Stress, Psychological Factors, and IBS

What is the relationship of stress to IBS?

One way to understand IBS is that there is increased gastrointestinal response to stress. Stress can be understood as anything that can stimulate the GI tract: diet, hormonal changes, physical activity, and psychological stress.

Stress is defined as a perceived or actual disturbance in the balance between mind, brain and body. It can occur with or without conscious feelings of anxiety, stress, or anger. Stress can be acute (short term) or chronic (long acting, e.g. more than 3 months). It can range from daily hassles to life-threatening events. Chronic stress experienced in early life (less than 18 years of age) has been shown to be associated with an increased prevalence of many medical conditions, including asthma, high blood pressure, obesity, and IBS.

There are various types of stressors, which may impact IBS symptoms. These may be physical (e.g., infection, surgery) and/or psychological (e.g., loss of job, divorce, history of abuse) in origin. Stress has been shown to increase motility and sensation of the colon to a greater degree in IBS patients compared to healthy individuals without IBS.

IBS results from a complex biologic interaction between the brain and gut affecting both peripheral (arising in the gut) function, and central (arising in the central nervous system, or CNS) factors. To understand IBS, one must understand that this condition represents a heightened sensitivity of the bowel and this can be manifest in response to internal and external stressors.

Addressing stressors, which may be associated with IBS symptoms, is the first step in understanding the relationship between stress and IBS. Patients should work with their health care providers in developing a management plan to address these issues effectively, when present, in order to decrease symptoms and improve overall quality of life.

Is there a relationship between psychological factors and IBS?

Some people with IBS report psychological symptoms, such as depressed mood or anxiety.  This occurs mainly in persons with more severe symptoms and patients seen in highly specialized (tertiary) medical care referral centers. However, not all people with IBS symptoms have symptoms of psychological distress. Psychological factors are not a primary cause of IBS. They may influence how a person seeks to manage and deal with IBS.

Emotional distress may be associated with a worsening of IBS symptoms. Not uncommonly, people with IBS may develop symptoms while eating at restaurants and social gatherings. In persons with more severe diarrhea, they may even experience episodes of bowel incontinence.

Symptoms may induce an appropriate but unwanted anticipatory anxiety due to the severity, unpredictability, and associated negatively perceived consequences of having an “attack.” This may result in continuing symptom occurrence and set up a vicious cycle between emotional distress, symptoms, and personal management strategies. In other words, concerns, worries, and fears can be due to the symptoms experienced by persons with IBS, rather than due to general anxiety.

In a significant number of women with IBS or other functional bowel disorders, a history of sexual, physical, or emotional and verbal abuse during childhood and/or adulthood has been elicited. More severe forms of abuse have been associated with increased pain, poorer daily function, and increased health care visits. Addressing any unresolved issues with an empathetic health care provider, who can refer the patient for counseling, would be important to improve IBS symptoms and daily function in these individuals.

Many people experience abdominal pain and constipation or diarrhea without any evidence of anxiety, depression, or other psychological symptoms. Stressful events like losing a job or becoming embroiled in an argument are events that can cause a transient change in bowel habits and even abdominal pain for most people. This response in people with IBS is more pronounced on a recurrent or chronic basis; therefore, they are more likely to experience symptoms or experience worse symptoms when they are exposed to a significant stressor. Read more about Stress and IBS

 

 

Adapted from IFFGD publication #101 revised and updated by: Lin Chang, MD, UCLA School of Medicine, Los Angeles, CA, and Douglas A. Drossman, MD, University of North Carolina, Chapel Hill, NC