Man with IBD experiencing stress and flares
By Kerry Weiss

Medically reviewed by Matthew J. Hamilton, MD

Everyone experiences stress from time to time. However, when you have inflammatory bowel disease (IBD), it’s important to consider how factors like stress may impact your condition.

“There’s kind of a bidirectional link,” says Megan Riehl, PsyD, a clinical psychologist and assistant professor of medicine in the Division of Gastroenterology at the University of Michigan Health System in Ann Arbor. “Stress can certainly lead to increased risk of flare and triggering IBD symptoms, but then there’s also stress associated with just having IBD.”

In other words, it becomes a snowball effect, where it can be overwhelming to deal with the day-to-day of life with IBD when things like unexpected flare-ups of symptoms can strike at any moment—and yet, stress can actually trigger your symptoms and bring on a flare.

The Stress-Gut Connection

While exactly what happens in the body that links stress and your gastrointestinal (GI) tract is complicated, “We know that the brain and the gut are very connected,” says Dr. Riehl.

“Stress can increase GI inflammation through reduced HPA function, which is a role of your brain, and altered GI permeability. So there’s an actual brain-gut pathway that impacts our gastric secretions and inflammation, which impacts the functioning of the gut.”

What’s more, when you’re feeling stressed, you may be more likely try to cope with unhealthy habits like smoking or end up skipping your medication, which can in turn make IBD symptoms worse.

Take Steps to Keep Stress at Bay

Research has also shown that your individual personality may influence disease activity, and your individual personality traits can also play a role in your immunological reaction to stress—and how well you cope. So it’s important to recognize how you deal with stress, and take steps to keep it in check.

“Recognize that there are certain coping strategies that are helpful for managing stressors that are in your control,” says Riehl. Start with these steps:

1. Attend regular checkups. “Keep your medical team informed of changes in your health or your symptoms so they can give guidance and support based on the medical therapy you’re using,” says Riehl.

2. Eat a healthy diet. “Make sure you’re following a healthy diet,” says Riehl. “Try working with a dietitian to help facilitate those choices.”

3. Stay active. “Exercise when you’re able to, and modify exercise when and if you’re flaring,” adds Riehl.

4. Join a support group. “I always recommend participating with others that have IBD in more of a community setting,” says Riehl, who suggests getting involved with your local Crohn’s and Colitis Foundation affiliate. “Connecting and making meaningful relationships can help mitigate some of the stress by talking with others about similar issues.”

5. Know when to reach out for additional help. If you’re still having trouble managing the more emotional effects of stress or the emotional toll of living with a chronic disease like IBD, “That can be addressed with a psychologist or a mental health provider if you feel like you’re not getting everything you need through your support system,” adds Riehl.