If you’ve ever felt like your stomach was in knots after stressing over an upcoming test, you know the power your mind has to affect the rest of your body. April is Irritable Bowel Syndrome (IBS) Awareness Month, and part of this awareness is exploring the connection between IBS and mental health.
IBS is a gastrointestinal disorder that is characterized by issues in the large intestine or colon, as well as the small intestine, according to the International Foundation for Functional Gastrointestinal Disorders website. Common symptoms include “abdominal pain or discomfort,” “bloating or a sense of gaseousness,” and “a change in bowel habits (diarrhea and/or constipation),” according to the website.
Although IBS is a physical condition and the exact cause hasn’t been found yet, experts have found a link between IBS and mental health issues. According to the website, IBS could be a result of an “increased gastrointestinal response to stress.” However, stress can be defined by anything ranging from “physical activity” to “psychological stress.”
The website states that mental health issues shouldn’t be considered as a primary cause of IBS, and sometimes patients who have IBS later on develop mental health issues. For example, patients might become anxious and stressed over their symptoms because they don’t have control over them and the consequences can be embarrassing. The website does also state that psychological and emotional issues can aggravate IBS symptoms.
The National Digestive Diseases Information Clearinghouse (NDDIC) website also states that the colon can be sensitive to stress for people with IBS.
“Stress—feeling mentally or emotionally tense, troubled, angry, or overwhelmed—can stimulate colon spasms in people with IBS,” according to the website.
“People often experience cramps or ‘butterflies’ when they are nervous or upset. In people with IBS, the colon can be overly responsive to even slight conflict or stress. Stress makes the mind more aware of the sensations that arise in the colon, making the person perceive these sensations as unpleasant.”
The website goes into more detail about how stress affects different systems in the body, which then could lead to IBS, and suggests that people with IBS work on managing their stress through different therapies, meditation, counseling, support, exercise (like walking or yoga), lifestyle changes and proper sleep.
Experts and IBS sufferers have other information and advice on the link between IBS and mental health.
Frank Sileo, a licensed psychologist, has suffered from IBS for over 20 years and now treats both children and adults who have the condition.
“There is a definite link between between IBS and mental health,” Sileo said in an email. “Stress and anxiety play a key role. Diet is the other. The mental health issues associated with IBS is poor stress management, anxiety [and] perfectionism.”
In order to track possible triggers of IBS symptoms, he suggested that people keep a journal of their diet and any events and thoughts they have. He also suggested cognitive behavioral therapy as a treatment option for IBS in some cases.
“The cognitive part of the therapy is helping the IBS patient identify maladaptive thoughts related to their lives,” Sileo said. “Perhaps they catastrophize things in their [life] all the time (i.e., they always think the [worst]) or perhaps they are all or nothing thinkers (black or white thinkers) (i.e., if I'm not a total success then I'm a total failure).”
“The behavioral aspect of the therapy involves teaching them relaxation skills through [breathing], muscle relaxation exercises [and] visual imagery to name a few,” Sileo added. “The patient is asked to do homework in-between sessions to practice the skills and to check in with the mental health professional on a weekly basis to monitor progress and help with barriers to healing.”
He said that statistically speaking women are burdened with IBS more often than men, but men also don’t report as often usually.
“I think the ways to cope is to learn how to handle stress better via changing one's unproductive thoughts, beliefs and perceptions about others, self and life in general,” Sileo said.
“IBS is a very common syndrome in this country. If people can work on their stress and mental health issues and follow an IBS diet (I would recommend working with a nutritionist), they can find symptom relief.”
David Clarke, a clinical assistant professor of gastroenterology emeritus at Oregon Health and Science University, and author of the book “They Can’t Find Anything Wrong! : 7 Keys to Understanding, Treating, and Healing Stress Illness,” said in an email that relieving IBS can be a matter of treating mental health issues.
“Many IBS patients experience improvement in their symptoms when mental health issues are uncovered and treated,” Clarke said. “The prolonged effects of childhood stress (including child abuse), depression, anxiety and post-traumatic stress are the most common [mental health issues associated with IBS].”
He suggested that doctors ask more questions about mental health issues when diagnosing and treating IBS.
