Stress And Stomach Issues Can Go Hand-In-Hand

For many women, the everyday pressures of life can hit them below the belt–literally. Here’s how to find relief.

You’re stuck in traffic, already 20 minutes late picking up the kids from soccer practice, and your stomach starts churning. Or your in-laws come to stay for a week, and by the end of it, you feel like your gut is in triple knots. You’re gassy, crampy, and miserable.

Up to 70 million of us have diseases and disorders of the digestive tract. And doctors say stress can often be the cause of such problems or, at the very least, the trigger for flare-ups. “We know that there are clear-cut physiologic changes in the bowel associated with stress,” says Joanne A. P. Wilson, M.D., a professor of medicine in the division of gastroenterology at Duke University Medical Center in Durham, NC.

IBS is a war in your insides.
IBS is a war in your insides.

It isn’t clear exactly how stress triggers stomach mayhem, but one theory is that the brain sends signals to the gut, which, in turn, affect how the gut’s own brain (known as the enteric nervous system) functions. It’s thought that acids and other substances are secreted in response to these signals and that stress can also slow down intestinal function (leading to constipation, gassiness, and nausea) or speed it up (causing cramping and diarrhea).

Beasts in the Belly

Last spring, Linda Kelly,(*) a 32-year-old New York City medical technologist, began having intense, knifelike pain in her lower abdomen. “I was bent over, the pain was so bad. When I went to my doctor, he did tests for a urinary tract infection and an ovarian cyst, which came back negative.” Over the next few months, the pain subsided, but other problems-alternating bouts of diarrhea and constipation–appeared. All this was happening about the same time Kelly had relocated from upstate New York and started looking for a job.

She eventually saw a gastroenterologist, who diagnosed her ailment as irritable bowel syndrome (IBS). This condition, characterized by diarrhea, constipation (or varying episodes of both), bloating, stomach spasms, and gassiness, affects up to 15 to 20 percent of adults in the United States. In fact, IBS is second only to the common cold as the leading cause of absenteeism from work.

With IBS, the bowel looks totally normal, but nerves in the bowel seem to be hypersensitive to even normal stimuli, including food, gas, and stress. The upshot is that for some people, “what goes on in the head may be reflected in the gut,” says Susan Lucak, M.D., a gastroenterologist and codirector of the Center for Intestinal Dysfunction at Columbia-Presbyterian Medical Center in New York City.

In contrast, inflammatory trowel disease (IBD), of which Crohn’s disease and ulcerative colitis are the principle forms, is a structural problem. Crohn’s disease involves inflammation of the intestinal wall (and sometimes the mouth, esophagus, and other areas of the digestive tract); ulcerative colitis involves just the colon and rectum.

About half a million Americans suffer from IBD. The cause is unknown, but some experts suspect that a virus or bacteria attacks the immune system and triggers the inflammation. Symptoms–which include abdominal pain and diarrhea–can be exacerbated by stress but, again, doctors aren’t sure why.

The list of stress-aggravated stomach problems goes on. Some people gulp air when they’re anxious (aerophagia), which leads to bloating and gassiness. Revved-up acid production can intensify the symptoms of heartburn as well as nonulcer dyspepsia (a condition that can bring on nausea, bloating, and a sense of extreme fullness after eating small amounts of food). Even ulcers-now known to be chiefly caused by bacteria–can be worsened by increased acid production.

Are Women More Prone?

While IBD affects roughly equal numbers of women and men, women are two to five times more likely than men to report IBS, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). And about one million more women than men report acute nonulcer dyspepsia.

So is there something about women’s digestive tracts that makes them more susceptible to stomach problems? Doctors say no. “I think you see more women with these problems because their complaints get to the doctor more,” says Gary M. Gray, M.D., professor of medicine at Stanfod University Medical School in Stanford, CA, and director of the National Institutes of Health-Digestive Disease Center. “Men tend to ignore their discomfort or put off seeking help.”

True, women are greater consumers of medical care than men. But that may not be the whole story. For starters, women have to contend with a monthly surge and decline of estrogen and progesterone, and these hormones can either stimulate or slow down the bowel’s activity, causing the diarrhea and constipation many of us complain of during our periods. Women also report suffering more often from depression, which can cause a chemical imbalance in the brain and possibly the gastrointestinal tract’s enteric nervous system.

Stomach Soothers

The good news is that relief is at the ready. The first step is knowing when to seek help. See a doctor if the discomfort is chronic, disabling (for instance, you’re so concerned about the availability of bathrooms that you don’t venture far from home), or accompanied by a fever, which can signal an infection. Also seek medical attention if you have any unexplained weight loss or bloody stool.

Your doctor can help steer you to over-the-counter antidiarrheals or laxatives. Using these only when symptoms appear–as opposed to signing on for life–can sometimes be enough to take care of the problem. Prescription antispasmodics (for IBS) and anti-inflammatory drugs (for IBD) may also be necessary.

And like many illnesses, there’s plenty you can do to help yourself, such as 30 minutes of aerobic activity or weight training three to four times a week. “People who exercise regularly tend to have fewer symptoms because exercise releases endorphins, which help relax the gut,” says Frank A. Hamilton, M.D., chief of the digestive diseases branch of the NIDDK. Dietary changes also ease symptoms. These include eating more fiber if you’re constipated, fewer beans and certain vegetables like cauliflower and cabbage if you have gas, and fewer fatty foods or sorbitol-containing products (commonly found in sugar-free candy and other foods) if you have diarrhea (since these may make the bowel contract soon after eating).

Reducing stress is also key. Look for stress-reduction seminars offered by your employer or a local adult-education program. If you want more intensive instruction, have your doctor refer you to a psychologist who can teach you such stress-reducers as guided imagery, progressive muscle relaxation, and deep-breathing exercises. “Doing these techniques is like inoculating yourself against stress,” says Kenneth Gorfinkle, Ph.D., a clinical psychologist in the behavioral medicine program at Columbia University in New York City. “You’ll have a lot longer to go before you feel tense later on.”

Carol Marshall,(*) a 42-year-old IBS sufferer from New Jersey, swears by these methods. “I sit for fifteen to thirty minutes in the morning and concentrate on my breathing, on being still. I get into a place in my head where I’m not thinking about everything I have to do. It’s like having a time-out–I feel relaxed. And when a stressful situation comes along, I manage it better. I don’t get crazy so quickly.”

Linda Kelly, who also suffers from IBS, takes a more informal approach. “I tell myself to breathe, to not let the situation make me nuts. During my lunch break, I try to do more deep-breathing exercises or take a walk–something to shake off the stress. And I do end up feeling calmer.” That, in turn, helps her stomach feel calmer.

If self-relaxation techniques don’t work, your doctor may prescribe an antianxiety drug to help you relieve stress and tension. The bottom line: “Don’t throw up your hands and say nothing can be done,” says Dr. Lucak. “We may not be able to cure what’s wrong, but we can manage it.”

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