Most people with IBS or SIBO will tell you that they experience anxiety because of the GI symptoms they experience and that stress can have an impact on symptom management, even if it doesn’t cause the condition.
This is because the nervous system is usually more sensitive in IBS patients compared to normal people.
In this article, we will discuss the relationship between IBS and anxiety, as well as IBS and stress and what you can do to effectively manage stress and anxiety along with the microbiome aspect of the disorder.
Irritable bowel syndrome (IBS) is a multifunctional disorder of the gastrointestinal (GI) system that is most often associated with a wide realm of symptoms that can include:
Diarrhea and/or constipation
Anxiety, depression, and brain symptoms
For a long time, physicians considered IBS to be a strictly stress-related disorder, meaning that people who experienced consistent stresses in their lives were more likely to either exacerbate or cause their GI symptoms and IBS to occur.
But, just chalking the illness up solely to stress didn’t make sense because practically everyone deals with stress. We now understand that stress plays a role in symptom management, but the growing research in the microbiome and the nervous system shows there’s more to it.
To better understand the relationship between IBS, stress, and anxiety, it is important to recognize the different types of factors that have been shown to correlate stress and IBS.
Frequency and/or intensity of major life changes that have occurred over the past 6-12 months
Frequency and/or intensity of minor annoyances or hassles over the past month
Minor stressful events or self-ratings of stress
To determine whether any of the above-mentioned stress measurements and your IBS symptoms are related, it is recommended that you first rate and record your IBS symptoms, as well as any stress that you experienced on a daily or weekly basis for several weeks.
Therefore, if you notice that your IBS symptoms are worse when you feel particularly stressed or anxious, then there is probably a relationship between the stress you experience and your symptoms that may be worth investigating.
A 2008 study conducted by Blanchard et al. used this same journaling technique to determine whether minor or major stresses showed any influence on exacerbating the symptoms of IBS patients. However, the researchers in this study found only a minor correlation 1.
If, from the results of this study, stress doesn’t play a direct role in causing IBS symptoms, how else can this relationship be understood?
A Gut Feeling: Balancing Stress and the Microbiome
The microbiome is made up of a complex community of 10-100 trillion microbial species that are composed of bacteria, viruses, and fungi. There is a wide realm of ways in which the microbiome plays a role in maintaining our health and protecting our bodies against an attack by diseases or other foreign pathogens.
In fact, the microbiome plays a particularly important role in people with IBS, SIBO and other GI disorders, as a disruption in the diversity and/or amount of the microbial populations in these patients is often seen.
This disruption can play a role in how IBS patients experience stress and anxiety.
Some ways in which microbiome disruption can occur include:
Food poisoning (gastroenteritis)
Poor gut motility
A Maladaptive Stress Response
As researchers have continued to discover more information on the complexity of the microbiome, as well as its role in the gut-brain connection, they have determined that patients with IBS experience what is known as a maladaptive stress response.
What exactly does this mean?
A maladaptive stress response involves an exaggerated response to stress that is accompanied by an inability to reduce the way in which your body responds to the stress, even when whatever is causing you stress has subsided.
For example, imagine that you are at your desk at work getting through your tasks for the day when your boss places a 2-foot pile of paperwork he expects you to have completed by the end of the day.
Now, any normal individual will experience some type of stress response to this situation – however, if you are someone with IBS, you may not only experience the emotional stress of this situation, but your GI tract may also react to the situation. This response can contribute to altered gut motility, diarrhea, bloating, nausea and more.
As a hallmark characteristic of IBS, visceral hypersensitivity means that when a patient with IBS experiences a certain GI symptom, they become more vulnerable to the discomfort and abdominal pain that results in an exaggerated pain response despite being a symptom they have experienced previously 2.
This effect of IBS is associated with a number of neurological related phenomena that cause the neurons, or nervous system cells, that line the GI system to become overly sensitive to stimuli. This hypersensitivity causes the neurons to go crazy whenever they experience any type of gas, bloating, constipation, diarrhea or other related GI symptoms, thereby causing a much greater amount of pain than normally experienced.
The psychological impact of a lower pain threshold associated with IBS symptoms is that patients often fear the pain or sensitivity they may experience with the onset of their GI symptoms.
For example, if someone with IBS senses they are about to have a stomach ache or flare up, they may get anxious or panic just at the thought of their last stomach ache that kept them up until 4 am on the bathroom floor.
The GI symptoms associated with IBS in this situation therefore can cause a cascade of neurological and subsequential psychological effects to occur, which demonstrate the ability of this disorder to impact stress and anxiety.
It’s not that stress is causing IBS or SIBO, but that people with IBS have more sensitive nervous systems which can cause a cascade of psychological triggers that make the condition worse.
If someone has lived with the condition for a length of time, they can develop stress and anxiety from this trained subconscious process.
IBS and Stress-Related Deficits in Cognitive Function
A recent study published in 2013 evaluated the neurological and cognitive effects of patients with IBS, and how this GI disorder causes a number of hormonal responses to occur. This study found that IBS patients showed a reduced ability to memorize material that was accompanied with a lowered amount of cortisol in their blood, thereby showing that IBS may have a direct effect on impairing the cognitive ability of affected patients 3.
Treating Stress and Anxiety in IBS
It’s important to learn to manage your stress and the responses you have to different life situations with IBS or SIBO because the nervous system is usually more sensitive to stimuli.
This means that stressful events can impact your gut function more than others.
Some psychological therapies that have been proven helpful for patients with IBS include:
Cognitive behavioral therapy
Several hypotheses have been developed as to what is the best treatment option for patients struggling with both their IBS and psychological symptoms. For example, one person may believe that improving their anxiety and depressive symptoms with gut-specific hypnotherapy will help them the most. While someone else might incorporate lifestyle changes like meditation or cognitive therapy to help.
One aspect of this research on the effect of psychological treatments on IBS patients is that researchers have firmly determined that it is also important that IBS patients do not focus only on treating their psychological symptoms. We now understand that bacterial overgrowth and gut motility also play a main role in the illness.
Therefore, when possible, researchers suggest that not only should psychological therapies like gut-specific hypnotherapy be a part of an IBS patient’s treatment plan, but the plan should also incorporate SIBO antibiotics when needed, diet changes, and prokinetics if needed to achieve a comprehensive treatment plan.
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There are a number of factors that support the theory that IBS is a stress-sensitive disorder. This means that in situations where an individual with IBS is exposed to stressful situations, they may be more vulnerable to a series of GI responses and even negative psychological behaviors.
However, it is also important to recognize that the interaction between the gut and nervous system is a two-way street in which the current state of our gut (including our microbiome) can also severely impact our neurological well-being.