Stress, Colitis, And Ways to Manage Both More Effectively

It has been established that stress is not the direct cause of ulcerative colitis, but research indicates that psychological stress can promote the condition by increasing the risk of experiencing flare-ups. No one knows what causes ulcerative colitis, although it is believed that an autoimmune action may be to blame. 

By learning how to manage your stress, you may be able to reduce the risk of experiencing a flare-up of symptoms of colitis. It may also help to speak with a counselor who specializes in helping people reduce stress that contributes to symptoms of inflammatory bowel disease.

What is ulcerative colitis?

Colitis is an inflammatory bowel disease that causes chronic inflammation and sores in your digestive tract. It affects the innermost lining of your colon (or large intestine) and rectum. Most people with an inflammatory bowel disease experience symptoms that are mild to moderate, which can vary, and usually develop gradually over time. For some patients, however, colitis can be debilitating and life-altering and may lead to life-threatening complications. It is most prevalent in Western cultures and East Asia.

Symptoms of ulcerative colitis may include:

• Abdominal pain
• Abdominal cramping
• Mild fever
• Rectal bleeding (e.g., if you notice blood traces in undergarments)
• Frequent bowel movements or recurring diarrhea (i.e., loose stools)
• Suddenly, a persistent feeling of having to go
• Fatigue
• Decreased appetite
• Nausea
• Dehydration
• Sleeplessness
• Weight loss
• Anemia
• Pain, redness, and swelling of the joints
• Liver problems

While the above symptoms may indicate that a person has colitis, only a healthcare provider can diagnose the condition. Diagnosis may involve ordering diagnostic tests, including an endoscopy, analysis of a stool sample (which typically requires storing stool in a container), and blood work (e.g., blood tests for anemia or infection). The diagnostic process may help providers rule out other disorders, such as irritable bowel syndrome, which doesn’t typically cause inflammation or show signs upon inspection of the colon. 

It was once thought that certain foods and stress were the factors ultimately responsible for causing colitis. Although the exact causes of colitis are still largely unknown, experts believe that some foods and psychological stress can aggravate the condition. Colitis is believed to be brought on by an autoimmune process, which is an immune system malfunction. This occurs happens when your immune system, designed to fight off viruses and bacteria, instead attacks healthy cells and beneficial bacteria (i.e. gut bacteria that help maintain balance). In other words, during an autoimmune response, your immune system turns on your body and goes after the digestive system and, in the case of colitis, causes colonic inflammation and ulceration.

Environment and genetics are also factors in the risk of developing ulcerative colitis. Colitis most often strikes people under 30 or in late middle age and is slightly more prevalent in men than in women. There is no cure for colitis, but treatment and management can alleviate symptoms and may lead to long-term remission in some cases.

The impact of stress 

Millions of people experience all types of stress daily for a variety of reasons, and stress may be linked to colitis flare-ups in some people. Psychological stress may contribute to colitis flare-ups or worsen symptoms in some people.

On the flip side, people with colitis may be more vulnerable to stress, to begin with, and rates of depression are also higher among patients who have colitis and other inflammatory bowel diseases. Those who have Crohn's disease or colitis have twice the risk of also developing a generalized anxiety disorder at some point in life, and for women, the risk is even higher, as many as four times the rate of men. 

Like stress, anxiety can cause more flare-ups. Other risk factors that make a colitis patient more likely to also experience stress may include increasing age, other severe diseases, lack of disease education, an ostomy procedure, and socioeconomic status.

The relationship between stress and colitis

The duration and intensity of the colitis reaction may relate directly to the duration and intensity of the stressor. For example, stressful events or difficult situations, such as being a caregiver or going through a marital separation, are more likely to trigger more severe colitis symptoms than a bad day at work or an argument with your best friend.

Stress may not directly cause the condition of ulcerative colitis, but it can aggravate its symptoms and increase the risk, frequency, and severity of flare-ups. Further, severe, chronic psychological stress may lead to increased intestinal inflammation. Colitis patients who also live with mental health challenges may be at a higher risk of reduced medication adherence, lower quality of life, and higher healthcare utilization.

Under stressful conditions, the human body prepares for fight or flight by producing proteins called cytokines, releasing the stress hormone cortisol, and producing adrenaline. These biological processes stimulate the immune system to help fend off injury or infection, which then activates inflammation throughout the body, including the colon. If an individual has colitis, this can lead to a flare-up.

