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Stress and Gastrointestinal diseases

Stress and Gastrointestinal diseases

Mental stress in intricately connected to the gastrointestinal (digestive) system. There is a cross talk between the brain and the gut and both of them can influence one another. This system of cross talk is called as brain-gut axis.

The diseases that result out of this interaction between the brain and the gut are called as functional gastrointestinal diseases (FGID). These include irritable bowel syndrome (IBS), functional dyspepsia, constipation, diarrhea, bloating etc. These are called as ‘functional’ diseases because the structure of the gastrointestinal (digestive) system remain normal.  Thus, despite significant symptoms, all the reports and investigations turn up normal or nearly normal.

How the brain affects the digestive system?

The brain controls the stomach, small and the large bowel through the vagus nerve. It can control the multiple aspects of the GI system like salivation, acid production, digestive juice secretion, peristalsis (bowel movements that helps in digestion and propels food), defecation etc. 

Apart from direct connection via nerves, the brain also helps releases hormones, e.g. ACTH hormone which releases the stress hormone – cortisol. This hormone leads to changes in the immune system causing inflammation.

An example of this is the uneasiness in stomach or increased stool frequency we feel just before an exam, an interview, meeting, presentation or public speaking etc.

To summarise, mental (psychological) stress and mood can affect our digestive system. Adverse life events such as losing a loved one, broken relationship, divorce, abuse, major accident, loss of job etc can sensitise and affect the brain and in turn predispose to long term digestive issues.

How does the digestive system affect the mental health?

The gut microbiota consists of billions of microbes living in our intestines. These are mainly bacteria but also includes viruses, yeast, parasites etc. This is a thriving ecosystem. It consists of health promoting bacteria as well as harmful bacteria.

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A healthy colon with plenty of ‘good’ bacteriaA colon with unhealthy proportion of ‘bad’ bacteria

The changes within the gut microbiota can influence the mental health. It does so through the nervous system, by producing chemicals and hormones that affect the brain and via the immune system.

An example of this is when we have an illness like viral infection of bowel causing diarrhea and vomiting, we feel lethargic and don’t feel like doing for work. 

What are the statistics?

Around 40-60% of patients with chronic GI related diseases like Irritable Bowel Syndrome (IBS) have anxiety or depression. The manifestations of IBS include abdominal pain, constipation or loose motions, belching, bloating, mucus in stools, burning sensation etc.

In a study conducted by myself at CIMS hospital, 1 of 3 patients with chronic abdominal diseases had anxiety and/or depression with 20% having both.

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How does psychological stress affect diseases of digestive system?

Psychological stress leads to hyper sensitisation of the nerve endings. This leads the person to feel more pain or bloating than what is actually there. E.g. a person can have their lunch and continue to do their work with some bloat or gas and not be bothered by it. Whereas a person who is stressed, will be bothered even by mild discomfort. This is due to decreased threshold for these sensations. This phenomenon is called as visceral hypersensitivity.

Stress and anxiety may make the mind more aware of spasms or normal movements in the colon. Such movements occur in everyone, but does not affect most. People who are stressed or those with FGID’s are more fixated at their bodily functions and due to hypersensitivity this leads to feeling of cramps or pain.

Gas is present in the intestines of normal people as well. But this doesn’t lead to a sensation of bloating in them. They do register some fullness, but it is not bothersome.
The same amount of gas in a patient of functional disease like IBS or someone with psychological stress can be perceived as significant bloating, and they feel very bothered by the sensation.

Although psychological problems like anxiety don’t cause the digestive disorder, people with FGID may be more sensitive to emotional troubles.

FGID’s are complex diseases and there are a number of other factors that affect the symptom including the diet, genetics, gut microbiota and abnormal motility (either slower or faster movement) etc. Psychological factors described above are also one of the important factors at play, but not the only one. Not all patients are equal. Some are more affected by stress, some are less.

But in those patients that have psychological stressors, need to be identified and treated together to achieve a good control of the disease.

How to identify?

Some people easily identify their source of their stress, while others have a hard time. One of the ways to start treating your stress and its connection to digestive issues is to keep a symptom diary. You can enter your symptoms and track your mood.

You can take professional help by visiting a doctor who will guide you. There are questionnaires that can be filled, and a score is calculated based on the responses that help predict the presence of anxiety, depression etc.

How to cope?

  • Meditation and yoga
  • Sleep at least 7-8 hours a day. If you have trouble sleeping, medications may help. But these can become addictive, and should be used cautiously. 
  • Talk to other patients with similar problem. Your doctor may help you connect with other patients with IBS or similar gastrointestinal disease.
  • Regular exercise can help in reducing stress. 
  • Seek professional help from a psychiatrist.
  • Medicines

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