By Felicia Newell

Irritable bowel syndrome (IBS) affects 6-18% of people worldwide and is the most common gastrointestinal (GI) disorder seen in people who visit general practitioners for GI-related complaints.

Symptoms of IBS vary from person to person, but include:

• Pain and cramping
• Diarrhea
• Constipation
• Alternating constipation and diarrhea
• Changes in bowel movements
• Gas and bloating
• Food intolerance
• Fatigue and difficulty sleeping

Diet, stress, poor sleep and changes in gut bacteria may all trigger symptoms. However, triggers are different for each person, making it difficult to name specific foods or stressors that everyone with the disorder should avoid.

If you’re someone with IBS, you have probably experienced some or all of the above symptoms and know of the stress they can bring when you’re trying to socialize and live your life.

IBS and Mental Health

Many people report avoiding social situations in fear of having unavoidable and potentially embarrassing symptoms. This alone can cause social isolation, which in and of itself can affect a person’s mental health.

Due to the stressful nature many of the symptoms of IBS can bring, IBS has been linked to mental health issues such as depression and anxiety. In a large study of 94,000 men and women, people with IBS were over 50% more likely to have an anxiety disorder and over 70% more likely to have a mood disorder, such as depression.

Studies have also shown that cortisol – the ‘stress hormone’ – is elevated in people with IBS, suggesting that those with IBS have greater stress levels. We do need some cortisol, but too much can have negative health impacts. Higher than normal cortisol levels for an extended period of time have been linked to anxiety, depression, and a whole host of other health issues.

It’s unclear whether IBS symptoms are an expression of mental stress or whether the stress of living with IBS makes people more prone to psychological difficulties.

Whichever it is that comes first, anxiety and IBS symptoms reinforce one another in a viscous cycle. Symptoms cause anxiety, anxiety and stress trigger more symptoms, and so on. This is because the colon is in part controlled by the nervous system, which responds to stress. Evidence also suggests that the immune system, also responding to stress, plays a role.

Managing Anxiety and Digestive Symptoms

Anxiety is one of the most common psychological issue associated with IBS and is most often related to the stress associated with the discomfort of symptoms as well as the inability to control bowel habits (also referred to as bowel control anxiety [BCA]).

Of course, managing the symptoms related to IBS is one way to help manage the anxiety associated with IBS.

Some tips to help manage digestive and/or psychological symptoms of IBS are:

• Cognitive-behavioral therapyto learn how to cope with anxiety and depression. Many gastroenterologists recommend psychological therapy as the 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.
• Fiber supplements and increase water intake or laxatives to decrease constipation.
• Relaxation techniques to reduce stress.
• Stress relief techniques such as meditation, deep breathing exercises, reaching out for support, listening to music, etc. can all help.
• 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 and water intake, which can relieve constipation, or eating smaller meals more often instead of two or three large meals, which can cause cramping. Interestingly, the  low-FODMAPs diet is one of the most promising diet/lifestyle changes for alleviating symptoms. Each and every person with IBS is different, so it is important to work with a registered dietitian to find out the diet strategies that work best for you.
• Lifestyle changes such as exercise can help significantly reduce anxiety. All forms of exercise, including yoga and walking, can ease depression and anxiety by helping the brain release feel good chemicals and by giving your body a way to practice and get good at handling (good) stress. Exercise can also help improve digestive symptoms for some.
• Antispasmodic medications might be recommended by your doctor to control muscle spasms in the colon and reduce abdominal pain.
• If your psychological symptoms persist and/or if they are serious. Talk to your doctor to see if antidepressants might be right for you to help minimize symptoms of anxiety and depression.

As with anything, work on one small diet and lifestyle change at a time so you don’t get overwhelmed.

If you have symptoms of IBS that interfere with your quality of life, visit your doctor, who can help diagnose IBS and rule out other diseases that mimic it.