If you have been secretly dealing with uncomfortable symptoms such as bloating, constipation or diarrhoea for quite some time, you are not alone.  Or were you absolutely fine and suddenly these symptoms came from nowhere?  Have you been wondering if stress could have caused these problems for you?  You will find plenty of clues about whether stress is a possible cause in this blog.

But wait.  I don’t know if I have IBS

If you haven’t already spoken with your GP, it’s important to take your concerns to them first.  Especially if your bowel habits have changed suddenly, you are getting frequent diarrhoea, if you are having pain that never goes away, and (sorry for TMI) if you are seeing blood in your poo. 

If you experience unexplained weight loss alongside any of these symptoms or you feel full when eating very little, it’s also best to get these symptoms checked out.

Doctors will listen carefully to your symptoms and may run some tests to rule out certain possible causes. It is often when all these checks have been done and no other causes have been identified that irritable bowel syndrome (IBS) is diagnosed.

Testing for IBS

IBS is a functional gastrointestinal disorder (FGID), with no standard testing options to diagnose it in the UK.  However, if your tummy is swollen and painful when you see your GP, they may feel your abdomen and identify whether distention (when there is a build-up of gas in your bowels) is present and this is a common problem in IBS.

Blood tests, x-rays, ultrasound or internal investigations such as endoscopies are all testing options that can be used to rule out other causes.

The science bit

According to the Mayo Clinic, FGIDs are “brain-gut interaction disorders that affect 1 in every 4 adults.” There are other FGIDs in this category and it is estimated that IBS affects between 10 and 20 percent of people in the UK.  The most common age group to develop these symptoms are in their twenties or thirties (BUPA).

The distinction between IBS and other bowel disorders is identified by the lack of evidence of an “organic disorder” (for example a blockage or ulcer), any structural abnormality or other potential cause of long-lasting gastrointestinal symptoms (Mayo Clinic).

A common characteristic of IBS is persistent or recurrent pain or discomfort and altered bowel habits.  This can show up as frequent constipation, diarrhoea, or a mixture of the two.

Medical Treatments

If IBS is suspected, your GP may offer medications such as antispasmodics, pain relief or even a mild antidepressant which relaxes the gut.  With constipation, laxatives may be offered, while an anti-diarrhoeal medication may be used for diarrhoea. 

When acid reflux features as a recurring problem, you may be offered a type of medication called a Proton Pump Inhibitor (PPI), such as omeprazole, pantoprazole or lansoprazole.  These medications prevent production of stomach acid and last for up to 24 hours.  These medications however are intended for short term use until the root of the problem is resolved.

Many people will often try over-the-counter medicines that suppress their symptoms temporarily, only to find that they need to return to the medication repeatedly or the symptoms quickly return.

Other side-effects of IBS

Clients often describe feeling and looking like they’re seven months pregnant, or their bellies swelling up and cramps soon after eating.  Many people find that certain foods will trigger a quick onset of these symptoms and may find themselves avoiding lots of foods.  Or for some they may feel worried or fearful about eating anything in case they have a flare up.

You may find that your clothes feel tight or that you can’t or don’t want to wear favourite outfits because of the discomfort or embarrassment about your swollen abdomen.

And sadly, many people who suffer with IBS find themselves worrying about trips out in public, social occasions, eating out and may even find themselves needing to plan their activities based on whether a loo is nearby.  This can make unfamiliar places or travelling more stressful.

Is Stress the Cause?

IBS is a complex condition involving lots of different systems including nerves, hormones and muscles in the digestive tract, plus digestive enzymes and the microbiome – the trillions of bacteria and other organisms in the gut.  And then of course there’s the interaction of food itself with the gut.  So, there’s seldom one clear cause.

For some people, IBS arises after a tummy bug, food poisoning, or use of strong antibiotics.  IBS can seem to run in families, implying a possible familial disposition.  This may potentially involve certain genetics and often involves the nervous system too.

While an imbalanced diet may potentially be a big trigger, one issue that often seems to lead up to the development of IBS is stress.

Not all Stress is Equal

Stress itself can be neutral, good, or unhelpful.  For example, we experience physical stress when we exert ourselves, which generally keeps us fit and encourages adaptation in the muscles.  And generally, exercise can make us feel pretty good!  But over-exercising and inadequate rest can put too much stress on the body and drive cortisol up - the stress hormone.

You may well have met the type of person who seems to breeze through life and be able to deal with absolutely anything and function on little rest.  Or perhaps you’re all too familiar with your own tendency to try and burn the candle at both ends? Or trying to please everyone and never putting yourself first?

Internalising stress so that you do not show it on the outside can mean that on the inside, the body is still having to deal with being overburdened. 

Then, you might also have met the type of person who seems to be very easily tipped over the edge.  Running on adrenaline, reacting to everything, missing all the good things and on high alert for all the dangers, risks and failings they can easily see in life?

Often people who are at this stage were once the swans, appearing to glide along while under the surface their legs were madly paddling away.  Too long in this mode and never quite dealing with it can tend to push you towards burnout.

As you near burnout, you can often find yourself reacting to everything, losing control of your emotions.  It’s like being on a runaway train.

Unresolved grief, trauma, big life changes and being unable to speak truthfully around friends or loved ones are all other reasons why the body can start to show physical stress.

Adverse Childhood Experiences

The long-term health effects of serious trauma experienced by children has been repeatedly studied in recent decades.  A significant experience causing trauma or distress to children is known as an Adverse Childhood Experience (ACE).

The Rome Foundation, a not-for-profit organization working to provide the most up to date information on gut-brain disorders to health practitioners, has documented key studies on this subject. Their article on chronic stress and IBS makes for interesting reading. Most significantly, 76% of people with IBS have suffered at least 1 ACE.  The higher the amount of ACEs, the higher the risk for IBS.

