Stress May Be A Trigger Of Bowel Disease Symptoms
By Amy Norton, Reuters Health
4 Min Read
NEW YORK – People with inflammatory bowel disease commonly believe that stress can trigger their symptoms, and a new study suggests they may be right.
Canadian researchers found that among 552 bowel-disease patients they followed for a year, the risk of a symptom flare-up increased when patients were feeling particularly stressed.
The findings, reported in the American Journal of Gastroenterology, lend support to what many people with inflammatory bowel disease have believed to be true.
IBD refers to a group of conditions marked by chronic inflammation in the intestines, leading to symptoms like abdominal pain and diarrhea. The major forms are Crohns disease and ulcerative colitis.
The precise cause of the conditions is unclear, but they are thought to involve an immune system overreaction that injures the bodys own intestinal tissue. While stress does not cause IBD, it is one of the environmental factors suspected of triggering symptom flare-ups in some people.
Studies show that many people with IBD feel that stress worsens their symptoms, but there has been relatively little scientific evidence of that.
This is among the first evidence to show that the perception of stress had a direct association with disease course, Dr. Charles N. Bernstein, the lead researcher on the new study, told Reuters Health in an email.
Etiology Of Ulcerative Colitis
The exact cause of ulcerative colitis is unknown. The most accepted theory about its etiology is that ulcerative colitis is an autoimmune disorder. Also, genetic and environmental factors play a role.
Unlike Crohns disease, smoking doesnt represent a risk factor in ulcerative colitis. The incidence of ulcerative colitis is lower among smokers 80% of the patients are nonsmokers.
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How Ulcerative Colitis Is Treated
Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and prevent symptoms from returning .
In most people, this is achieved by taking medication such as:
Mild to moderate flare-ups can usually be treated at home. However, more severe flare-ups need to be treated in hospital to reduce the risk of serious complications, such as the colon becoming stretched and enlarged or developing large ulcers. Both of these can increase the risk of developing a hole in the bowel.
If medications arent effective at controlling your symptoms, or your quality of life is significantly affected by your condition, surgery to remove your colon may be an option.
Read more about:
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Can I Treat Ibd If I Am Pregnant Or Breastfeeding
Yes, but your doctor may change the type or amount of the medicine you take. Some medicines, such as methotrexate and thalidomide, cause birth defects and other health problems and should not be taken while you are pregnant or breastfeeding.31
Before you get pregnant, make a plan with your obstetrician and gastroenterologist about the medicines you will take during and after pregnancy. Take your medicines as your doctor tells you to. If you stop taking your medicines and your symptoms come back , it may be difficult to get them back under control.31
Talk with your doctor about your medicines and breastfeeding before you give birth. You can search for your medicine in the LactMed database to find out if your medicine passes through your breastmilk and, if so, if it has any possible side effects for your nursing baby.
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Speak With Your Doctor
Without treatment, people with UC tend to relapse.
For many people with mild or moderate symptoms, things improve somewhat after diagnosis. This is thanks to medication, along with identifying and avoiding triggers.
More aggressive cases are less common, and only a small number of severe cases will require hospitalization.
Repeated flare-ups can indicate problems with your current treatment, so speak with your doctor and discuss adjusting your medication.
Several classes of medication now exist that can help you get into and stay in remission. Your doctor may need to add another type or increase your dosage.
The only way to prevent UC flare-ups is to have surgery. The most common type of UC surgery is the proctocolectomy, which involves the removal of the rectum and colon.
Candidates for UC surgery include people who:
- have sudden or severe disease
- have a perforated colon
- are at risk for colorectal cancer
- are unable to tolerate their UC medications due to side effects
- have stopped responding to their UC medications
In addition to knowing how to manage flare-ups, its also helpful to recognize factors that can trigger your flare-ups.
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Do Downward Dog To Boost Your Quality Of Life
Yoga, a mind-body practice that combines breathing and stretching to induce relaxation, can also help relieve symptoms of UC. A small study published in March 2020 in the Journal of Psychosomatic Research found that people who did yoga for 12 weeks saw an improvement in their quality of life and experienced less UC activity.
Yoga classes are offered at many local gyms and recreational centers, as well as on YouTube and in Apple and Android apps.
Ulcerative Colitis: Causes And Risk Factors
Experts dont know what causes ulcerative colitis, but it may be related to your immune system. Normally, your immune system attacks bacteria and viruses that could make you sick. However, with UC, the immune system mistakes the cells of your large intestine for a threat and attacks. When your immune system attacks your own healthy cells, it is referred to as an autoimmune condition. This causes inflammation and ulcers.
Why some people develop ulcerative colitis and not others is still being studied. It may have to do with genetic factors. You are more likely to develop UC if a family member has it. However, most cases develop in people without a family history.
Environmental factors, like exposure to certain viruses or bacteria, may also play a role. Your body may try to fight this infection and then overreact.