The Crohn's & Colitis Foundation talks about the GI (gastrointestinal) stress cycle: Initial GI discomfort (nausea, abdominal pain, or diarrhea) leads to unhelpful thoughts, such as "Uh oh, not again…," which can then cause negative emotions like stress, frustration, anxiety, embarrassment, and anger. These negative emotions may trigger what is known as sympathetic arousal, with biological processes like increased heart rate and perspiration, decreased respiration, tightening of muscles, and eventually, additional GI distress kicking in. Finally, we arrive at the worsening of GI symptoms, which starts the cycle over again. Breaking the GI stress cycle can be as simple as focusing on taking deep, diaphragmatic breaths, and muscle relaxation can begin to slow the sympathetic arousal mechanisms.

One additional hurdle a colitis patient may face is getting a dual diagnosis in the first place. Physicians who usually care for those with ulcerative colitis may not have much formal training in identifying or diagnosing mental health disorders, much like psychologists and therapists wouldn't normally look for or recognize the symptoms of colitis. Experts urge patients to speak up if they believe they have symptoms of both ulcerative colitis and stress. They also encourage doctors and therapists to educate themselves on the comorbidity of colitis and stress and to be on the lookout for one where the other has been diagnosed.

For patients, one step that may help in managing colitis and stress can be securing the right healthcare team, chiefly a gastroenterologist and a psychiatrist, psychologist, or therapist.

Manage your stress, manage your colitis

Managing symptoms of psychological stress may not cure chronic colitis, but it may help alleviate some of its symptoms and reduce the frequency of ulcerative colitis-related incidents. 

Avoiding psychological stress entirely can be unrealistic. Therefore, it's unreasonable to think that you can manage your ulcerative colitis by keeping stress out of your life. You can, however, realistically keep your stress levels down by eating well and avoiding foods that cause your ulcerative colitis to flare up. Try incorporating whole grains, nuts, seeds, and fibrous fruits into your meals, but with the guidance of a healthcare provider. It can also be helpful to take any prescribed medications as directed, sleep well, exercise, have a strong support system, and commit to taking time to relax through methods of self-care. Yoga can be especially effective because, in addition to relieving symptoms of stress, yoga has also been shown to relieve symptoms of ulcerative colitis.

Cognitive behavioral therapy can also be beneficial. Using CBT techniques, a psychologist or therapist can help you learn to observe your negative thoughts and then change or reframe them. Instead of "Oh no, here we go again…," you might think, "I'm going to face this flare-up more calmly, so it will be less severe than last time." Studies show that CBT may not eliminate the symptoms of colitis, but can improve one’s quality of life. 

Other tried-and-true strategies which have been recommended for reducing psychological stress include:

• Light aerobic exercises, like walking, swimming, or tai chi
• Reading or listening to a book
• Writing in a journal
• Guided meditation
• Hypnotherapy
• Massage therapy
• Joining a support group
• Pursuing hobbies and activities that you enjoy
• Planning by knowing where bathrooms are in advance and always having supplies and a change of clothes on hand
• Emotional control through focused strategies, like learning to accept the situation, constructive self-talk, and letting go

It can be essential to recognize the common signs of emotional trouble and get help for stress if you need it. Treating your colitis may not entirely alleviate your symptoms of stress (and vice versa), so while getting digestive issues under control can be helpful and important, it might not be enough. You can get support from a healthcare professional to manage your mental health, just as you would for your physical health.

Online counseling with BetterHelp

Managing your mental health can be just as important as taking care of your physical well-being. If you are experiencing mental health concerns like stress, consider reaching out to a qualified counselor online. BetterHelp is an online counseling platform that allows you to receive care from your home. Worrying about all the details of therapy may cause you to take on more stress, but BetterHelp seeks to eliminate those worries. You can easily sign up and be matched with a therapist using an online form and choose to talk through: 

• Phone calls
• Video chats
• In-app messaging

You won’t need to stress about driving far distances to appointments or waiting for a spot to open up on a long waiting list. Instead, you can start getting the support you need when you need it. 

Online counseling can be effective for those experiencing stress. One study assessed the efficacy of a web-based program for reducing nurses’ stress levels. Researchers found that “participants experienced significantly greater reductions than the control group on the full Nursing Stress Scale, and six of the seven subscales.” Nurses with greater experience had even more pronounced benefits than those with less.