Dynamic Duo: IBS and Anxiety

​Dynamic Duo: IBS and Anxiety

​Written by Megan Allegretti, MA, LPC

I wanted to take the opportunity to discuss a relationship that impacts many; the duo of IBS and Anxiety.  Let's first take a look at what each of these conditions are.  
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What is IBS? Irritable Bowel Syndrome (IBS) is the most common functional gastrointestinal disorder found in humans.  According to the International Foundation for Functional Gastrointestinal Disorders, IBS impacts 10-15% of the population worldwide.  Fun Fact: IBS is the #2 reason people miss work, second to only the common cold. The symptoms of IBS do not have to be present all the time, they can come and go as they please.  Symptoms typically include abdominal pain or cramping, bloating, constipation, diarrhea or a combination. 

IBS is unique in that it’s very common for people to experience gastrointestinal (GI) distress, but we actually know very little about what causes it.  IBS is diagnosed not by its own test, but by ruling out other conditions in people experiencing symptoms, and lumping these under the “IBS” label.  We often call IBS a brain-gut disorder; meaning it can be caused or exacerbated by both the digestive and nervous systems. There are currently no pharmacological treatments with consistent results for this diagnosis, only dietary recommendations and maintenance of symptoms. 

What is Anxiety? Here we’re looking at anxiety as an emotional reaction, and not necessarily the diagnosable anxiety disorder. We all have some level of anxiety, or fear as an emotional reaction that evolved as part of our survival.  Anxiety is a fear response, but the stimuli might be unknown or an internal threat.  
What happens when our body experiences fear or anxiety?  Our body is responding to perceived threats with an action urge to avoid the situation.  This is how our ancestors survived dangerous situations, by avoiding them.  However, our modern society has adapted a lot quicker than our bodies which still respond to perceived threats the same way as actual threats- with the urge to avoid.  

How Do the Two Tango? A high percentage of people with IBS also experience anxiety.  When our body detects anxiety/fear/stress, the autonomic nervous system is activated to prepare us to fight for our lives or flee from the situation- Fight or Flight response.  In this state, the amygdala (a part of our brain) sounds the alarm to our nervous system to dump a bunch of neurotransmitters (like serotonin and dopamine) into the digestive tract to quit worrying about digesting and prepare for the imminent threat.  When fighting off a bear, we do not need to be digesting our breakfast.  However, when our body is responding to perceived threats like stress or anxiety, things that we cannot avoid, this dump of neurotransmitters wreaks havoc on the digestive system.  

It is a Game of What Came First, the IBS symptoms or Anxiety Symptoms? Why is IBS called a brain-gut disorder?  Because the autonomic nervous system (brain) and the digestive tract’s nervous system (gut) are in constant communication. FunFact: The gut is the only peripheral organ with its own nervous system. I learn best by examples, so let's look at some to highlight this bidirectional communication.  Say you have stomach cramping due to IBS symptoms, and then you worry, “Will I make it to the bathroom in time?”.  This increases anxiety which increases digestive distress, and the cycle continues.  Or perhaps you have some anxiety with work, then you experience stomach tension, and now you are questioning if it is IBS symptoms; for example,did I eat something wrong?”, which increases anxiety.  

How can psychotherapy help? As the above examples show, IBS and anxiety have overlapping causes and symptoms and it is hard to tease apart which one came first.  What we do have is supporting research showing psychotherapy can help reduce IBS symptoms.  Current research supports several different evidence-based treatments with the starting points being education and management of anxiety symptoms.  These techniques teach us how cognitions impact our bodies physiological reactions, and if we can manage our anxiety responses then we potentially lower IBS symptoms. The body and the mind are interconnected to the point where we cannot consider one without the other.   

If you are experiencing symptoms of IBS which may be linked to anxiety, and want to learn how to manage anxiety symptoms through evidence based treatments, give OakHeart a call at 630-570-0050 or email us at [email protected].and let us know how we can help!