Psychological factors in IBS

Psychological factors and Irritable Bowel Syndrome (IBS) are, in many cases, thought to be linked. Our understanding of the cause and effect relationship between these issues is, however, less clear.

IBS can give rise to psychological issues such stress, anxiety, panic attacks or even, in some cases, depression. On the other hand, the burden of troublesome symptoms of IBS can have a huge impact on our lives and have a detrimental impact on our confidence and mood.

On this page we consider how feelings of stress or other negative emotions can affect our digestive system. There is a well established brain-gut connection and many of the whole-body consequences of chronic stress are thought to land in our gut.

There is a so-called brain-gut axis in your body. The gut has its very own nervous system called the enteric nervous system which has strong links with your central nervous system and the brain. An efficient communication system exists with nervous signals continually travelling in both directions.

An example of this is when you think of, or smell tasty food, your gut stimulates the release of digestive juices in an instant.

As signals travel both ways, in less fortunate circumstances, a troubled brain may give rise to a troubled gut and vice versa. This is a theory backing the phenomenon that psychological factors such as stress, anxiety or depression and IBS are all closely connected and can influence one another.

Stressful situations are a part of modern life. Many of us are likely to feel stressed before a big job interview or a public speaking event and for people who don’t suffer from IBS, our digestive system may well become unsettled for a couple of hours as a result of such events.

However, chronic, or long-term stress and the effects it can have on the digestive system is a real issue.

During stress, our sympathetic nervous system becomes more active and the so-called ‘fight or flight’ response is triggered. This causes our heart rate, blood pressure and breathing rate to increase, preparing your body for action, meanwhile, processes such as digestion or immune function dwindle as they are not required in a stressful or life threatening situation (stress would traditionally only appear in response to physical danger).

Nowadays psychological or emotional stress is abundant and the ‘fight or flight’ responds to this. It can dominate as a result of chronic stress, meaning our digestive system will suffer as a result. Uncoordinated contractions, spasms, pain and sudden changes in bowel movement are common and if happening very regularly, the gut will become continually uncoordinated and irritated and IBS may take hold.

Stressful, busy lives often go hand in hand with poor or erratic eating habits. Many people are guilty of eating too quickly or on the go, not eating enough, eating food lacking in nutritional quality, upping quantities of sugar for a quick fix of energy or consuming alcohol to try and calm down (although this won’t help in the long-term!). These habits associated with stress will only have further detrimental effects on our digestion, not to mention our general health.

There is evidence to suggest that traumatic or stressful events in childhood, such as abuse, neglect or losing a parent can predispose children to IBS in later life. The reasons as to why this happens aren’t absolute but theories suggest these individuals may develop hypersensitivity to pain, discomfort and stress as a result of certain early-life experiences.

Although it is generally agreed that emotional issues such as anxiety or panic disorders don’t independently cause IBS, they are thought to have a significant part to play.

People battling anxiety often get very concerned and nervous about situations that regular people wouldn’t – and the state of their bowels is no exception. It is likely that if you suffer from anxiety, you are going to be much more aware of your bowel movements and are more likely to react to twinges, pain or discomfort compared to others. This could lead to panic setting in.

As the brain and gut are so in tune with one another, with a network of nerves connecting them, it is not surprising that symptoms of IBS are often associated with a vicious cycle of emotional troubles. If your bowel movements suddenly change this can be enough to trigger anxiety or even a panic attack in a sensitive individual. Emotional stress is then more likely to upset your bowels and so on.

The causal relationship between depression and IBS is somewhat ambiguous like that of stress and anxiety disorders. The cause and effect in some cases is hard to determine but this is often irrelevant as symptoms get lost in a complex circle of events.

IBS is thought to arise from a combination of contributing factors including dietary factors, lifestyle habits, psychological factors, hormones, gut bacteria, and genetic factors. It is very likely in a case of clinical depression that the affected individual isn’t looking after themselves properly and a compromised diet, sleeping pattern, exercise regime and state of mental health are likely to cause a host of problems for your gut.

