In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as any real or perceived disturbance of an organism's homeostasis, or state of harmony or balance. For example, in this viewpoint a severe hemorrhage, starvation, extreme temperature, or worry about the unpredictable onset of abdominal pain all qualify as stressors – some as "physical" stressors, others as "psychological" stressors. The fear to leave the house in the morning without knowing if one can make it to work without having to stop on a busy highway because of an uncontrollable bowel movement, or the fear of experiencing uncontrollable abdominal discomfort during an important business meeting are sufficient stressors to activate the central stress system.
The central stress system involves the release of chemical stress mediators in the brain (such as corticotropin releasing factor), which in turn orchestrate an integrated autonomic, behavioral, neuroendocrine, and pain modulatory response. This biological response in turn will alter the way the brain and the gut interact, and this altered brain-gut interaction can result in worsening of irritable bowel syndrome (IBS) symptoms. Thus, pain and discomfort, fear of these symptoms, activation of the stress response, and modulation of the brain-gut interactions by stress mediators are part of a vicious cycle which need to be interrupted to produce symptom relief.
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) in origin. Stress, the body’s response to stimuli, has been shown to increase motility and sensation of the colon to a greater degree in IBS patients compared to healthy individuals without IBS.
To understand IBS, one must understand that the disorder represents a heightened sensitivity of the bowel 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. When stressors are present, patients should work with their health care providers in developing a management plan to address these issues effectively in order to decrease symptoms and improve overall quality of life.
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