Understand Which Stressors Are Within Your Control
Understand that there are many sources of stress that may be out of our control, like the COVID-19 pandemic, fluctuations in income, and natural disasters. While these events may cause feelings of stress, understanding which stressors you can and cannot control can help you to better manage that stress.
Worrying about things that are out of your control, like having to cancel a major event due to pandemic-related restrictions, may cause you to have feelings of irritation, discouragement, and stress. If you understand that you did not have control over the restrictions related to COVID-19, it may help you feel more accepting of the need to change your plans. This type of thinking can help keep your stress levels manageable.
I try to just pick my battles, and say to myself, If it doesn’t directly affect me, then just let it pass, one MyCrohnsAndColitisTeam member recommended. Another team member highlighted how they let go of stressors that they dont have control over: I’ve been practicing not letting things stress me out at work. The only thing I’m in control of is the way I choose to react.
Chronic Psychological Stress And Adverse Life Events In Ibd
In the 1950s, IBD was classified as a psychosomatic disorder with many early studies finding an association between IBD and psychiatric diagnoses. However, a review in 1990 of 138 such studies found most to have serious flaws, while in the seven which did not, there was no association between psychiatric disease and UC. In contrast, in a study published in 2004, Mittermaier et al reported that patients with inactive IBD had a significantly increased chance of relapse over the next 18 months if their baseline score on the Becks depression inventory was raised.
Placebo response rates in many therapeutic trials of IBD remain as high as 3040%. This response rate relates not only to subjective measures such as patients feelings of well being, but also to objective measures such as the degree of mucosal inflammation seen at endoscopy, and provides further evidence to suggest that changes in psychological state can affect disease activity.
Summary of studies assessing association between stress and disease exacerbations in inflammatory bowel disease
Which Came First: Ibd Or The Stress
It is easy to see why early researchers hypothesized that IBD was psychosomatic: Many of the patients with IBD they saw showed signs of severe stress or other emotional or psychological problems. But those signs may have stemmed from the constant pain, diarrhea, bleeding, and social stigma that the patients endured because of their IBD.
In short, stress or emotional or psychological problems do not cause IBD. However, these problems can make IBD worse.
John E. Franklin. Psychosocial Issues in Inflammatory Bowel Disease and Intestinal Failure. Am J Gastroenterol Jun 2007.
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Find A Schedule That Works For You
Laine dealt with several years of challenges at work before finding his current job, where he’s been for 15 years.
“Crohn’s made a huge impact on my professional life,” says Laine. “I am lucky I have a job I have been at for 15 years now, but I have been through dozens of other jobs. Because of Crohn’s I could not keep a job. I was either laid off, fired, or I had to quit.”
At his current job, he’s been able to work out accommodations with his employer that help him manage his symptoms. He works Monday through Friday and negotiated Wednesdays off to recuperate physically and mentally.
For those who are currently working full time, he acknowledges that while Crohn’s disease is different for everyone, he’s found personally that taking small breaks throughout the day has helped him reduce fatigue and stress.
“Take breaks and lunch don’t work through them,” says Laine. “Take your own food and drink and eat little and often throughout the day.”
Flexible scheduling has also become more common in the modern workplace. In a survey conducted by Zenefits, 67% of small businesses offer some form of flexible work schedules. Consider asking your employer if you can work from home for part of the week, if being at home would help you better manage symptoms and stress.
Know That Crohn’s Doesn’t Define You
Even after talking with your manager about accommodations, identifying your food triggers, and managing your stress, Crohn’s disease might still feel like the elephant in the conference room.
“When I worked full-time as a news anchor and reporter and then as a PR professional, my Crohn’s was always a part of my day,” says Natalie Hayden, freelance writer and blogger at Lights, Camera, Crohn’s. “Even when you aren’t symptomatic or flaring,’ Crohn’s is always top of mind, no matter what I do.”
Hayden says she considered most decisions through the lens of how it might impact her symptoms. A morning cup of coffee could trigger cramps later in the day. Dress pants would be too restrictive if she felt bloated later so she wore dresses to work most of the time.
At the same time, while she had to revolve some decisions at least partly around her Crohn’s disease, the condition didn’t define her then, and doesn’t in her role now, as a stay-at-home mom and freelance writer.
“When I was diagnosed with Crohn’s two months after college graduation at age 21, I didn’t allow the disease to stop me from achieving my dream of working in television,” says Hayden. “I landed a job two months after being diagnosed and moved eight hours away from family and friends while on 22 pills a day and navigating the new’ me. It is possible.”
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Does Stress Cause Inflammatory Bowel Disease
Shadi Hamdeh, MD, is a board-certified gastroenterologist and an assistant professor of medicine at the University of Kansas Medical Center.
What role does stress play in the development of inflammatory bowel disease ? Could these diseases be partially psychosomatic ? Does stress cause IBD?
