The gut-brain axis
The goings-on in your gut are closely connected to the thoughts circling around your mind thanks to the gut-brain axis, which could explain how anxiety influences your IBS and vice versa.
The gut-brain axis is the two-way communication channel between your bowel and brain. Messages travel back and forth along the vagus nerve, think of it as a superhighway of nerve fibers.
How your gut and brain influence each other can be explained in a few ways.
Firstly, microbes in your colon have been shown to affect your mental health and may even cause psychological illnesses such as anxiety disorder or depression. This could occur as a direct impact of the microbes themselves or how they may be causing inflammation in your GI tract. The way these microbes work in your gut also implies that your diet could directly impact your mental health.
Secondly, the biopsychosocial model also helps explain the link between anxiety and IBS.
This model was conceived in 1977, and it refers to the connection between our biological, psychological, and social interactions.
It explains how our social experiences, such as trauma, can lead to psychological and, in turn, biological effects. It also helps to explain how biological processes in IBS, such as distension of the bowel, can influence psychological distress and anxiety.
Triggers and Causes of IBS and Anxiety
IBS and anxiety share some common causes and triggers that are related to the gut-brain axis and biopsychosocial model as discussed above.
Stress
One of the primary triggers of both IBS and anxiety is stress. Stressful life events, such as work-related pressures, relationship difficulties, or major life transitions, can exacerbate symptoms of IBS and trigger anxiety. Stress activates the release of stress hormones like cortisol, which can impact gut motility, increase visceral sensitivity, and disrupt the delicate balance of the gut microbiota. These changes can lead to the onset or worsening of IBS symptoms and contribute to heightened anxiety levels.
Altered Gut Microbiota
Emerging evidence suggests that an imbalance in the gut microbiota, the complex community of microorganisms residing in our intestines, can contribute to the development of both IBS and anxiety. Disruptions in the composition and diversity of the gut microbiota, known as dysbiosis, have been linked to gastrointestinal symptoms and mood disorders. The gut microbiota produces neurotransmitters like serotonin, a key regulator of mood and intestinal function. Imbalances in serotonin levels, often observed in IBS and anxiety, can lead to alterations in gut motility, visceral hypersensitivity, and emotional well-being.
Hypersensitivity of the Gut-Brain Axis
Individuals with IBS and anxiety often display heightened sensitivity of the gut-brain axis. This means that normal gut sensations or stimuli that wouldn't typically elicit a response can trigger exaggerated and distressing symptoms. This hypersensitivity can manifest as visceral pain, increased awareness of bowel movements, or an amplified perception of gastrointestinal symptoms. The overactive communication between the gut and the brain amplifies discomfort, anxiety, and emotional distress, creating a vicious cycle where IBS symptoms exacerbate anxiety and vice versa.
Psychological Factors
Psychological factors, including personality traits, coping mechanisms, and past traumatic experiences, can contribute to the development and perpetuation of both IBS and anxiety. Individuals with a tendency towards perfectionism, high levels of neuroticism, or a history of childhood adversity may be more susceptible to developing both conditions. Moreover, coping strategies such as catastrophising, rumination, and avoidance behaviours can exacerbate symptoms and heighten anxiety levels, further entwining the two disorders.
Treatments for IBS and anxiety
While there’s no cure for IBS, it is a treatable condition that can be managed with hypnotherapy, cognitive behavioral therapy (CBT), mindfulness-based treatments, antidepressants, or elimination diets such as the low FODMAP diet.
Similarly, anxiety treatments also include CBT, hypnotherapy, and antidepressants.
As these treatments target your nervous system, they have the potential to treat both your IBS and anxiety.
Antidepressants
Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to help both your anxiety and IBS at the same time.
Tricyclic antidepressants: A 2015 study assessing several clinical trials found tricyclic antidepressants improved IBS symptoms overall compared to other antidepressants, and these could be a good first option to try.
Tricyclics, such as Desipramine (Norpramin) or Nortriptyline (Pamelor), may help with your abdominal pain and tend to work best for those with diarrhea-predominant IBS (IBS-D). Just keep in mind that there are known side effects with tricyclics like difficulty sleeping and urinating, dizziness, sexual challenges, and a dry mouth.
SSRIs: While there isn’t as much research supporting SSRIs as a treatment for IBS and anxiety, they have been effective for some people and have fewer side effects. If you have constipation-predominant IBS (IBS-C), speak with your doctor to see if these are a good option for you.
Hypnotherapy
Research has shown how hypnotherapy can improve your IBS symptoms, one study demonstrated how six weeks of hypnotherapy decreased IBS symptoms in 70% of people, making it equally as effective as the low FODMAP diet.
While there is research about how hypnotherapy can contribute to reducing mood and anxiety disorders, it’s generally not considered a treatment for mood disorders. Instead, it’s an aid to psychotherapy.
The hypnotic process involves reaching a state of deep relaxation. It allows you to probe more deeply into thoughts hidden from your conscious mind, teaching you coping skills through experiential learning.
CBT
CBT treatment is a type of talk therapy that treats both anxiety disorders and IBS by teaching you techniques and strategies to manage your condition and reduce stress.
Cognitive restructuring is one such technique that helps you end obsessive thought patterns related to your IBS. It helps grow your awareness of your distorted thinking, which could lead to reduced symptoms.
You’ll also be taught how to put other relaxation training strategies in place through CBT, such as diaphragmatic breathing. This technique activates your parasympathetic nervous system (the system responsible for controlling your body’s ability to relax), and it helps promote normal digestion and fewer gastrointestinal symptoms.
Low FODMAP diet for IBS
Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, better known as FODMAPs, are carbohydrates that may be making your IBS symptoms worse. Foods high in FODMAPs ferment more quickly in your oversensitive gut, leading to increased gas in your intestines, as well as digestive symptoms such as abdominal pain and bloating.
There’s evidence that switching to a low FODMAP diet can reduce your symptoms significantly. This in turn can benefit your anxiety as it can reduce your anxious, obsessive thoughts about your gut.
The Wrap Up
The connection between anxiety and IBS is complex, and both conditions can be incredibly frustrating and painful. The impact on your overall quality of life can be significant. Often
anxious feelings arise from unwanted sensations in your GI tract and from the fear of a flare-up. The gut-brain axis contributes to how your anxiety influences your IBS and vice versa. Treatments to help manage both conditions include hypnotherapy, CBT, antidepressants, and a low FODMAP diet.
References
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