Large scale studies have shown that as well as IBS, ACEs can increase the risk of heart disease, diabetes, chronic lung disease, obesity and substance abuse.

Chronic Stress

We’re supposed to experience little bursts of stress as human beings.  It helps us to stay alive, avoid serious injury (most of the time!), achieve and succeed at things in life. 

Back in the times when we didn’t have jobs, the time spent foraging, hunting and escaping predators was actually quite a small part of our awake time.  Most of it would have been spent relaxing, eating together, playing and doing activities that gave enjoyment.

We are not designed to spend our days switching in and out of a stressed state most of the time.

A job we don’t enjoy, excessive working hours, financial worries, disharmony in relationships and friendships, over-consuming social media, addictions, habits that cause us more pain than joy, not being physically active…. The list could go on and on, these all contribute to chronic stress. 

If this is the state you live in for years or decades, rather than just minutes or hours, this is a long time for stress to be affecting how your body functions.

How Does Stress Affect IBS?

As an embryo, the large bundle of nerves in your gut started to develop before your brain did.  Which is why the gut is sometimes referred to as your second brain!  There is a constant cross-talk between your digestive tract (muscles and friendly bacteria especially) and the dense network of nerves linking your gut and your brain.

This is why an upsetting experience, or even an exciting one, can trigger a clenching of the gut, “butterflies” or even an upset tummy.

One way that early-life stress and trauma can create the conditions for IBS is by heightening the sensitivity of the nerves in the gastrointestinal tract. This can cause the gut to be more sensitive, and in response the muscular contractions stimulated by the nerves affected are more extreme.  This can cause the gut to spasm, contributing to the cramps, pain and sometimes diarrhoea.  And it’s why anti-spasmodic medications are often prescribed and can provide relief.

The changes in nerve sensitivity can become permanent, making a child who has had trauma have permanent hypersensitivity.  This effect can also take hold during the teen years and early twenties.

Another effect is the way that stress turns off the part of the nervous system that helps to digest food. This is the parasympathetic nervous system, also known as “rest and digest” mode.  When you are in the “fight or flight” mode, known as the sympathetic nervous system, blood is diverted to vital organs and many bodily functions are suppressed to allow you to fight or flee.

During this time, you do not produce so much stomach acid or digestive enzymes.  The stomach acid helps to break down protein, and the digestive enzymes help you to break down all of your food.  So, food will sit for longer in your stomach and small intestine.

When Stress Becomes a Problem

It’s normal to switch briefly in and out of the sympathetic nervous mode (fight or flight) numerous times each day, normally in response to automatic cues in the body to breathe, pump blood around your body and to maintain balance with all your systems. 

But when a stressful event happens, you spend longer in this mode, telling your mind and body that you are not safe.

This is all fine if you accidentally step into the road and need to move quickly to get out of the way of a car, but if you spend hours in this prolonged state (say always having high pressure at work, having difficult relationships and so on), your digestive capacity is being switched off for long periods of time.

All the hours of suppression of your digestive system can lower your stomach acid, prevent enzymes from being sent in to digest certain foods, and allow food to sit for longer in the gut fermenting and causing uncomfortable symptoms such as bloating and smelly gas.

Plus, when your food is not being digested well, there is no way of knowing how much of the nutrients you need for your health are being absorbed to be used, or just passing through.  You could be eating all the right foods and be left wondering why your tummy feels bad, you feel tired and your skin isn’t glowing like all the healthy eating messages promised you it would be!

Friendly Bacteria

Everything about our health is reliant on the balance of bacteria and other organisms that outnumber our human cells, known as the microbiome.  We actually have several microbiomes, the best known one being in the gut.

When we have mostly friendly bacteria, they all run the show and keep everything ticking along.  Absolutely every function in your body depends on this. 

When you experience stress, the cross-talk between your nervous system and gut influences which types of bacteria thrive.  Not only just that, but the way that your stressed state suppresses your digestion also weakens your guts defences against more harmful types of bacteria.

This creates a recipe for an imbalanced gut microbiome – often too few of some of the types of friendly bacteria and an overgrowth of the less friendly ones.  When present in small amounts, many of the more harmful or pathogenic bacteria are generally kept under control by the other microbes and immune defences. 

But when left unchecked, these bacteria wreak havoc – interfering with how you detoxify and get rid of toxins and oestrogen, creating their own toxins and challenging your gut’s immunity.  And of course, what you’ll tend to notice first will be digestive symptoms such as bloating, diarrhoea, constipation, reflux, tiredness, feeling sluggish, skin break outs and more!

Food Intolerances

Often another symptom of an imbalanced gut microbiome is reactivity to certain foods.  This can often be temporary – the symptoms you get can be the result of the types of bacteria that are overabundant or lacking in the gut.  You may be low on those digestive enzymes that are not being secreted because of the dampening effect of being stressed most of the time.

Many clients come to me having already undertaken food intolerance tests, or otherwise avoiding a growing list of foods, because they are under the impression that their intolerance is likely to be permanent.

Addressing the balance of the gut microbiome with a balanced diet is an important step to move towards being able to tolerate all foods well again.  But if stress is a big factor in your life, stress-reduction needs to also be part of your recovery.

For some tips on how to address your stress levels, you can read on here.

Victoria Bell is a Registered Nutritional Therapist, Health Coach, Breathwork Coach and qualified as a Mindfulness Teacher for Children.  To enquire about her Women’s Wellbeing Coaching Programme or to get help with your IBS you can contact her here or book a free 30-minute Health Review here.