What’s the Connection Between IBS and Anxiety?

What Is Anxiety?

Anxiety disorders are chronic conditions characterized by persistent worry about specific or general situations. They are some of the most prevalent mental health disorders, with a reported 18% of the population experiencing symptoms per year. While there are many anxiety disorders, some of the common overlapping symptoms include panic attacks, nightmares, fatigue, trembling, and shortness of breath.

People with high levels of anxiety often experience an intense sense of dread throughout the day. Even in milder cases, anxiety can interfere with one’s daily routine and create problems with school, work, relationships, and self-esteem. Researchers theorize that a combination of genetics, environment, and individual stress levels may contribute to anxiety.¹

What Is IBS?

Irritable Bowel Syndrome (IBS) is a chronic medical issue that causes variable symptoms such as abdominal pain, bloating, increased gas, diarrhea, and constipation.  Research shows that IBS symptoms affect about 10-15% of all American adults.² Risk factors include being young, female, and having a family history of IBS, but environmental factors can increase a person’s likelihood of developing IBS.³

It’s easy to get irritable bowel syndrome (IBS) and inflammatory bowel disease(IBD) mixed up. Both are chronic conditions that cause abdominal pains, cramping, and urgent bowel movements. But despite having similar acronyms and symptoms, these two conditions are very different. IBS is a disorder of the gastrointestinal (GI) tract. IBS is not characterized by inflammation and destruction of the intestine but rather a variety of symptoms without any changes in the intestinal tissue, so IBS cannot be detected with a colonoscopy, either visually or through a biopsy. IBD is inflammation or destruction of the bowel wall, which can lead to sores and narrowing of the intestines. IBD is a term for a broad spectrum of diseases, but Crohn’s disease and ulcerative colitis are the most common. It’s possible to have both IBD and IBS.

IBS exists on a spectrum. Some people manage their symptoms by modifying their diet or making simple lifestyle changes, while others may need specific medication or higher levels of medical attention. However, there is no cure or specific, efficient medical treatment for IBS, and often depends on the person’s place on the IBS spectrum.

How Are Anxiety and IBS Related?

Symptoms and experiences associated with both anxiety and IBS can overlap, such as nausea and stomach pains. For example, people with IBS may be more sensitive to their emotions and thoughts, making them more aware of their body’s sensations. However, being increasingly aware of their own body may also bring awareness to things that may trigger a panic attack, such as an increased heart rate. Similarly, people with anxiety disorders might also experience intense digestive issues.

There is also a general link between chronic illness and mental health, which can help explain why someone with IBS would experience symptoms of anxiety, and vice-versa. Although researchers haven’t identified an exact culprit in this particular instance, anxiety and IBS do appear to be connected.

Can Anxiety Cause IBS?

Even if anxiety plays a role, it is unlikely that it causes IBS. Instead, it appears that the combination of risk factors may increase one’s likelihood of developing IBS. Likewise, anxiety might intensify IBS symptoms.

What Else Can Cause IBS?

There doesn’t appear to be a single cause of IBS. Instead, medical experts tend to examine clusters of symptoms that may be present in an individual and use their specific information to trace their IBS to a cause.

Potential risk factors for developing IBS include:

• Bacterial overgrowth in the intestines
• Muscle contractions in the intestine
• Abnormalities in the digestive system’s nerves
• Gut microbe changes
• Food allergies or intolerances
• Chronic stress and early life stress

How to Manage IBS Symptoms

IBS can be a frustrating and exhausting condition as it is difficult to diagnose because it is often a disorder of exclusion, meaning other disorders such as IBD must be ruled out. Living with such discomfort can compromise anyone’s quality of life, but there are steps people can take to manage their symptoms. Many people with moderate or severe cases indicate feeling depressed or anxious over their IBS, so it is important to address the physical and mental tolls of IBS through a combination of lifestyle changes, medications, and relaxation techniques.

Lifestyle Changes

Common treatment interventions include implementing healthier habits into people’s daily routines. Lifestyle changes that can help improve IBS symptoms might consist of:⁴

• Eating more fiber
• Drinking more water
• Avoiding or limiting caffeine
• Avoiding or limiting dairy
• Following a low-FODMAP diet
• Exercising consistently
• Eating smaller amounts of foods frequently
• Tracking foods to determine potential triggers

Medications

Based on someone’s symptoms, their healthcare provider might recommend medications to provide relief. Medications that can help with IBS include:

• Laxatives
• Fiber supplements
• Over-the-counter anti-diarrheal medications
• Antidepressants
• Anticholinergic medications
• Pain medication

Can Probiotics Help IBS and Anxiety?

