We are all exposed to various forms of stress on a daily basis. Some people handle stress very well, while others become anxious even at the slightest deviation from their normal routine. It is important to emphasize that in small doses, stress can be beneficial. It can give you the necessary boost, motivate you to do your best, and keep you focused and alert. Problems arise only when stress is constantly present or chronic. While stress is a normal response of the body to everyday challenges, chronic stress can significantly impact our health. One of the body systems that can be affected by stress is the digestive system, manifesting in stomach cramps, bloating, gas, constipation, and diarrhea. Chronic stress increases the production of the cortisol hormone, which can disrupt the balance of intestinal bacteria and lead to digestive disorders.
The digestive system and the brain are connected through the portion of the nervous system located in the intestines. This is why the intestines are often referred to as our ‘second brain.’ This system controls digestive functions such as the secretion of digestive juices and contractions of smooth muscles in the intestines. The intestines are partially under the control of the central nervous system in the brain and spinal cord. Our digestive tract has its own nervous system – the enteric nervous system. It is composed of the same cluster of nerves as the central nervous system, namely the brain and spinal cord. In addition to having a similar composition, the nervous system in the intestines uses neurotransmitters, such as serotonin, to communicate with the brain. Due to their interconnection, stress can either trigger or worsen digestive issues and vice versa. Prolonged digestive problems can also increase stress and anxiety.
What Happens When Your Body Is Under Stress?
When we find ourselves in a potentially dangerous situation, the sympathetic nervous system – part of the autonomic nervous system that regulates bodily functions such as heart rate, breathing, and blood pressure – responds by triggering the “fight or flight” response and begins to release the stress hormone cortisol, preparing the body for danger.
Stress causes physiological changes such as heightened awareness, faster breathing and heart rate, elevated blood pressure, increased cholesterol levels in the blood, and heightened muscle tension. When stress triggers the ‘fight or flight’ response, it can have several consequences:
- Esophageal spasms occur,
- Secretion of gastric acid increases,
- Feeling of nausea arises,
- Changes in bowel movements occur (constipation or diarrhea),
- Worsening of digestive disorders, such as irritable bowel syndrome, inflammatory bowel disease, peptic ulcers, and gastroesophageal reflux disease.
Specific signs and symptoms of stress vary from one person to another, but stress can likely harm your health, emotional well-being, and relationships with others. Stress affects not only the digestive tract, but also the mind, body, and behavior in many ways, including fluctuations in body weight, headaches, muscle pain, mood changes, and altered mental functions.
What Is the Real Effect of Stress on Our Gut?
Numerous studies have shown that stressful life events are associated with the onset or exacerbation of symptoms in several gastrointestinal diseases, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and peptic ulcers. Constipation can also be a consequence.
Inflammatory Bowel Diseases
A study has shown that chronic stress, negative life events, and depression can increase the risk of recurrence in inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. This research has identified several mechanisms through which stress affects the systemic and gastrointestinal immune and inflammatory response.
Irritable Bowel Syndrome
In a prospective cohort study involving nearly 600 individuals who had Campylobacter-induced gastroenteritis, researchers found that the patient’s ability to manage stress before infection was a key factor in whether they would develop irritable bowel syndrome. Patients with higher levels of perceived stress, anxiety, and negative illness perceptions at the time of infection were more susceptible to the development of irritable bowel syndrome.
Gastroesophageal Reflux Disease
A study conducted at a women’s health medical center showed that individuals under acute stress did not exhibit a higher incidence of reflux. However, in practice, chronically anxious individuals are more likely to perceive an exacerbation of symptoms during stressful events. In other words, their mindset influences their perception of the severity of symptoms.
Most ulcers are caused by an infection with Helicobacter pylori bacteria. Contrary to common belief, ulcers do not occur due to the consumption of spicy food or a stressful lifestyle. The H. pylori bacteria weakens the protective layer of the mucous membrane in the esophagus, stomach, or duodenum, allowing gastric acid to penetrate inside. The acid and bacteria irritate the mucous membrane, leading to inflammation or ulcers. However, there is also evidence that prolonged stress can contribute to mucous membrane inflammation, making the stomach juices irritate the sensitive stomach lining.
Other Digestive Issues
Stress increases gut mobility and the secretion of fluids. Therefore, during or after a stressful event, diarrhea or a more frequent need to urinate may occur. Stress can slow down the emptying of stomach contents and accelerate their passage through the intestines. This combination easily causes abdominal pain and changes in bowel habits.
The digestive tract is lined with smooth muscles. These muscles involuntarily contract in a wavelike movement called peristalsis. This contraction allows food to move through the digestive system. Peristalsis is initiated when the body uses the parasympathetic nervous system. When the body is under stress, it shifts into the “fight or flight” response. In this case, the body is no longer focused on peristalsis, which can result in constipation.
