IBS and Mental Health: The Vicious Cycle

There is no single known cause of irritable bowel syndrome (IBS). Instead, experts think it is a combination of several different factors. But more research is needed to determine exactly how these issues arise and come together to cause IBS. It is also unclear which factors might cause IBS versus worsen symptoms that already exist.1,2 A few of these potential factors include:1,2 Issues with the way the gut moves food through the digestive system (gut motility) An increased sensitivity to gut-related pain (visceral hypersensitivity) Gut inflammation from an imbalance of immune system cells or the proteins they make Changes to the gut caused by infections Changes in usual gut bacteria Sensitivities or allergies to certain foods Genetic changes that increase the risk of IBS in families Stress, anxiety, depression, or other mental health issues Stress and other mental health concerns is a factor that has gotten a lot of attention in recent years as experts learn more about what they call the gut-brain axis.3 Understanding the gut-brain axis All the organs and systems in your body are in close communication with one another. Your brain is part of your central nervous system. It sends signals in the form of hormones, proteins, or other messengers called neurotransmitters.3-5 These signals help tell different parts of your body what to do. When these signals are out of balance or not performing their normal role, different health issues can arise.3-5 Just like the brain can send signals to the rest of the body, the body can send signals back to the brain. The gut is a great example of a system that has this constant back-and-forth communication. The gut has its own network of nerves and signals that are called the enteric nervous system. Some people refer to this gut-driven nervous system as the body's "little brain."3 The relationship between the brain and the gut is called the gut-brain axis. Together, these play a role in sensing pain. They can also lead to changes in gut motility, inflammation, and more.3-5 The amount and type of bacteria in the gut can affect the gut-brain axis too. This is sometimes called the microbiota-gut-brain axis.3-5 The gut-brain axis and IBS Because the brain and gut are so closely linked, many experts wonder if mental health distress can be a cause of IBS. The answer to this is not very clear. But experts do know that stress and anxiety are triggers for IBS symptoms. They also know that stressful events early in life, like childhood abuse, are linked to an increased risk of developing IBS.1,2,6 Overall, it is not clear clear whether or how stress can directly cause IBS to develop in the first place.1,2,6 Some researchers have looked at mice to try to find the answer. One team found that mice with stress and depression had increased gut motility and diarrhea. These mice also had increased sensitivity to pain that could explain some of the abdominal pain experienced in IBS.7 What is helpful about this study is that the IBS-like symptoms occurred after the mice were exposed to stress, not before. This suggests that stress and mental health issues may be a cause of IBS rather than a symptom trigger. But much more research is needed to understand the true relationship between the 2.7 The cycle between stress and IBS symptoms While stress can worsen IBS symptoms, IBS symptoms can cause their own stress. This relationship can create a cycle that is hard to break. The cycle can keep going, leading to both worsening stress and worsening IBS if not stopped. This is why stress reduction and mental health support are often part of IBS treatment plans.8 Finding ways to reduce stress Lowering stress can be difficult. But there are several things you can do on your own to help bring down your stress level:4,6,8 Journaling Enjoyable and safe physical activity like dancing, walking, gardening, or group exercise classes Yoga Hobbies like making art, singing, or playing board games with friends Meditation and mindfulness Deep breathing techniques Joining a support group (either in-person or online) Depending on your situation and other health conditions you may have, these tactics might not be enough. If this is the case, there are more formal options to reduce stress, like talk therapy.9 One therapy approach that has been studied as a way to potentially improve IBS symptoms is cognitive behavioral therapy (CBT). CBT can be performed by many licensed mental health providers. Hypnotherapy and acupuncture are other stress-reduction options that can be performed by a trained professional in a more formal setting.6,9 Some people with IBS may benefit from anti-anxiety or antidepressant drugs if they have underlying anxiety or depression. A few of these drugs may also help with reducing pain perception. Talking honestly with your doctor about your mental health and stress levels can help you create the best, safest plan for your overall well-being.8 [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] What does that mean, you might ask? What does my mental health look like? Does it look like anything? It is very rare for me to have a conversation with someone with IBS where the topic of mental health doesn’t come up. I’m sure that there are those of you that don’t necessarily think that mental health is a major factor in your IBS experience. One thing I’ve learned is that IBS comes in so many shapes and variations that no two people have the same root cause or experience. Do I believe my mental health is inextricably tied to my IBS? Yes, without a doubt. I am sure of it. Identify your mental health needs I know my mind and my body. I know that many other people with IBS feel the same way. IBS can be a reaction to years of anxiety and unmanaged stress coupled with the way we treat our bodies when we feel bad. So take a look inside and see what your mental health looks like. Is it happy, stable and friendly? Or is it anxious, frustrated, hopeless and angry? This brings me to the main point of this article. When people hear the term ‘mental health’ they very often immediately start thinking about mental