I’ve been in practice for close to 30 years and I’ve seen the effects of stress on people’s health. Tests get ordered, surgery gets performed, work is missed and relationships are strained from the effect of stress on our health. 60-70 million people have disorders of the digestive tract, with the most common being Irritable Bowel Syndrome with a worldwide prevalence ranging from 9-23% and US rates of 10-15% of the population. This is referred to as a Functional Disorder, meaning there is an absence of structural or biochemical abnormalities on common diagnostic tests to explain the digestive symptoms. Although 70% of people with “stomach issues” have mild symptoms and don’t go to the doctor, 25% have moderate and 5% have severe enough symptoms that they seek medical attention. 2.4-3.5 million people per year visit their physician for the functional disorder of Irritable Bowel Syndrome in the US alone. This is the most common disorder diagnosed by gastroenterologists and also accounts for 12% of the total visits to primary care. Cost estimates range from $21 billion upwards.
Stress is all around us, every day, but it is our attitude and our approach to life that determines how we will live. We must remember that we have the power to determine how we lead our life and we must never forget to smile! Please feel free to visit me at my smiley face office!
It is not stress that kills us, it is our reaction to it. Hans Selye
HOW DOES STRESS CAUSE DIGESTIVE PROBLEMS?
The exact cause is not completely understood but research has shown that people with functional gastrointestinal complaints have predisposing factors such as genetics, prior infection/trauma, or tendency toward anxiety and depression. Symptoms result from disturbance in colonic motility and increased sensitivity to food, gas or stool in the bowel.
Chronic stressful life events or psychosocial factors can disrupt the communication between the brain and gut known as brain-gut axis. More severe symptoms can be associated with psychological symptoms such as depressed mood or anxiety although not all people with functional symptoms have psychological distress.
Our greatest glory is not in never falling but in rising every time we fall. Confucius
THE CYCLE OF WORRY:
Emotional distress can worsen symptoms. Not uncommonly people with functional digestive complaints may develop symptoms while eating at restaurants or in social gatherings and then develop an anticipatory anxiety due to the fear of having an attack of diarrhea and this fear can then cause the symptoms keeping the cycle going. Stress can lead to abdominal pain and change in bowel habits to either constipation or diarrhea in most of us, but for most of us, this is temporary. When it is chronic, then there is considered to be a functional disease.
If you think you can or you think you can’t then you are right. Henry Ford
WHAT IS STRESS?
Stress is any real or perceived disturbance in our sense of feeling balanced. This can be in the form of physical stress (infection, surgery) or psychological stress (divorce, loss of job)
Our central nervous system releases chemicals in the brain that mediate stress and orchestrate an integrated autonomic, behavioral, neuroendocrine and pain modulatory response which alters the way the brain and gut interact. This altered brain-gut interaction can lead to functional symptoms. Pain, discomfort, fear, activation of a stress response and modulation of brain-gut interactions by stress mediators are part of a vicious cycle that needs to be interrupted for symptoms relief. In other words,
FUNCTIONAL DISORDER REPRESENTS HEIGHTENED SENSITIVITY OF THE BOWEL TO INTERNAL AND EXTRERNAL STRESSORS.
Therefore, both addressing and dealing with the stressors becomes the first step in symptom relief.
What lies behind us and what lies before us are tiny matters compared to what lies within us. Ralph Waldo Emerson
HOW CAN THIS COME FROM STRESS WHEN I HAVE REAL SYMPTOMS?
Stress generates visceral responses necessary for survival such as fear when we see a bear charging at us. Our blood pressure increases as does our heart rate and cardiac input to prepare for fight/flight. In functional digestive disorders, the upper GI tract (stomach and duodenum) has contractions and secretions, and with stimulation of the lower GI tract (colon) there will be motility and secretions. The former may contribute to the sensation of fullness and lack of appetite and the latter to diarrhea and lower abdominal pain. This response pattern of the digestive tract may have evolved in order to minimize exposure of small and large intestine to ingested food and waste material during a time when energy is needed to maximize success of the fight/flight response. When emotions shift to anger, the pattern of upper GI activity is reversed, with stimulation of gastric contractions and acid secretion.
