Premenstrual Syndrome Exacerbates Irritable Bowel Syndrome (Pms-IBS)

Abstract

Purpose: Symptoms of irritable bowel syndrome (IBS) have been reported to affect females 3 to 20 times more frequently than males. Clinical studies have demonstrated hormone-related increases in the severity of IBS symptoms regardless of predominant bowel pattern. Females with IBS often experience more severe gastrointestinal (GI) symptoms (eg, bloating, abdominal discomfort, diarrhea) during the premenstrual phase of the menstrual cycle (ie, 1 to 3 days before menstruation). In the cases described in this series, the nonsystemic antibiotic rifaximin was administered for the treatment of worsened IBS symptoms of bloating, abdominal discomfort, or diarrhea associated with premenstrual syndrome (PMS). Methods: This case series details 3 female patients with IBS symptoms that worsened during PMS. Results:Patient 1. A 23-year-old female with a history of constipation-predominant IBS complained of worsened abdominal pain, gas, and bloating during PMS. The patient received rifaximin 200 mg three times daily (t.i.d.) for 3 days at the onset of PMS-associated exacerbations in IBS symptoms (ie, 3 days before menstruation). At a follow-up visit 9 weeks later, the patient reported improvement in PMS-associated IBS symptoms after daily rifaximin treatment during the premenstrual phase of 2 menstrual cycles. Patient 2. A 28-year-old female with a history of diarrhea-predominant IBS complained of worsened symptoms of abdominal gas, cramping, bloating, and diarrhea during PMS. The patient received rifaximin 200 mg t.i.d. for 3 days at the onset of PMS-associated IBS symptoms. At a follow-up visit 4 months later, the patient reported substantial improvement in IBS symptoms after repeated rifaximin treatment during the premenstrual phase of 3 menstrual cycles. Improvement in PMS-associated IBS symptoms was maintained such that the patient did not require rifaximin treatment during the subsequent premenstrual phase of the fourth menstrual cycle after initiating rifaximin therapy. Patient 3. A 34-year-old female with a history of chronic diarrhea complained of bloating, abdominal pain, and fecal incontinence during PMS. The patient received rifaximin 200 mg t.i.d. for 3 days at the onset of PMS-associated GI symptoms. At a follow-up visit 8 weeks later, the patient reported complete resolution of diarrhea after rifaximin treatment during the premenstrual phase of 2 menstrual cycles. Conclusion: In these patients, treatment with rifaximin 600 mg/d for 1 to 3 days during the premenstrual phase of multiple menstrual cycles effectively alleviated symptoms of abdominal pain, gas, bloating, or diarrhea. Rifaximin may prove beneficial for the treatment of cyclical GI symptoms associated with PMS in some patients.