STRESS AND SYMPTOMS – Is There a Relationship?

We often use our gut to express our feelings or make decisions; butterflies in the tummy, gut feelings… there’s research emerging that there’s actual science behind this – the brain-gut axis (BGA)! The current understanding is that the BGA is made up of the central nervous system, the enteric nervous system (the division of the autonomic nervous system that controls the function of the gastrointestinal tract), the gut wall and the hypothalamo-pituitary-adrenal (HPA) axis. The communication between the gut and central nervous system is bi-directional, relying on several neural, endocrine and neuroimmune pathways. 

Under normal conditions, the brain receives signals from the gut and in response can alter gastrointestinal tract motility, gastric secretions and immune function. This means that this axis and its effective communication, is very important in the regulation of food intake, digestion and control of bowel movements. Long-term structural and functional changes to the BGA can change the system’s response to stimuli, and may lead to the development of gastrointestinal disorders, including IBS. 

Components of the BGA – the ENS, a division of the autonomic nervous system, and the HPA axis, are considered to play a significant part in the body’s stress response. Changes to this system have been linked to anxiety (and related conditions) and stress-sensitive pain disorders. IBS patients often demonstrate decreased parasympathetic and increased sympathetic nervous system activity. This means the body is in ‘fight’ mode more than ‘flight’ mode – a constant state of stress. Chronic stress can modify the central pain system, as well as the motility and permeability of the gastrointestinal tract. Due to this, IBS patients may be more sensitive or have a heightened sense of pain, with abdominal pain being one of the main symptoms of IBS. Chronic stress can also lead chronic inflammation, which is believed to be one of the leading causes of IBS. Stress has further roll on effects, impacting the immune system, delayed recovery from infection; another risk factor for IBS development. Prolonged infection and poor immune system function also impacts the gut’s healthy community of bacteria. Interestingly, recent observational studies have found people with depression to have different gut microbes to people without depression. 

IBS patients have also been found to have a decreased production of serotonin, ‘the happy hormone’, which is produced by cells in gut. This hormone also controls the reflex that moves food through the digestive system, hence affecting gastric motility, something known to change with the development of IBS. With less serotonin in the body, a person may be more sensitive to mood changes and low energy. 

The relationship between stress and IBS is not one way. Patients have reported feelings of stress triggering the presentation and increased intensity of symptoms. To add to this, symptoms can also cause big emotional shifts as it is believed that irritation of the gut may send signals to the brain, triggering changes in mood. This is evidenced in the extremely high proportion of IBS patients who following their diagnosis, develop depression, anxiety and/or related conditions. 

Unfortunately, stress is an unavoidable part of life and some people may tend to experience or feel stressed more than others. However, it’s only when we fail to manage it in a healthy way that it becomes damaging to mental, as well as physical health. By managing stress effectively, it may lead to a reduction in the presentation or intensity of IBS-related symptoms, as well as increasing energy levels and productivity, improving concentration and sleep and decreasing fatigue and general feelings of anxiety. It will also improve self-confidence – all wins in my book! Here’s some suggestions on techniques that can be used to help reduce stress: 

• Deep breathing exercises. Try to breath in for 6 seconds, hold for 6 seconds and release for 6 seconds.

• Spending time in nature.

• Visualisation techniques and positive imagery.

• Self-care rituals – long baths, facials, massages.

• Using essential oils.

• Exercise.

Most importantly – find something that works for you. Something that you enjoy and do it regularly, take time each day for YOU, even if it’s only 10 minutes. 

Reference List: 

1. Fichna J, Storr M.A. Brain-gut interactions in IBS. Front. Pharmacol. 2012;3(127). doi: 10.3389/fphar.2012.00127 

2. Pasricha J. The brain-gut connection. 2020. John Hopkins Medicine. Available from: https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-connection 

3. Quigley E.M.M. The Gut-Brain Axis and the Microbiome: Clues to Pathophysiology and Opportunities for Novel Management Strategies in Irritable Bowel Syndrome (IBS). J. Clin. Med. 2018; 7(1):6. Doi: 10.3390/jcm7010006. 

4. Moloney R.D et al. Stress and the Microbiota-Gut-Brain Axis in Visceral Pain: Relevance to Irritable Bowel Syndrome. CNS Neurosci Ther. 2016; 22(2): 102-117. doi: 10.1111/cns.12490. 

5. Dr Megan Rossi. Gut Health & Mental Health: what’s the link? 2019. Available from: https://www.theguthealthdoctor.com/all-articles/gut-health-and-mental-health-link 

6. International Foundation for Gastrointestinal Disorders. Relaxation Techniques to Manage IBS Symptoms. 2014. Available from: https://www.aboutibs.org/psychological-treatments/relaxation-techniques-for-ibs.html 

7. Saha L. Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014; 20(22): 6759-6773. Doi: 10.3748/wjg.v20.i22.6759