The body can turn off this system immediately when it is no longer needed. Apparently these systems of activation and inactivation of stress response have been perfected to deal with daily threats to survival.
The greatest mistake you can make in life is to be continually fearing you will make one. Elbert Hubbard
WHY ME? THIS DOESN’T HAPPEN TO EVERYONE.
In the absence of predisposing vulnerability factors or in the presence of resilience factors (including strong support system) a large number of people are remarkably resilient to this chronic stress response. But if you have vulnerabilities (genetic, emotional or experiential) it frequently has significant consequences.
Research does seem to support the concept of “enhanced stress responsiveness” as a major vulnerability factor in functional disease. Under stress, the mechanism that turns off the stress response is overwhelmed and the nervous system cannot adapt. Fear of having symptoms is often sufficient in many patients to maintain the stress responsiveness in chronically enhanced state. Just wondering if you are close enough to the bathroom, or if you’ll be OK for the rest of the day if you don’t completely empty your colon in the morning is enough to create that anxiety that perpetuates the fear response.
When I look back on all these worries, I remember the story of the old man who said on his deathbed that he had had a lot of trouble in his life, most of which had never happened. Winston Churchill
WHAT CAN I DO?
Although little can be done to reverse your vulnerability because this has been programmed, cognitive and behavioral approaches may help protect you from the effects of the overload of stress and the cycle of symptoms.
You can develop effective coping styles towards life stress including reading, exercising, relaxation, yoga, meditation and social support.
I have learned to meditate, to read inspirational quotes and to read books about controlling my own happiness. I find these strategies to be very helpful. (See some books I recommend at the end of the article).
In addition, gradually adding more fiber and avoiding chocolate, sugar-free sweeteners, cauliflower, broccoli, cabbage, beans and dairy. And drink enough fluids but avoid alcohol, coffee, tea, caffeinated drinks and carbonated drinks can be helpful. Antispasmodics can also reduce muscle spasms and abdominal pain.
The most important thing you can do is to feel in control of your life and to feel that you are important.
In times of great stress or adversity, it’s always best to keep busy, to plow your anger and your energy into something positive. Lee Iacocca
HOW DO I KNOW IF MY SYMPTOMS ARE FUNCTIONAL OR NOT?
Stress induced functional symptoms are not associated with excessive weight loss, intestinal bleeding or blood in the stool, increased urination, fever, anemia or inflammation of the colon.
It may be associated with change in bowel habits, stools that are watery, hard, lumpy or contain mucus, diarrhea, constipation or a combination, the sensation of retained stool after a bowel movement, abdominal bloating, cramping, gas or pain, heartburn or discomfort after eating normal meals, frequent bathroom emergencies, and lower back pain.
Of course, it is always recommended that you let us decide what is causing your symptoms and the best strategy for their management.
The greatest weapon against stress is our ability to choose one thought over another. William James
I have learned much from listening to my patients over the years and I keep those lessons on my phone so I can read them whenever I want.
- Life is all about “the dash” which is the line on a tombstone between the date you were born and the date that you die. We all get to choose how to live our dash.
- Life can change in a moment so live with joy and not fear
- There are no mistakes if you learn from them
- Positive attitude does make a difference
- Surround yourself with people who are kind, caring and have a positive attitude
- Life is not a dress rehearsal
- You can plan for the future but live in the present
- It takes work to be positive but the benefit achieved from that effort is priceless.
- You have to work on your attitude every day to keep stress at bay
- S M I L E ! ! !
Make Each Day Your Masterpiece. Practical Wisdom for Living an Exceptional Life by Michael Lynberg.
Don’t Sweat the Small Stuff and It’s All Small Stuff by Richard Carlson
Happiness is a Choice by Barry Neil Kaufman.
True Love. A Practice for Awakening the Heart. Thich Nhat Hanh.
Happier by Tal Ben-Shahar, Ph.D.
The Precious Present by Spencer Johnson.
The Pocket Book of Positives. A reassuring Companion for Life’s Journey, Published by Arcturus.