Most of the time we talk about the “mental” part of the mental health symptoms of disorders and challenges, and even when we talk about the physical symptoms, we’re usually talking about the ones directly related to the condition. For example, a person with anxiety may have rapid heartbeat associated specifically with the adrenaline that anxiety produces.
But what about physical symptoms that are related to mental health, but not *directly* – meaning, although mental health causes or contributes to these issues, they are not seen as symptoms of these conditions, but rather possible physical challenges a person may experience because they have these conditions.
Irritable bowel syndrome (IBS) is one example.
IBS and anxiety are separate conditions. But they are closely linked, with research showing that the two conditions often coexist and can influence each other. IBS is a functional gastrointestinal disorder characterized by abdominal pain, bloating, gas, and irregular bowel movements (constipation, diarrhea, or both).
Anxiety, on the other hand, is a mental health condition that involves excessive worry, nervousness, and physical symptoms such as a racing heart or muscle tension.
The connection between anxiety and IBS is rooted in the brain-gut axis – a complex communication network between the central nervous system (CNS) and the enteric nervous system (ENS) that regulates digestive function. When this connection becomes dysregulated due to stress or anxiety, it can lead to IBS symptoms or make existing symptoms worse.
How Anxiety Affects IBS Symptoms
Anxiety influences IBS in several ways, both through physical and psychological mechanisms. The most well-known ways anxiety contributes to IBS include:
- Heightened Sensitivity to Pain – Anxiety can increase the brain’s perception of pain signals from the gut. This makes normal digestive sensations, such as gas or bowel movements, feel more intense and painful.
- Increased/Decreased Gut Motility and Muscle Spasms – When a person is anxious, the body’s fight-or-flight response is activated, releasing stress hormones like cortisol. This can increase the speed at which food moves through the intestines, leading to diarrhea or cramping. Conversely, it can also cause the muscles in the intestines to tense up, leading to constipation.
- Altered Gut Microbiome – Stress and anxiety can disrupt the balance of beneficial bacteria in the gut, which can impair digestion and increase gut inflammation. An imbalanced gut microbiome is commonly linked to IBS symptoms.
- Stress-Induced Inflammation – Chronic anxiety and stress can increase inflammation in the digestive tract, which may worsen IBS symptoms and contribute to gut discomfort.
- Increased Self-Monitoring and Sensitization – Anxiety often causes individuals to become hyper-aware of bodily sensations. This increased awareness can make normal gut activity feel uncomfortable and lead to a cycle of increased stress and worsened symptoms.
- Poor Sleep – When a person is anxious, they may not sleep well. When they do not sleep well, their gut experiences additional stress, which in turn can cause stomach related issues associated with IBS.
Anxiety doesn’t create IBS in one specific way, but rather several, acting as both a direct trigger and as a contributing factor to worsening symptoms.
How IBS Contributes to Anxiety
The relationship between anxiety and IBS is bidirectional, especially with severe IBS. IBS symptoms can also increase anxiety levels. Some of the ways IBS may worsen anxiety include:
- Unpredictability of Symptoms – IBS symptoms such as diarrhea, cramping, and bloating can occur without warning, leading to increased anxiety about leaving home or participating in social activities.
- Fear of Embarrassment – The possibility of needing immediate access to a restroom or experiencing visible discomfort can create social anxiety and avoidance behaviors.
- Impact on Quality of Life – Ongoing digestive discomfort and dietary restrictions can increase stress levels, limit social interactions, and contribute to feelings of depression and anxiety.
- Sleep Disruption – IBS symptoms, especially abdominal pain and irregular bowel movements, can interfere with sleep. Poor sleep quality can worsen both IBS symptoms and anxiety levels.
This can be especially problematic as a person ages, as well, when their ability to control bowel movements becomes more difficult. Many seniors with IBS and anxiety experience worsening anxiety as a result of their symptoms.
Managing the Relationship Between Anxiety and IBS
Because anxiety and IBS reinforce each other, treating both conditions simultaneously often leads to better outcomes. Effective approaches include:
- Cognitive Behavioral Therapy (CBT) – CBT helps address negative thought patterns related to anxiety and gut sensitivity, reducing the psychological component of IBS symptoms.
- Gut-Directed Hypnotherapy – This form of therapy targets the brain-gut connection, helping to reduce pain and improve bowel function.
- Dietary Modifications – Low FODMAP diets (which eliminate certain fermentable carbohydrates) can help reduce IBS symptoms, which may in turn reduce anxiety levels.
- Stress Reduction Techniques – Meditation, deep breathing, and yoga can help calm the nervous system and reduce gut sensitivity.
- Probiotics and Gut Health Support – Improving gut microbiome health with probiotics or prebiotic-rich foods may help reduce both IBS symptoms and anxiety.
The relationship between anxiety and IBS is complex but well-established. Anxiety can heighten gut sensitivity and disrupt digestion, while IBS symptoms can increase psychological distress. Addressing both the mental health and gastrointestinal aspects of the condition is often the most effective approach for long-term symptom management and improved quality of life.
