How stress causes a nervous stomach and bad digestion
Copyright 2011 by Morris Rosenthal All Rights Reserved
Diamond symbols linked to decision text. I'm
not a doctor, these are my observations on troubleshooting my own digestive
problems. I'm currently reading the first academic tome on the
immune system and its integral
connection with mental and physical health which makes any sense.
Anxiety causing vomiting, diarrhea and frequent bowel problems
Is the problem stress related? If you haven't even considered stress as a possible cause for your problems, think about it now. It came as a shock to me when I was in my mid-twenties and suffering from all sorts of dizzy spells and digestive problems, when I eventually figured out they were caused by stress. I actually went to doctors back then, I think it was the one job in my life where I had health insurance, and not one doctor asked me, "Are you working seven days a week, ten, twelve, fourteen hour days, and commuting 50 miles each way on Rte #128 and the Mass Pike at 85 miles an hour?" I couldn't figure it out, because I thought I was superman. Turns out, stress was usually my main trigger for digestive problems. I used to eat breakfast in the car, lifting myself up to let the gas out, and still didn't figure it out that those symptoms, and speeding in traffic, could be related.
It seems to me that when I was a kid, stress was associated with ulcers 100%, but that now, doctors have gone almost 100% the opposite direction, saying that ulcers are caused by bacteria and stress and anxiety have nothing to do with it. I suspect the truth is somewhere in between. I know that the pains I associate with ulcers, a continual sharp pain in the side, often accompanied by heartburn, I have only experienced during extended times of stress. These are the pains that antacid helps with for a while, but eventually, the body seems to just produce more and more acid until you're eating Tums like candy. There are many acid inhibitor drugs out now, over the counter, and if I had the kind of pains I did when I was in my twenties and was a stress junkie, I'd probably self diagnose overproduction of acid and try them.
Obviously, not all GI (Gastro Intestinal) problems are caused by stress, but I would bet that most are made worse by stress. I've known I have a nervous stomach since I was a child, probably before I got out of the single digits. Since being sick is in itself stressful, there's a negative feedback loop, that for many people with ulcers or inflammations in the intestines will send them in a downward spiral. As I studied up about intestinal problems on the web, I found that the two "IB" groups were often confused. IBD stands for Inflammatory Bowel Disease, which includes problems that can be tested for, like colitis and Crohn's. IBS stands for Irritable Bowel Syndrome, which includes problems that can't be diagnosed, and which doctors therefore group into IBS rather than saying "I don't know." IBS is closely associated with stress, with some researchers believing it's basically a brain/body communication problem. What both groups share is that the diseases or syndromes, take your pick, aren't usually curable. If you go to a surgeon, you may end up with surgery, and that may relieve some of the symptoms, but the idea that removing your colon is a cure for a colon condition is an abuse of language. Self diagnosis may not lead me to a cure, and if I miss something major, I could end up worse off. But the alternative is being sick, as opposed to just having stomach problems. I've seen too many people take on the "I'm sick and therefore I'm special" mindset and let it run their lives, for me to be tempted to go that route myself.
Do you suffer from diarrhea and the mad dash for a toilet? There's diarrhea and then there's serious diarrhea. Diarrhea that results from food poisoning or some stomach bug and then clears up like it never happened is part of life. Diarrhea that occurs regularly is always a problem, for quality of life if nothing else. I stopped eating in restaurants for a decade or more after a couple incidents of diarrhea that had me running from the table in the middle of a meal to spend fifteen minutes in the bathroom as my colon turned itself inside out. I find it pretty intolerable to be stuck in situations where the people I'm with feel they have to check up on me to see if I'm OK, even family, so I just stopped eating out. Diarrhea is largely caused by the muscles around the large intestine pushing the refuse through too quickly, so the liquid doesn't get absorbed. The trick for self diagnosis is figuring out why your digestive system is dumping the colon in a hurry, and it could be due to anything from an inflammation of the large intestine to the brain sending the wrong instructions.
