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You calculate in your head how long it will take to bolt across the room to the restroom. This is how your mind works whenever you go out. People may tell you not to let your exocrine pancreatic insufficiency (EPI) get the best of you – and not to stress. But that’s easier said than done for those not worried about bloating in the belly, flatulence (gas), and explosive diarrhea. Though you can’t imagine not worrying about your condition, trying to get a better handle on stress can help you stay on top of the challenges. 

How Stress Affects Exocrine Pancreatic Insufficiency (EPI)

You know with EPI, your pancreas isn’t making enough digestive enzymes, so foods are passing through your intestines in a more whole or undigested state. If your body isn’t getting the nutrients it needs, EPI can lead to malnutrition.

Since your body has trouble absorbing fats from foods, you get uncomfortable digestive problems including constipation, pain, gas, bloating, diarrhea, weight loss, and pale, bulky foul-smelling stools. And if that wasn’t enough to worry about, you can also imagine your stool possibly floating or sticking to the side of the toilet bowl, making it difficult to flush away. 

“Simple social interactions, like having a meal with a friend, can lead to significant amounts of stress and anxiety for individuals anticipating symptoms, which are often worsened by food,” says Vinay Chandrasekhara, MD, an American Gastroenterological Association spokesperson. “People plan their day and activities around the fact that they have access to a restroom, and may limit travel so that they are not stuck in an unfamiliar location.”

The main cause of EPI in adults is chronic pancreatitis, which triggers inflammation and swelling of the pancreas and can damage the cells that make digestive enzymes. Over time, the inflammation can lead to damage to the pancreas that can’t be fixed. As many as eight in 10 adults with chronic pancreatitis develop EPI.

EPI in adults may also be caused by: 

  • Inflammatory bowel disease (IBD)
  • Diabetes
  • Celiac disease
  • Pancreatic cancer 
  • Surgery on the digestive tract

As difficult as living with EPI is, stress can make the symptoms worse. A study in the Journal of Clinical Biochemistry and Nutrition found that the emotional state of anxiety – feeling fearful and tense about what might happen – was linked to EPI patients who have indigestion that keeps coming back. Emotional stress also keeps the stomach and pancreas from releasing enzymes the way they should. Chronic stress can make that worse.

Managing chronic stress is critical for people at risk for pancreatitis. Stressors – things that cause stress – can be physical, mental, or a combination of both. Stressors that can make EPI worse include: 

  • Forgetting to take your medication
  • Not knowing what to eat
  • A hard time paying for meds
  • Feeling alone and humiliated
  • Assuming your social life is over

How to Stress Less

Just knowing that you have EPI means you’re ahead of many people who might be battling digestive issues. Often overlooked, EPI is tough to diagnose because it overlaps with other gastrointestinal disorders. Once you have your EPI diagnosis, you can take better care of your health and be your own advocate. 

Do Your Research

When you are informed about your condition, it can help ease anxious feelings. You’ll understand what to expect moving forward, and you’ll be better equipped to ask your doctor questions about your care.

“Knowing more about your condition is empowering. It allows you to realize that the symptoms of EPI are treatable and that you can learn to manage the condition to live a long, meaningful life. This understanding can reduce the stress that comes with uncertainty,” Chandrasekhara says.

Explore Payment Options

The main treatment option for EPI is replacing enzymes that the pancreas isn’t providing with pancreatic enzyme replacement therapy (PERT). Avoiding symptoms means taking PERT capsules with every meal and snack. This can add up and make it hard to pay for. Some patients take smaller doses of their PERT to make it last longer. But that means they are not getting the correct dose to ease their symptoms. 

Check with the manufacturers of enzymes, because most have assistance programs. You can also ask your doctor for help with the programs and try to get authorization from your insurance company. Organizations like the National Pancreas Foundation also offer resources to help pay for care.

Plan Your Outings

You can go to parties, shows, out to dinner, and stay healthy when you make sure to pack your PERT. You need to take it with all your snacks and meals, but not on an empty stomach. “We advise patients that require multiple pills to take a portion prior to the meal and a portion midway through the meal. That way, you are ensuring maximal digestion throughout the meal,” Chandrasekhara says. “These simple changes can lead to symptom improvement.” 

You can’t cure EPI, but PERT can reduce the embarrassing and annoying symptoms that can interfere with your social or professional life.

It’s good to pack a small bag of supplies like wipes and extra clothes. You can also stress less when you’re out and about with a bathroom-finder app on your smartphone like Flush, Toilet Finder, or SitOrSquat.

Eat for Nutrition

You want to do your best to stay nourished. Start with a menu high in fruits, vegetables, whole grains, and healthy proteins. A high-calorie diet – including some fat – is recommended so you get enough nutrients. That’s because fat is needed to absorb many essential vitamins. You can talk to your health care provider about the right amount of fat to include in your diet. It’s also a good idea to ask for a nutrition consultation so an expert can help you with foods to avoid – like greasy pizza and fried chicken – and offer alternatives. You may also need to take prescription vitamins to make up for what you don’t get from food.

Tap into Your Support System

Lean on others. You may want to turn to family and friends and join a support group or an online community to share what you’re going through. Talking to people you trust and who may understand the embarrassing symptoms you have can be a big stress relief. If you feel overwhelmed, a counselor or therapist can help you find ways to manage stress.

Find Time to Unwind

It’s important to take time out for yourself and do something you enjoy. Make sure you get enough sleep, and try to de-stress with relaxation exercises. Many chronic diseases are stress-related, and practicing mindfulness can ease symptoms of stress. 

Mindfulness is a type of meditation that lets you focus on being aware of your senses and feelings in the moment. It can involve deep breathing and guided imagery to help reduce your mind and body stress. 

Show Sources

Photo Credit: PeopleImages / Getty Images


Cleveland Clinic: “Exocrine Pancreatic Insufficiency (EPI).”

Merck Manual: “Overview of Malabsorption.”

Vinay Chandrasekhara, MD, American Gastroenterological Association spokesperson.

The National Pancreas Foundation, patient information: “Exocrine Pancreatic Insufficiency,” “Financial Assistance.”

Journal of Clinical Biochemistry and Nutrition: “State of anxiety may be associated with exocrine pancreatic insufficiency in functional dyspepsia patients with pancreatic enzyme abnormalities.”

Systematic Reviews in Pharmacy: “The Pancreatic Secretions are Under Conditions of Emotional Stress.”

World Journal of Gastroenterology: “Acute pancreatitis: The stress factor.”

Columbia University Irving Medical Center: “Stress May Accelerate Pancreatic Cancer, Study Finds.” 

Frontiers in Physiology: “Pancreas – Its Functions, Disorders, and Physiological Impact on the Mammals’ Organism.”

Mission: Cure: “Expert Q&A: EPI And Pancreatic Enzymes.”

Current Opinion in Psychology: “Mindfulness and Physical Disease: A Concise Review.” 

Mayo Clinic: “Mindfulness exercises.”