A woman wrote to doctors at the University of California Los Angeles asking whether stress could be behind her new irritable bowel syndrome (IBS) diagnosis. She’d been diagnosed during the pandemic. She’d just started a new job, then lockdowns had her working in addition to homeschooling her children. Like many of us, she’d been incredibly stressed.
Spoiler alert: the doctors cannot definitively tell her the cause of her irritable bowel, but stress is a known trigger that often precedes both diagnoses and flare ups. Over the past few years, researchers have begun to understand more and more of the reasons why.
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Can Stress Cause Stomach Pain?
Anyone who’s felt butterflies in their stomach or had their stomach in knots before having to give a speech knows that your mood and your stomach are intimately intertwined, but researchers are just starting to understand how that relationship can go beyond the butterflies to causing chronic illness.
Your digestive system includes your esophagus, stomach and intestines. These organs are lined with about 100 million nerve cells that communicate directly with your brain. They also contain trillions of microbes and help you digest your food, producing all kinds of metabolites (chemical byproducts of digestion) that can influence how you feel. In other words, mood and digestion are not only connected but can create a cycle of influencing one another.
What Is IBS?
IBS stands for irritable bowel syndrome. Everyone feels mild digestive discomfort from time to time, but if your symptoms happen once a week or more for at least three months, you may have IBS.
There are three different subtypes of IBS, based on your most frequent symptom:
- IBS-D (mostly diarrhea)
- IBS-C (mostly constipation)
- IBS-M (mixture of both diarrhea and constipation)
Can Stress Cause IBS?
The short answer is yes. Scientists have known for a long time that conditions such as anxiety and depression are more common in people with IBS than they are in the general population. Nearly 45% of people with IBS also have a mental health condition. A large 2014 review article laid out several different ways through which stress can impact digestion, and recommended that IBS treatment always include a well-rounded healthcare approach that addresses mental health alongside digestive symptoms. Patients frequently report that in the months leading up to the diagnosis, they’d undergone major life stressors such as losing jobs or ending romantic relationships.
There are many pathways that the gut and brain use to communicate and scientists don’t yet understand all of them. However, one study found, for example, that stress was associated with eosinophils (a type of immune cell) in the lining of the intestines, containing more of a peptide called corticotropin-releasing factor (CRF). CRF is also found in the brain where it regulates our stress responses. Having more of it in your intestines was associated with worse IBS symptoms.
What to Eat When Your Stomach is Upset from Stress
What you should eat during a moment of digestive distress depends on the exact symptoms you’re feeling. For example, if you are constipated, fibrous fruits and vegetables may help move your bowels along, but if you have diarrhea, these same generally healthy foods may make things worse.
For Vomiting or Diarrhea
It’s important to stay hydrated if you’re losing fluids through vomiting or diarrhea. Consider drinking coconut water, sports drinks, or broth, but drink small sips frequently (rather than all at once) so that your stomach has time to absorb it. For many years, doctors recommended the BRAT (bananas, rice, applesauce and toast) to help settle your stomach, but in recent years the advice has become controversial. Some say it can lengthen your symptoms. Trust your judgment when it comes to adding solid foods and start with small servings to see how your body reacts.
Constipation
If you’re constipated, consider adding fruits, vegetables, and whole grains which have high amounts of fiber. Hydration is also key to keeping your bowels moving. If you’re up for it, light exercise, like going for a walk, may also help. Some foods with high amounts of fiber include:
- Oats
- Artichokes
- Beans
- Brussels sprouts
- Kale
- Strawberries
- Pears
- Popcorn
- Almonds
Nausea
Ginger is one of the best known remedies for an upset stomach. You’ll want to consume about one gram of ginger for it to be helpful. A gram of ginger can be found in:
- A capsule that has 1g ginger extract in it
- A teaspoon of fresh, grated, ginger root
- 4 cups (8 oz each) ginger tea, steeping 1/2 teaspoon grated ginger for 5 to10 min
- 8-oz cup ginger ale, made with real ginger
- 2 pieces crystallized ginger, each 1 inch square, 1/4 inch thick
Since you probably aren’t eating or drinking as much when you’re nauseous, it’s important to consider hydration and nutrition. Like when you have diarrhea, you can slowly sip fluids and consider adding in liquids that have nutrients such as sports drinks, broth, and soup.
How to Manage Stress with IBS
Not only can stress cause IBS, but IBS itself can worsen stress and anxiety. Vicki Mayer, for example, told NPR that she was “riddled with anxiety and fear” anytime she went out to eat because she was worried about what she’d do if she needed to use the restroom urgently.
Practicing mindfulness meditation and breathing exercises helped Mayer reframe her thoughts. She realized that leaving the table at a restaurant if she needed the restroom would not harm anyone, which helped her let go of a lot of anxiety and enjoy time spent out.
Cognitive Behavioral Therapy (CBT)
CBT, which is known for helping you manage stress, anxiety, depression and other conditions, has been shown to help reduce IBS symptoms in several small studies.
Mindfulness Meditation
An eight-week mindfulness class improved IBS symptoms in a small 2020 study.
If you want to give it a try, you don’t necessarily need a class. There are many ways to practice mindfulness. One of the simplest is to just close your eyes and spend a few minutes feeling and focusing on your breath.
Read more about reducing stress and learn some specific breathing exercises in MedShadow’s Stress Need Not Be Your Constant Companion.
Drugs That Can Upset Your Stomach
While stress is a major trigger of nausea, diarrhea, and constipation, it’s certainly not the only one. Infections, inflammation from an autoimmune disorder, food intolerances, and drug side effects are also common causes of digestive struggles. In fact, since we swallow most of the drugs we take regularly, an upset stomach is a very common side effect. If a frequently upset stomach is a new symptom for you, consider checking your medicine cabinet. Many prescription drugs, over-the-counter medications and even supplements can mess with your digestion. Using a symptom tracker may help you notice patterns early.
Some common culprits include:
- Non-steroidal anti inflammatory drugs (NSAIDs)
- Antibiotics
- Pre-exposure Prophylactics (PrEP)
- Antidepressants
For more about causes and treatments for IBS aside from stress and stress management, see MedShadow’s IBS is Manageable, Doctors Say.
