IBS and Stress: The Gut-Brain Link, Causes, & Management

What is stress?

Before understanding the relationship between stress and irritable bowel syndrome, it's important to understand how stress affects your body and what causes stress.

Stress is your body's response to difficult situations that require immediate action or adjustment.

Stress may trigger the ‘fight-or-flight’ stress response as the body prepares to fight or escape a perceived threat. This stress response is accompanied by increased heart rate, the release of hormones such as cortisol, reduced blood flow to certain organs, and slower digestion.

Types of stress include:

• ‍Eustress: This is a positive form of stress. It is usually experienced as feelings of excitement and energy.
• ‍Acute stress: A short-term stress that may be positive or negative.
• ‍Chronic stress: Long-term stress that may seem never-ending.

Once the threat is gone, your relaxation response returns your body to normal. But when we're stressed, this relaxation response does not occur. This is harmful as it may deplete and tax the body and lead to conditions including IBS.

Can stress cause IBS symptoms?

The gut and brain influence one another continually. This served us well in prehistoric times: stressful situations would activate the ‘fight-or-flight’ system – blood flow to the stomach would reduce, and the bowels empty or tense up. This would allow for more energy to flee or fight.

In today’s world, life-threatening situations are rare, but we are still wired the same way. Modern ‘predators’ may come in the form of deadlines and busy schedules and may cause ongoing stress. This chronic stress is a key factor in what often leads to issues such as IBS.

What evidence links stress and IBS?

The science well supports the link between stress and IBS.

A study over 16 months documented people's stress levels and IBS symptoms. It showed that chronic stress predicts the severity of IBS symptoms. During the study, almost all changes in IBS symptoms were based on changes in stress, and not one patient with ongoing stress improved in IBS symptoms significantly.

Another study showed people with IBS are more sensitive to pain during stress. When placing their hands in cold water or listening to unpleasant music, IBS patients became more sensitive to rectal sensations. This form of sensitivity to pain in the internal organs is called ‘visceral hypersensitivity’ and is associated with abdominal discomfort in IBS.

Can stress make IBS symptoms worse?

Stress is known to be a common trigger that can worsen the symptoms of IBS. Many people with IBS experience increased symptoms such as abdominal pain, bloating, and bowel habit changes during heightened stress or anxiety. Stress can disrupt the normal functioning of the digestive system and contribute to IBS symptoms.

Stress can lead to increased muscle contractions and spasms in the intestines. This can cause a whole host of issues like gut pain and cramping. It can affect the speed at which food moves through the digestive tract (hello, diarrhea and constipation!) and disrupt the balance of the gut microbiota – a crucial factor in maintaining gut health.

Recognizing stress-induced IBS symptoms

Stress causes many changes in the body, affecting hormones, nerves, and the delicate balance of gut bacteria. These changes may lead to IBS and can include:

• Pain perception: Stress causes higher sensitivity to pain in the colon and rectum in response to stretching. This leads to abdominal pain in IBS.
• Brain activation: Brain areas associated with attention are changed in stress, leading to a greater conscious focus on sensations in the body and more pain.
• Gut bacteria: Levels change in response to stress, potentially causing IBS as gut bacteria interact with the nervous system and immune system.
• Immune system: Becomes activated. Although this may seem like a good thing, it has adverse effects, as is the case in an allergic reaction. In particular, the activation of ‘silent’ pain receptor cells increases sensitivity to pain in IBS.
• Hormonal changes: Include the release of a corticotropin-releasing factor (CRF). This leads to changes in gut bacteria and the immune system – both of which contribute to IBS.

The gut-brain connection

These changes are features of the ‘gut-brain connection’ – the two-way link between the brain and bowels. This link is made up of several parts of the central nervous system, including the vagus nerve and millions of neurons that surround the gut.