illness. Schizophrenia, bipolar, personality disorders, etc. But mental health also includes major depressive disorder, anxiety disorders, and about a hundred other categories and sub-categories. Mental illness sounds scary and it can be. But just because you may ‘only’ have bad anxiety, doesn’t mean it is not an illness. Mental illness carries stigma very much like IBS. So let’s see what our mental health really looks like. Finding a balance between mental health and physical health Ultimately, mental health is exactly what the name suggests. Nothing more and nothing less. How healthy are you mentally? Do you ask yourself that question? You should. I have found that with IBS you tend to get consumed with all the things you need to do to help ‘fix’ your body. It takes a lot of time, money and energy and often leaves you too tired or fed up to look at the mental wellness piece. We can’t do that. There has to be a balance between those two parts of managing IBS. The mental and the physical are tied together in all things. Illness, love, work, sports and the list of life activities go on. There is no true physical wellness without mental wellness and vice versa. I believe this to be true. In my experience, visiting my therapist, meditation, coping skills, and medication is just as important to my management of IBS as is seeing my GI doc and working on my diet and exercise. I’d like to share something I’ve learned in my job as a counselor and social worker. When I first started in this field I think I truly believed that there was a sort of ‘Tier’ system with mental illness. You know, schizophrenia was the worst, followed by bipolar 1, followed by certain personality disorders. Depression and anxiety disorder were on the ‘bottom’ tier. I couldn’t have been more wrong. All of these things are spectrum disorders. There are people with generalized anxiety disorder and depressive disorder that suffer every bit as much and more than some people with schizophrenia. The reverse is also true. There is no one way, one rule, one treatment. Just like IBS. Point is, if you spend a little more time thinking about mental wellness, you might find your IBS will thank you for it. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] I have written a few articles over the years about my IBS and depression, and I am proud to say that since I began this journey of advocating for myself and others with invisible illnesses, I continued to gain a better handle over my mental health. Now that’s not to say I’m completely depression-free; I’d be lying if I said that I still don’t experience depressive episodes every now and then. Let’s be honest, who seriously enjoys living with a debilitating condition that constantly finds ways to hold the sufferer back in life? When I was new to the invisible-illness community, I didn’t know how to take my condition serious enough to even advocate for myself, let alone for others. I felt so pitiful and miserable simply because I did not want to accept what I was going through, and instead, I fought hard to return to the days of feeling “normal” and “healthy”. Clearly, that act only lasted for so long until my condition started effectively affecting my quality of life and mental health in the worst of ways. IBS and depression When I finally came to terms with my IBS, I realized depression was deeply tied to how I felt due to my condition. It seemed to always come along for the ride during and after some of my worst flare ups. Therefore, I had to learn to live with both conditions, which for a newbie is obviously a very hard thing to do. It requires accepting the fact that you also have depression on top of having IBS. When I accepted both of those diseases, I began to notice all of the things they took from me without me being aware at the time. Because of my IBS and depression, I dropped out of college, lost a number of jobs, lost touch with many good friends, and have had deep issues with some family members. At one point, I lost all hope and any ounce of confidence in myself. So basically, learning to live with these conditions was similar to learning to find a reason to live every day. How I overcame depression It took me a while, a long while, but I realized a lot of my depression wasn’t just coming from IBS, but also from me. A lot of my mental anguish was self-inflicted simply because of my perception on my condition, and life in general. For instance, I used to compare myself a lot to other people who didn’t suffer from this horrible condition, and because of that I had a hard time keeping my self-esteem high, which eventually lead to a depressive state. One of the hardest things for me to learn was to stop comparing myself to others, and simply accept my shortcomings by finding new and different ways to do the things I really wanted. For me, that was literally a key moment and realization that helped me slowly get out of my depressive-funk and start taking control over my life. I could go down a list of how I was self-inflicting my own depression in many other ways, but I feel the most important things to point out are the fact that I took accountability for my self-inflicted depression and realized how I needed to change my perception of the limitations placed upon my life. When I finally decided to do things my way, my attitude changed about my condition and dealing with depression became a lot easier overtime. I’ve used this once in an article and I’ll use it again, since it is one of my favorite quotes, “Change your mindset. Change your life.” For me, that’s the key to getting over many obstacles. