If nervousness feels like butterflies in your stomach, anxiety can feel like a small, live rodent loudly nesting in there, pushing things around, making you wish you hadn't eaten that day. For some anxiety sufferers, deeply unpleasant digestive problems are extremely common—even though stomach troubles aren't exactly the first symptoms we tend to associate with anxiety.
When we think of anxiety, we typically picture panic attacks, which are often characterized by a racing heart, trouble breathing, and warped vision. But if your anxiety is frequently accompanied by various kinds of digestive discomfort, you're far from alone. Stomach problems tend to be less debilitating than panic attacks, but loud gurgling, stomach pain, gas, nausea, and diarrhea can be embarrassing, inconvenient, and seriously uncomfortable when you're trying to get through your day. Especially if that day involves a big date or work presentation—which may have sparked your anxiety to begin with.
The Brain-Gut Connection
Daniela Jodorkovsky, M.D., a gastroenterologist at NewYork-Presbyterian/Columbia University Medical Center, says that the relationship between gastrointestinal discomfort and anxiety is "very complex," but offers a couple of explanations for the link between anxious feelings and stomach-churning.
"The GI tract is considered the 'second brain' because it contains many nerves, which send signals back and forth to the brain," she says. "Chronic stress and anxiety release a compound in the brain called corticotropin-releasing factor (CRF). This can have effects on spasms or diarrhea, as well as increased pain signaling from the nerve fibers of the gut to the brain."
So it makes perfect sense that anxiety-brain can lead to anxiety-stomach—the connection between the brain and the digestive system is strong in the human body, and that's before complicating factors like anxiety disorders or IBS even enter the picture.
The Anxiety and Depression Association of America estimates that at least half—and up to 90 percent—of IBS sufferers also have anxiety and/or depression, which makes sense, considering IBS is the condition of having a sensitive colon, which is easily upset by certain foods or by stress. "Having anxiety and/or depression are independent risk factors for the development of irritable bowel syndrome, but even those without anxiety disorders can notice their symptoms worsening when they are feeling anxious or stressed," Jodorkovsky says.
Anxiety, like most human experiences, is theorized to have had a purpose in our biological development as a species—what Walter Bradford termed the "fight-or-flight" response in the early part of the 20th century.
"When we're anxious, our bodies believe we're in danger, and that has historically been very useful," says New York-based psychotherapist Nicole Reiner, LMHC. This kind of response made sense when early humans were, say, running from saber-toothed cats, but nowadays, "we find that our stomachs become collateral damage," Reiner says.
So while it might be helpful when faced with a large, hungry cat or a bear, most modern anxiety-sufferers do not benefit from the physiological changes of anxiety, including but not limited to blood flow being diverted to the muscles (to aid in running or fighting) and away from other body parts, such as the digestive system.
How to Handle It
Because the GI tract and anxiety are so closely related, it's not always obvious what physical symptoms are caused by IBS, or anxiety, or IBS as a result of anxiety—so it can be useful to take a two-pronged approach.
Reiner urges her clients to tackle the problem not just psychologically, but medically, as well. "When someone is reporting debilitating stomach issues, I will first direct them to a gastroenterologist or primary care physician to rule out any underlying issues," she says. Even if your symptoms seem to be spiked by anxiety, there might be a physical cause that therapy or psychiatry alone cannot treat.
But if symptoms can't be fully treated through other means, there are practical ways of dealing with anxiety-induced (or worsened) GI discomfort when it arises. For some patients, Reiner suggests breathing exercises as a way to manage the physical symptoms, as well as the feeling of anxiety itself.
"Diaphragmatic breathing relaxes your stomach," she says. "Breathe in really slowly for about five counts, hold it in, and breathe it out for somewhere between six and eight counts." This can help turn on the rest-and-digest response, the body's natural recovery mechanism to fight-or-flight, Reiner says.
Jodorkovsky says that hypervigilance is one pitfall you can try to avoid. "When we are anxious, our bodies become 'hyper-aware' of our symptoms, as if the nerve signals are amplified. This makes the symptoms even more distressing than they would otherwise be."
Reiner refers to the tendency to constantly check in with your physical pain or discomfort as "body-scanning" and says that "the more we look for something, the more likely we are to find it." It's a vicious cycle: The anxiety and discomfort make us hyper-aware of how bad we feel, and focusing on how bad we feel makes us feel worse.
Of course, it's nearly impossible to just ignore debilitating pain and discomfort, so Reiner recommends practicing mindfulness meditation instead. "It's a different way of being with the pain—paying attention to the moment with curiosity and kindness. You're noticing your pain, but not becoming consumed by it."
It’s important to resist ways of managing symptoms that are potentially unhealthy and unhelpful—such as avoiding food. While it may seem intuitive to refrain from eating if you’re anticipating your body having trouble digesting, there are, predictably, some major problems with depriving your body of nourishment. However, your doctor may suggest you steer clear of certain foods or avoid eating close to bedtime (both common strategies for gut healing).
"When you're not eating, you're more likely to be jittery and anxious," Reiner says. "The anxiety gets worse, not better." It's important to continue taking care of your body in all of the ways you normally would. And remember: Like all bouts of anxiety, this, too, shall pass.