The jury is still out on how stress and irritable bowel syndrome are related. It’s a bit of a chicken and the egg scenario as to which comes first. Research reveals about 60% of IBS sufferers meet the criteria for a psychiatric disorder, most commonly generalized anxiety disorder. There may be a number of reasons why stress and IBS tend to co-occur:
- IBS sufferers may be more sensitive to stress
- Stress and anxiety may make the person more aware of bodily reactions e.g., spasms in the colon and stomach bloating
- IBS may be triggered by the immune system, which is highly receptive to stress
For many IBS sufferers, the low FODMAP diet can help to significantly reduce unpleasant gastrointestinal symptoms. However, often it is not a complete cure. If you have Irritable Bowel Syndrome (IBS), have ruled out other dietary triggers, and are still having digestive issues, it may be worthwhile focusing on your psychological health, particularly your stress levels.
Our nervous system has two modes: 1) The Parasympathetic: when we are calm, our heart rate and breathing slows, our pupils are constricted, our digestion is stimulated, and bowels work normally (happy days!) and 2) The Sympathetic: when we are stressed or frightened, our heart rate increases, our mouth goes dry, our breathing increases, our pupils dilate, and our digestion slows right down as the large intestine attempts to empty, sending us rushing for the loo. While this temporary ‘fight or flight mode’ is handy for what it is biologically intended: fighting off attackers, chasing prey and running away from danger… chronic stress is less than ideal for digestion. Stress can affect our digestive system in a number of ways, including slowing down how quickly food passes out of our stomach and upper small intestine, and stimulating how quickly food is pushed through our lower bowels.
Adding to this, our brain learns the association between feeling stressed and experiencing GI symptoms. This hypervigilance applies to how IBS sufferers perceive GI discomfort. Someone who rarely or doesn’t experience IBS (lucky duck!) wouldn’t pay any attention to mild stomach cramps or slight bloating, but for someone who is hypervigilant, this can be a stressful event. A study has confirmed this, finding people who have IBS show increased sensitivity in the intestinal lining to minor electric shocks when under intense psychological and physical stress. However, this sensitivity isn’t evident in those who do not have IBS when they are put under stress.
Now, what to do to break this toxic stress-IBS cycle??? It is human nature to try to avoid coping with difficult situations, but this may not be the best strategy for long-term health. Research shows the more we attempt to distract ourselves or avoid/disengage with our thoughts and feelings, the poorer our mental health is likely to be.
OK so trying to pretend we are not stressed isn’t the way to go about it, but what is? The answer is “stress management” over “stress avoidance”. Research shows the more you keep your stress levels under control, the less severe your IBS symptoms will be, provided all other factors (e.g., diet, exercise etc.) are constant. This does NOT mean your IBS will be a thing of the past if you’re totally Zen but indulge in bucket loads of high FODMAP foods if you know they are a trigger for you! If this is the case, stress management coupled with a low FODMAP diet will be the best strategy. Some handy relaxation techniques to incorporate alongside your low FODMAP diet include:
- Meditation: studies suggest daily meditation may alter the brain’s neural pathways, making you more resilient to stress. To practice meditation sit up straight with both feet on the floor, close your eyes, focus your attention on reciting a mantra that makes sense to you e.g., “I feel at peace”, while breathing deeply. You can do this anywhere … although perhaps not while driving.
- Deep Breathing: with your hand on your belly so you can feel it contracting and distending, slowly inhale through your nose for five slow counts, and exhale through your mouth for five seconds. Do this at least five times.
- Be Present and Practice Mindfulness: especially when eating! Make sure you’re taking at least 20 minutes to finish each of your main meals. Chew slowly, focus on the flavour of your food, the colour, how it feels in your mouth, its temperature. This will do wonders for your digestion, as you’re giving your stomach enough time to properly extract the nutrients, produce the necessary stomach acid, and digest what’s coming in. Less likelihood of accumulating gas and choking too (added bonuses!)
- Have a Solid Social Support Network: this will be one of your best aids for handling stress. Talk to others – preferably face to face but even a long phone chat with an old friend will do wonders. Share what’s going. Sometimes, hearing about others’ lives and experiences can help bring a new perspective to your current situation. Friends and family tend to give good advice too. If you’re struggling to find someone to confide in, there are free telephone counselling services you can make use of.
- Burn Essential Oils: aromatherapy has been used for centuries in the treatment of anxiety. You can find some great relaxation blends out there too.
- Enjoy a Hot Cup of Tea: peppermint or ginger will do wonders for your digestion. Remember to sip slowly, as a burnt tongue is NOT likely to promote relaxation.
- Get a Massage: whether it’s a paid service or from a loved one, relaxing your body’s muscles will force your brain to slow down too. Stomach massages are great ways to stimulate bowel movements, but be sure to find someone appropriately trained.
- Have a Hot Bath with a Good Read: set half an hour aside to just focus on doing nothing. Playing some relaxing tunes in the background will help too.
- Decompress: place a warm heat pad around your neck and shoulders for 10 minutes. Once you’re finished, you can use a tennis ball or foam roller if you have one to do some self-massage and remove any remaining tension.
- Laugh: go see a funny movie, chat to a friend who always gets you giggling, try something you know you’ll be terrible at (who is even good at stand-up paddle boarding other than Victoria Secret models anyway?!)
- Get Creative: art therapy is used all over the world for a reason! You can buy some great coloring in mandala books for next to nothing. Try to apply zero judgement to your artistic pursuits … you’re not being tested.
- Get Amongst Nature: go for a walk, hike, or, if it’s within your means, try out a horse riding class. Nature = peace and calm.
- Take a Holiday and Turn your Work Phone/Emails Off: not always possible, but make sure you’re putting as many strategies in place as possible to maintain work/life balance.
- Listen to Music: research shows this can lower blood pressure, heart rate and anxiety. Create your “chill” playlist and have it on repeat as necessary!
- Get Your Minimum Eight Hours of Sleep: if you’re unable to do so for practical reasons during the week, get these precious hours of mental downtime and rest during the weekend. Insufficient sleep will lower your resilience to stress and also adversely affect digestion.
- Exercise: this doesn’t have to be cross-fit style, even some gentle walking or yoga can ease anxiety by helping the brain release feel-good chemicals and relieve you of physical symptoms of stress. It will also teach your body how to breathe properly.
- Practice being Grateful for What You Have: you only have to turn on the news to realise there are always others who have it worse. Dealing with IBS is no treat, but in comparison to natural disaster or relentless poverty, you’re not doing too bad! Plus, IBS CAN be manageable.