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from IrritableBowelSyndrome.net:"],This month IrrititableBowelSyndrome.net is featuring discussions about coping with IBS related pain. If you take a quick look at my articles, you’ll see a good portion of them are about recovery, mental health and wellness. Because of this, I was anxious to put my two cents in with regards to this issue. While it is true that most serious illnesses may cause mental health related pain related to anxiety, depression and such, I truly believe that the psychological and emotional toll taken by IBS is unique and incredibly painful. It really becomes about creating a plan and learning to cope in the healthiest way you can. In the hopes that all of us engaged here on this site can relate to each other in some way, I will share my experience with the psychological and emotional pain that IBS can cause. IBS and mental health As I have mentioned before, I had anxiety and mental health related issues long before I was diagnosed with IBS. From what I understand, this is not uncommon amongst folks suffering with IBS. I had spent years getting my mental health under control and learned how to cope with the very real pain and suffering that living with mental illness can cause. I was so dedicated to my recovery and my wish to live a life free of anxiety, mood swings and depression, that I was able to become stable enough to work in social services, with a wish to support others struggling with the same types of problems. The point of all this, is that on that day I went to the GI doc and they told me I had IBS…I was very, truly; stable. Since then, I have found myself struggling again due to the many, many stressors that IBS places on your self-esteem, your physical ability to function and your sense of empowerment. No one wants IBS. Just the very nature of the disorder is disturbing. Even though I had been experiencing IBS symptoms prior to my diagnosis (obviously), once I started reading about IBS and the fact that it can’t be cured and all that…my heart just sank. After really bad flare ups I get blue and depressed. In between, I get worried and anxious about when it is going to happen again, what will happen if I eat the wrong food, what if I can’t have a normal relationship and on and on and on. This is NO WAY TO LIVE. So, how to cope you ask me? Well, I will try to explain my approach in a few words. How to cope? First things first, please try to judge your psychological symptoms honestly. I know that many people will seek help for anxiety and depression from their family doctors. While I’m sure many are equipped to deal with mild cases of nerves or the blues, they may not be the best option once things get past a certain point and these psychological and emotional symptoms become a constant part of your life. In this case, it is important to find a specialist. There is no shame in seeing a therapist or a psychiatrist. There is an overwhelming stigma associated with mental health issues, just as there is with IBS. See the specialist, work with the specialist and accept that it may take time and perhaps be a bit uncomfortable. Open yourself up to the help. Otherwise, please look into taking back your happiness by doing all the things we know we should do to keep ourselves well. Do not isolate; enjoy the outdoors. Do not couch potato; please exercise. Do not drink booze; drink good tea and water. Do not sit and worry; listen to music. You get the point. Someone said, ‘Stop hating yourself for what you are not and start loving yourself for what you are.’ I think this says it all. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Mental and physical health are intrinsically linked. Managing the stresses of a physical condition can be mentally and emotionally exhausting. Here we share 10 strategies for coping when you’re feeling overwhelmed. 1. Breathing exercises Focusing on your breath is a technique used to lower stress and anxiety. There are many different forms of breathing exercises including belly breathing, nasal breathing, and timing and guiding your breath. 2. Guided meditation Don’t let the name turn you off! There’s a lot of ways to practice mindfulness and meditation, and finding the right one for you can help slow down racing thoughts, release worries, and focus the body. There can be a learning curve with meditation, so be sure to shop around - with practice it gets easier. 3. Exercise, diet, and vitamins Emotional wellbeing is both body and mind. Though it’s important to note that these are not cures, how you nourish your body can affect the way you feel. Movement, whether high impact or low, can decrease stress and increase energy. 4. Sleep There’s no underestimating the importance of sleep. It gives your body and mind the time it needs to recharge and can increase emotional resilience. A good night’s sleep doesn’t come easy to everyone, so finding a schedule for you and even consulting a specialist might be helpful. 5. Laughter: take a break Laughter is the best medicine? Distraction in the form of entertainment or humor can help relieve the day-to-day physical and mental stress. If you’re in the midst of a stressful situation or environment, you may want to try physically removing yourself and seeking a calmer place. 6. Nature therapy You’ve probably noticed the joy that comes with taking a walk through the trees, but it may come as a surprise that natural environments really can have an impact on our minds. Being surrounded by nature can provide both an escape and a point of focus when you’re feeling overwhelmed, allowing you to focus on something bigger than ourselves. 7. Acupressure You’ve probably heard of acupuncture. Acupressure has a similar goal, to release tension, center thoughts, and focus your energy. They both have origins in Eastern medicine. Acupressure uses precise pressure and finger placement over specific points along the body that are known to target stress and anxiety. You can try doing it yourself, or ask a friend or loved one to help you. 8. Thought exercises We all have days when negative thoughts consume us. These techniques can help to redirect these thoughts. Some exercises involve journaling, affirmations, gratitude, and list-making. For example, you might make a list of your strengths or repeat a positive mantra. 9. Seek out support Even with these tools in hand, there will be times when it’s difficult to cope on your own. Support can come in lots of different forms. Family, pets, friends, online communities, meetups and support groups - all of these resources can provide a strong foundation for the times when you need reinforcements. 