Anxiety During Illness May Trigger IBS

Pushing Self During Intestinal Infection Also Raises Risk of IBS, Study Shows

From the WebMD Archives

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 study.

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 IBS.

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 illness.

“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.

WebMD Health News


SOURCES: Spence, M. Gut, 2007; online edition. Rona Moss-Morris, PhD, associate professor of health psychology, University of Southampton, Southampton, England. Beth Schorr-Lesnick, MD, assistant clinical professor, Albert Einstein College of Medicine, Bronx, N.Y.

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