What is the link between IBS and anxiety?

IBS is a common condition that affects up to 1 in 5 people in the world.

According to Tina Wright, IBS Psychotherapist, Evolve Psychotherapy, Norfolk, UK, up to 6 out of 10 people with IBS report having anxiety or depression.

She explains that people with IBS often develop a heightened fear of symptoms in public or social situations. This can create a cycle of worry and physical discomfort.

"Anxiety can trigger IBS flare-ups, while IBS symptoms like urgency or diarrhoea can, in turn, worsen anxiety," says Wright. "This interplay highlights the importance of addressing both physical and mental health when managing IBS."

What is the gut-brain axis?

Gut-brain axis

Graphic: Ben Hudson

Your emotional state can play a big role in influencing IBS and may cause your gut symptoms to worsen.

The gut-brain axis is a two-way communication system that connects your gut and your brain. This happens primarily through the vagus nerve - a major nerve responsible for transmitting signals between the two. Hormonal signals - such as serotonin - and the gut microbiome play significant roles in this relationship.

How to manage IBS and anxiety

How to manage IBS and anxiety

Graphic: Ben Hudson

Making changes to your lifestyle can also help manage both IBS and anxiety. According to Wright, there are some effective strategies for minimising these symptoms.

De-stress

Long-term stress can negatively affect your gut, so finding ways to manage it is essential for your health.

Some helpful tips can include:

• Mindfulness meditation - reduces the severity of your symptoms and fosters emotional resilience.

• Yoga and gentle exercise - can help improve your gut motility and lower stress hormones such as cortisol.

• Nature walks - exposure to green spaces can lessen your stress levels and improve your mood.

Sleep more

Not getting enough sleep - both in quality and quantity - can heighten stress levels and make your gut more sensitive.

You can support restful sleep by:

• Maintaining a regular sleep schedule.

• Avoiding caffeine or heavy meals before bed.

• Practising relaxation techniques such as progressive muscle relaxation.

See here for some useful tips to help you get a good night's sleep.

Eat well

Eating foods that nourish your gut can improve both your gut health and your overall wellbeing.

Try probiotics

Probiotics are friendly microorganisms that help keep your gut healthy. By incorporating probiotics into your diet, you can keep a balanced gut microbiome, helping good bacteria to thrive, and minimising the growth of harmful ones.

Wright explains that a healthy gut microbiome is vital for both digestion and emotional wellbeing.

"Specific probiotic strains like Lactobacillus rhamnosus and Bifidobacterium longum have been shown to reduce abdominal pain and improve mental health," she says. "A wide range of plant-based foods supports microbial diversity, which is linked to improved gut and mental health."

Manage fears

While diet is not the only solution to reducing IBS symptoms, it plays a key role in managing them.

Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) are carbohydrates that ferment in your gut, producing gas.

"It is believed these foods can cause IBS flare-ups in some people," Wright explains. "However, research suggests the gas produced is no different in those with or without IBS. Instead, those with IBS may experience increased sensitivity to gas and bloating, making dietary discomfort more painful."

She adds that managing gut sensitivity and pain perception is better than relying on overly restrictive diets. This often involves addressing anxiety and building tolerance for previously feared foods.

"A diverse diet - such as the Mediterranean diet - rich in fruits, vegetables, nuts, seeds, pulses, whole grains, and healthy fats helps balance the gut microbiome," says Wright. "However, these foods are often avoided by people with IBS due to fear of symptoms, so working to reduce anxiety while gradually reintroducing variety is essential."

Relieve anxiety

Managing anxiety during IBS flare-ups is critical for breaking the stress-symptom cycle.

Cognitive behavioural therapy (CBT)

Given the strong link between IBS, stress and anxiety, CBT can be a powerful tool for helping to question negative thought patterns and reduce IBS symptoms.

Wright explains it can help you:

• Reframe anxious thoughts about your symptoms.

• Challenge beliefs about catastrophic outcomes - for example, fear of public embarrassment.

• Develop coping strategies to manage IBS-related distress.

Reduce triggers

IBS triggers often include stress, diet, or hormonal changes.

Wright suggests that a multi-pronged approach that addresses diet, gut microbiota, and stress is often the most effective way to manage IBS and anxiety.

"IBS and anxiety are closely linked, but understanding the gut-brain connection and adopting evidence-based strategies can break the cycle of symptoms and stress," she concludes. "By managing dietary fears, restoring gut balance, and building emotional resilience, it’s possible to regain control and lead a fulfilling life."