When you think about the inner workings of your gut, you probably don't automatically connect what's going on down there with what's happening in your brain. But for people with irritable bowel syndrome (IBS), the connection between symptoms like diarrhea and constipation and their emotions is a very real — if somewhat complicated — relationship.
Stress and anxiety in particular play a major role in IBS, and the relationship is often a two-way street, Elena Ivanina, DO, a gastroenterologist with Lenox Hill Hospital in New York City, tells LIVESTRONG.com. Emotional distress can aggravate IBS symptoms, and symptoms can in turn exacerbate stress and anxiety.
The problem is caused by the brain-gut axis, meaning the communication system between the digestive tract and the brain, according to Johns Hopkins Medicine. The brain has a direct effect on the stomach and intestines, and vice versa.
This is especially problematic for people with IBS because their brains are more responsive to pain signals from the GI tract, so they tend to perceive pain more acutely than others, according to Harvard Health Publishing. Then stress can make that existing pain seem even worse, Dr. Ivanina says.
Fortunately, a variety of stress-management therapies can help reduce the discomfort in both your brain and your gut, William Chey, MD, a member of the board of directors of the International Foundation for Gastrointestinal Disorders (IFFGD), tells LIVESTRONG.com. Here's a look at six of the most common.
1. Gut-Directed Hypnosis
Hypnotherapy is the most common mind-body intervention used for IBS, according to the National Center for Complementary and Integrative Health (NCCIH).
In gut-directed hypnotherapy, a trained therapist guides a person into a focused but relaxed state of awareness and uses suggestion and imagery to calm the digestive tract and divert the focus from discomfort in the body, per Michigan Medicine.
According to a June 2015 review in Alimentary Pharmacology & Therapeutics, studies have found that people with IBS who undergo hypnosis tend to experience significant and long-term relief from symptoms.
"It works on that brain-gut dysregulation and calms nerve sensitivity," says Megan Riehl, PsyD, a gastrointestinal psychologist at Michigan Medicine in Ann Arbor, who treats patients over seven sessions once every other week. Between sessions, patients practice at home.
2. Cognitive Behavioral Therapy
Cognitive behavioral therapy, or CBT — used to treat a range of mental-health issues — can also help people with IBS, Riehl says.
"CBT is very much looking at how our thoughts impact how we feel and behave," she explains. "If our thoughts are not constructive, we work to come up with alternatives."
For example, CBT might help someone with IBS reframe their thoughts so they're no longer afraid to leave the house for fear of not having access to a bathroom.
Several studies have confirmed the effectiveness of CBT in treating IBS, according to a July 2017 review article in the journal Psychology Research and Behavior Management.
"CBT is as effective as medications," Dr. Chey says.
3. Diaphragmatic Breathing
Also called deep breathing or belly breathing, this practice focuses on moving your abdomen in and out with each breath rather than your chest.
Not only can this technique regulate your heart beat and blood pressure, according to Harvard Health Publishing, but the diaphragm — the large muscle below the lungs — may also massage the intestinal organs.
"That can be helpful for urgency and for calming the system to help with diarrhea," Riehl says. "And it can help relax the colon to help with constipation."
4. Physical Activity
"Any kind of moderate aerobic exercise confers potential benefits for IBS [and] certainly also overall health benefits," says Dr. Chey, who is also professor of medicine and nutrition sciences at Michigan Medicine.
In one study, published January 2015 in the World Journal of Gastroenterology, people with IBS who did moderate aerobic exercise (usually walking or cycling about five hours a week) reported a decrease in symptoms and felt less tired, less anxious and less depressed. Plus, physical activity in general is known to reduce stress, according to the Mayo Clinic.
Although there hasn't been one big, definitive study on yoga, Dr. Chey says, "There is emerging data to suggest that yoga can be very good for IBS."
Indeed, a study published December 2015 in the European Journal of Integrative Medicine found that one hour of yoga three times a week for three months greatly decreased symptoms of IBS while also improving quality of life and easing anxiety.
Psychiatric medications can also treat IBS and anxiety.
There are three classes of antidepressants that treat both the brain and the gut, according to the University of North Carolina Center for Functional GI & Motility Disorders. Those three are tricyclic antidepressants (TCAs like Elavil), selective serotonin reuptake inhibitors (SSRIs like Prozac) and selective norepinephrine reuptake inhibitors (Effexor, for example).
"Those three categories of drugs to varying degrees have effects in the brain and the GI tract and can have effects on anxiety, which can be beneficial," Dr. Chey says.
The Bottom Line
If you're suffering from IBS and anxiety and looking for treatment options, keep in mind there’s no one thing that works best for everyone. “Different patients prefer different approaches,” Dr. Ivanina confirms. Talk to your doctor about the best option for you.
- University of Washington: “Fast Facts About The Human Microbiome.”
- National Center for Complementary and Integrative Health: “6 Tips: IBS and Complementary Health Practices.”
- Alimentary Pharmacology & Therapeutics: “Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease.”
- Psychology Research and Behavior Management: “Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights.”
- Harvard University: “Learning diaphragmatic breathing.”
- World Journal of Gastroenterology: “Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects.”
- Mayo Clinic: “Stress management.”
- European Journal of Integrative Medicine: “Remedial yoga module remarkably improves symptoms in irritable bowel syndrome patients: A 12-week randomized controlled trial
- University of North Carolina Center for Functional GI & Motility Disorders: “The Use of Antidepressants in the Treatment of Irritable Bowel Syndrome and Other Functional GI Disorders.”
- Johns Hopkins Medicine: "The Brain-Gut Connection"
- Michigan Medicine: "How Gut-Directed Hypnosis Helps IBS, IBD and Other GI Disorders"
- Harvard Health Publishing: "The gut-brain connection"