Probiotics can restore gut microbe balance and support a healthier digestive system. However, the research on the role of probiotic treatment appears to be somewhat inconclusive. Some studies in a meta-analysis show that probiotics aren’t any more effective than placebo treatment or following a low-FODMAP diet. Other studies slightly favor probiotic intervention.⁵

If interested in trying probiotic treatment, it’s best to consult with a primary care physician. They can evaluate a person’s symptoms and current treatment options, and recommend an appropriate plan based on their evaluation.

How to Cope With Stress & Anxiety

It’s normal to feel stressed from time to time, but taking proactive steps toward coping with stress and anxiety symptoms can go a long way in supporting one’s physical and mental health. Subsequently, doing so can also mitigate IBS symptoms, which can, in turn, make people feel less anxious.

Here are some simple tips to help cope with stress and anxiety:

Exercise

Regular physical activity supports stress management by releasing adrenaline and cortisol, and producing endorphins. People tend to feel calmer after just 20-30 minutes of aerobic movement, and these positive effects can persist for hours. Fortunately, any kind of exercise seems to boost these benefits, so try to find an enjoyable activity and commit to regularly doing it, whether that is swimming a few times a week or taking long walks with a pet.⁶

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction (MBSR) refers to a structured group course that draws upon themes of mindfulness to challenge common emotional responses, such as anxiety. MSBR is associated with improved mood, better health, and a decrease in the intensity of medical symptoms. People can typically find MBSR courses in local clinics, hospitals, colleges, private organizations, or fully online.

Meditation

Meditation can help people feel more grounded in the present moment by directing participants to focus on the here-and-now without judging any thoughts or distractions that arise. While there are many types of meditation, the overarching premise remains the same. Meditation improves physical and mental health and is widely recommended to treat conditions like anxiety and depression.

Relaxation Exercises

Relaxation exercises like grounding techniques can help individuals manage anxiety when it becomes overwhelming. Implementing these strategies into one’s daily routine can help with feeling calmer and more empowered in moments of stress and crisis.

Some grounding techniques to consider implementing include:

• Deep breathing exercises
• Yoga
• The 54321 method
• The 333 rule
• Progressive muscle relaxation
• Autogenic training

When to Consider Therapy for Anxiety and IBS

Anxiety, of course, can be a complicated issue that sometimes requires professional attention. Although self-help strategies can improve mood and decrease frustrating symptoms, some people may benefit from seeking professional support, as it may increase the likelihood of a positive outcome. If someone’s anxiety feels stagnant, or if things continue worsening, it’s worth considering therapy.

Other signs that someone should seek therapy for anxiety, stress, or IBS include:

• Feeling suicidal or having thoughts of hurting themselves
• Having trouble sleeping for several weeks or months
• Engaging in maladaptive habits to cope (drinking too much, overeating, withdrawing from loved ones)
• Feeling like their symptoms have taken center stage in everything they do
• Not feeling better despite making healthy lifestyle changes

Cognitive-Behavioral Therapy (CBT)

CBT for anxiety is a well-known, evidence-based psychotherapy model that focuses on assessing the relationship between thoughts, feelings, and behaviors. By learning how to challenge negative thoughts, people can develop a more helpful framework about themselves and the world, which may help them feel and cope better. This may be especially helpful for someone with IBS, who may be dealing with negative thoughts due to chronic illness.

Hypnotherapy

Hypnotherapy helps activate the subconscious mind by guiding the patient to a deeply relaxed state. Hypnotherapists strive to resolve problematic issues that might be “stuck here.” Hypnotherapy for IBS often includes relaxation exercises, reframing and right-sizing, and pain reduction techniques. Hypnotherapy for anxiety often emphasizes deep relaxation, reframing, right-sizing, and self-management to cope with anxiety when it arises in the future.

Stress Inoculation Training (SIT)

SIT is a type of CBT that focuses on changing how people react to specific stressors. This work typically entails a combination of dealing directly and indirectly with a person’s stressors. In SIT, the patient will identify their inherent strengths and support systems, and learn how to use them–along with other healthy coping strategies–to feel better.

Biofeedback

Biofeedback offers concrete data on the body’s vital functions (breathing, sweat levels, brain waves, heart rate, and other physiological responses) and can help people become more aware of their bodily processes. Combined with other psychological treatments, biofeedback supports learning how to intervene and even change automatic systems, some of which exacerbate symptoms of anxiety and IBS.

Final Thoughts

IBS and anxiety are undoubtedly challenging disorders to live with, both individually and together. Since some symptoms may overlap, such as a reduced appetite and nausea, it can be difficult to identify whether one is causing the other. However, there are many treatment options people struggling with IBS, anxiety, or both can choose from, including medications, lifestyle changes, relaxation techniques, and multiple types of therapy. With the right course of treatment, people can learn to manage their symptoms and live a fulfilling life.