Anxiety doesn’t directly cause IBS, but it may make your symptoms worse. Overlapping genetic pathways and two-way communication between your gut and your brain could help explain the link between these two conditions.

It’s fairly common to notice gastrointestinal (GI) symptoms when you’re feeling anxious. Known as having a “nervous stomach,” feeling nauseated or like your stomach is in knots is usually a sign that your body is experiencing a stress response.

Anyone can get a nervous stomach from time to time. But when you live with irritable bowel syndrome (IBS), anxiety can make symptoms such as diarrhea and abdominal pain significantly worse.

What’s more, GI symptoms may increase anxiety, creating an ongoing cycle of mental and physical distress.

Treating IBS and learning how to manage anxiety can help improve the symptoms of both conditions.

Anxiety and IBS are common comorbidities — separate conditions that happen at the same time.

For people with IBS, anxiety is a common comorbidity. This means anxiety occurs more frequently in people with IBS than it does in the broader population.

According to a 2023 research review, as many as one-third of people who have IBS also experience anxiety or depression. And one nationwide analysis of more than 1.2 million IBS hospitalizations found that 38.1% of people with IBS also had anxiety.

The exact reasons for this link aren’t fully understood, but experts believe disruptions in gut-brain communication, as well as shared genetic pathways, may help explain why IBS and anxiety frequently occur together.

The gut-brain axis

Your brain and your GI system are connected through a two-way direct communication network called the gut-brain axis. This shared system of nerves, lymphatic tissues, and blood vessels means immune and chemical changes in your gut can affect the function of your brain, and changes in your brain can affect the function of your gut.

IBS is classified as a functional GI disorder, a condition thought to be caused by changes in gut-brain communication rather than by structural or biochemical changes in your GI tract. As a functional GI disorder, IBS is naturally sensitive to emotional stimuli, such as anxiety, through the altered gut-brain pathway.

What would be just a nervous stomach in someone without IBS can result in symptom flares of diarrhea, constipation, bloating, and severe abdominal pain in someone with IBS. And because communication between your gut and your brain goes both ways, GI symptoms can also make anxiety feel more intense.

Genetic overlap

The gut-brain axis might not be the only contributing factor to IBS and anxiety comorbidity.

According to a large 2021 study, IBS and anxiety have similar genetic risk factors. This suggests that genetics that predispose you to IBS, for example, may also predispose you to anxiety — and vice versa.

What is the cycle of anxiety and IBS?

For many people, IBS and anxiety create an ongoing cycle in which one condition worsens the symptoms of the other in a continuous loop.

Anxiety can trigger GI changes that worsen physical symptoms in IBS, and GI changes in IBS can send signals to your brain that increase anxiety. In addition, the worse your IBS symptoms become, the more likely you might be to worry and stress about how they affect your daily life.

There’s currently no cure for IBS, but you can manage the symptoms through lifestyle strategies, psychotherapy, and medication (if needed).

Avoiding triggers such as anxiety is a big component of successful IBS flare-up management.

Anxiety reduction techniques

Anxiety reduction techniques are in-the-moment and proactive strategies you can use to help reduce anxiety. Examples of techniques to try when you need immediate relief include:

Examples of long-term, proactive anxiety reduction strategies include:

Lifestyle changes

Often, lifestyle habits can affect your emotional state. For example, consistently getting too little sleep can increase your stress level and worsen feelings of chronic anxiety.

Lifestyle strategies to help reduce anxiety include:

If you’re experiencing an anxiety-induced IBS flare-up, you may be able to manage your symptoms at home using:

  • in-the-moment anxiety reduction techniques
  • over-the-counter medications for pain, diarrhea, or constipation
  • heating pads
  • gentle abdominal massage
  • light to moderate physical activity
  • peppermint oil capsules

At your time of diagnosis, your doctor should have gone over what medications to use if you have a flare-up and when to call the office if symptoms don’t improve.

IBS affects everyone differently, and you’ll work closely with your doctor to create a flare-up management plan that works for you.

Chronic medical conditions can often have an emotional effect too. IBS symptoms can be painful, and some people feel self-conscious about experiencing bloating, gas, and diarrhea.

Anxiety in IBS is common — but so are feelings of depression.

If IBS is causing you psychological distress, you can empower yourself through symptom management and promote positive thinking by:

  • learning more about IBS and its management
  • tracking your symptoms
  • sticking to treatments as directed
  • joining IBS support groups
  • journaling
  • practicing mindfulness
  • using positive affirmations daily
  • focusing on habits that improve your overall wellness, such as proper nutrition and exercise

In addition to making any necessary lifestyle changes, you can manage IBS medically through medications and therapy.

Psychotherapy (also known as talk therapy) may help when anxiety causes IBS flare-ups.

Working closely with a mental health professional can help you learn to restructure unhelpful thought and behavior patterns that promote anxiety, such as rumination and catastrophizing. A therapist or counselor can also help you develop new coping strategies for both IBS and anxious thoughts.

Cognitive behavioral therapy, gut-directed hypnotherapy, and relaxation training are common psychotherapy methods that mental health professionals use to help people manage IBS.

Your GI specialist can prescribe medications to help relieve symptoms such as diarrhea, constipation, gas, and abdominal pain. Prescription medications will vary depending on the subtype of IBS you have, but here are some common examples:

For diarrhea:

  • loperamide
  • rifaximin (Xifaxan)
  • eluxadoline (Viberzi)

For constipation:

  • fiber supplements
  • laxatives
  • lubiprostone (Amitiza)

For abdominal pain:

Your doctor may also discuss the use of psychobiotic therapy. Psychobiotics, including probiotics, are substances that influence gut-brain communication. While this is an area of ongoing research, some evidence suggests that psychobiotic supplementation may help with both GI symptoms and psychological symptoms in IBS.

If cognitive and behavioral strategies aren’t effective enough to manage your anxiety, your doctor may add anti-anxiety medications to your routine.

Anxiety and IBS often occur together. Disruptions in gut-brain communication and overlapping genetic risk factors can help explain this common comorbidity.

Treating IBS and managing anxiety may help improve the symptoms of both conditions. Medications, lifestyle changes, and psychotherapy are standard options for IBS and anxiety treatment.