“It is essential to screen for mental health issues because these may not be obvious,” Clarke said. “Depression, for example, is missed by doctors in 2/3 of cases because they don't ask enough questions to uncover it or because they don't inquire about it at all. Once uncovered, patients can be treated either by a primary care clinician or by a mental health professional.”
He agrees that more women tend to be seen for IBS. “In my practice, about 85 percent of patients with IBS linked to mental health issues were women,” Clarke said.
He particularly wants to emphasize how stress affects the body. “In many of my patients the IBS was caused or exacerbated by stress, particularly stress they didn't fully recognize,” Clarke said.
“These patients did not have a mental health issue but they were suffering because they didn't see the connection between their symptoms and the stresses in their lives. One common example is a person who cares for everyone in her world but has difficulty taking time for herself. These are often people who didn't get adequate opportunities to play as children and so failed to learn good self-care skills.”
Alicia Benjamin, a social media manager for MeYou Health, a “social well-being company,” said in an email that she has IBS and that it also runs in her family.
“There is, without a doubt in my mind, a direct link between IBS and the gut, and how I feel about myself and the world,” Benjamin said.
“On good days, I am unstoppable. On the days I suffer, I am sluggish, moody, and pessimistic. Even with a balanced, wholesome diet, how I feel often feels, well, out of my control. It can be discouraging and embarrassing. You'd never know it by looking at me - I work out, I eat right, I get plenty of sleep. And yet, there's this ‘black cloud’ that follows me around and is always on my mind: Am I going to have a good day or a bad one?”
Patsy Catsos, a registered licensed dietician, author of “IBS – Free at Last!” and editor of www.ibsfree.net, said in an email that she doesn’t think mental health issues cause IBS but there is a link between the two.
“Bingeing and compulsive overeating usually mean large portion sizes,” Catsos said.
“Sometime people with OCD or bipolar disorder get carried away to diet extremes of various kinds. Large portions of certain sugars in the diet can trigger bouts of gas and watery, urgent diarrhea hours later. You might already know that large portions of lactose in milk, yogurt or ice cream bother you. Fruit sugar (fructose) can cause a similar effect when you eat lots of fresh fruit, dried fruit, or fruit juice.”
She said sometimes medication used to treat mental health disorders can cause other issues like dry mouth, and patients sometimes will chew gum or suck on candy and cough drops to counteract the dry mouth, which can lead to diarrhea.
“Sometimes IBS patients with anxiety have a tendency to over-restrict their food intake in an effort to reduce symptoms,” Catsos added.
She said that it’s important for IBS sufferers to talk to a registered dietitian because diet changes can sometimes relieve symptoms and improve quality of life.
“I do not believe that IBS is caused by mental health issues, though stress and anxiety can make the symptoms worse,” Catsos said. “There is also a ‘chicken and the egg’ effect here; IBS symptoms can increase anxiety. It's not hard to imagine why it might be anxiety-provoking to wonder when your next attack of IBS will strike. It can be stressful and hard on your relationships to plan your life around the toilet and your next bowel movement. Excess gas or flatulence is also difficult socially.”
International Foundation for Functional Gastrointestinal Disorders. Introduction to IBS: Symptoms, Diagnosis, and Testing. Web. March 20, 2012. http://www.aboutibs.org/site/about-ibs/intro-to-ibs
International Foundation for Functional Gastrointestinal Disorders. Stress, Psychological Factors, and IBS. Web. March 21, 2012. http://www.aboutibs.org/site/about-ibs/intro-to-ibs/stress-psychological-ibs
National Digestive Diseases Information Clearinghouse (NDDIC). Irritable Bowel Syndrome. How does stress affect IBS? Web. March 21, 2012. http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/#stress
Clarke, David. Buy the Book – Stress Illness. Web. March 21, 2012. http://www.stressillness.com/buy.php
Sileo, Frank. Email interview. March 20, 2012.
Clarke, David. Email interview. March 20, 2012.
Benjamin, Alicia. Email interview. March 20, 2012.
Catsos, Patsy. Email interview. March 20, 2012.
Reviewed March 21, 2012
by Michele Blacksberg RN
Edited by Jody Smith