10. Volunteer to help others Reaching out beyond your social network to help out others can give you a sense of purpose. It allows you to use your skills and energy to make a difference in someone else’s life. Volunteering can take many forms, such as letter writing, donating, or offering your time to a local nonprofit. Further resources Sometimes coping becomes impossible to manage on your own, even with the help of loved ones. There is professional help available: Psychotherapy Medication Resources [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from IrritableBowelSyndrome.net:"],Irritable bowel syndrome (IBS) is a condition that stems from a problem with how the brain and the gut communicate with each other. IBS can cause symptoms like belly pain, bloating, diarrhea, and constipation. But the condition does not just involve gut troubles – it also has a strong link to mental health.1,2 As many as 1 in 3 people with IBS experience anxiety or depression. Many also live with high stress levels. Experts are still trying to understand all the ways that IBS and mental health affect each other. But learning all you can about this connection may help you manage both your physical and emotional symptoms better.3 The gut-brain axis Experts call the connection between the gut and the brain the "gut-brain axis." The gut-brain axis is made up of a network of nerves connecting the brain to the digestive tract. With millions of nerve cells (neurons) that pass through this network, the gut and brain constantly send signals to each other.1 When something goes wrong in either the gut or the brain, it can affect the other. For example, if you are nervous or worried about something, you might feel “butterflies” in your stomach. Or you might have an urgent need to use the bathroom. The close connection between the gut and the brain is likely 1 reason why people with IBS commonly also live with mental health issues like anxiety and depression.1,4 How mental health challenges can affect IBS symptoms When people with IBS experience stress, anxiety, or depression, their brain sends signals to their body that can make their IBS symptoms worse. These signals may go directly to the gut or through a related organ system like the endocrine system or immune system.1 For example, when your stress levels increase, your brain signals your endocrine system to release stress hormones like adrenaline and cortisol. These hormones change how quickly your body digests food. They can also cause muscle spasms in your intestines. Both digestive changes and muscle spasms can lead to IBS symptoms.4 Further, stress can lead to changes in the balance of bacteria in your gut (called your gut microbiome). Many people with IBS already have gut bacteria that is out of balance, and stress can make the problem worse. This imbalance may lead to new or worse IBS symptoms.4,5 How living with IBS can affect mental health Having imbalanced gut bacteria also can change the levels of hormones and chemicals called neurotransmitters in your gut. Both hormones and neurotransmitters play a big role in your mood. When the levels of these substances change over time, the result might be a mental health condition like depression or anxiety.1,4 It is also true that just living with IBS symptoms day in and day out can make you feel anxious, depressed, or stressed out. The result may be a vicious cycle of gut problems and mental health challenges that is hard to break.3 Why does stress have such a big effect? People with IBS may be especially prone to the effects of stress on the digestive system. This is because part of their endocrine system is already impaired – the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis controls the release of hormones the body needs to manage stress effectively.3,6 When a person with IBS is overwhelmed with stress, their HPA axis may not function well to manage or recover from the stress. This may make the person’s gut symptoms and mental health symptoms worse.3,6 Another issue related to the gut-brain axis is called visceral hypersensitivity. This term means that you feel pain in your internal organs more intensely than other people do. Experts think that about 40 percent of people with IBS have visceral hypersensitivity. And stress can make it worse, increasing your sensitivity to existing belly pain.4,7 Could genetics be at play? Along with the direct effect the gut and brain have on each other, some research suggests that IBS and certain mental health conditions share genetic risk factors. Researchers found that IBS may stem from the same biological processes as mental health conditions like anxiety and depression do. These processes are set in motion by certain genes. But more research is needed to fully understand this connection.8 How can I manage both my IBS and my mental health? Mind-body therapies may be particularly helpful for people living with IBS and mental health challenges. These are therapies that target the gut-brain axis to relax your digestive system, lessen mental health effects, and improve your ability to cope with pain and discomfort. Examples of mind-body therapies for IBS include:1,9 Cognitive-behavioral therapy (CBT) – In CBT, a mental health professional helps you perceive and react to your IBS and mental health symptoms more positively. Relaxation therapy – In combination with CBT, methods like visualization and progressive muscle relaxation may help improve your body’s reaction to stress. Gut-directed hypnotherapy – This technique uses deep relaxation (hypnosis) to help calm your digestive system and relieve IBS pain. To address imbalances in your gut microbiome, taking probiotic or prebiotic supplements may be helpful. Cutting out foods that might be triggering your symptoms also may help. One way to do this is with the low FODMAP diet.7 Talk to your doctor before trying any of these treatment methods. Your doctor can give you a referral or instructions for trying a method safely and effectively. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"]

IBS and Mental Health: The Vicious Cycle

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