Doctors used to think that excess stress and certain foods cause ulcerative colitis, but we now know this isnt true. Diet and stress can make symptoms worse, but they dont cause them.
A risk factor is anything that increases your chance of developing a certain disease. Some risk factors for ulcerative colitis include:
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Is Colitis In Dogs Deadly
Colitis is also very treatable and preventable.
Find out more here about what causes Colitis and how to make sure that your dog doesnât get it.
Colitis in dogs is an irritation of the colon and is a common malady.
The big ones are stress, infection or parasites, allergies, or any of several bowel diseases.
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Evaluation Of Mental State And Sleep Condition
To evaluate each patients mental state, we used an 11-item form of the Center for Epidemiologic Studies Depression scale, Japanese version. The CES-D scale is a validated scale, comprising 9 negative items and 2 positive items, with each negative item scored on a Likert scale from 0 to 2 and each positive item scored from 0 to 2 . The total points range from 0 to 22 and a depressive state was defined as a CES-D score of at least 7. To assess the general sleep condition, we used a simple version of a sleep questionnaire based on the validated Insomnia Severity Index to reduce recall bias. Patients were asked how much they felt their daily life was affected by their sleep condition during the past week, scored on a Likert scale from 1 to 5 . We defined a Likert score of 3 or more as insomnia.
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Vitamin And Mineral Supplements
People with IBD often have vitamin or mineral deficiencies because digestive dysfunction prevents the body from absorbing important nutrients. These include iron, folate, vitamin D, and vitamin B12. As part of treatment at NYU Langones Inflammatory Bowel Disease Center, nutritionists may recommend dietary changes. They may also advise supplementing your diet with vitamins and minerals to boost your digestive health.
Fatigue In Children With Ulcerative Colitis
In a 2019 study , researchers looked at how children with ulcerative colitis experienced fatigue.
They found that, like adults, children with the condition can experience high levels of fatigue. They noted the following potential reasons for this:
- disease activity level
According to the Crohns and Colitis Foundation, fatigue is a common issue among people with IBD. It affects 80% of people with active IBD and 50% of people in clinical remission.
Despite the frequency of fatigue in IBD, researchers have indicated that it is often underreported and undertreated. They have noted that doctors often do not treat fatigue because of the subjective nature of the condition.
People with fatigue should talk with a doctor and make sure that they understand how much fatigue affects their life. The more information a person can provide about their symptoms, the more likely the doctor is to understand fatigue as a serious symptom and make recommendations for treatment.
In addition to taking steps to manage and treat ulcerative colitis, a person can make certain lifestyle changes to help reduce fatigue.
Some potential ways for a person to improve fatigue and boost energy levels include:
In one 2020 study , researchers found that the best way to treat fatigue is to treat its underlying causes.
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Work With Your Doctor To Understand Uc Severity
Its important for you and your doctor to understand how severe your symptoms are. Beyond that, tests and procedures may be done to evaluate your disease activity and get an even better understanding of whats really happening inside your bodyand the inflammation thats occurringgetting you to the treatment plan thats right for you.
Is Surgery Needed For Colitis
The only way to cure ulcerative colitis is to get surgery to remove the diseased colon and rectum. You may also choose an operation if you want to cut your risk of colon cancer. Your chances of getting colon cancer go up if you have ulcerative colitis for 8 years or more or have a lot of colon damage.
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Factors That Can Affect Ulcerative Colitis Flares
When patients with ulcerative colitis experience a flare-up, they can endure severe pain, discomfort, and fatigue. At their worst, the symptoms of a UC flare can require immediate medical attention.
As UC is a chronic condition, patients need education on how to mitigate symptoms and keep inflammation down. There are a number of factors that can play a role in worsening a UC flare that your patients should know about for their health and quality of life. As their health care professional, what are some notable factors you can share with them?
The medications a patient takes can play a role in the likelihood and severity of a UC flare. In particular, pain relievers like nonsteroidal anti-inflammatory drugs are strongly associated with flares.¹ Antibiotics may also create a flare risk, as they can change gut bacteria. Patients with UC that are getting flares triggered by NSAIDs or antibiotics should speak with their physician about potential substitutes.
Medication withdrawal has also been shown to increase the risk of a flare, particularly withdrawal from steroids.¹ Skipping days and weeks, or generally not taking medication as prescribed, also has the potential to cause a UC flare.²
As ulcerative colitis is an autoimmune disease, stress is a major factor and can cause a UC flare to be made even worse.³ Stress can stimulate the immune system, which can lead to inflammation and increase the risk of a flare-up.
- Foods high in fiber
Points To Remember: Psychological Stress In Ibd
Recent studies indicate that chronic stress, adverse life events, and depression can cause relapse in patients with IBD.
The effects of stress on inflammation in IBD are likely to be mediated through changes in hypothalamic-pituitary-adrenal function, alterations in bacterial-mucosal floral interactions, activation of mucosal mast cells, and peripheral release of corticotrophin releasing factor.
