Stress, Anxiety, and Irritable Bowel Syndrome

Medically Reviewed by Minesh Khatri, MD on March 25, 2023
4 min read

It's not clear how stress, anxiety, and irritable bowel syndrome (IBS) are related or which one comes first. But studies show they can happen together.

When a doctor talks to people with this digestive disorder, "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 people with IBS have is generalized anxiety disorder, Blanchard says. He thinks more than 60% of IBS patients with a psychiatric illness have that type of anxiety. Another 20% have depression, and the rest have other disorders.

Regardless of whether they have irritable bowel syndrome, people with anxiety tend to worry greatly about issues such as health, money, or careers. The anxiety can lead to other symptoms that include upset stomach, trembling, muscle aches, insomnia, dizziness, and irritability.

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

  • Although psychological problems like anxiety don’t cause the digestive disorder, people with IBS may be more sensitive to emotional troubles.
  • Strong emotions like stress, anxiety, and depression trigger chemicals in the brain that turn on pain signals in your gut that may cause your colon to react.
  • 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.

There's proof that keeping your stress under control can help you prevent or ease IBS symptoms. Here’s why. Your gut has what you can call a brain of its own. It's the enteric nervous system. And it's the reason you get butterflies in your stomach when you're nervous. This “second brain” controls how you digest food. It also constantly talks with your actual brain. This connection may help you manage your IBS.

What you can do on your own

You can zap tension by simply doing something fun, like talk to a friend, read, listen to music, or go shopping. You might also try:

Exercise. Walking, running, swimming, and other physical activities can reduce stress and depression. They also help your bowels contract in a more normal way instead of overreacting.

Mind-body exercises. Meditation, relaxation breathing, yoga, tai chi, and qi gong can all trigger your body's relaxation response.

Mindfulness-based stress reduction classes and meditation. You can find courses offered online and in person, often at universities. They help you learn to manage stress by changing the way you think. Or you can learn to meditate online, in a class, or from a book.

Relaxation exercises. Relaxation techniques such as deep breathing can help you restore calm. You can also learn about visualization, where you imagine a peaceful scene.

It also helps to get enough sleep and eat a good diet for IBS. You may want to join a self-help group for people with IBS irritable bowel syndrome or other digestive disorders.

When to consider therapy

If you’re still tense and anxious, talk with your doctor. Make sure you're getting the right medical treatment for your constipation or diarrhea. Then discuss whether talk therapy might help.

People with irritable bowel syndrome "should really start with their primary care physician, and work with that person," Blanchard says. "They should only go to the  next step [psychological care] if what they're doing with their doctor is not working."

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

A therapist can teach you how to break the mind-body cycle that may be making your IBS symptoms worse. They can also help you come up with strategies to handle your triggers and ways to better deal with challenging situations. Research shows that therapy can also help with some IBS symptoms in many people who try it, though it may not improve your constipation or belly aches.

Therapies to treat IBS focus mainly on behavior. Types of therapy that may be helpful include:

Cognitive behavioral therapy (CBT). This is a type of talk therapy. You work through common situations that trigger your symptoms and learn to handle them in different ways. For instance, if the idea of eating at a restaurant makes you anxious, CBT can help you recognize the thoughts and patterns you have and teach you how to spot and change them. 

Psychodynamic therapy. This type of talk therapy looks at how your emotions affect IBS. Your therapist will typically focus on relaxation techniques and stress management.

Hypnotherapy. Therapists use hypnosis to put you in a very relaxed state. That lets you be more open to hearing positive ways to work with stress and change behaviors. You'll still be awake, and you can't be made to do anything against your will.

Relaxation training. There are many ways to calm your nervous system and lower your stress levels. One method is progressive relaxation. With it, you work your way through your body, tightening and then releasing your muscles. Over time, you learn to tell the difference between feeling tense and feeling relaxed. Then you can use the technique to calm yourself.

Biofeedback. With biofeedback, a doctor connects you to a device that gives you information on what's happening in your body. You use that information to make changes. For example, it can help you gain better control over the muscles that control your bowels.

Show 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." 

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," "Association of Participation in a Mindfulness Programme With Bowel Symptoms, Gastrointestinal Symptom-Specific Anxiety and Quality of Life," "Psychological Treatments in Functional Gastrointestinal Disorders."

Johns Hopkins Medicine: "The Brain-Gut Connection."

NYU Langone Medical Center: "Stress Reduction for Irritable Bowel Syndrome in Adults."

UCLA, Gail and Gerald Oppenheimer Center for Neurobiology of Stress and Resilience: "Irritable Bowel Syndrome (IBS)."

Anxiety and Depression Association of America: "Irritable Bowel Syndrome (IBS)."

PubMed: "A collaborative health care model for the treatment of irritable bowel syndrome."

U.S. National Library of Medicine: "Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment."

National Health Service: "Irritable Bowel Syndrome (IBS)."

National Institute of Diabetes and Digestive and Kidney Diseases: "Irritable Bowel Syndrome (IBS)."

Harvard Medical School: "Relaxation techniques: Breath control helps quell errant stress response."

Massachusetts General Hospital, Benson-Henry Institute for Mind Body Medicine: "The Relaxation Response."

University of Massachusetts Medical School: "Mindfulness-Based Programs."

UCSF, Osher Center for Integrative Medicine: "Mindfulness-Based Stress Reduction."

Rutgers Student Affairs, Counseling, ADAP and Psychiatric Services: "Mindfulness Meditation."

University of North Carolina Center for Functional GI and Motility Disorders: "Ask the Expert: Why See a Psychologist When the Diagnosis is IBS?"

International Foundation for Functional Gastrointestinal Disorders, About IBS: "Hypnosis for IBS." "Physiotherapy and IBS."

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