Serious diarrhea is full of blood or acid. I've not experienced bloody diarrhea that I've noticed, which is often a sign of ulcerative colitis. But they again, not having bloody diarrhea doesn't exclude colitis. For decades, I suffered from acid diarrhea, stronger and stronger over the years until it felt like I was passing battery acid. When it shows up every couple months it's bad enough, when it got to a couple times a week, I actually considered seeing a doctor. But then it would normally clear up, perhaps in part because I would get very careful about my diet, avoiding alcohol and coffee, which I once considered a laxative. About a year ago, after an intestinal blockage and a couple months of being sick with swollen bowels, burning pains and cramps, I realized I hadn't had the burning acidic diarrhea for a while, and a year later, it still hasn't returned. How's that for a silver lining, though I wonder if it has something to do with the gallbladder not functioning (the gall bladder releases heavy duty bile when the digestive system calls for it) and the permanent stitch in my right side.
Having the sudden urge for a bowel movement and having to sprint to the bathroom (or the woods) and barely getting your pants down in time is termed "sudden fecal urge." For a baby with a diaper it would be no big deal, but for an adult outside the home, sudden fecal urge is a game changer. Stress is often a trigger, the old animal "fight or flight" mechanism functioning somewhere deep in the brain sometimes figures you'll be fitter for survival if your body can put all of it's effort into pumping blood and just dump everything else. It seems to me that periods when I'm frequently rushing for the bathroom are accompanied by passing mucus, sometimes nothing but mucus, a clear gel that I assume is from the lining of the large intestine. Passing transparent goo can be a symptom of ulcerative colitis or any other inflammatory bowel disease (IBD).
The real problem with sudden fecal urge, to my thinking, is it can turn into a self fulfilling prophecy. If you get to feeling you're "trapped" whenever you're in a theatre, bus, car, etc, the trapped feeling could turn out to be the very stress that brings on the urge. While riding out waves of panic or anxiety may be important in overcoming those problems in general, I haven't seen it work with the need to defecate - you don't want to tell yourself it's all in your head until the moment it's all in your pants. For the main part, a good diet combined with regular bathroom habits is the best defence, and regular bathroom habits pretty much require a regular life. I don't know if taking meals at a precise hour of the day helps or not, but staying up very late or getting up very early often impacts regularity if it goes on for more than a day or two. One useful habit I picked up when I had to go out a couple hours early twice a week was to get up even earlier than needed those day, to take my time having breakfast, so I was usually able to relax and use the bathroom before going out.
Another problem can be frequent defecation. Instead of having a bowel movement once or twice a day, all of a sudden it's six times, or ten. You start to wonder where all the crap is coming from, especially if you are eating less than usual. The laws of conservation of energy, as applied to the digestive system, suggest that you can't be putting out more than you're putting in, so odds are that frequent bowel movements are much smaller than normal, even if they feel the same. The only way to really take note of what's going on is to start looking in the toilet after you go, and to make a habit of it so you notice changes in the size, color and consistency of your poop. No fun, but necessary. And if you want to find out how long it's taking food to complete the trip through your digestive tract, just eat a market, like canned corn, which doesn't get fully digested, or beets, which stain everything purple or dark red.
Do you feel you can't eat and experience vomiting when you do eat? Not everybody suffers from stress or anxiety, and those who do can have very different reactions. Some people eat like crazy when they're nervous, others can't even look at food without getting nauseous. I'm in the second camp. When I was at my worst, I'd have trouble eating a real meal for a week at a time, and often spend the night curled up around the toilet vomiting my guts out if I did force something down. I used to get the dry heaves so bad that I worried about tearing abdominal muscles. I eventually figured out that it the best I could do was to keep some prepared food ready to eat on an instant's notice, like a tuna sandwich in the fridge, and if I could stomach it, to eat a bite and put it back. I suppose there are all sorts of drugs you can get from a doctor that would calm you down enough to eat, maybe even to overeat, from what I've seen:-) The only cure I found for stress related eating problems myself was exercise, which I'll get to later.
