutstomach, exercises that reduce inflammation, and daily activities that lessen anxiety as opposed to triggering it can all be useful. 

Furthermore, some people find that specific foods can exacerbate IBS. Examples of foods that may exacerbate IBS include: greasy foods (including fast food), dairy products, wheat, beans and legumes, artificial sweeteners, alcohol, and soda. On the other hand, foods that can be helpful in reducing symptoms include lean meats, eggs, salmon, leafy greens, and It can be tedious and detrimental to your health to needlessly remove foods from your diet, so be sure to work with a registered dietitian to guide you through this process. A common protocol is to rule out intolerances and allergies, and focus on fruits and vegetables low in ‘FODMAPS.’ FODMAP stands for fermentables, oligosaccharides (a carbohydrate chain made up of 3 simple sugars), disaccharides (milk sugar lactose), monosaccharides (think fructose), and polyols (sugar alcohols), and these refer to several categories of carbohydrates that could aggravate IBS. We emphasize ‘could’ here, because everyone is different: if you have IBS, but you know you get along well with dairy, then just because it bothers others with IBS does not mean you need to cut it out. We mention low-FODMAP foods as ones worth exploring with a healthcare provider because nutrition can play a massive role in how you feel everyday, your mental health, and how your PCOS symptoms present themselves. As such, it is well worth finding a healthcare partner who is enthusiastic about not just covering up your IBS and PCOS symptoms with medication – which can be useful – but instead tackling them together as part of the bigger picture, tuning into your body’s needs, and discovering what foods work best for you

Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.