By Melody Khorrami, PharmD, RPh, INHC

Stress management is an important area that is discussed during GI visits for patients who are dealing with irritable bowel syndrome. The relationship between the brain and the digestive system is important to consider when developing a plan for managing irritable bowel syndrome (IBS). Certain emotions such as stress, depression and anxiety can activate signals in the gut (the stomach and intestines) which cause gastrointestinal distress.  Improving psychological and emotional health can also help to improve digestive conditions such as IBS. This may require that you work with not just your doctor but also a nutritionist and a therapist. 

Why stress can be a trigger for IBS?

Psychological stress is an important factor in the development of irritable bowel syndrome. Studies have shown that psychological stress can have an impact on intestinal motility, sensitivity, and permeability. There are complex interactions between the nervous system, hormones, and the immune system that can affect the intestinal microbiota, which contribute to IBS. IBS is sensitive to stress, and treatment should incorporate stress management. An integrative approach to IBS management is important, including pharmacological treatments, dietary changes, adding the right probiotic, and relaxation techniques. When stress stimulates the hypothalamic-pituitary-adrenal axis, HPA, it triggers cortisol release, which can affect the gut function and create an imbalance in the microbiota. Chronic stress can contribute to dysbiosis, one factor in developing IBS. There is a strong correlation between co-morbidity of psychiatric disorders, such as depression and anxiety, and the severity of IBS symptoms.

Negative emotions like anxiety have a major role in gut functioning because of the brain-gut axis. Homeostasis or the ability of the body to maintain a certain state of equilibrium, can be disrupted by negative emotions, like stress, if they are not processed in a healthy manner. The gut-brain-axis has an important communication role between the gut and the central nervous system. Dysregulation in this pathway can create altered bowel motility and hypersensitivity, which contributes to IBS symptoms. 

Stress management is possible!

For many patients who receive a recommendation to reduce or manage stress, it is pretty clear why it is essential, but the bigger question is: how can they go about managing the stress in a healthy way? Here are some suggestions for you the next time your doctor indicates reducing stress levels to manage a gut disorder. 

There are some every day wellness steps you can take to improve your psychological well-being. These include the following:

• Exercise:Practicing yoga, or swimming a couple times a week can help with abdominal pain, and with calming the intestines. Aerobic exercises such as a brisk walk can help to lower stress in the body by reducing stress hormones in the body such as adrenaline and cortisol.

• Meditation: Meditation is a form of deep relaxation which has been used for centuries. It can help to bring emotional balance and reduce stress in the body. Dedicate a few minutes in the morning to set up your day easefully or at night before bed to calm your nerves and reflect on the positives of your day.
• Quality sleep: Stress is a major factor for poor sleep, and conversely poor sleep quality is a major factor for increased stress. Sleep allows the body to recharge and sleep deprivation can affect mood, having good judgment and decision-making skills, and memory. Survey findings have shown that adults who sleep less than 8 hours a night are more likely to have increased stress and feel more irritable.
• Spending time in Nature: According to studies, taking time to connect with nature, even as little as 20 minutes a day can lower the stress hormone cortisol in the body. Consider taking a walk outdoors daily and take in fresh air.
• Cognitive Behavioral Therapyand psychodynamic psychotherapy: Working with a licensed therapist can help you learn tips for managing your anxiety and stress. Most cognitive behavioral therapy interventions aim to modulate behavioral patterns and reduce irrational fears. Psychodynamic psychotherapy focuses on interpersonal and intrapersonal conflicts and how they may contribute to developing and maintaining symptoms in IBS. Learning the right tools to manage your stress and emotions will impact your gut health and improve the rest of your life profoundly.
• Nutrition: Eliminating processed foods and eating a whole food diet are important factors in managing the stress response and improving mood.  Foods that are included in the Mediterranean diet such as poultry, wild caught fish, an assortment of vegetables and fruits, and healthy fats can be helpful in stress management. Eliminating high sugar foods and drinks, and reducing alcohol and caffeine, are an important part of stress management and a healthy brain. Another aspect to consider is keeping blood sugar balanced. Being chronically in a low blood sugar state can be stressful on the body, so making sure not to skip meals, and eating on a more consistent schedule can be helpful in balancing blood sugar levels and allow you to manage stress better. Working with a nutritionist or licensed dietician can help with creating a nutrition plan that works for you and your life.  

Stress is a major problem in its contribution to the development of many health conditions including gut conditions like irritable bowel syndrome. Learning the tools needed to manage stress and other negative emotions is arguably one of the greatest personal endeavors you can undertake. There are ample resources available to those who want to learn new techniques for managing their stress and anxiety. Unlearning patterns, and addressing the root cause of your emotional state can be important in healing the underlying issues that contribute to your state of stress.