Anxiety and IBS often go hand in hand, we take a look at what causes feelings of anxiety, how this can impact IBS symptoms and what you can do to help mitigate them.
As an accredited Cognitive Behavioural Psychotherapist, Mindfulness teacher, and Chronic Pain specialist, I'm here to help you to evolve beyond IBS.
What is Anxiety?
Anxiety is a natural response to perceived threats, but when it becomes chronic, it can profoundly impact our lives. IBS is one of the ways that it can surface.
Anxiety is often a feeling of unease, such panic or fear, that can range from mild to severe. For many people, anxiety and worry are intertwined, each feeding off the other, creating a vicious cycle that is difficult to break. This cycle is particularly challenging for individuals suffering from Irritable Bowel Syndrome (IBS), where anxiety can exacerbate IBS symptoms and vice versa.
Understanding this link can alleviate some worry and therefore start to reduce the awful symptoms of IBS, such as irregular, unpredictable bowel movements, pain or discomfort, bloating, and excessive flatulence. So, let’s dive in.
Worry and IBS
Anxiety is expressed cognitively via worry. But what exactly is worry?
It’s been estimated that we have between 60,000 and 90,000 thoughts a day. Many of these thoughts are recycled, with 90% not being new. They can be positive, negative, or neutral. How we think affects what we choose to do and how we feel emotionally and physically. Negative thoughts can cause emotional negativity, while positive thoughts can lead to positive emotions.
Worry is a process, an action we take with our thoughts. It tends to be 'sticky,' with the same concerns playing out repeatedly and often disguising itself as problem-solving or showing concern for others.
How IBS worries escalate:
“What if my IBS doesn’t go away?”
“What if it gets worse?”
“What if I can’t carry on working?”
“I’ll have to give up work.”
“I won’t have any money.”
“I’ll end up homeless.”
As you can see, they can get progressively worse over time. Without awareness, worries escalate, multiply, and cause more intense anxiety.
The Snowball Analogy
Think of a snowball. White and clean, sitting at the top of a grassy, snow-covered slope. That’s a thought in your mind. When it is pushed over the edge, it builds momentum; it grows bigger and bigger, collecting all the rubbish and dirt on the ground. It ends up at the bottom of the hill as a large, messy blob. You’re unable to see the original snowball and have no idea how you got to this place.
Worry is essentially 'overthinking'—thinking too much, especially about the future, and creating seemingly realistic predictions about the outcome of events, most of which never materialise. Yet, this catastrophising can cause increasing anxiety, which is evident in the body, often as digestive issues.
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How Worry and Anxiety Affect IBS and the Body
The brain doesn’t distinguish between real or perceived threats.
The brain has a fantastic ability to imagine. But if you imagine a potential threat to survival (physical or moral) it does not distinguish between them. It sends a message to the body to act as if it’s a real threat (just in case).
When you encounter a real or imagined threatening situation, the adrenal glands release adrenaline (also known as epinephrine) into the bloodstream. This powerful hormone triggers the "fight/flight/freeze" response, preparing the body for immediate action.
Adrenaline causes the breathing rate to accelerate, providing more oxygen to the bloodstream. The heart rate increases, pumping more blood to vital organs and muscles. Causing the muscles to receive an enhanced blood supply, making them more ready for quick, powerful movements.
This means there is less blood in the digestive system. So, digestion is inhibited, and all non-essential bodily functions are temporarily halted.
This ensures that energy is focused on responding to the perceived immediate threat. This coordinated response enables a person to react swiftly and effectively in critical situations.
But is unnecessary in imagined scenarios caused by anxiety and worry.
Here’s another analogy to explain further:
Imagine being called to the start line for the 100 meters sprint.
“On your marks.” You head to the start line.
You are then told to, “Get set.” As you take up the position, fingers on the line, body bent over and supported on your toes. And you wait. The body starts to prepare for the race.
Your muscles tense, you try to control your breathing, you focus on the finish line.
Hypervigilant and eager to hear the word, “GO!”
But it doesn’t come.
You are suspended there, waiting. Looking and listening. Ready to run as soon as you’re told to. But there is no further instruction. Your body starts to ache. Your shoulders get stiff. You crane your head around, looking for any sign the order might come. Your heart is beating harder and faster. You are breathing harder and faster, unable to take in air effectively due to the position you are stuck in. You become fatigued, anxious, and alert.
It feels like having your foot on the accelerator (gas) and the brake at the same time.
As you wait longer, the physical sensations intensify. Your focus dwindles, and you start to worry. “What’s going on?” “What if I can’t run well now?” What if they’ve forgotten to start the race?”
