You’re feeling anxious studying for an important test, preparing to ask your employer for a raise, or getting ready to sit down and have a tough conversation with your spouse. Then, that familiar gurgling feeling hits you: Your stomach is hard and sore, and maybe you need to rush to the bathroom quickly. An upset stomach is a common reaction to anxiety-inducing situations. Nerves and digestive problems often go hand-in-hand. But is there a connection between life-events or psychiatric disorders and irritable bowel syndrome (IBS)? It’s complicated.
What is irritable bowel syndrome (IBS)?
According to the Office of Women’s Health, irritable bowel syndrome (IBS) is a combination of symptoms that last for at least three months. Common symptoms of IBS include:
- Stomachaches or cramping
- Abdominal pain
“Other conditions can cause similar symptoms, so it is important to have a medical evaluation to be sure none of these is present,” says David D. Clarke, MD, professor of gastroenterology and president of the Psychophysiologic Disorders Association.
For example, your healthcare provider may want to rule out celiac disease, inflammatory bowel disease, Crohn’s disease, lactose intolerance, or colon cancer. IBS is often a diagnosis by elimination, a process of making sure your symptoms aren’t caused by other look-alike diseases.
What causes IBS?
There is no one clear cause of IBS, according to the Cleveland Clinic. However, there are some risk factors:
- Gender: IBS is more common in women than in men. About 2 in 3 people with IBS are female.
- Stress: “You can start having IBS while going through significant mental stress,” explains Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
- Mental disorders: Conditions like post-traumatic stress disorder, panic disorder, depression, anxiety, and adverse childhood experiences (ACE) might be connected to IBS, according to Dr. Clarke.
- Disturbances in gut biome: Around one or two out of every five patients with IBS will have bacterial overgrowth in the small intestine. “There are conditions in the gut that can predispose you. You can have a bad episode of gastroenteritis…when the infection is gone, the hypersensitivity that remains afterward can result in symptoms of IBS,” says Dr. Farhadi.
Luckily, IBS does not shorten a patient’s lifespan, both Dr. Farhadi and Dr. Clarke confirmed. It also does not lead to cancer. There are effective treatments that can restore your quality of life, whether you’re experiencing just IBS, or anxiety, too.
How are IBS and anxiety related?
Your brain and your gastrointestinal (GI) symptoms are linked, by a communication system in your body called the gut-brain axis. In other words, when your nervous system (which controls your emotions and thoughts) experiences stress, that reaction impacts your GI tract—and vice versa.
When you feel anxious, the stress hormones making you feel that way could be transmitted to your gut—triggering the physical symptoms people often call “nervous stomach,” those sudden bowel movements when you’re upset. Or, when regular stomach cramps make you feel like you might need to rush to the bathroom at any time, your mood will likely be impacted. Simple things like a night out with friends or going on a long car drive can increase stress and social anxiety. It’s difficult to know which comes first—the anxiety, or IBS symptoms.
“The cause and effect in medicine is really hard to establish, at most what we can establish is association,” Dr. Farhadi says. “Anxiety is highly associated with IBS, and IBS is highly associated with anxiety. Whether IBS is causing anxiety, or anxiety is causing IBS has yet to be proved.” It’s like the chicken and egg conundrum.
Anxiety and IBS can exacerbate each other, says Dr. Clarke. Studies show that depression and generalized anxiety disorder are more prevalent in patients with IBS, in comparison to the general population.
One study concludes that adverse childhood experiences (ACE’s) increase the likelihood of IBS. Another study says that 30% of IBS patients report experiencing depression, compared to 18% of the general population. Likewise, 16% of IBS patients said that they have anxiety, while 6% of the general population reported anxiety. In some research the numbers were even more alarming: 44% of IBS patients reported anxiety, and 84% reported depression. The general consensus is that you cannot separate mental health and IBS.
How to manage stress-related IBS
Treatment of IBS can include lifestyle modifications and prescription medications, depending on the symptoms and severity of the disease. When anxiety is in the mix, treatment should also include therapies to reduce stress or deal with symptoms of a related mental disorder.
According to Harvard Health, some lifestyle changes include:
- Gradually increasing fiber intake to regulate bowels
- Tracking food intake to identify any foods that trigger IBS
- Eating smaller meals to avoid bloating and gas
- Ensuring appropriate water intake
Dr. Farhadi says that he believes education is the most important component to manage IBS, and he encourages his patients to understand their bodies and how to control the flare-ups of IBS.
Some medications that he said may be helpful to treat IBS include:
- Antibiotics, which kill bad bacteria in the small intestine. The most commonly studied antibiotic for IBS is Xifaxin (rifaximin).
- Probiotics, which increase the good bacteria in the gut and may help improve mood. Supplementing antibiotics with a probiotic can alleviate gastrointestinal side effects, like bloating, and diarrhea.
- Prebiotics, which feed the good bacteria (probiotics) help to create a healthy gut biome.
- Antidepressants (off-label prescription), particularly those in the tricyclic family of antidepressants, can help to control the gut, or help a mood disorder.
The following therapies can help to manage stress and related psychiatric conditions:
- Psychotherapy: “Getting professional help for anxiety, depression, trauma, or consequences from past ACEs that are not improving is important,” says Dr. Clarke.
- Relaxation techniques: The International Foundation for Gastrointestinal Disorders (IFFGD) recommends deep breathing, or diaphragmatic/abdominal breathing; progressive muscle relaxation, which requires that you focus on specific muscles that you tense, and then relax; and positive imagery, which means you use your mind to imagine yourself in a calm and peaceful setting.
- Cognitive-behavioral therapy (CBT): This technique can help to change thought and behavior patterns. It is helpful to treat anxiety, depression, and IBS symptoms.
- Support groups: Meeting with other people who experience anxiety-related IBS can reinforce that you’re not alone.
If you think stress is causing IBS to flare-up, taking steps to manage it can reduce the severity of your symptoms and their longevity—so you can get back to normal life.