Stress helps my IBS

Hello Dr. Thatcher:

I am 35 years old and have both inflammatory bowel disease and Irritable Bowel Syndrome. I am trying to get control of and develop some predictability of my IBS episodes. I have found that my IBS occurs after a stressful event has resolved, during periods of extreme stress, I do well.

I was diagnosed with both about the same time, in 1997. I have no other medical problems. Currently I take Lialda (Mesalamine) 1000mg daily. I do not smoke or use drugs. I do drink red wine, 1/2 - 1 glass of wine a day. I do not have any Family Medical History of GI problems, I'm the only one. My father died at age 61 from lung cancer. My mom is 59 and has HTN that is well controlled. I have not had any major surgeries. My last colonoscopy was in May 2011 and revealed chronic rectal colonic inflammation but nothing acute at the time.

In my life, I have found my IBS to be much more problematic than my IBD. I find the IBS harder to control and it has the more negative impact on my life. I have not had many IBD flares. In fact, I am classified as having a "mild" case of it. On the contrary, my IBS is more recurrent. Actually, I had a period of about 3-4 years (2005-2009) when I had no symptoms of either one. Prior to that, I was having horrible IBS symptoms for about 1 year, virtually making me poorly functional. I was told that my IBS was due to stress, although I did not feel stressed. But in 2005, I completely revamped my life, moved to another part of the state and "started over", so maybe it was stress.

From 2009 to present, I have been having a variable number of flare ups a year of IBS with fluctuations in the severity and duration of each occurrence. When the flare up occurs, it debilitates me because I have to plan my day and life around the ease of accessibility of a restroom. It can last days to weeks. In order to control the symptoms, I overdose on Donnatol to stop the spasms so I can go to work and participate in life (although groggy I become).

Interestingly, I have found that my IBS flare ups occur AFTER the passing of a stressful period of time and usually is relationship related. My work is extremely demanding and stressful. So, if stress was a contributing factor, I would expect to have more frequent, if not chronic, flare ups. I have had extremely stressful events in my life (non-work related too) that have not caused the IBS to occur. What I have started to notice, although, is that when I am having problems in a committed relationship, the symptoms occur after everything has been ironed out and I no longer have any stress over the relationship. Almost immediately after the resolved conflict (2-3 days later) I suddenly get hit with IBS. But during the actual stressful situation/time, I have absolutely no GI symptoms. (As a side, in contrast to the IBS, since 2005, I have only had 1 symptomatic IBD exacerbation that was easily controlled).

My diet stays pretty much the same all year round. I have eliminated caffeine and also taken in too much caffeine, for example, and have no change in symptoms or number of flare ups in relationship to diet. I have had the flare ups with or without probiotics, fiber supplements, etc.

There is a lot of information, treatment options, and resources available to people to reduce stress in order to minimize IBS. So my question is this, how does one who thrives during periods stress, and develops the IBS symptoms after a stressful event has resolved, minimise the number of exacerbations or predict when they will occur? The only thing I can think of is to not relax and stay stressed.

Thank you for your time and response.

Your IBS symptoms

Thanks for your question about your IBS symptoms. First of all, IBS is not “caused by stress”, nor is it “in the mind” and it is very frustrating and annoying for sufferers (and specialists!) to hear this. It’s a sign of the doctors ignorance about the condition as I am sure you are aware! There are lots of theories about IBS causes, but these are only theories including the brain-gut axis theory. This is where the brain is stimulated by external and internal stimuli such as touch, sight, smell and taste. This leads to chemical messengers in the brain firing off abnormal signals through the spinal cord to the gut with an exaggerated intestinal response.

In most cases, stress (whatever this really is!) seems to make symptoms worse probably because of a combination of changes in both the hormonal responses, the excess levels of adrenaline and possibly the excessive intestinal response from the brain-gut axis.

In your case, it appears the opposite is true and the cause for this is unclear. You don’t mention the type of IBS symptoms you experience, but if these are constipation predominant symptoms you could theorise that you symptoms are improved by increased adrenaline levels during times of stress, stimulating increased peristalsis of the gut, resulting in a laxative effect to move the stool along. However, this is only a theory and not a fact, but interesting all the same!

I note you have IBD as well as IBS. Inflammatory bowel disease often responds to steroids and during times of stress we know the body produces increased levels of the bodies own natural steroid called cortisol. Maybe the increased cortisol levels are having an effect on your IBD!

When stressed we are distracted and this could explain why symptoms of pain may be reduced. This is a well know phenomenon known as the Melzack and Wall gate theory and is the basis of why TENS machines (Transcutaneous nerve stimulators) work in pain conditions.

Finally, we know that the bodies own natural pain killers called endorphins are increased in times of stress. If your IBS symptoms are pain related, this could potentially reduce the amount of pain you are experiencing.

These are all theories that I have put forward to you and are by no means fact. They are interesting though and could help to explain why your symptoms are improved when under stress.

As to how to improve your symptoms, that is difficult to answer other than to try some of the treatment options that can be found in the treatment for IBS section

My name is Dr Peter Thatcher MBBS, MRCPI and I am a consultant physician and gastroenterologist in the UK. I have an interest in internet based medicine and administer this site in my spare time. I hope you find this site useful and informative. If you have any suggestions, please Contact Me or if you would like to comment on my site, please do so by Clicking Here. If you like the site and would like to make a donation to support what I am doing please do so by Clicking Here. Thank you for visiting and please drop by again!