Anxiety During Illness May Trigger IBS
Pushing Self During Intestinal Infection Also Raises Risk of IBS, Study Shows
Feb. 26, 2007 -- People who are overly anxious or refuse to slow down during
a bout of food poisoning or other infection-related gastrointestinal illness
may be prone to developing irritable bowel syndrome, according to a new
The findings reinforce the view that emotional factors like stress and
anxiety contribute to the chronic bowel condition. But they also suggest that
the way a person deals with acute illness plays a role.
Researchers found that people who pushed themselves too hard when they had
bacterial gastroenteritis developed irritable bowel syndrome (IBS) more often
than people who took it easy.
Gastroenteritis is inflammation of the digestive tract that can result from
a viral, bacterial, or parasitic infection.
“Instead of resting up, these driven people kept going until they collapsed
in a heap,” study co-author Rona Moss-Morris, PhD, tells WebMD. “The
gastroenteritis triggered the symptoms, but this ‘all-or-nothing’ behavior may
have helped prolong them.”
1 in 5 Americans
Roughly one in five Americans has IBS, a chronic condition characterized by
abdominal pain, bloating, and either constipation, diarrhea, or both, according
to the American College of Gastroenterology (ACG).
Four out of five cases occur among women, and symptoms usually begin in late
adolescence or early adulthood.
Though the disorder remains a mystery, previous studies have shown that
acute gastrointestinal illness, such as a bout of food poisoning, seems to
trigger IBS in some people.
In an effort to determine if psychological response to biological illness
plays a role in IBS, Moss-Morris and colleagues followed 620 people who had
confirmed gastroenteritis caused by a bacterial infection.
Who Got IBS
None of the participants had IBS, or any other chronic bowel disorder, when
they entered the study.
During their illness, the enrollees answered questionnaires designed to
determine their mood, perceived stress, and anxiety levels, and how they were
coping with sickness. They also completed follow-up questionnaires three and
six months after the infection.
Six months later, 49 of the study participants had developed symptoms of
Women developed the disorder twice as often as men.
People with IBS were no more likely to be depressed than people who did not
develop the disorder. But they were more likely to have reported high levels of
stress and anxiety during their initial stomach sickness.
They were also more likely to view their initial symptoms as worse than
people who got over their illness, and to express more concern about their
“These people tended to interpret their symptoms more negatively from the
beginning,” Moss-Morris says.
Learning to Slow Down
The fact that they were also more likely to push themselves too hard while
sick could have implications for treating IBS, Moss-Morris and study co-author
Meagan J. Spence wrote.
“Patients who have ongoing symptoms following gastroenteritis may benefit
from a simple early cognitive-behavioral intervention where they are encouraged
to slowly regain levels of activity and to avoid fluctuating between
overactivity and underactivity,” they wrote in the journal Gut.
The study is not the first to find that biological and psychological factors
interact in IBS, says New York gastroenterologist Beth Schorr-Lesnick, MD.
But she adds that it isn’t likely a single cause will be found for the
disorder or a single treatment that will work for everyone.
Some patients respond well to non-absorbable antibiotics, which are widely
prescribed for traveler’s diarrhea, she says. Others respond to dietary
intervention with probiotics -- foods and supplements that contain beneficial
bacteria or yeast to aid digestion.
Other treatments include behavioral therapy, antianxiety drugs,
antispasmodics, and therapies used to treat constipation or diarrhea.
“As we learn more about IBS, we should be better able to tell which patients
will respond to which treatments,” she says.