If you have IBD, you may have had someone tell you that you should “relax” or that you should learn to manage your stress. Perhaps someone has even told you that your stress was a direct cause of your IBD. This is because, in the past, it was widely believed that there was a psychological component to IBD. However, we now know that this is not the case. Stress management plays an important role for anyone who has stress and it is vital for people with IBD. It is important to note, however, that stress isn’t a direct cause of IBD.
Further Possibilities For More Effective Research
All variables mentioned in the 20 publications plus regular physical activity and anthropomorphic measures should be considered. These variables are either of general clinical importance, well-known IBD risk factors, or recently identified relapse predictors , although not necessarily confounders.
To avoid dilution effects, IBD cohort samples should be divided into groups with the same diagnosis, or, depending on the sample size, restricted to one diagnosis . It is intriguing that none of the reviewed studies commented on indeterminate colitis, although this entity is diagnosed in 10% of IBD. CD must be divided into groups of inflammatory, stricturing, and fistulizing behavior because these types show different disease courses . Moreover, investigations on UC might profit from patient assignment into pANCA-positive and negative groups because stress appeared to particularly predict adverse outcome in the pANCA-negative UC patients . As recently shown, the categorization of patients by their autonomic stress response, as measured by opposite changes in heart rate variability during acute psychological stress and recovery, seems also a fruitful endeavor for future studies .
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Add Some Zen To Your Day
There are plenty of options to build your mindfulness toolkit, including meditation and yoga , a mindfulness practice that also provides gentle exercise. But dont stop there. Diaphragmatic breathing can calm you in just a few minutes, notes Dr. Szigethy. Just inhale a deep breath through your nose until you feel your abdomen expand, hold for about two seconds, then exhale slowly while thinking of a soothing word. Take it a step further with guided imagery: You can distract yourself from your symptoms by putting your mind in a more relaxed place, like on a beach, she adds.
What Is The Importance Of The Innate Immune System
Without properly functioning immune cells, the bodys epithelial cellular wall will begin to break down and allow microbes to invade the gut and trigger Crohns symptom flare-ups. Epithelial cells rely on molecular signals from the bodys immune cells to keep our harmful microbes and repair the cell wall.
Psychological stress impedes the bodys ability to fight off gut bacteria that may be implicated in Crohns disease stated the senior author, professor and chair of biochemistry and biomedical sciences at McMaster, Brian Coombes.
Psychological stress impedes the bodys ability to fight off gut bacteria that may be implicated in Crohns disease
Coombes said that removing stress hormones in the mouse models restored proper function to immune cells and epithelial cells, blocking the invasion of harmful microbes. Although this study shows immense promise in in the future treatment and management of Crohns symptoms, Coombes emphasised that this research is still in the early pre-clinical stages of research and there is a long way to go.
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Functioning Of The Stress Axes In Ibd
Several studies have suggested that the functioning of the HPA axis may be altered in patients with IBD and this may be important in relation to stress induced increases in disease activity. Usually, the release of CRF within the pituitary, and hence the serum concentration of cortisol, is increased by inflammatory cytokines, particularly IL-6. As the prevailing action of cortisol is anti-inflammatory in this context it provides a negative feedback which reduces inflammation. However, in a study of 64 patients with UC, serum concentrations of cortisol were found to bear no relation to serum IL-6 levels or to scores of disease activity.
The function of the ANS may also be altered in patients with IBD as some authors have reported marked autonomic nervous hyperreflexia in patients with UC and CD.
Psychological Stress And Gastrointestinal Motility And Water And Ion Secretion
As in humans, acute stress in the form of restraint stress, loud noise, inescapable foot shock, or water avoidance all increase colonic motility and defecation in the rodent. The mechanisms for these changes involve CRF and its receptors .
Similar alterations in ion and water transport to those seen in humans are also well described in animals in response to psychological stress. Increases in gastrointestinal water and chloride ion secretion occur in response to restraint stress in the rat. It is now recognised that, as with changes in intestinal permeability, this secretory response is related to both cholinergic nerves and mast cells as it was increased in cholinesterase deficient Wistar-Kyoto rats, blocked by pretreatment with atropine, and absent in mast cell deficient rats. Restraint stress also increased colonic mucus secretion in ex vivo colonic segments and in vivo, as measured by histological goblet cell depletion. This effect could also be reproduced by peripheral CRF administration and inhibited by mast cell stabilisers.
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Crohns Symptoms: Identifying Your Triggers
Before you can avoid triggers, you must identify them. Because triggers can vary from person to person, the best strategy is to keep track of the circumstances surrounding your flare-ups. Answer these questions a doctor would ask:
- Are you taking ibuprofen, aspirin, or a similar medication?
- Were you recently on antibiotics?
- Did you recently have an infection?
- Have you traveled recently?
- Do you smoke?
- In the week before your flare-up, did you experience stress or anything unusual?
Another useful way to identify triggers is to keep a food journal. That way, you will know everything you ate within 24 hours of experiencing symptoms. Its probably not necessary to write down every bite, Sartor says, but it makes sense to get into the habit of listing the foods and beverages you consume each day, particularly ones that commonly trigger Crohns symptoms.