There are foods that are traditionally thought of as stomach friendly, like white rice, yogurt, toast. Toast won't work if you're on a gluten free diet, but the idea is to keep it simple and to try to get an appetite back. Keeping pot of cooked rice around is a good idea, it lasts for many days, and I've found the Activa yogurt, the stuff that supposedly has beneficial bacteria in it, to be helpful in general. I would stay the hell away from soda, coffee and booze if you can't eat, and drink water. Many people have lactose intolerance to varying degrees, which makes self diagnosing from symptoms tricky. Some moderately lactose intolerant people are fine with Yogurt, hard cheeses, minor amounts of dairy, others get gas, cramping and pain from ingesting just a little. I stopped drinking milk by the time I was 11 or 12 because it always gave me gas, and I don't remember that I ever talked about it with my folks other than saying I hated milk. Kids are funny that way. In my 40's, it's seemed to get somewhat worse, but it's hard to tell with everything else going on.
If there's some activity that you know relaxes you, it's not a bad idea to try it right before you want to eat, and see if you can get down a modest meal. Of course, people who have never had trouble with stress and getting obsessed over problems that can't be controlled will give you that useless advice "Think about something else." I've never any luck with passive mind tricks, other than meditation, and that only worked for me when I was only a little wired. But recently I discovered that producing little videos for YouTube really drives everything else out of my head because I'm concentrating so hard on trying not to say "Uh" and on trying to say something intelligent. If you have a little FlipCam or digital recorder, give it a shot. Make a how-to video, something you can do just sitting in a chair to start, don't go overboard with creating a set with props and lighting or you'll just get stressed over that. If you find that by the tenth take you're focused on what your saying and otherwise relaxed, take a break and eat something from the fridge.
And try to relax after you eat. We're all used to jumping up from the table, if we bother to sit down to start with. If I recall, Americans are the second fastest eaters in the world, after Mexicans, and Mexicans have an even higher rate of intestinal problems than we do. If you don't eat with family or other people and stretch it out with talk, eat with a newspaper. I won't recommend eating in front of TV because I stopped watching a few years ago, but if it keeps you in one place without getting worked up, it might be a good idea. Just don't watch the evening news while eating, that's enough to get anybody stressed out. If you eat out a lot, try to sit at the table for fifteen minutes when you're done, sip a cup of tea, or make sure when you leave that you stroll rather than hurrying. And if your work schedule or life style don't allow for relaxed meals, that might be the proper diagnosis of your symptoms right there. Don't work while you're eating, that's called being stupid.
Does it feel like you have an alien in your stomach, or that your intestines are blocked? I assume that everybody has seen the movie "Alien" where the parasitic creature grows in the guy's stomach and then bursts out, killing him in the process. A few times in my life, I've felt like that guy, and actually been able to see the skin over my stomach lurching and rippling as the muscles around the intestines fired all out of control. Thinking about it now, I was probably lying on my back at the time, which is a pretty dumb thing to do if you can't sleep or if your stomach is convulsing. If you look at pictures of how the guts are arranged in the body, the colon, or large intestines, do a big loop around the outside of the abdominal cavity, ending in the exit (rectum) on one end and the appendix on the other end. Nobody seems to know why the appendix is there, but half of the online diagnostic tools for abdominal pain will send you rushing to the hospital with a possible appendicitis attack. The length of the large intestine depends on the size of the individual, probably in th range of 4 feet to 7 feet. The small intestine is much longer, it's the part all piled up like pasta under the stomach where the absorption of nutrients takes place. What keeps food moving through the intestines is muscle contractions, but they should be very gentle and something you would never notice.
Intestinal blockages can be extremely painful, especially if gas builds up behind the blockage and can't be released by burping. Stress may lead to intestinal blockages, either though the effect on your digestive process, or by the unconscious tensing of muscles. If all of your abdominal muscles are rigid with stress and the muscles around the intestines stop moving the food along, you can end up with constipation or with an actual blockage. Eating food that's difficult to digest at a time when your digestive system is functioning poorly is always a bad idea. When I'm stressed out, I try to stay away from fried food, meat, anything heavy, and eat more fruit and foods with soluble fiber. While high fiber foods, , like the super-high fiber breads many supermarkets sell these days, may help with regularity and soft bowel movements, they can also aggravate intestinal inflammations since the fiber is non-soluble, sort of like rubbing your intestine wall with sandpaper.
