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Stress, Anxiety, and IBS: Coping Techniques

Nov 1, 2013
By Christine Celio
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Ever had an upset stomach or other gastrointestinal issues before a test, a first date, or a job interview? You’re not alone–for some, this is such a regular occurrence that they anticipate these events and pack extra Pepto-Bismol or locate the nearest restroom in advance.

Medical experts have long thought that excess stress may worsen underlying gastrointestinal issues. The good news: There are a number of effective strategies for dealing with these troublesome symptoms.

About IBS

Irritable bowel syndrome (IBS) is a disorder of the colon that can cause cramping, abdominal pain, bloating, gas, diarrhea, and constipation. Unlike more severe intestinal diseases such as ulcerative colitis and Crohn’s disease, IBS doesn’t cause inflammation or changes in bowel tissue or increase your risk of colorectal cancer.

Not all IBS cases are stress-related, but in many cases, it’s possible to control irritable bowel syndrome by managing your diet, lifestyle, and stress. However, it’s important to discuss your concerns with your health care provider to confirm you don’t have another underlying medical disorder causing these symptoms.

The Stress-IBS Link

The directional relationship between stress, anxiety, and IBS hasn’t been clearly established, but research indicates that they often co-exist. There are two primary theories about how the relationship functions. One is that stress and anxiety may make you hyperaware of spasms in the colon, potentially worsening your experience with these symptoms. Another theory is that IBS may be triggered by the immune system, which is affected by stress.

The human gut and brain are in constant communication. In prehistoric times, this relationship served us well: During times of imminent threat, the fight-or-flight response would kick in, and the stomach would react by either emptying immediately or holding on to its contents until the threat was over.

Today, despite the fact that our day-to-day stressors aren’t the momentary, potentially lethal threats our ancestors faced, we’re still wired the same way. Our “predators” aren’t the occasional large carnivores; they’re ever-present things like deadlines, performance reviews, and busy schedules. This constant stress and anxiety can result in chronic gastrointestinal issues.

Where to Turn for Help

A nutritionist or naturopathic doctor may be able to help resolve or reduce IBS symptoms, and can discuss the potential benefits of nutrition and supplementation. These health care providers may also help you identify possible dietary triggers to be aware of. In addition, there are some other steps you can take to positively impact how your brain and gut communicate, including cognitive behavioral therapy (CBT) for irritable bowel syndrome, and learning how to manage symptoms on your own.

Cognitive Behavioral Therapy for IBS

Although experts don’t know what causes anxiety to trigger stomach pain, discomfort, diarrhea, and constipation, effectively managing emotional reactions seems to ease symptoms. CBT helps users identify thoughts and behaviors that affect the gastrointestinal system, and understand how, in turn, the gastrointestinal system affects mood. In addition, CBT equips users with coping techniques to manage these unhelpful thoughts and behaviors with the goal of reducing IBS symptoms.

Relaxation exercises and calming self-talk are two CBT coping techniques that may help. These exercises enable users to actively lessen the stress response, thereby reducing the gut changes that occur in response to thoughts and feelings. For example, when you breathe deeply or use calming self-talk to quell anxiety, you send a message to your body that there is no crisis. This reduces the effects of the body’s natural stress response on your digestive system, helping to ease symptoms. Breathing deeply also can lessen anxiety and may help reduce pain.

How to Be Prepared for Future IBS Attacks

Once you’ve had a bad IBS attack, it’s very common to be worried about having another one. You may find that you go on alert, scanning your body for signs and symptoms. Unfortunately, anxiety about future attacks may actually increase your chances of having one. To deal with this:

  • Remain calm in the face of early symptoms. Try different coping techniques until you find what is most effective for you.
  • Keep a symptom diary. This can help you identify possible patterns related to your attacks. For example, if you know you’re more likely to experience attacks in the morning, you can plan your day accordingly (e.g., ensuring you know where the nearest restroom is).
  • Practice regular stress management activities.
  • Be wise about what you eat. It’s important to be aware of dietary sensitivities that may trigger an attack. Common trigger foods include dairy, gluten, and caffeine. Know your triggers, and avoid or reduce your intake accordingly.

While the relationship between stress and gastrointestinal issues is still unclear, understanding how stress affects you can help you be prepared by developing a variety of coping strategies.

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Christine Celio

As a licensed clinical psychologist, Christine approaches patient care with empathy and a listening ear. She has a broad base of experience in clinical psychology and research, having taught in various academic settings and published articles in several academic journals. After earning her master's in sociology from Stanford, Christine coordinated clinical research studies at the Stanford School of Medicine. She went on to complete an additional master's in clinical psychology and received her PhD in clinical psychology from Loyola University Chicago. She completed residency and fellowship at the West Los Angeles VA Medical Center and the San Francisco VA Medical Center/UCSF Center for Excellence in Primary Care. Christine is a board-certified psychologist.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

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