How to Manage Irritable Bowel Syndrome With Your Brain

The abdominal pain, gas, diarrhea or constipation of irritable bowel syndrome (IBS) can irritate more than your gut. Ongoing symptoms can irritate your mind as well, making you feel anxious, depressed, annoyed or just plain angry.

Those negative emotions aren’t any good for IBS. Studies show that emotional stress can make gastrointestinal symptoms worse.

But the opposite also is true, says Judith Scheman, PhD, Director of Behavioral Medicine in Cleveland Clinic’s Digestive Disease & Surgery Institute. Good emotional health can help ease IBS symptoms. So we spoke with her to get the low-down on how behavioral medicine techniques can help your brain help your belly feel better.

The brain-belly link

Your brain and spinal cord form your body’s central nervous system. Nerve cells and neurotransmitters, which are chemicals that send signals from one nerve cell to another, run from your brain through your body. Those that run along your gastrointestinal tract — including through your stomach and intestines — are called the enteric nervous system.

“Your brain and belly talk to each other through this network of nerves,” Dr. Scheman says. “And they respond to the same neurotransmitters. That explains why emotional distress can cause digestive distress and vice versa.”

Some of the neurotransmitters responsible for our emotions, such as serotonin, are actually produced in the gut, Dr. Scheman adds. “Perhaps that’s why we describe our emotions in gut-related terms. Maybe it is why we say that things are ‘gut-wrenching’ or ‘nauseating.’”

In turn, stress releases pro-inflammatory agents, increasing inflammation in our gut and elsewhere. It can affect our immune system, as well as the ability of our gut to function properly.

It can also slow down or speed up gut motility, the movement of the muscles in your gastrointestinal tract. For example, stress can trigger a fight-or-flight reaction in your central nervous system. Your hormones and neurotransmitters start pumping and your enteric nervous system responds by slowing down or stopping digestion to reserve energy for warding off danger. And that slower digestion can lead to abdominal pain or other gastrointestinal problems.

On the flip-side, Dr. Scheman adds, faster gut motility can result in problems like diarrhea.

Change your brain, change your gut

Because of this brain-gut connection, gastrointestinal and behavioral medicine together can treat IBS and other digestive disorders. Sometimes it takes both to help you cope with ongoing symptoms.

Behavioral medicine treatments for IBS include:

• Relaxation therapy. “Progressive muscle relaxation and guided imagery can help reduce your body’s reaction to stress,” Dr. Scheman says. “This training can help calm your body and mind and help you sleep better, which also promotes healing. Deep relaxation causes your brain to release endorphins, your body’s natural painkiller.”
• Cognitive-behavioral therapy. Changing how you think and behave can improve your body’s response to stress. “You learn coping skills, such as focusing on positive emotions, physical activity and finding joy,” Dr. Scheman says. “Change your thoughts, change your brain, change your gut.”
• Biofeedback. This behavioral technique allows you to take control of body functions, such as your hand temperature, breathing or heart rate. For example, you can slow your heart rate or relax your breathing when you’re stressed.

Can behavioral medicine help you?

Behavioral medicine techniques like these can help improve your mood and your quality of life. And that can mean fewer IBS flare-ups.

If medication or other treatments aren’t helping your IBS, or if you notice that stress makes your symptoms worse, be sure to contact your health care provider to see what next steps you might consider.