title: Association between gastro-intestinal symptoms and menstruation in patients with ileal pouches.
abstract: OBJECTIVE
  Gastro-intestinal (GI) symptoms are often experienced by healthy women during menstruation. An increased frequency of GI symptoms during menses has also been reported in women with irritable bowel syndrome or inflammatory bowel disease (IBD); however, IBD patients with restorative proctocolectomy and ileal pouch-anal anastomoses (IPAA) have not been studied. We aimed to examine the association between GI symptoms before and during menses in patients with IPAA, and to assess factors for exacerbation of GI symptoms in those patients.
  
  
  METHODS
  Adult women recorded in the Pouchitis Registry were invited to participate in a mailed survey. Participants reported on GI symptoms 1-5 days prior to- (pre-menses) and during the days of their menses in recent months. Demographic and clinical variables were obtained through the survey and chart review.
  
  
  RESULTS
  One hundred and twenty-eight (21.3%) out of 600 women with IPAA responded to the survey questionnaire. Forty-three (33.5%) were excluded for reasons including post-menopausal (n = 25), hysterectomy (n = 14) and use of contraceptives (n = 4). Abdominal pain (P = 0.001), diarrhea (P = 0.021), and urgency (P = 0.031) were more commonly reported during menses than pre-menses by the participants. Only a history of painful menses was significantly associated with increased GI symptoms during menses for patients with ileal pouch (odds ratio = 5.67; 95% confidence interval: 1.41-22.88; P = 0.015).
  
  
  CONCLUSIONS
  GI symptoms such as abdominal pain, diarrhea, and urgency are commonly associated with menses in patients with ileo-anal pouch. Painful menses may be associated with worsening of GI symptoms.
authors.affiliation: Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Colorectal surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA and Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA and Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Shishira
authors.initials: S
authors.lastname: Bharadwaj
authors.affiliation: Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Colorectal surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA and Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA and Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Xian-Rui
authors.initials: XR
authors.lastname: Wu
authors.affiliation: Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Colorectal surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA and Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA and Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.affiliation: Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Colorectal surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA and Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA and Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Queener
authors.affiliation: Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Colorectal surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA and Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA and Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Lesley
authors.initials: L
authors.lastname: Graff
authors.affiliation: Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Colorectal surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA and Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA and Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada shenb@ccf.org.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
keywords: ileal pouch-anal anastomosis; inflammatory bowel disease; menstruation; restorative proctocolectomy; symptomatology