The symptoms of IBD may be exacerbated by the effects of stress on gut motility and fluid secretion.
There is a need for further controlled studies of the potential benefits of stress reduction therapy in IBD.
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How To Manage Pain And Fatigue
Pain and fatigue are common symptoms of ulcerative colitis. They can each cause distress, and a range of strategies and treatments can help.
A doctors first approach is to reduce these symptoms by managing the underlying condition. They may also prescribe acetaminophen to ease the pain. Unlike nonsteroidal anti-inflammatory drugs , acetaminophen is with an increased risk of ulcerative colitis flare-ups. It may also be worth noting that a 2018 systemic review did not find conclusive evidence that NSAIDs increased the risk of flare-ups.
Doctors sometimes prescribe anticonvulsants to ease nerve pain, though there is very limited evidence that these drugs can address the pain when it relates to bowel symptoms.
Doctors also prescribe antidepressants to people with irritable bowel syndrome as an adjuvant analgesic, a drug not only intended to relieve pain but used for that purpose.
Meanwhile, fatigue affects
To support and enhance mental wellbeing while dealing with ulcerative colitis, a person might try:
- eating healthy, nourishing food that does not cause digestive upset
- limiting the consumption of alcohol and caffeine
- exercising regularly
- trying to get plenty of sleep each night
- practicing relaxation techniques such as deep breathing exercises or yoga
- using supplements, if a doctor recommends it
The following techniques may also help reduce anxiety and depression:
Having social support can also help. People may benefit from:
Manage Your Anxiety Manage Your Colitis
Managing symptoms of psychological stress and anxiety, unfortunately, won’t cure your ulcerative colitis, but it may help alleviate some of its symptoms and reduce the frequency of ulcerative colitis incidents. Put simply, reduce your stress levels, reduce your discomfort caused by colitis.
It’s virtually impossible to avoid psychological stress and stressful situations at all times completely, so it’s unreasonable and unrealistic to think that you can manage your ulcerative colitis by keeping stress and anxiety out of your life. You can, however, realistically keep stress levels down by eating well and avoiding foods that trigger your ulcerative colitis, like whole grains, nuts, seeds, and fibrous fruits. It is also helpful to take any prescribed medications as directed, sleep well, exercise, have a strong support system, and commit to taking time to relax, through meditation, or just a few dedicated minutes each day for self-care. Yoga can be especially effective because, in addition to relieving symptoms of stress and anxiety, yoga has also been shown to relieve symptoms of ulcerative colitis.
Cognitive behavioral therapy can also be extremely helpful. Using CBT techniques, a psychologist or therapist can help you learn to observe your negative thoughts and then change or reframe them. Instead of “Oh no, here we go againâ¦,” you might think, “I’m going to face this flare-up more calmly, so it will be less severe than last time.”
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Can Nsaids Cause Allergic Reactions
Rarely, an NSAID can cause a generalized allergic reaction known as anaphylactic shock. If this happens, it usually occurs soon after the person starts taking the NSAID. The symptoms of this reaction include:
- Swollen eyes, lips or tongue.
- Difficulty swallowing.
- Rapid heart rate.
- Chest pain or tightness.
If any of these symptoms occur, call 9-1-1 or have someone drive you to the nearest emergency room immediately.
Remember, before any medication is prescribed, tell your doctor:
- If you are allergic to any medications, foods or other substances.
- If you currently take any other medications and/or herbal or dietary supplements.
- If you are pregnant, planning to become pregnant, or are breast-feeding.
- If you have problems taking any medications.
- If you have anemia, kidney or liver disease, stomach or peptic ulcers, heart disease, high blood pressure, bleeding or clotting problems, asthma or growth in the nose .
Last reviewed by a Cleveland Clinic medical professional on 01/25/2020.
Encountering Emotional Stressors And Facing Them
Possible Emotional Stressors
Other Peoples Perception of UCIts hard if you feel isolated because people around you dont understand how your condition affects you. The symptoms of UC can often be invisible on the outside and you could be worried that others may see you differently because of your condition.
Ways You Can Face Them
Refuse to Suffer in SilenceIf youre concerned that others dont understand what youre going through, try your best to talk about it. Open up and crush the stigma. Educate others that may not understand the facts and let go of the people who refuse to understand. Keep the people who really want to understand and support you close.
Having Symptoms at Work or SchoolWorrying about how to manage your UC symptoms when youre not in the comfort of your own home can be hard. Especially if you arent getting what you need, like a flexible schedule or support from your boss. And while you may know your rights as a patient with a medical condition, sometimes there are negative impacts, like unsupportive people, that are outside your control.
Being in Social SituationsIt can feel easy to stay isolated and keep yourself at home. But every now and then everyone needs to get out and have fun. Thinking of your UC might hinder you from doing things like going to parties, seeing friends, or attending events.
Possible Emotional Stressors
Ways You Can Face Them
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