April is recognized as Irritable Bowel Syndrome (IBS) Awareness Month by the International Foundation for Gastrointestinal Disorders, a month dedicated to increasing awareness and decreasing stigma for people living with IBS.¹ With greater awareness, patients and their loved ones can better understand how IBS affects them and what factors may affect their IBS.

One such factor is anxiety. Stress and nerves may exacerbate IBS symptoms, and that has been made clear over the past two years. The anxiety many have experienced during the COVID-19 pandemic has made IBS symptom management difficult, and many patients have developed IBS during this time.² Your patients may be unaware of the way the brain and gut can interact with one another, and may have some questions about the link. How can you explain anxiety and the potential effects it can have on their IBS?

How Anxiety Affects IBS


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Anxiety and IBS are often linked; some studies have suggested that anxiety and depression are more prevalent in patients with IBS.³ The brain and gut interact with one another through the central nervous system, which is often divided into sympathetic and parasympathetic nervous systems.⁴ These systems generally work together, but IBS can cause disturbances. These disturbances mean that stress, which triggers the sympathetic nervous system, can create overactive nerves in the gut. This results in common IBS symptoms like stomach pain and diarrhea.

In some instances, the disturbances in the nervous system can cause underactivity in the gut, causing constipation instead.

Do Anxiety and Stress Trigger IBS?

Chronic stress and anxiety can potentially cause dysbiosis, a disorder of imbalanced intestinal bacteria.⁴ This can play a part in a patient developing IBS.

Stress can cause the release of certain hormones, such as cortisol and adrenaline.⁵ Though these can be very helpful hormones, the way they affect the body can be a problem for patients with IBS. Stress can, among other things, reduce blood flow in the intestines, increasing the severity of IBS symptoms and potentially triggering a flare.

IBS Subtypes

Can the subtype of IBS predict the prevalence and level of anxiety a patient is likely to have? A study published in BMC Gastroenterology in 2021 examined the link between IBS subtype and depression and anxiety comorbidities.⁶ The subtypes were divided by the primary symptom, meaning whether the participant had IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), IBS with a mix of the two symptoms (IBS-M), or unclassified IBS (IBS-U). The researchers found that while the difference in anxiety between subtypes was not significant, all groups had higher levels of anxiety than healthy controls.

The researchers also suggested that IBS-M may demonstrate the highest level of anxiety and depression symptoms, while IBS-C may demonstrate the most prevalence of them.

References

1. IBS Awareness Month. International Foundation for Gastrointestinal Disorders. https://aboutibs.org/living-with-ibs/ibs-awareness-month/. Accessed April 12, 2022.

2. Aubrey A. Pandemic anxiety was hard on IBS patients. Here’s how to find relief. NPR. https://www.npr.org/sections/health-shots/2022/04/11/1091758002/pandemic-anxiety-ibs. Published April 11, 2022. Accessed April 12, 2022.

3. Banerjee A, Sarkhel S, Sarkar R, Dhali GK. Anxiety and Depression in Irritable Bowel Syndrome. Indian J Psychol Med. 2017;39(6):741-745. doi:10.4103/IJPSYM.IJPSYM_46_17

4. Nall R. How stress and anxiety can aggravate IBS symptoms. Healthline. https://www.healthline.com/health/ibs-c/stress-and-anxiety. Reviewed June 30, 2017. Accessed April 19, 2022.

5. Understanding stress. International Foundation for Gastrointestinal Disorders. https://aboutibs.org/treatment/psychological-treatments/understanding-stress/. Accessed April 19, 2022.

6. Hu Z, Li M, Yao L, et al. The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis. BMC Gastroenterol. 2021;21(1):23. Published 2021 Jan 7. doi:10.1186/s12876-020-01593-5