Understanding dietary influences with regards to IBS can be tricky: determining what exactly is aggravating your symptoms isn’t always easy. There could be a specific intolerance or just a few more minor trigger foods, but in most cases it is important to pay attention to your eating patterns and even create a food and symptoms diary to help you understand these patterns of eating and subsequent symptoms as much as possible.

Once this first phase is complete and you have an idea of what foods are affecting you, is it then up to us as individuals to manage our diet in an attempt to keep symptoms at bay. This can be time consuming and involves effort and confidence, for example when deciphering food labels.

Someone suffering from depression is more to struggle with these concepts and less likely to actively employ them. Symptoms are therefore less likely to improve.

A fragile mental state together with IBS means there is likely to be a whole host of symptoms that we need to contend with. These can include:

• Changes in levels of stomach acid – Stomach acid is crucial for the initial stages of digestion and for keeping potentially pathogenic bacteria at bay. In stress, stomach acid levels can be affected. Intense short bouts of stress may cause an increase in production but long-term stress can cause stomach acid to decrease resulting in indigestion and the improper digestion of food. This will add to the irritation in the gut

• Nausea and loss of appetite – Eating is usually an enjoyable experience but when you are upset or going through emotional turmoil the desire to eat is often lost

• Cramping and diarrhoea – this is much more likely when under stress. As our sympathetic nervous system takes over in stress, the digestive system is no longer the focus and it can become uncoordinated. Rhythmical contractions are lost and a quicker transit time, cramping sensations and diarrhoea are likely outcomes

• Bloating –Bloating can occur for a number of reasons if we are emotionally stressed and have an irritable gut. If gut contractions quicken, as seen in times of stress, food moves too quickly though the digestive system, trapping air with it. In an opposite situation, where transit time is too slow (for example if we aren’t looking after ourselves, eating enough food, especially rich sources of dietary fibre or drinking enough water), air can similarly become trapped and struggle to dislodge. In times of anxiety or stress our breathing rate can increase and we may swallow excess air by accident which can result in bloating

• Insomnia – Trouble initiating or maintaining sleep is likely with both emotional troubles and IBS. An over-active mind, not to mention hormone imbalances, can disrupt our sleep cycle. IBS flare ups are also common at night, especially after eating a large meal later in the day. This can affect your sleep. People with depression are thought to have disrupted circadian rhythms which are important in the sleep-wake cycle. This may explain why people with depression often sleep too much or too little

• Fatigue – Stress, anxiety and depression can be both physically and mentally exhausting. Stress and anxiety make our bodies work harder, increasing heart rate, blood pressure and our breathing rate which is physically demanding. If we can’t relax our minds, we are more likely to become emotionally stressed which is draining, and sleeping problems which are likely to coincide with emotional troubles will only add to this. IBS can also contribute to fatigue

• Urgency – The sudden and uncomfortable urge to use the toilet quickly is common in IBS and even more so if anxiety or panic disorder is present. This is thought to be linked to the brain-gut axis which is in some way disturbed

• Weight loss – A reduction in body weight occurs when you expend more energy than you are consuming. This is likely in chronic stress if your body is in overdrive and expending lots of energy or perhaps in depression if we aren’t eating properly. IBS symptoms such as diarrhoea could cause weight loss as a result of malabsorption of food. 

Treating emotional symptoms can often have a positive effect on symptoms of IBS: you might want to consider some of the following approaches:

• Talking techniques. Talking therapies, from group sessions such as support groups to more tailored cognitive behavioural therapy sessions can be useful for chronic stress, anxiety or clinical depression. Addressing your emotional troubles can have a positive impact on the gut

• Herbal remedies. There are herbal remedies available to help you deal with symptoms of stress or anxiety. Stress Relief Daytime drops contain a synergistic combination of Valerian and Hops which can help us to cope with stress or mild anxiety. St. John’s Wort can be taken if feelings of low moods are apparent

• A trip to your doctor might be necessary if the emotional troubles or IBS symptoms are becoming unbearable or if you suspect you are feeling depressed. Anti-anxiety or antidepressant medication may be required which can actually have positive effects on the gut directly due to the interaction with nerves supplying the bowel

• Finally, if we are able to target the underlying problem this may. Refer to our IBS treatments for our advice on treating IBS.