Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by recurrent abdominal pain and changes in bowel habits. IBS affects approximately 10-15% of the global population and is twice as prevalent in women compared to men. Many individuals with IBS also experience anxiety related to their IBS symptoms. This is known as IBS anxiety.
IBS anxiety can significantly impact quality of life. Symptoms of anxiety related to IBS may include excessive worry about IBS symptoms, fear of being unable to access a restroom, embarrassment about symptoms, avoidance of activities, social isolation, fatigue, difficulty concentrating, and panic attacks. Understanding what IBS anxiety feels like can help sufferers identify when anxiety is contributing to their symptoms.
Physical symptoms of IBS anxiety
IBS anxiety often manifests physically through the digestive system. Common physical symptoms include:
– Stomach pain, cramps, bloating
– Nausea
– Diarrhea
– Constipation
– Gas
– Feeling that you urgently need to use the restroom
These digestive issues may be exacerbated during times of stress and are the direct result of the “fight or flight” response activated by anxiety. When you feel threatened or stressed, your body goes into survival mode, sending extra blood to your muscles to prepare for “fight or flight.” But this diverts blood away from your digestive system, disrupts digestion, and can trigger IBS symptoms like diarrhea, constipation, cramping, and pain.
For those with IBS anxiety, this stress response and subsequent digestive issues can occur frequently throughout the day in response to routine anxiety and worry. Physical symptoms may also be worse during periods of prolonged, high anxiety.
Mental symptoms of IBS anxiety
In additional to physical symptoms, IBS anxiety also causes many mental and emotional symptoms including:
– Excessive worry about IBS symptoms
– Fear of being unable to access a restroom
– Embarrassment about symptoms
– Hypervigilance or feeling constantly “on guard” about possible IBS symptoms
– Avoidance of activities due to IBS symptoms
– Social isolation
– Fatigue
– Impaired concentration
– Irritability
– Panic attacks
Those with IBS anxiety may spend an excessive amount of time each day worried about their bowels, gastrointestinal symptoms, and the availability of restrooms. This worry can reach the level of obsession in severe cases. IBS anxiety also frequently causes a fear of being unable to access a restroom when symptomatic. This can lead to avoidance of activities, events, and travel.
Many individuals with IBS anxiety also experience profound embarrassment about their IBS symptoms. This may cause them to withdraw from social relationships and isolate themselves. The preoccupation with symptoms can also result in mental exhaustion and an inability to focus. Some people with severe IBS anxiety have full-blown panic attacks when symptoms flare up.
How IBS anxiety affects daily life
IBS anxiety can severely impact daily functioning. For those with moderate to high levels of IBS anxiety, symptoms may:
– Cause them to cancel social activities frequently
– Interfere with work performance
– Disrupt sleep
– Make it difficult to leave the house for long periods of time
– Interfere with relationships
– Prevent exercise
– Make it hard to follow through with responsibilities
– Reduce overall quality of life
Some examples of how IBS anxiety might disrupt daily life include:
– Having to cancel a dinner party you planned because of a flare up of symptoms
– Struggling to concentrate during an important work presentation due to anxiety about your IBS
– Choosing a job or college based on the location and availability of restrooms
– Avoiding going on dates or pursuing romantic relationships because of embarrassment about symptoms
– Saying no to a friend’s wedding because you’re afraid of having an IBS attack during the ceremony
– Planning your whole day around proximity to restrooms and limiting your time away from home
For those with severe IBS anxiety, symptoms may make it extremely difficult to leave the house at all. Basic daily activities like working, grocery shopping, exercising, seeing friends, and even sleep end up revolving around the individual’s IBS anxiety and need to manage symptoms. This can result in profound social isolation.
When to seek help for IBS anxiety
Mild to moderate IBS anxiety can often be managed with lifestyle changes, IBS treatment, and self-help techniques like cognitive behavioral therapy. However, severe IBS anxiety accompanied by the following symptoms warrants seeking professional mental health treatment:
– Inability to leave your home for extended periods of time
– Avoiding nearly all social activities and relationships
– Calling in sick to work frequently due to IBS symptoms
– Experiencing panic attacks related to your IBS
– Depression or suicidal thoughts related to quality of life impairment from IBS
– An excessive amount of time spent worrying about your IBS each day
A psychologist or therapist can help identify underlying thought patterns contributing to intense anxiety about IBS symptoms. Cognitive behavioral therapy, exposure therapy, mindfulness, and anxiety medication may all be helpful in addressing IBS anxiety. A multidisciplinary approach involving both a mental health professional and a gastroenterologist experienced in IBS treatment leads to the best outcomes.
