Stress, Anxiety, and IBS: The Gut-Brain Connection

Millions of people are affected by IBS, and it is one of the most common gastrointestinal disorders. While the cause of IBS is unknown, there is a growing body of evidence that suggests the gut-brain connection may play a role in this disorder. Stress and anxiety can trigger IBS symptoms, and managing these emotions can be an important part of reducing IBS flare-ups. Let's find out what we know about the  link between stress, anxiety, and IBS in integrative medicine. We will also explore ways to reduce stress and anxiety to help manage this condition.

Irritable bowel syndrome (IBS) is the name given to a collection of digestive symptoms that affect about 11% of people worldwide. In fact, it’s the most common gastrointestinal diagnosis and the second most common cause of absence from work, just behind the common cold.

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What causes IBS?

Scientists and doctors aren't sure what causes all cases of IBS, since it's likely that the circumstances for developing IBS vary quite a bit between individuals.

Post-infectious IBS, for example, occurs after another infection, where the microbiome struggles to regain balance, resulting in IBS symptoms like diarrhea, gas, or bloating.

Other possible causes include food passing through the gut too quickly or too slowly, stress, or over-sensitive nerves in the gut or immune system thought to be caused by trauma or a disruption in intestinal flora (1).

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What are the most common IBS symptoms?

The most common symptoms IBS patients experience include:

  • Abdominal pain or cramping
  • Bloating
  • Diarrhea and/or constipation
  • Gas
  • Indigestion

For most IBS patients, symptoms usually come and go. They can last a few days, or up to weeks to months. Symptoms may be mild, or quite severe to the point of dramatically interfering with quality of life.

Learn more about conditions we treat: Leaky Gut

Risk factors for IBS

There are a few risk factors that can increase your chances of having irritable bowel syndrome. These include (2):

  • Being female – Women are more likely to have IBS than men
  • Age – IBS can occur at any age, but it's most common in adults under the age of 50
  • Stress – Stress, or chronic stress, can trigger or worsen IBS symptoms
  • Family history – If you have a family member with IBS, you're more likely to have the condition
  • Anxiety and depression – People with anxiety or depression are also more likely to develop IBS

Can stress cause stomach pain and IBS?

Stressful situations or chronic stress often play a role in the development of IBS symptoms, including stomach pain and cramps. One downstream effect of the body's stress response is the activation of the nervous system that resides in the gut, known as the enteric nervous system. This is a system of signaling pathways which releases hormones affecting the digestive systems of the stomach, which can lead to gastrointestinal problems.

Psychological stress is known to make IBS symptoms worse, or increase the likelihood of a person developing IBS (3).

Read: Is SIBO the Missing Link Between IBS and IBD?

How are anxiety and IBS related?

IBS triggers stress and anxiety, but can also cause anxiety which can create a vicious cycle. This occurs because of a complex, 2-way signaling system between your brain and your gut, known as the gut-brain connection (or gut-brain axis).

The gut-brain connection is likely why stress and anxiety are linked with IBS.

Because the brain communicates with the gut via the nervous system, thoughts, feelings, and emotions lead to a release of chemicals that affect digestive function. Basically, anxious feelings in the mind travel through the nervous system where they trigger a stress response in your gut. This manifests as abdominal pain, a change in your gut bacteria, and/or abnormal bowel movements.

It’s worth it to note, however, that not everyone who experiences high levels of stress will go on to develop IBS. This suggests possibly a genetic component to susceptibility of stress-mediated digestive disorders.

Read: The Gut-Brain Connection

Want to learn more?

How the gut affects your brain

A poorly functioning gut has been linked to mental health problems, including anxiety and depression. This is because our brain depends on nutrients, hormones, and other special signaling molecules that (in many cases) can only be made by the bacteria in the gut (4). 

Take serotonin for example, which is a neurotransmitter responsible for feelings of wellbeing. The vast majority of this feel-good chemical—about 70-90 percent— is made in the gut, and then travels to the brain (5). If there’s not enough serotonin produced in the gut, you may not have enough in the brain to calm anxious thoughts and feelings.

