The Connection Between IBS and Mental Health

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.