Treatments for IBS anxiety
A number of lifestyle changes, medications, and therapies may help reduce anxiety related to IBS symptoms. Possible treatment options include:
Lifestyle changes:
– Following an IBS-friendly diet such as the low FODMAP diet
– Limiting alcohol, caffeine, spicy foods, and other IBS triggers
– Staying hydrated
– Exercising regularly
– Getting enough sleep
– Practicing stress management techniques like yoga, meditation, deep breathing
Medications:
– Antispasmodics to reduce intestinal spasms
– Tricyclic antidepressants to reduce pain signaling
– SSRIs or other antidepressants to manage anxiety
– Anti-diarrheals or laxatives to treat bowel pattern abnormalities
Psychological treatments:
– Cognitive behavioral therapy to modify anxiety-provoking thought patterns
– Exposure therapy to reduce avoidance behaviors
– Hypnosis for anxiety and IBS symptom reduction
– Mindfulness-based stress reduction
– Support groups to reduce social isolation
Other treatments:
– Probiotics to improve gut microbiome
– Peppermint oil to reduce bloating and abdominal pain
– A low FODMAP diet to identify food triggers
– Regular meetings with a mental health professional and gastroenterologist
A combination of lifestyle changes, medications, psychological treatments, and other therapies tailored to the individual offers the best chance at managing IBS anxiety. Severe anxiety may require anti-anxiety medication in addition to therapy and lifestyle changes. Support from friends, family, and the healthcare team is also crucial.
Coping strategies for IBS anxiety
In addition to professional treatment, individuals can utilize self-help coping strategies to better manage anxiety related to their IBS symptoms. Helpful coping techniques include:
– Practicing deep breathing or meditation when feeling anxious
– Doing gentle yoga poses to relax the mind and body
– Keeping an IBS symptom journal to identify triggers
– Learning gut-directed hypnotherapy
– Practicing self-talk to challenge negative thoughts when symptomatic
– Carrying anxiety medication for use when needed
– Finding enjoyable distractions like reading or listening to music
– Avoiding reassurance seeking and “catastrophizing” thought patterns
– Maintaining social support systems to prevent isolation
– Joining an IBS anxiety support group
Developing a toolbox of go-to, portable coping skills can help individuals with IBS anxiety manage symptoms when they arise. Support groups also provide a sense of community and remind those with IBS that they are not alone.
When to see a doctor
Those experiencing anxiety about their IBS symptoms should see both a mental health professional and a gastroenterologist. A psychologist or therapist can provide interventions to reduce IBS anxiety, while a gastroenterologist can ensure proper diagnosis and medical management of IBS.
It is important to rule out other gastrointestinal disorders beyond IBS. Symptoms like bleeding, weight loss, or family history of colon cancer warrant further testing. A combination of counseling and medical treatment tailored to the individual’s symptoms and psychological profile offers the best chance at managing IBS anxiety.
Some signs that it may be time to see a professional include:
– Excessive worry or fear about IBS symptoms most days
– Avoidance of work, social events, or leaving home due to IBS
– Depressive symptoms related to IBS anxiety
– Panic attacks related to IBS
– Suicidal thoughts associated with quality of life impairment from IBS
– Persistent or worsening IBS symptoms despite self-management
Neither anxiety nor IBS symptoms should be considered “normal” or just tolerated. Seeking help from mental health and medical providers leads to the best quality of life for those with IBS.
