Spotlight
Anxiety and Your Health:
Irritable Bowel Syndrome and Inflammatory Bowel Disease

People feel the effects of stress and anxiety in many ways. One common symptom is stomachaches. Anxiety can worsen symptoms of abdominal cramps and pain and make you literally feel sick to your stomach.

But when is it more than just an upset stomach? Millions suffer from gastrointestinal problems, including irritable bowel syndrome and inflammatory bowel disease. Though they sound similar, these two disorders are quite different in their causes and treatments.

Read on to learn more about these two gastrointestinal disorders and their connection to stress and anxiety.

Irritable Bowel Syndrome
Approximately one in five U.S. adults has irritable bowel syndrome, or IBS, a gastrointestinal disorder characterized by abdominal pain, cramping, bloating, gas, constipation, and diarrhea. Women are more likely to experience symptoms, which usually begin in late adolescence or early adulthood.

There is no specific cause, but some experts suggest people who suffer from IBS have a colon that is more sensitive and reactive to certain foods and stress. (The disorder is also known as spastic colon.) Although IBS can be painful and uncomfortable, it is not permanently damaging to the intestines, nor does it cause other gastrointestinal diseases.

People with IBS frequently suffer from anxiety and depression, which can worsen IBS symptoms. That’s because the colon is in part controlled by the nervous system, which responds to stress. There is also evidence to suggest that the immune system – which also responds to stress – plays a role in the disorder. And while anxiety and depression can worsen IBS symptoms, IBS symptoms can also make one feel more anxious and depressed.

While there is no cure for IBS, there are treatments that can manage the symptoms and discomfort. The National Digestive Diseases Information Clearinghouse estimates that up to 70 percent of people with IBS are not receiving treatment. Of those who do seek treatment, research has found that 50 to 90 percent have a psychiatric disorder such as an anxiety disorder or depression.

It is possible to treat both disorders at the same time. Your doctor may recommend one or a combination of the following:

• Fiber supplements or laxatives to decrease constipation.
• Antispasmodic medication to control muscle spasms in the colon and reduce abdominal pain.
• Antidepressants to help minimize symptoms of anxiety and depression.
• Cognitive-behavioral therapy to learn how to cope with anxiety and depression. The British Society of Gastroenterology says that psychological therapy should be first-line treatment for IBS when the patient has a history of anxiety, panic attacks, or depression. The American College of Gastroenterology also recommends therapy and says it can reduce both anxiety and IBS symptoms in some patients. Find a therapist near you.
• Relaxation techniques to reduce stress.
• Diet changes. For some, that may mean avoiding dairy products or carbonated beverages, which can aggravate symptoms. For others, that may mean increasing dietary fiber, which can relieve constipation, or eating smaller meals more often instead of two or three large meals, which can cause cramping.
• Alosetrin hydrochloride (brand name is Lotronex) specifically treats IBS and has been approved by the FDA for women. This medication is recommended only when over-the-counter medication and therapy are not effective, and when the primary symptom is diarrhea. Side effects can be serious and include decreased blood flow to the colon and severe constipation. Lubiprostone (brand name is Amitiza) is also approved by the FDA but only for adult women with IBS and constipation. Side effects include nausea, diarrhea, and abdominal pain. There are no FDA-approved medications for men for the treatment of IBS.

Inflammatory Bowel Disease
Up to one million Americans have inflammatory bowel disease, or IBD, a group of chronic illnesses that causes inflammation of the intestines. The two main diseases under this group of illnesses are Crohn’s disease and ulcerative colitis. Here are some facts about both illnesses, from the Crohn’s and Colitis Foundation of America:

• Men and women are affected equally.
• IBD primarily affects people between ages 15 and 35.
• American Jews of European descent are four to five times more likely to develop IBD than the general population.
• The disease tends to run in families.

IBD symptoms include persistent diarrhea, abdominal cramps and pain, fever, and rectal bleeding. Those with the disease may also experience fatigue and loss of appetite. IBD is not the same as IBS. While both can be painful and interrupt daily life, IBD is more serious because it can damage the intestines, and surgery is sometimes necessary. Also, while there are links between IBD and anxiety and depressive disorders, and cognitive-behavioral therapy (CBT) can help with the symptoms of these conditions, patients with IBD cannot improve their gastrointestinal symptoms with CBT or other psychological treatments alone, as patients with IBS can.

A 2001 study found that those diagnosed with ulcerative colitis were more likely to have an anxiety disorder or depression, compared to the general population. This was not true of Crohn’s disease; those diagnosed with Crohn’s were not more or less likely to have anxiety or depression before their diagnosis, though the rate of anxiety and depression rose in the year after their initial diagnosis.

In another study, published in 2008 in the American Journal of Gastroenterology, IBD patients – those with either Crohn’s or ulcerative colitis – were shown to have higher rates of panic disorder, generalized anxiety disorders, obsessive-compulsive disorder (OCD), and depression, compared to the general population. They were less likely, however, to have social anxiety disorder or bipolar disorder. It’s important to note, however, that an anxiety disorder does not cause IBD.

IBD is believed to be caused by the immune system’s reaction to normal bacteria in the intestines. In people with Crohn’s or ulcerative colitis, the immune system thinks the bacteria is a foreign substance and starts attacking it. White blood cells, which normally help the body ward off infection, are sent into the intestines, where they produce chronic inflammation, which can lead to ulcerations and bowel injury.

Like IBS, there is no cure for Crohn’s disease or ulcerative colitis. Your doctor may recommend medication to suppress IBD symptoms and decrease flare-ups. Surgery is required for the majority of people with Crohn’s disease and 25 to 33 percent of people with ulcerative colitis. To deal with the emotional stress that may come with IBD, your doctor may recommend a therapist familiar with IBD.

Resources
Irritable Bowel Syndrome
Organizations
- International Foundation for Functional Gastrointestinal Disorders

General Information
- What I need to know about irritable bowel syndrome – National Digestive Diseases Information Clearinghouse from the National Institutes of Health
- Irritable Bowel Syndrome – Mayo Clinic
- Irritable Bowel Syndrome - American Gastroenterological Association
- Irritable Bowel Syndrome - KidsHealth from the Nemours Foundation

Inflammatory Bowel Disease
Organizations
- Crohn’s and Colitis Foundation of America

General Information
- Inflammatory Bowel Disease - KidsHealth from the Nemours Foundation
- FAQ: Inflammatory Bowel Disease – National Women’s Health Information Center from the U.S. Department of Health and Human Services
- Understanding Inflammatory Bowel Disease – American Gastroenterological Association
- Inflammatory Bowel Disease – American College of Gastroenterology

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