- Leaky Gut Syndrome
Cells lining our intestines act as a barrier against harmful substances and pathogens. However, under the influence of stress, there can be an increase in the permeability of these cells. The greater the stress, the easier it becomes for unwanted substances to penetrate our intestines. This condition is referred to as “leaky gut syndrome.”
When the body reacts to stress, it prioritizes the brain and muscles. Blood flow to these areas increases, while blood flow to the intestines decreases. As a result, the digestive system’s ability to perform its tasks may be reduced. Without sufficient blood flow, movement through the digestive tract becomes challenging, leading to bloating.
- Gut Microbiota Dysbiosis
Diet and overall gut health influence the balance of gut bacteria. If the digestive tract is affected by any of the mentioned symptoms, beneficial gut bacteria will also suffer. Research indicates that there is regular communication between the brain, gut, immune system, and gut microbiota. Fortunately, we can mitigate the negative effects of stress on the balance of gut microbiota through proper nutrition.
Advice for Patients
The first step in managing stress and digestive problems is recognizing the source of stress and finding ways to reduce or control it. This, among other things, includes lifestyle changes, such as regular exercise, meditation, or deep breathing techniques.
In addition to stress management, taking care of digestive health is crucial. This involves maintaining a healthy diet rich in fiber and whole foods, along with adequate hydration by drinking plenty of water. It is also important to avoid processed foods, caffeine, and alcohol, which can irritate the digestive system and exacerbate the symptoms.
If the symptoms persist, it is recommended to consult a gastroenterologist and undergo tests such as colonoscopy or endoscopy to determine the cause of the symptoms and create an individualized treatment plan.
Here are some very helpful tips.
- Regular Exercise
Physical activity reduces tension and promotes the release of endorphins, which act as natural analgesics. Endorphins improve sleep, which can help reduce stress. This is one of the best ways to manage stress and maintain a healthy digestive system.
A study published in January 2022 in the Journal of Affective Disorders examined the connection between exercise and anxiety symptoms. In this study, researchers randomly assigned 286 people with anxiety to one of three groups: the first group participated in a three-month program of moderate to intense exercise three times a week, the second engaged in the same amount of exercise over the same period but with lower intensity, and the third, a control group, did not engage in exercise. At the end of the study period, anxiety symptoms had improved more in both exercise groups than in the control group. Scientists concluded that even less intense physical activity is more beneficial for anxiety than a sedentary lifestyle.
This exercise for the body and mind combines different poses with breathing techniques and meditation. As shown by a 2018 study published in the International Journal of Preventive Medicine, women who practiced hatha yoga for one hour three times a week experienced a significant reduction in stress, anxiety, and depression after a total of 12 exercise sessions. The research also demonstrated that yoga can reduce blood pressure and pulse. Additionally, yoga can be beneficial for individuals with digestive disorders. A review study published in 2022 showed that yoga is good for reducing stress, anxiety, and depression, as well as improving the quality of life for patients with inflammatory bowel disease.
Various meditation techniques can help you focus your mind on a specific object, activity, or thought to achieve tranquility. Although the primary goal of meditation is not stress reduction, it is a side effect of this ancient practice.
- Quality and Regular Sleep
Some studies suggest that melatonin has “significant protective effects” against stress-related damage to the digestive tract. While it has not been proven that supplements of melatonin help with sleep, the body naturally produces this hormone in the dark, which is a good reason to turn off all screen devices before bedtime and darken the room. Regular, seven-hour sleep can contribute to stress reduction.
Excessive stress can impact the health of the digestive system. Symptoms such as bloating, constipation, heartburn, and discomfort in the stomach may be signs that you are under more stress than you realize. Stress can also have less noticeable consequences, such as a decrease in the number of beneficial gut bacteria and increased secretion of stomach acid. While experiencing some stress in everyday life is unavoidable, there are many ways to manage and reduce it. If you are aware of stress and actively manage it, both your brain and your gut will be happier and healthier.
- Mayer, EA. The neurobiology of stress and gastrointestinal disease. Gut 2000;47;861-869.
- Mawdsley JE, Rampton DS. Psychological stress in IBD: New insights into pathogenic and therapeutic implications. Gut 2005;54:1481-1491.
- Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis. Gut 2007;56:1066-1071.
- Naliboff BD, Mayer M, et al. The effect of life stress on symptoms of heartburn. Psychosomatic Medicine 2004;66:426-434.
- Mayer, EA. The neurobiology of stress and gastrointestinal disease. Gut 2000;47;861-869.
- Mawdsley JE, Rampton DS. Psychological stress in IBD: News insights into pathogenic and therapeutic implications. Gut 2005;54:1481-1491.