The neurons in the gut are complex and described as the ‘second brain’. This second brain interacts with the actual brain in several ways. The brain sends signals to the stomach and intestines to control digestion. Meanwhile, the gut sends feedback signals back to the brain. Usually operating beneath our conscious radar, these essential processes get thrown off balance in people with IBS, leading to a heightened perception of pain signals.

The gut-brain connection is at the heart of IBS. At its simplest, the symptoms you experience (like pain, diarrhea, and constipation) occur because of a miscommunication between the gut and the brain.

Trauma and IBS

Just as stress and anxiety can play a role in IBS, so can trauma. Up to 50% of people with IBS have experienced trauma, including PTSD, from life events such as:

• Sexual abuse
• Death of a loved one
• Emotional abuse
• The break-up of a serious relationship.

This kind of trauma is known as ‘psychosocial stress’ and is strongly linked with the development of IBS, which may be why many of the most effective treatments for IBS reduce stress and anxiety.

Managing stress-inducted IBS flare-ups

IBS is a stress-sensitive chronic condition. Several stress management strategies have been shown effective for relieving symptoms of IBS:

Yoga
‍A 2006 study showed that yoga reduced symptoms of IBS. The program consisted of a one-hour live demonstration and an instructional video followed daily for four weeks. All measures of IBS symptoms were reduced in the yoga group compared to those on a waiting list.

Cognitive behavioral therapy (CBT)
‍Several studies show CBT improves symptoms of IBS.

Mindfulness training
‍A 2011 trial showed mindfulness training reduced bowel-related symptoms and distress. The program emphasized the mind-body connection and present-moment awareness. The program lasted eight weeks, and substantial results were maintained 3 months after treatment.

Gut-directed hypnotherapy
‍Hypnotherapy targeted to the gut has been shown to reduce symptoms such as pain, bloating, and wind to the same extent as the low-FODMAP diet. Imagery was used, such as suggestions of the gut as a series of watery pipes after patients were hypnotically induced.

Symptom improvements were maintained for at least six months. And as a bonus, levels of anxiety were also reduced.

While IBS is not 'all in the mind,' the gut-brain connection means targeting the mind through stress management can positively influence perceptions of pain in the gut. Symptoms of stress and anxiety, which worsen IBS, may also be reduced.

Lifestyle factors for stress management

On a day-to-day basis, positive lifestyle adjustments can also reduce stress levels. This may, in turn, benefit the symptoms of IBS. Important lifestyle factors to consider include:

Exercise
Exercise releases chemicals in the brain called endorphins, the body’s ‘natural painkillers’ that reduce stress and improve sleep. Even ten minutes of aerobic exercise can stimulate anti-anxiety effects.

‍Meditation
Meditation and relaxation techniques have a range of benefits to the mind and body, including stress relief. An 8-week program improved overall psychological well-being and perceived control over life. Meditation and relaxation techniques can be easy to learn; even 5 minutes of practice can help reduce stress.

‍Maintaining a healthy diet
‍Eating whole foods and five serves of vegetables can boost mood and reduce stress. Foods high in fiber, such as wholegrain bread and cereals, may lower stress, and citrus fruits and other vitamin C-containing foods reduce anxiety.

Maintaining a sense of humor
‍While this may feel challenging in times of pain and emotional stress, laughter releases endorphins and other healthy hormones and distracts people from anger, physical stress, and other negative emotions.

Building supportive relationships
Building a strong support network helps to enhance self-esteem and reduce stress levels. Feeling supported acts as a powerful antidote to loneliness, which has been closely linked to feelings of depression and anxiety.

The Wrap Up

There is a direct connection between stress and irritable bowel syndrome. Higher levels of stress are common among people experiencing IBS symptoms. This occurs through the gut-brain axis. Stress, anxiety, and trauma are often linked with and activate the 'fight-or-flight' response. This may affect the digestive tract and lead to functional gastrointestinal disorders like IBS.

To reduce psychological stress, try stress reduction strategies such as hypnotherapy or cognitive behavioral therapy. The treatment of irritable bowel syndrome is complex, but relaxation techniques may help to restore the digestive system.