Have you tried exercise? To borrow a computer term, good aerobic exercise is like hitting Ctrl-Alt-Delete for your body. Sometimes it works for your mind as well, but it almost always works for the body. However, you have to get in shape before you can do enough exercise, regardless of your mental state and the physical condition you mental state has put you in, to do enough exercise to matter. And it has to be aerobic exercise, or at least for me it did. I used to be a serious home weight lifter, free weights, and a half hour workout never did anything for stress, it may even have made it worse. But a half hour or more of running, somewhere in the seven to eight minute mile range, has worked for every time save once in 20 years. That one time was when I didn't even try to stop thinking about the decision I was messed up over while I was out running, and literally ground to a halt after a few miles. Exercise is the best cure for a nervous stomach.
Exercise doesn't just bring your body back to some normative post-exercise state, it also encourages the body to heal itself. It is quite literally the best thing you can do for yourself if you look at your body as a piece of equipment that needs maintaining. It's not going to solve your emotional problems, but it will help you build the strength to deal with them rather than going into that downward spiral of failing mental and physical health that for some many people ends with hospitalization or prescription drugs. If you haven't tried building up to where you can do aerobic exercise for a half hour or 45 minutes a day, you haven't tried exercise at all. Walking around the block or climbing up and down the stairs doesn't count - you need to get your heart rate up and keep it there. Long walks at a fast pace, over an hour or so, may help some, but not as much as serious exercise.
Do you drink caffeine or alcohol? Yes, you've been drinking coffee every morning your whole life and it never bothered you before. Yes, you know how to handle your alcohol and you were drinking before you were old enough to drive. It doesn't matter. Our bodies age, things changes the metabolism, and both caffeine and alcohol are bad for stress and can trigger intestinal problems. If you haven't tried dropping coffee and alcohol for a couple weeks, try. If you try and you can't do it, you have a different problem, and should deal with that. I'm harping on coffee and alcohol because their dual role here, in adding to stress and triggering digestive problems. Both have a third effect, which is increasing urinary frequency for men, leading to waking up three or four times a night, which also adds to stress and digestive problems.
I associate drinking neat Scotch with intestinal pains in the morning, going way back to my teens. Why didn't I ever stop? I did, many times, haven't had a drink for at least six months at this date, but I really like the stuff. What I don't like is diluting it with water, I like the bite. It seems to me that even drinking Scotch on the rocks (ice) is less problematic, as the melted ice cubes end up diluting it by half. If you can't break yourself of drinking for long enough to to a trial, at least make yourself drink a good glass of water before bed and again when you wake up in the night. There's no solution for coffee, drinking it weak is gross, so I dropped it last year and haven't gone back. It may be that coffee was my main trigger for diarrhea.
Have you changed your diet or tried meditation? Some alternative medicine practitioners will attribute everything that happens in your life to your diet, which is very stupid indeed. You aren't what you eat, even though what goes in largely controls what comes out. Once the stuff is broken down by your stomach and absorbed through the intestines, your body doesn't know what food it came from or how it was grown, it's all a myth. But just because so many of the diet preachers are certified whackos doesn't mean that diet isn't important. Even if stress is the main trigger for your dietary problems, it's probably acting in conjunction with eating habits that wouldn't bother you when you're at full mental and physical strength, but sneak in when you're weakened by constant worry, lack of sleep, over generation of acid, etc. So knock off the fried food, the hot sauce, the sweets and rich food for a while and see if it helps. And be fair about judging the results. A minor change in diet is likely to result in a minor improvement, not in your return to full normal.
