Stress, Anxiety, and Irritable Bowel Syndrome (IBS)

It is not entirely clear how stress, anxiety, and irritable bowel syndrome (IBS) are related -- or which one comes first -- but studies show they tend to co-exist.

"If you do diagnostic interviews, what you find is that about 60% of IBS patients will meet the criteria for one or more psychiatric disorders," says Edward Blanchard, PhD, professor of psychology at the State University of New York at Albany.

The most common mental ailment suffered by people with IBS is generalized anxiety disorder (GAD), says Blanchard. He suspects that more than 60% of IBS patients with a psychiatric illness have GAD. Another 20% have depression, and the rest have other disorders.

Anxiety and IBS

Regardless of whether they have IBS, people with anxiety tend to worry greatly about issues such as health, money, or careers, according to the Anxiety Disorders Association of America. Other symptoms include stomach upset, trembling, muscle aches, insomnia, dizziness, and irritability.

There are several theories about the connection between IBS and stress and anxiety:

  • Although psychological problems such as anxiety do not cause IBS, people with IBS may be more sensitive to emotional troubles.
  • Stress and anxiety may make the mind more aware of spasms in the colon.
  • IBS may be triggered by the immune system, which is affected by stress.

Coping With Stress and Anxiety

There's proof that stress management can help prevent or ease IBS symptoms. Some people use relaxation techniques such a deep breathing or visualization, where they image a peaceful scene. Others reduce stress by doing something enjoyable, such as talking to a friend, reading, listening to music, or shopping.

Regular exercise, getting enough sleep, and eating a good diet for IBS also helps reduce tension.

Try out different stress management techniques to see which may help ease your IBS symptoms. If you still find yourself stressed and anxious, talk with your doctor. Make sure you're getting proper medical treatment for IBS-related constipation and diarrhea. Then discuss whether you might benefit from seeing a mental health professional.

People with IBS "should really start with their primary care physician, and work with that person," says Blanchard. "They should only go the next step (psychological care) if what they're doing with their doctor is not working."

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Considering Therapy and Support for IBS

Blanchard says two-thirds of IBS sufferers tend to get better with changes in diet and medication. The other third, people with more severe symptoms, are good candidates for psychological help. "Without that, they don't seem to get out of the problem that they're in," he says.

Behavioral therapy has been shown to relieve some IBS symptoms in many people who try it. This broad term covers a variety of therapies, including relaxation therapy, biofeedback, hypnosis, cognitive behavioral therapy, and traditional psychotherapy. Therapy has limitations, however. Some studies have found it does not help relieve constipation or constant abdominal aches that come with IBS.

Another option is to attend a self-help group for people with IBS or other digestive disorders. Members of these groups know what it's like to live with IBS. Sometimes they can offer more meaningful support than you could get from even your closest friends.

"You are not alone in trying to handle it all," says Lynn Jacks, founder of an IBS support group in Summit, N.J.

There are support groups around the globe. Contact the International Foundation for Functional Gastrointestinal Disorders at 888-964-2001 for referrals. Or tap into the web site of the IBS Self-Help and Support Group at http://www.ibsgroup.org. You can also go to WebMD's Digestive Disorders Support Group, which is available 24 hours a day.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on August 13, 2014

Sources

SOURCES: 

Philip Schoenfeld, MD, MSEd, MSc, co-author of American College of Gastroenterology's "Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome in North America." 

Janine Blackman, MD, PhD, former medical director of the University of Maryland Center for Integrative Medicine, adjunct professor of medicine at Georgetown University Medical Center, founder of RiverSoul Wellness in Bethesda, MD.

Jonathan Gilbert, who has a diplomate in herbology and acupuncture from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). 

The National Center for Complementary and Alternative Medicine: "Acupuncture." 

Mayo Clinic: "Irritable Bowel Syndrome." 

WebMD Feature: "Natural Alternatives for IBS." 

University of California at Berkeley Wellness Letter. 

Medscape: "Probiotics Significantly Reduce Symptoms of IBS, Ulcerative Colitis" and "Highlights from Digestive Disease Week: An Expert Interview with Lawrence R. Schiller, MD."

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