And there starts another release of hormones. And you become more aware of the physical discomfort.
In situations perceived as threatening, but which may not be, we experience uncertainty and start to worry. Worry is a type of freeze response. You can’t run away or fight the situation. You are stuck.
The impact of this on our body at that moment is unpleasant. Tense muscles, aches, and pains, digestive symptoms shutting down, hypervigilant listening for the start gun, and fighting to stay focused. But with extended time, and the repetitive nature of worry, comes the escalation of, and sensitisation to, these feelings.
Being a worrier means experiencing increases in adrenaline and cortisol more frequently than others in the population and, therefore, the physical sensations that accompany anxiety.
The Physiological Impact of Anxiety on IBS
When in a life-threatening position, there is no time to waste excreting waste or eating. Therefore, the digestive system shuts down. This can cause gurgling sounds, pain, and discomfort, and if happening regularly, constipation. In some instances, the brain may decide to evacuate all contents of the gut or stomach before running or fighting if this could increase the chance of survival. All of this increases the severity of IBS symptoms.
Cortisol, the other chemical designed to keep us safe, is released so often in people who worry a lot that it affects aspects of the body it was supposed to support.
Endorphins are reduced, increasing the sense of pain, known as visceral sensitivity.
Insulin is overproduced, increasing the risk of diabetes, and increasing the risk of nerve damage to the vagal nerve (the connection between the brain and the gut), and in some cases causing dysbiosis in the gut microbiome.
Serotonin is depleted over time, adversely affecting mood and sleep, adding more stress and cause for worry.
The immune system is disrupted, and inflammation increases, affecting the balance of the gut microbiome and increasing the risk of infections.
All these result in further discomfort, anxiety and IBS symptoms.
The unrelenting nature of worry is its ‘stickiness’. The way it comes back time and again undermines the person's autonomy. They feel helpless against the worry and anxiety, and thus the resulting physical symptoms. This further compounds mood and the motivation to make changes.
And with increased pain comes increased worry. That is why visceral hypersensitivity seems to escalate over time.
Is Anxiety a Symptom or Cause of IBS?
This is a common question: Is anxiety a symptom or cause of IBS? The answer is both. Anxiety can trigger IBS symptoms, and the stress of dealing with IBS can lead to increased anxiety, creating a harmful cycle.
How Anxiety and IBS Create a Vicious Cycle
Anxiety Increases IBS Symptoms: High-stress levels can worsen IBS symptoms, leading to more frequent and severe episodes.
IBS Symptoms Increase Anxiety: Experiencing IBS symptoms can cause worry and anxiety about future episodes, social embarrassment, and daily functioning.
Reinforcing Cycle: This leads to a reinforcing cycle where anxiety increases IBS symptoms, and worsening IBS symptoms increase anxiety.
So, if Worry is so Bad for Us, How and Why Did it Evolve?
Since humans evolved to have a prefrontal cortex, they've had the ability to imagine the future. This has been a blessing, allowing us to survive as a race. It enabled the advent of fire, the wheel, and the Internet. Every invention started with someone imagining a different future. But with this amazing capacity comes the ability to imagine the bad as well as the good, the negative as well as positive solutions.
The brain provides the resources to construct several possibilities from just one input, which includes what we see, hear, taste, touch, and feel, internally or externally. The stimulus sparks a thought. With no further attention, that thought will evaporate (and any emotional tone with it). With positive curiosity, it will develop into various hypotheses. And if the emotional tone is negative, it has the possibility of becoming worry.
Worry may have been learned vicariously from parents or caregivers or as a survival strategy, as a way to solve problems when young. This is especially true if the individual wasn’t taught emotional intelligence.
Without the knowledge gained from emotions, a person doesn’t have the body to provide answers and ground them in the present. They instead learn to live in their head, in the future, to overthink, and form beliefs about the practical benefits of worrying.
Common Misconceptions About Worry:
Worrying proves I care
Worrying increases my thoroughness
Worrying increases my effectiveness
Worrying keeps me safe
Over time, worry becomes a habit.
Breaking the Worry Habit to Reduce Anxiety and IBS Symptoms
Habits can be learned and unlearned. New habits can be created. To be able to change anything, all we need is hope, the right skills, and the motivation to do the work.
Hope comes from the curiosity to become aware of and understand the status quo and the alternatives. The right skills can be learned from someone that has been there before you. And the motivation to change comes from the willingness to invest time and energy into making the change, knowing that it will pay dividends.
Cognitive Behavioural Therapy (CBT) is an effective therapy for anxiety and IBS. It helps you identify and change unhelpful habits, such as worry, that contribute to your anxiety and IBS symptoms.
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