Gender Differences in IBD

IBD May Affect Men and Women Differently

illustration of man and woman internal organs
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In general, women develop more autoimmune or immune-mediated conditions than men. While inflammatory bowel disease (IBD), which is considered an immune condition, appears to affect roughly equal numbers of men and women, some studies have shown that IBD may affect men and women differently. In particular, it is Crohn’s disease which—so far—is shown to have the most variation in terms of how it affects men and women in different ways.

There is, however, some research that includes how ulcerative colitis affects the sexes as well. It’s possible that hormones and other sex-specific characteristics play a role in how some diseases, like IBD, affect men and women differently, but in some cases it may also be related to how men and women (and boys and girls) receive treatment for illnesses.

One reason why IBD might be different in men and women is because of the exposure to potential risk factors. Researchers still don’t know exactly what causes IBD, but there are some ideas as to what could trigger the disease in some people. Genes associated with IBD have been identified, but not everyone who has these genes develops IBD, which means that there is something (or several somethings) contributing to its development. These triggers could be environmental, as in something people are exposed to during their lifetime, or it could be something in the body, like hormones.

Its likely there are many such things working together that then lead to the development of IBD in some people.  

Antibiotics and Risk of IBD in Boys and Men

One of these potential triggers for IBD includes the repeated use of antibiotics. One study found that boys may develop IBD more often after having antibiotics as an infant but another study found that boys are prescribed antibiotics more than girls.

This means that it’s still not known for certain if boys may be more likely than girls to develop IBD after antibiotic use in the first year of life. The study also showed that Crohn’s disease was diagnosed more often, in 75 percent of cases, after one or more courses of antibiotics were given to children when they were infants.

In general, men are more likely to develop infections with parasites, fungi, bacteria, and viruses than women are. It’s thought that men have more problems with contracting infections than women because of a lowered immune response. The immune system seems to react differently in men than it does in women as a result of the variations in male and female hormones. Male hormones may cause the immune system to work less well to fight off infection. In addition, there could be a second factor at work, where male hormones also have an effect on the genes that are responsible for resisting infections. It’s for these reasons that men and boys might get sick with infections more often and this could lead to a need for treatment with antibiotics.

Appendix and Risk of IBD in Girls and Women

Having the appendix removed, through an operation called an appendectomy, is another potential factor that has a complicated relationship to IBD.

After the appendix is removed, studies have shown there’s a trend toward an increased risk of Crohn’s disease but a decreased risk of ulcerative colitis. The increased risk of Crohn’s disease was even greater in women than it was in men, and it stayed that way for the 20 years after the appendectomy.

Women and the Risk of Skin Conditions

One type of extra-intestinal manifestation that affects a significant amount of people with IBD are skin problems. In particular, there are two skin conditions that are closely associated with IBD, erythema nodosum and pyoderma gangrenosum. One study showed that there were several factors that seemed to go hand-in-hand with the likelihood of developing one of these skin conditions.

Aside from being diagnosed with IBD at a young age, and having Crohn’s disease, the other predictor that increased the risk of these skin conditions was gender. Women were more likely to develop erythema nodosum and pyoderma gangrenosum than men with IBD. Having previous treatment with a biologic medication showed a lower risk of these skin conditions in this study.

Men With IBD and the Risk of Liver Disease

A type of liver disease that is more common in men than it is in women is primary sclerosing cholangitis (PSC). PSC is also more common in people with ulcerative colitis than it is in people who have Crohn’s disease. The typical person with PSC is a middle-aged man who also has ulcerative colitis, though the colitis is sometimes not diagnosed until after the PSC is found. Women who have PSC usually do not also have IBD. PSC is an uncommon condition, and while it is quite serious and may require a liver transplant, most patients do well after treatment.

Differences After Surgery for Men and Women

For many characteristics of IBD, men and women appear to be fairly similar: the age at diagnosis and the time to first surgery in the case of Crohn’s disease, for instance. However, after resection surgery, one study found that women have a shorter time (4.8 years) than men (6.5 years) before the Crohn’s disease recurred. Women were also shown more likely to need ileocecal resections (which is the removal of the last part of the small intestine) to treat their Crohn’s disease than men were.

Perianal Disease in Men and Women

The perianal area is the part of the backside that surrounds the anus. Crohn’s disease in particular can affect this area of the body and cause complications such as fistulas (which is an abnormal tunnel between two body cavities) and ulcers. Fistulas affect men and women with IBD equally but one study showed that other perianal conditions (such as lesions) are more common in women with Crohn’s disease than they are in men.

Is There a Gender Bias in Studies?

There are a few things that could be happening that may account for some the differences that research shows in how IBD affects men and women differently. These things need to be taken into account in order to understand the true differences between IBD in men and women, but it's often difficult to separate them out during a research study. In some cases it’s thought that men and women might choose different treatments because women of child-bearing age may have concerns over how IBD treatments would affect a pregnancy. Women might wind up choosing surgery over medication if they’re planning on a pregnancy.

In addition, there are some studies that show that women with IBD might be under-treated or treated with different medications than men are, have fewer colonoscopies, and might also be less likely to take medications as prescribed. In other cases, there’s a concern that the basic social differences in men and women might affect study results, making the topic a difficult one to study.

A Word From Verywell

Crohn’s disease and ulcerative colitis affect men and women in similar numbers but there may be some differences when it comes to how these diseases affect the sexes. In most cases it’s not entirely certain as to why some complications or extra intestinal manifestations of IBD affect one sex more often than they do the other. While it’s not understood why this happens, the outcomes of the studies done on IBD in men and women can help in diagnosing and treating these diseases when it’s known that certain complications are more common in one sex over the other.

Sources:

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García-Gómez E, González-Pedrajo B, Camacho-Arroyo I. "Role of sex steroid hormones in bacterial-host interactions." Biomed Res Int. 2013: 928290.

Peyrin-Biroulet L, Loftus EV Jr, Tremaine WJ, et al. "Perianal Crohn's disease findings other than fistulas in a population-based cohort.” Inflamm Bowel Dis. 2012 Jan;18:43-48. doi: 10.1002/ibd.21674.

Virta L, Auvinen A, Helenius H, Huovinen P, Kolho KL. "Association of repeated exposure to antibiotics with the development of pediatric Crohn's disease--a nationwide, register-based finnish case-control study." Am J Epidemiol. 2012;175:775-784. doi: 10.1093/aje/kwr400

Wagtmans MJ1, Verspaget HW, Lamers CB, van Hogezand RA. "Gender-related differences in the clinical course of Crohn's disease.” Am J Gastroenterol. 2001;96:1541-1546. doi: 10.1111/j.1572-0241.2001.03755

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