Professional treatment plan for IBS anxiety
A comprehensive treatment plan for IBS anxiety often includes:
Gastroenterologist:
– Thorough evaluation to confirm IBS diagnosis and rule out other conditions
– Testing for celiac disease, inflammatory bowel disease, lactose intolerance
– Prescription medications to treat IBS symptoms
– Referrals to dietitians familiar with IBS dietary plans
– Follow-up appointments to monitor and adjust treatment
Mental health professional:
– Diagnostic evaluation of anxiety symptoms and severity
– Cognitive behavioral therapy focusing on IBS anxiety
– Exposure therapy to reduce avoidance of activities
– Anxiety management techniques and coping skills
– Anti-anxiety medication when indicated
– Ongoing counseling and support
Other providers:
– Dietitian for IBS meal planning and trigger identification
– Pelvic floor physical therapist if needed
– Primary care provider for coordination of care
Ongoing communication between providers is key. A combination approach addressing both physical IBS symptoms and IBS anxiety mental health symptoms provides the greatest chance of recovery.
Self-care tips for IBS anxiety
Practicing consistent self-care can help individuals with IBS anxiety manage symptoms. Helpful self-care approaches include:
– Eating a balanced IBS-friendly diet with adequate fiber
– Staying hydrated by drinking 64+ ounces of water daily
– Exercising regularly to reduce stress
– Getting 7-9 hours of quality sleep per night
– Avoiding alcohol, coffee, sodas, and other caffeine sources
– Taking probiotic supplements to support gut health
– Doing relaxing activities like yoga, massage, reading
– Avoiding Known IBS symptom triggers
– Practicing mindfulness, deep breathing, and meditation
– Maintaining relationships and social connections
– Adhering to provider-recommended treatments
– Utilizing cognitive coping skills and journaling
Consistent self-care maximizes physical and mental wellbeing. Support from loved ones also aids self-care efforts. Those with IBS anxiety should be patient with themselves and celebrate small daily wins.
Supporting a loved one with IBS anxiety
Friends and family of those with IBS anxiety can provide crucial social, emotional, and practical support. Ways to support a loved one with IBS anxiety include:
– Listening without judgement when they need to talk
– Offering to help find effective providers and treatment options
– Reminding them their feelings are valid and common with IBS
– Sharing articles or information you come across on IBS anxiety
– Making plans that accommodate their anxiety and symptoms
– Keeping snacks on hand that are within their dietary limits
– Asking how you can directly help in practical ways
– Helping create an IBS-friendly space and safe environment
– Making efforts to reduce their social isolation
– Learning alongside them about IBS anxiety
– Expressing love, empathy, and compassion
Support from loved ones facilitates treatment seeking and compliance. It also reduces the social stigma and isolation accompanying IBS anxiety. Offer flexible support based on what your loved one identifies as most helpful for them.
When to seek emergency treatment
While IBS anxiety is not life-threatening on its own, severe anxiety can sometimes create medical emergencies warranting emergency care.
Seek immediate emergency medical treatment if you or a loved one experiences:
– Difficulty breathing or sensations of choking
– Chest pain or tightness
– Feeling like you are having a heart attack
– Numbness, tingling, weakness in your arms, legs, face
– Severe and uncontrollable vomiting
– Fainting spells or loss of consciousness
– Suicidal thoughts with intent to act
Call 911 or go to your nearest emergency room if you have any of the above symptoms related to your IBS anxiety. They may indicate anaphylaxis, heart attack, stroke, or major panic attack requiring immediate medical intervention.
While IBS anxiety symptoms themselves are not dangerous, their physical manifestations like hyperventilation can sometimes become medical emergencies. Always seek immediate help for any breathing difficulties, fainting, or suspected allergic reaction.
Long term outlook and recovery
With proper treatment and ongoing self-care, individuals with IBS anxiety can achieve substantial symptom relief and marked improvements in their quality of life. While IBS anxiety may be chronic and lifelong for some, periods of remission are possible.
Approximately 50% of those who strictly adhere to professional treatment plans will experience significant improvement or remission of their IBS anxiety within 6-12 months. However, treatment is often needed long-term and intermittent flare ups may occur during times of stress.
Keys to long term recovery include:
– Consistently following provider treatment recommendations
– Keeping follow up appointments with gastroenterologists and mental health professionals
– Practicing daily self-care and preventative techniques
– Identifying and avoiding personal IBS symptom triggers
– Maintaining social and family support systems
– Not delaying treatment during flare-ups or difficult periods
IBS anxiety can disrupt many aspects of life, but finding the right team of professionals combined with diligent self-care offers hope. Be compassionate with yourself throughout the recovery process.