The best time to mediate may actually be while you are eating. It's not traditional meditation, but to eating slowly and chewing every bite will almost certainly help your digestion, even if it doesn't do anything for your stress. Treat eating like a breathing exercise, concentrate on every texture in your mouth, make sure it's all well chewed before swallowing. If you're having trouble eating anything at all, chewing for a long time can help relax you enough to swallow. If you're used to eating with a tablespoon, use a teaspoon instead, and try to avoid drinking while you are eating and swallowing air (adds to gas). Some people find meditation to be a cure all. I tried it for around a year, and while it took my resting heart rate down from 80 something to 70 something when I wasn't meditating, I never mastered it to the extent that I could achieve calm quickly, or when I really needed to. By comparison, when I took up running the following year, my resting heart rate dropped into the 50's, where it remains today as long as I'm on a running schedule. I never sought a meditation teacher, though, which probably would have made a difference. But maybe the difference would have been a shaved head, and orange robe and a begging bowl. In any case, it's important to try multiple stress relief mechanisms to find out what works for you.
Have you changed your life, including your job? The modern American ideal seems to be that we should all be able to live as if we were the strongest and toughest person we can imagine. If your roommate can sleep with the college kids partying downstairs, why can't you sleep? If other salesmen think the job is a cake walk, why shouldn't you? The answer is, we're all different people, with different aptitudes, strengths, and vulnerabilities. Trying to cover those differences up with pharmaceuticals works for some individuals, but when I hear yet another person relating how on Prozac, they feel like themselves for the first time in their lives, I just want to cry for them. If you're stressed out because your friends swap sex partners like candy (and guard their toothbrushes like treasures) and it's not your scene, you need a new set of friends. If your family drives you insane, better to leave home than for you all to be miserable. If school isn't for you, find a job, and if your job makes you crazy, try to figure out why it makes you crazy so you can find a different job that will work. Some of us feel in our hearts that owing money is bad, but other people don't feel anything about it. If your friends all run up their credit cards and you are going into sick debt keeping up, get new friends.
Work is the other major source of stress since most people spend about half their waking hours either at work, commuting, or getting ready for work. Lives revolve around work as much as they do around family, but many people try to convince themselves that family is the only thing that matters and work is just this place you go to get money for the family. I have no doubt that approach works for some people, but not for most. Working inevitably involves relationships with bosses, employees, customers and vendors, all of which can be good or bad, and which many people can't avoid taking home with them. The old approach was to tough it out, to ignore stress and symptoms and keep at it. Again, the modern approach is to deal with work generated stress by taking pharmaceuticals, so that it won't bother you anymore than it bothers the some other person at work who doesn't even understand why you're upset. But it's the classic case of treating the symptoms while letting the underlying problem run amok. You should be able to figure out if you hate your job, and if you do, a change may clear up your stress and your digestive problems. It's worth considering before you go to any radical extremes in medical treatment.
Some digestive problems are due to diseases, deformities or damage to your intestines or stomach. If your symptoms agree with an infection that an antibiotic could treat, it would be dumb not to take it. If you have cancer, it's probably won't go into remission on its own, no matter what diet you try or however many crystals and healings you fool around with. But as you read up about various dietary problems that are triggered by, or made worse by stress, you find that most of them aren't curable. I've read big chunks of material on inflammatory bowel diseases and irritable bowel syndrome where the authors deliver the sage advice that "maintaining a close and active relationship with your physician is the most important thing you can do." Huh? The physician can't cure the disease if there isn't a cure, the episodes and severity will wax and wan on their own, so what exactly is this physician relationship supposed to achieve for you? It's puzzling to read through some of the online support groups where people with problems just like mine proudly list all of the tests that have come back negative, as if they've accomplished something and it makes them special.
Most physicians realize they can't do anything for your stress, other than prescribe happy pills, because you're unlikely to make the changes in your life that will alleviate stress. If you were willing to make those changes, you'll probably lose your medical insurance and won't be talking to doctors anymore. Doctors are simply the easy out, the way people can justify to themselves not taking difficult actions, they way they abdicate responsibility for their own lives. If you know your intestinal problems are caused or aggravated by stress and your doctor just smirks and ignores you, try another doctor. They aren't all the same. One of the things that keeps me from going to doctors myself is that I know enough of them socially to know how hit and miss the profession is when it comes to finding a good doctor. The average doctor is average - that's by definition, and half of doctors are below average. Keep it in mind if you go that route.