We have all experienced stress in our everyday lives for various reasons (stressors) including work, finances, marital conflict, family problems, bereavement, Illness, lack of time and academic work. 

Stress can affect our health in significant ways and especially our digestive system. Have you ever suffered symptoms such as stomach cramps, nausea or urgency in bowel motions before a stressful event such as exams or important presentation? This is a simple demonstration of the link between our emotions and our digestive system.

Stress and the Stress response

Stress may be defined as an acute threat to body’s stable internal environment, be it real (physical) or perceived (psychological), and whether posed by events in the outside world or from within ourselves [1].

Stress induces bodily responses which serve to defend the stability of our body’s internal environment and to help ensure our survival. 

Physical responses to stress include rise in blood pressure, rapid breathing, increased heart rate, slowing down of the digestive system and increased muscle tension.

Additionally, our bodies release hormones such as adrenaline and cortisol during stress.

Prolonged stress results in higher levels of these hormones, particularly cortisol which can lead to weight gain, weakened immune function, depression and digestive problems.

Chronic stress and Irritable bowel syndrome

Stressful life events have been associated with the onset or symptom worsening in some of the most common chronic disorders of the digestive system, including functional gastrointestinal disorders (FGD), inflammatory bowel disease (IBD), gastro-oesophageal reflux disease (GORD), and peptic ulcer disease (PUD). [2]

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder and is often characterised by lower abdominal pain, bloating, diarrhoea and/or constipation, flatulence, passing mucus in stools and feeling of urgency to open bowels. [3]

It is often classified into 4 subtypes based on a person’s usual stool consistency: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), mixed IBS (IBS-M), and unsubtyped IBS (IBS-U) [4]

The relationship between stress and IBS is complex and multiple other factors including food intolerance or allergy, intestinal infection, injury (e.g., abdominal or pelvic surgery), intestinal inflammation, changes in the intestinal bacteria, abuse and early life learning have been found to contribute to the development of IBS syndrome. [4]

However, numerous studies have also shown that stress is a key contributor to IBS and may, in fact, worsen symptoms. [5]

Evidence from clinical and experimental studies showed that psychological stresses have marked impact on intestinal function such as sensitivity, motility, secretion and permeability5.

Managing stress-related digestive problems

1. Medical assessment: Many digestive problems have similar symptoms so a medical examination and investigations will need to be performed to confirm a diagnosis of IBS and indeed if stress is implicated in symptoms. You may also need drug treatment to manage your symptoms.

2. Manage your levels of stress: The best way to address a stress- related condition is to tackle the underlying stressor and/or find ways to cope with it. Simple techniques such as ensuring adequate sleep; physical activity, talking to friends and family and relaxation techniques like meditation and breathing exercises may be beneficial in managing stress levels.

3. Dietary therapy: For some individuals, dietary manipulation may provide digestive symptom improvement. A food and symptom diary may be beneficial to identify trigger foods. Typical trigger food components often include dietary fibre, fatty foods, alcohol, caffeine and fermentable carbohydrates known as FODMAPS (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). Other dietary therapies include linseeds, probiotic foods and an exclusion diet. A registered dietitian will be able to assess digestive symptoms and suggest the most appropriate dietary therapy tailored to the individual.

If you are diagnosed with a stress-related digestive disorder, don’t suffer in silence. Address your stress levels and seek help from a health professional.

References

1. Seaward BL. Managing stress. Jones & Bartlett Publishers; 2013 Dec 1.

2. Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000 Dec 1;47(6):861-9.

3. Rome II: A Multinational Consensus Document on Functional Gastrointestinal Disorders. Gut: An International Journal of Gastroenterology and Hepatology. No. II, Vol. 45.

4. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712–721.

5. Qin HY, Cheng CW, Tang XD, Bian ZX. Impact of psychological stress on irritable bowel syndrome. World journal of gastroenterology: WJG. 2014;20(39):14126–31.