Introduction
Understanding the relationship between chronic stress and IBS is vital for anyone looking to reduce their IBS symptoms and improve their quality of life.
This article explores the connection between chronic stress and IBS. It outlines some ways to address chronic stress. By focusing on strategies to eliminate, or significantly reduce chronic stress, you can help ease your IBS symptoms and improve your overall wellbeing and quality of life.
What is irritable bowel syndrome?
Irritable Bowel Syndrome (IBS) is the most diagnosed gastrointestinal disorder, affecting at least 10% of the global population. It affects the large intestine and is characterized by chronic or recurrent abdominal pain, associated with a change in bowel habits. Other symptoms include bloating, gas, and cramping.
IBS is not a disease, it is a functional disorder. This means the bowel does not function properly, but there is no observable structural damage to it. The malfunctioning is thought to be largely the result of problems with the gut-brain bidirectional communication system, referred to as the gut-brain axis.
While IBS is not a disease; the chronic and unpredictable nature of the condition can lead to severe anxiety and/or depression and a diminished quality of life.
The cause of IBS is unknown, but several factors are thought to be involved, including the immune, hormonal, and nervous systems. One of those factors is chronic stress.
The Gut-Brain Axis (GBA) and IBS
The GBA is the label given to the two-way communication system from gut to brain and brain to gut. The GBA includes the central nervous system (CNS), the enteric nervous system (ENS), and the autonomic nervous system (ANS), all coordinated through the hypothalamic-pituitary-adrenal (HPA) axis.
It is believed that impaired communication between the gut and the brain via the GBA contributes significantly to the development and maintenance of IBS. So much so that the condition is now classified as a ‘Disorder of the Gut-Brain Interaction (DGBI)’. One of the factors that causes impaired communication is chronic stress.
Chronic Stress
Chronic stress is the label given to chronic activation of our survival (stressor) response. The response is triggered by exposure to chronic stressors.
A ‘stressor’ is a person, event, or thing that our survival system has identified as a threat to our physical and/or emotional wellbeing. Examples of potential chronic stressors are poverty, excessive work pressure, a dysfunctional relationship, a chronic illness.
Chronic stress significantly affects our physical and emotional health. It can lead to conditions such as hypertension, headaches, insomnia, low energy, and gastrointestinal complaints, such as IBS.
Chronic Stress’s role in creating and maintaining IBS
Chronic stress exacerbates IBS symptoms and complicates management of the condition. Here are some problems chronic stress creates:
Disruption of the GBA: The gut microbiota play a pivotal role in maintaining normal GBA functioning. Gut microbiota influence everything from our immune responses to emotional and cognitive functions. Chronic stress can disrupt the delicate balance of gut microbiota, leading to both gastrointestinal and psychological symptoms, like anxiety and depression. This microbial imbalance is called dysbiosis.
Increased Flare-Ups: Chronic stressors trigger frequent and severe IBS flare-ups.
Altered Gut Functionality: When the survival (stressor) response is activated, energy and resources are diverted away from the digestive system to the muscles ready for fight-or-flight action. Our digestive system temporarily suspends its activity. The body shuts down the production of enzymes required for digestion and inhibits the production of stomach acid. Stomach acid (hydrochloric acid) is required to breakdown or metabolise our proteins, which, when undigested, can cause bloating and digestive discomfort. Prolonged suspension of activity within our digestive system alters normal gastrointestinal functionality and can cause altered bowel movements and other symptoms such as pain, bloating, and gas.
Increased cortisol: The chronic activation of the survival (stressor) response results in increased cortisol levels, which can directly influence gut motility, leading to IBS symptoms such as constipation, diarrhea or a mixture of the two,
Visceral Hypersensitivity: Chronic stress causes your gut to become overwhelmed with messages to speed up or slow down, and after a while, the regulating mechanisms responsible for your bowel function can no longer make the fine adjustments necessary for normal functioning. The result is your gut becomes hypersensitive, reacting to even low levels of stimulation such as normal levels of gas. As a result you perceive abdominal pain. Gut Hypersensitivity is one reason why foods you used to eat now trigger extreme IBS symptoms.