What Loved Ones Can Do
Here are some ways you can support someone you care about who has Crohnâs disease:
Respect their privacy. You may want to learn more about the disease to understand what theyâre dealing with. But to some people, that could feel like you’re invading their privacy. Talk to them before you do a lot of research. Or learn more about Crohn’s together.
Listen. If they share what life is like for them, listen with an open mind. Avoid the temptation to offer advice if thatâs not what they want. Instead, be empathetic.
Donât judge. Your loved one may need to reschedule or cancel social events with little notice. Your understanding can ease the anxiety or disappointment they may feel. Keep your opinions about their food choices to yourself. And understand that they may not be able to handle the same physical tasks as other people.
Build their self-esteem. Crohn’s or treatments for it might change your loved oneâs appearance and make them self-conscious. Do what you can to boost their self-image.
Crohnâs & Colitis UK: âSupporting Someone With IBD: A Guide For Friends and Family,â âMental health and wellbeing.â
Cleveland Clinic: âTaking Care of Your Mental Health Is a Key Piece of the IBD Puzzle.â
Mayo Clinic: âCrohnâs disease.â
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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.
Effects Of Stress On The Systemic Immune System In Humans
The effects of psychological stress on the systemic immune and inflammatory system are complex, and depend on both the duration and intensity of the stressor. Both chronic stress and acute stress are associated with alterations in systemic immune and inflammatory function which may have relevance to the pathogenesis of IBD.
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Response To Acute Stress In The Presence Of Chronic Stress
The physiological and immune response to acute experimental stress is exaggerated by the presence of chronic psychological stress . Individuals with high chronic stress levels, such as those caring for a long term dependent or women with a strong family history of breast cancer, showed greater and more prolonged increases in sympathetic activation in response to acute stressors than controls. This was associated with a greater increase in NK cell numbers, albeit with an attenuated increase in their activity, in the chronically stressed subjects than in controls.
Summary of the effects of adverse life events and acute experimental stress on systemic immune and inflammatory function in humans
Ibd Medication Side Effects
Some drugs used to treat IBD may contribute to oral symptoms.
For example, the immunomodulator methotrexate and the aminoacylate medication mesalamine can cause mouth sores. The antibiotic metronidazole, which may be used to treat infections that occur alongside Crohns disease, can cause a metallic taste in your mouth.
Crohns disease doesnt have a cure, but treatment can help you manage the symptoms. The primary treatments involve:
- taking steroid tablets and other medications to treat inflammation in your GI tract
- taking tablets or receiving injections to prevent inflammation from returning
- undergoing surgery to remove a small part of your intestine
- resting your bowel by drinking special liquids or receiving nutrients through an IV
You may use several types of medication to manage symptoms, such as:
- Aminosalicylates: These medications contain the active chemical 5-aminosalicylic acid to help reduce inflammation. Doctors typically recommend them in milder cases of Crohns disease.
- Corticosteroids:Corticosteroids, also called steroids, help decrease inflammation and reduce immune system activity.
- Immunomodulators: These medications reduce the activity of your immune system and decrease inflammation in your digestive tract.
- Biologic therapies: These medications neutralize proteins made by your immune system to reduce inflammation in your intestines.
Your doctor may also recommend specific treatments to target mouth sores or other oral symptoms, such as:
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Contact Your Doctor At The First Sign Of A Flare
You should contact your doctor if you think you are experiencing a flare so he or she can test to see if the flare is due to an infection, or determine if any new medications or exposures, such as recent antibiotics, might have triggered the flare. In the absence of infection or another reversible cause of the flare, your gastroenterologist may recommend a treatment course of corticosteroids, either topical or systemic .
Symptom flares can also indicate a change in your bodys response to your current treatment. For example, each year a portion of patients who take either immunomodulator or biologic medications such as infliximab or adalimumab stop responding to their medication. Sometimes a major symptom flare can signify that these medications are no longer working. Your doctor can perform tests to confirm if this is the case and, if necessary, switch you to a different medication.
Can A Health Psychologist Help You
If youre already frequenting your doctors office, makingyet another medical appointment mightnot be at the top of your things I want to do list.
But seeking help to cope with the mental and emotional aspects of the disease can be an important step in improving your quality of life and managing symptoms. Research suggests that the gut and the brain are connected through the gut-brain axis, and that stress may make symptoms worse.
My job is to talk to patients about all of the things that come along with being diagnosed with a gut condition, whether thats stress, anxiety or depression, or the lifestyle modifications that need to happen, Dr. Lupe says.
We also look at things like body image issues, the stress and fear that can sometimes come along with having to use the bathroom frequently, and even things like talking to our partners about sexual performance after being diagnosed.
A psychologist may recommend one of these forms of therapy:
- Cognitive behavioral therapy, which focuses on changing thinking and behavioral patterns.
- Acceptance and commitment therapy, where people learn to accept the challenges that come with their condition and focus on being present and mindful in their situation.
- Hypnotherapy, which uses mind-body techniques to help people reach a relaxed state where they are more open to suggestions which may influence the quantity or intensity of symptoms.
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