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Mind-Body Digestive Center:
Stress & Irritable Bowel Syndrome
While it has been considered common knowledge that stress affects irritable bowel syndrome, scientific data in patients has been lacking until recently.
At the MBDC, Drs. Mary-Joan and Charles Gerson have recently found a correlation between perception of stress — how overwhelmed versus how much in control patients felt — and their level of symptoms.
Many years ago, it was noted that the lining of the rectum can become reddened and swollen if a person is placed under acute mental stress. We now know that stress causes the brain to release hormones and activate nerve pathways. The end result of this process is the release of chemicals, called neuro-transmitters, in the lining of the colon, that can alter colonic motility and sensitivity to pain.
Recent studies showing the effect of stress in IBS
"Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction"
Whitehead WE, Crowell MD, Robinson JC, Heller BR, Schuster MM. Gut 1992:3, 825-830.
A group of 39 patients with IBS were followed over the course of a year, during which they filled out a stress questionnaire at three month intervals. These patients were accessed through a community questionnaire, not through doctors' offices, so they represent people not necessarily seeking medical care. They also completed a bowel symptom scale at the same three month period, as well as a record of medical visits and days absent from work. Results were compared to normal controls and people with GI symptoms who did not have IBS. There were a number of interesting results. IBS patients reported significantly more stress than the controls. There was a significant correlation between stress and GI symptoms for all three groups. However, in IBS patients, stress resulted in greater symptoms than in the other two groups, meaning that IBS patients are more affected by stress. There were also significant correlations between days of disability and physician visits and levels of stress. Stress is clearly not the only determinant of IBS symptoms. In this report, statistical evaluation showed that stress accounted for 11% of all contributing factors.
"A Study of Stress and IBS. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome" Bennett EJ, Tennant CC, Piesse C, Badcock C-A, Kellow JE. Gut 1998:43:256-261.
This article studies the relationship between chronic life stress and the clinical course of IBS. Of 117 patients followed for 16 months, 41% improved significantly.
Presence of at least one threatening chronic difficulty during the first 6 months highly predicted symptom intensity even after a time lag of 10 or more months.
None of the improved patients had asuffered a significant chronic stressor, defined as divorce, relationship difficulties, serious illness (of self or others), lawsuits, business failures, housing difficulties and caring for a family member with significant physical and/or emotional problems.
"The relationship between daily stress and symptoms of irritable bowel: A time-series approach"
Dancey, CP, Taghavi, M, Fox, RJ. Journal of Psychosomatic Research 1998:44:537-545.
Thirty-one IBS patients took part in this study which investigated the link between every day stress — called hassles — and GI symptoms. With the research method that was used, it was possible to determine whether symptoms were related to stress during the preceding days, the day that stress occurred or the following days.
For over half the patients, there was a time relationship between stress and symptoms. Symptoms were worse when hassles were troubling two days before and the the day of the stress itself.
This study shows that daily hassles can be as important as major stress.
"The relationship between daily life stress and gastrointestinal symptoms in women with irritable bowel syndrome"
Levy, RL, Cain, KC, Jarrett, M, Heitkemper, MM. Journal of Behavioral Medicine 1997:20:177-193.
This study also examined the relationship between daily stress and GI symptoms. Three groups of women were studied, 26 with IBS that caused them to visit a physician, 23 with IBS who did not seek medical help and 26 controls. Daily health diaries that monitored symptoms and stress were filled out over two menstrual cycles. There was a significant relationship between daily stress and daily symptoms for both IBS groups, but not in the control group. Stress levels were higher in both IBS groups than controls. Whether the women were pre-menstrual or menstruating did not affect the results.
The use of subjects with IBS who sought or did not seek medical help is important. There has been some controversy regarding IBS patients who do not visit the doctor. While it appears that patients who get help have more pain than the others and may have more psychological issues, this study shows that stress is an important factor in the lives of both groups.
Conclusion: The interaction of stress and IBS symptoms is complex. In some patients, symptoms worsen months after a stressful situation has occurred. In others, the time relationship may be a matter of days or even on the same day. In any case, this section underlines the importance of the MBDC treatment approach that investigates and facilitates coping with stress and hassles in daily life: at work, at home and in intimate relationships.
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