Immune System Activation: Chronic stress can trigger more frequent immune system activation contributing to dysregulated immune responses. The immune system and gut are closely connected. As many pathogens enter the body via the intestinal mucosa, it is vital the gut can provide effective immune responses when necessary.
The vagus nerve: The vagus nerve forms the core component of the GBA and is a key component of the rest and digest response. Chronic stress inhibits vagal nerve stimulation, resulting in harmful effects on the gastrointestinal tract.
The sensation of pain is increased: The sympathetic nervous system influences whether pain signals are sent up the spinal cord to the brain. Neurotransmitters linked to stress hormones can increase the sensation of pain.
Impaired Response to Treatment: Chronic stress can impair the effectiveness of IBS treatments because the experience of chronic stress causes poor concentration, low energy, low motivation.
Trapped in a viscous ‘symptom - stress - symptom’ cycle.
IBS symptoms can be a stressor. If your survival system identifies IBS symptoms as a stressor, it activates the survival (stressor) response, creating more stress. And so, a worsening cyclical pattern is created, whereby IBS symptoms (a stressor) activate the survival (stressor) response, which leads to more IBS symptoms, creating a continuous cycle. Interrupting this cycle is critical to reducing IBS symptoms.
The less you activate the survival (stressor) response, the more time your nervous system is going to be in rest and digest mode and the fewer IBS symptoms you should experience.
Addressing chronic stress to improve IBS symptoms.
The reduction and management of chronic stress needs to be a critical component of any IBS treatment strategy.
Strategies for reducing chronic stress include:
1. Psychoeducation: Understanding IBS and chronic stress and how they interrelate, can help ease anxiety surrounding the condition.
2. Gut-Directed Hypnotherapy: This is an evidenced based treatment for IBS. Besides correcting the miscommunication between gut and brain, it focuses on stress and anxiety reduction.
3. Chronic stressor management: The key to gaining relief from chronic stress is to identify your chronic stressors and act (if possible) to eliminate them or change them such that they are no longer tagged as a threat by your survival system.
4. Switch off the survival (stressor) response: When the survival (stressor) response is chronically activated, there’s little opportunity for the rest and digest (relaxation) response to switch on and bring your nervous system back into balance (homeostasis). Through regular practice of techniques that activate the rest and digest (relaxation) response, you can help to switch off the survival (stressor) response, giving your body time to rest and recover. The more time you spend in rest and digest mode, the more you can restore your digestive system to normal functioning.
5. Use coping chronic stress coping strategies: It’s not always possible, or practical, to eliminate all chronic stressors, or to change them into non-threats. Therefore, you need to become skilled at and practice some symptom management techniques. By reducing your symptom severity, you reduce the intensity of those symptoms as a threat, so reducing the intensity of activation of the survival (stressor) response resulting in a lower level of chronic stress being experienced.
Coping techniques typically include physical activity and relaxation techniques, such as:
a. Moderate Exercise: Activities like yoga, brisk walking, jogging, and swimming help regulate intestinal contractions and reduce abdominal pain.
b. Meditation and Deep Breathing: These practices promote relaxation, restore emotional balance.
c. Acupuncture and Acupressure: Techniques used to stimulate specific body points that enhance blood flow and promote overall relaxation.
Summary
Irritable Bowel Syndrome (IBS) is a ‘Disorder of the Gut-Brain Interaction (DGBI)’ that affects the bowel (large intestine). There is no organic or physical reason for the disorder and the condition is not a disease. The condition manifests through symptoms like abdominal discomfort, changes in bowel habits, and bloating, and gas.
The cause of IBS is still unknown, but several factors are believed to be involved, of which chronic stress is a significant factor. Therefore, understanding the relationship between chronic stress and IBS is vital for anyone looking to reduce their IBS symptoms and improve their quality of life.
Chronic stress results from chronic activation of the survival (stressor) response. Activation of the response suspends normal functioning of the digestive system. Prolonged disruption of the digestive system leads to changes in bowel function, hypersensitivity, and pain. The symptoms of IBS are themselves a stressor, triggering activation of the survival (stressor) response. This creates a vicious chronic stress–symptom cycle.
The ability to eliminate or significantly reduce chronic stress plays a pivotal role in achieving lasting freedom from IBS. One of the most effective ways of achieving this is through gut directed hypnotherapy.