Predictably, IBS patients are more likely to have anxiety or other mental health issues. In one study, the prevalence of anxiety in patients with IBS was 44%, and that of depression was 84%. In healthy controls, the prevalence of anxiety and depression was 8% and 6%, respectively (6).

Related: Heal Your Gut Naturally for Better Health & Immune Function

IBS can also worsen other mental health issues

Irritable bowel syndrome can affect a person’s mental and emotional health for obvious reasons like dealing with GI discomfort during important events, or needing to quickly locate a restroom at an inconvenient time. Dealing with these circumstances alone is enough to make even the most iron-willed person a little rattled.

But IBS symptoms themselves aren’t the only factor creating stress in the body. 

Inflammation produced in the gut has been shown to affect the brain. The gut microbiota affects various cells in the central nervous system, including microglia, which reside in the brain. Recent studies have shown that microglia are sensitive to factors produced by the gut microbiota (7).

Inflammatory signals that can harm brain cells and increase inflammation in the brain are known as neuroinflammation. Neuroinflammation has been linked to an array of mental health issues, such as depression, anxiety, and even Alzheimer’s disease (8).

People with IBS may be more sensitive to emotional troubles

Although psychological problems like anxiety don’t directly cause the digestive disorder, intense emotions like stress and anxiety trigger chemicals in the brain that cause receptors in your gut to be hypersensitive to the body’s stress response. 

For some people, it may be difficult to ‘turn off’ this hypersensitivity that results from psychological stress in your environment.

In order to treat IBS, you must address stress

There’s a large body of evidence showing that IBS is a stress-sensitive disorder, and that the treatment of IBS “should focus on managing stress and stress-induced responses” (3). In fact, many people report an increase in stress just before experiencing a flare up of IBS symptoms.

This is why it’s so important to treat IBS (and any digestive disorder) in a holistic way, and with an integrative approach.

How can I stop anxiety-induced IBS?

First, it’s helpful to identify the key stressors in your life. Because these will differ between individuals, and in some cases be things you didn’t expect to cause you so much stress. Try keeping a log of symptoms in addition to what else occurred that day (i.e. a big financial stress, a fight with a significant other, etc.). This establishes a pattern to identify connections between GI symptoms and how you’re feeling emotionally.

Once you’ve identified your triggers, you can take steps to manage stress. Because of the brain gut connection, this may lead to an improvement in IBS symptoms or fewer flare-ups.

  • Try stress-reducing activities, like yoga, meditation, acupuncture, or breathing exercises.
  • Get 7 to 8 hours of sleep per night. Get into a good nighttime routine by going to bed at roughly the same time each night, reducing screen time before bed, and keeping your room dark & cool.
  • Talk with your doctor to develop a plan for when you experience flare-ups. This can decrease the stressfulness of the situation somewhat.
  • Hydrate, hydrate, hydrate. Water supports healthy digestion. Aim for about 8, 8 oz glasses of water per day, and more if you’re active.
  • Cut down on caffeine, and other gut irritants like alcohol, which stimulate or inflame the gut.
  • Avoid fried or fatty foods.
  • Avoid foods that are known triggers for you – this might include dairy, beans, gluten, or a lot of high-fiber foods.
  • Get plenty of pre- and probiotics in your diet, including fermented vegetables, kefir, yogurt, or take a high-quality probiotic supplement.
  • Know the benefits and risks of different symptom-relieving medications. Your doctor can help you decide when to rely on a little extra support.

Talk with an integrative medicine physician who has experience with IBS

While we can’t know what causes each and every case of IBS, we do know that there is a significant link between stress, anxiety, and IBS. When your brain sends signals that trigger hypersensitivity in your gut, you may experience new or worsening IBS symptoms. The best way to deal with these flare ups proactively is the actively manage stress. 

In fact, many scientists and doctors believe that you can’t successfully treat IBS without addressing the body’s stress response. Numerous stress-reducing practices are effective for not only reducing stress but also providing relief from IBS symptoms. If you’re struggling with IBS, talk with an experienced integrative medicine doctor who can help you find relief from your symptoms.


  1. https://gut.bmj.com/content/51/suppl_1/i67
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879825/ 
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202343/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641835/  
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526216/ 
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733421/ 
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314531
  8. https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-020-00221-2


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