What is the link between IBS and anxiety?

woman with IBS holding her stomach
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Those with IBS know that stress is often a trigger for their symptoms, making it difficult to navigate IBS and anxiety together as interacting conditions. The anxiety around having IBS symptoms can result in more IBS symptoms, as our guts respond to stress hormones that we release, such as cortisol and adrenaline. 

Having uncontrollable IBS symptoms can in turn create higher levels of anxiety, as we try to navigate day to day life around flare-ups, restrictive diets and worry about where the next bathroom is. 

Our bodies are highways of information, something that our gut microbiome takes advantage of by communicating with our nervous system. Depending on the composition of this gut microbiome, we can find ourselves craving different foods or even experiencing mood changes. A diverse population of beneficial bacteria can improve our mental health, just as an overgrowth of pathogenic bacteria can cause a decline in mental health. This communication between gut and brain is known as the gut-brain axis

We speak to the experts to see why there is a link between IBS and anxiety, and if there are any reliable ways to manage these two conditions together.  

How is IBS linked to stress and anxiety?

The gut is sometimes known as our ‘second brain,’ and many of us can testify to feeling as though intense emotions come from our ‘guts’. The neurotransmitters (such as serotonin or dopamine) released in the gut are the same as those used by the central nervous system to communicate, according to a study in the Journal of Medicinal Food. There is also evidence that the bacteria in our gut (our microbiome) actually uses the vagus nerve to communicate information to the brain. When we experience stress, our brains flood our systems with the hormone cortisol, which can decimate these populations of gut bacteria, as they are very sensitive to hormonal changes and imbalance. 

elderly man looking thoughtful out of the window

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Dr Bridgette Wilson, a Doctify-reviewed gut specialist and clinical and research dietitian, explains the link between stress and IBS. “The nervous system in the gut is sometimes referred to as our second brain because the neurons are similar and use the same messaging system as the neurons in the brain. Emotions in the brain can signal sensations in the gut for example ‘butterflies in the stomach’. 

“Infections in the gut can lead to changes in the microbes which has been linked to an increased risk of developing anxiety disorders and targeted changes to the gut microbiota may lessen the brain response to stress, so the feedback goes both ways.”

Anxiety and mood disorders are characterized as disruptions in the brain’s emotional centers, according to an article in the journal of Psychiatric Clinics of North America, which are the areas of the brain that process serotonin and dopamine. 

“Research shows a strong correlation between IBS and mental health conditions, such as anxiety, depression and stress,” adds Dr. Tariq Mahmood, doctor and medical director at Concepto Diagnostics. “Major life traumas, such as breaking up with a partner, have also been reported to cause IBS symptoms. People who experience IBS might start to constantly fear suffering an IBS attack, causing them to drastically change their eating habits. This, in turn, creates a cycle of anxiety, avoidance and hypersensitivity.”

Ways to manage anxiety

Anxiety is a complex mental health condition, but there are ways to manage it. Cognitive behavioral therapy and other psychotherapeutic treatments have been shown to help in an American Family Physician study, and when combined with medication or holistic treatments, can reduce symptoms dramatically.

Dr Wilson encourages those who struggle with anxiety and stress to try various therapies to find out what works for them. “Therapies such as gut-directed hypnotherapy, mindfulness, yoga and cognitive behavioral therapy, which all aim to reduce stress responsiveness in the brain, have shown benefit in reducing IBS symptoms,” she says.

A review in the Annals of Internal Medicine journal found that people with generalized anxiety disorder are at higher risk of experiencing cardiovascular-related events and death by suicide. It also found that a lot of symptoms surrounding anxiety are non-specific, including sleep disturbance, brain fog and irritability, which indicates that effective treatment of anxiety can improve overall quality of life. 

“Anxiety is a fear or worry that causes a feeling of uneasiness,” adds Dr Mahmood. “Depending on the condition, it can be mild to severe. It can be triggered by an imbalance of noradrenaline and serotonin in the brain, chemicals which help to balance your mood. It can also be hereditary, caused by trauma or linked to long-term health conditions which cause pain. Lifestyle choices like cutting down on alcohol and quitting smoking can help manage anxiety, as well as regular exercise.”

Ways to manage IBS

As well as managing anxiety, you may want to be able to manage your IBS to reduce the stressful impact it has on your life. Our guide on 5 ways to improve gut health might help to improve your overall gut health.

Image shows a variety of low FODMAP foods including peppers, salmon, meat and eggs

(Image credit: Getty Images)

Dr Wilson encourages consulting a gut health specialist to manage IBS. “IBS can have many causes and therefore there are a range of ways to treat it: medication, diet, stress management, prebiotics and probiotics have all demonstrated effectiveness in treating IBS. It is important to consult with a health professional specializing in gut health to help determine the best management strategy for each individual patient.”

“Cooking meals at home using fresh ingredients can allow you to track exactly what you’re eating and monitor the amount of FODMAPs in your diet,” says Dr. Mahmood. “Avoid fatty, processed and spicy foods and don’t eat more than three portions of fruit per day.”

Lou Mudge
Health Writer

Lou Mudge is a health writer based in Bath, United Kingdom for Future PLC. She holds an undergraduate degree in creative writing from Bath Spa University, and her work has appeared in Live Science, Tom's Guide, Fit & Well, Coach, T3, and Tech Radar, among others. She regularly writes about health and fitness-related topics such as air quality, gut health, diet and nutrition and the impacts these things have on our lives. 

She has worked for the University of Bath on a chemistry research project and produced a short book in collaboration with the department of education at Bath Spa University.