Study Shows Impact of Irritable Bowel Syndrome on Mental Health is Not Exclusive to Individuals

New research found that irritable bowel syndrome (IBS) can take a big toll on an individual’s mental health.

A recent study published in the Irish Journal of Medical Science found a strong link between IBS and an increased risk for anxiety, depression, and suicidal behavior. The findings suggest healthcare providers should pay regularly screen IBS patients for common psychiatric disorders.

Between 10% and 15% of Americans have mild to severe IBS symptoms. While the condition varies from person to person, it commonly involves alternating bouts of diarrhea and constipation. It’s not a life-threatening disorder, but the inconvenience and embarrassment that comes with GI issues can emotionally and mentally affect a person.

“Many people believe if they didn’t have IBS symptoms that bothered every inch of their life, they wouldn’t have anxiety or depression,” said Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in California who was not involved in the study.

An overwhelming majority of people with IBS do not develop severe forms of anxiety and depression, continued Dr. Farhadi. He added that it’s improbable for IBS-related mental conditions will force you to be committed to a hospital or psychiatric facility. Instead, he advises readers to focus their attention on making specific lifestyle changes to manage IBS.

In order to link IBS with mental illness, the research team looked at how many people with IBS also had a psychiatric disorder. They collected medical information from the Agency for Healthcare Research and Quality’s National Inpatient Sample database, which had data on millions of hospital stays in the U.S.

From 2016 to 2019, there were 1,256,325 hospitalizations from adults with a confirmed IBS diagnosis. Of these, 38.1% had anxiety and 27.4% had depression.

Hospitalized patients with a history of IBS were more likely to have a coexisting psychiatric diagnosis than the general adult population. About 38.1% of people with IBS also had depression or anxiety compared to 15.1% of people without IBS. While smaller odds, 5.22% of people with IBS had bipolar disorder, compared to 2.38% without IBS.

There were several factors that influenced a person’s odds of having a psychiatric condition. Those with IBS with mostly diarrhea (IBS-D) were more likely to develop anxiety and depression. Those predominately with constipation (IBS-C) had a greater chance of developing anxiety symptoms. Those with a mix of diarrhea and constipation (IBS-M) had greater odds for depression. All three subtypes were associated with suicidal ideation and suicidal attempt.

Younger patients with IBS were more likely to have anxiety, while older adults showed higher rates of depression. Women showed signs of anxiety and depression more than men, but they experienced lower signs related to suicidal behavior. Across all races and ethnicities, white patients had increased odds of anxiety, depression, and suicidal ideation.

There are some issues to consider before drawing conclusions from the study. First is the group of patients handpicked by the study authors. Dr. Farhadi noted that a majority of people with IBS never seek medical attention because most are mild cases. Those who require hospitalization for IBS tend to skew toward the most severe and extreme cases, which is not reflective of the general IBS population.

While Dr. Farhadi did acknowledge that the rate of anxiety or depression in IBS patients might be a little higher than in people without IBS, it wouldn’t be to the degree seen in the current study. Based on the findings, he stressed that people with IBS symptoms shouldn’t be concerned or panicked that they will have depression or anxiety severe enough to land them in the hospital.

Another consideration to note is the assumption that IBS is the driving force behind psychiatric disorders. There is no single cause for IBS—the condition is believed to manifest from genetics, a severe intestinal infection, early life experiences, or changes to the gut microbiome. Changes in brain areas involved in regulating the gut could also contribute to the disorder.

“There is a direct and very powerful connection between a person’s mental state and their GI system,” explained David Feifel, MD, PhD, a professor emeritus of psychiatry at UC San Diego and director of Kadima Neuropsychiatry Institute. Research suggests mood disorders impact the gut enough to induce or worsen IBS symptoms by altering the speed and flow of digestion.

According to Sri Naveen Surapaneni, MD, a gastroenterologist at Memorial Hermann in Houston, one of the tell-tale signs of IBS is abdominal pain. Having diarrhea, constipation, or a mix of the two is also common. Other possible symptoms include bloating, gas, and feeling full even if you ate only small portions.

People who suspect they have IBS should keep track of their bowel habits, advised Dr. Surapaneni. You may find yourself having bowel movements you can’t control, or trouble passing it. Additionally, people with IBS tend to have large amounts of mucus when passing stools.

If you’re not sure whether you have IBS, it doesn’t hurt to get an evaluation from a primary care doctor who can then refer you to a gastroenterologist who specializes in IBS. Dr. Surapaneni recommended noting your symptoms for about six months before going to see a doctor, unless your symptoms start to interfere with your daily activities, you have bleeding, or you experience unexplained weight loss—then you should see someone as soon as possible.

While there is no cure for IBS, there are several non-pharmacological methods that may help curb your IBS and mental health symptoms.

Dr. Surapaneni noted that two-thirds of patients get better when they make healthy lifestyle changes, such as regular exercise, meditation, and getting the recommended hours of sleep. But the most important factor in avoiding an IBS flare-up is your diet. 

Most individuals with IBS have a food that triggers their symptoms. Some people can’t eat dairy while others may need to steer clear of breads and cereals made with refined grains. Even if you are not allergic to gluten, you may be gluten-sensitive or gluten-intolerant. 

Instead of testing out every food group and hoping for the best, Dr. Surapaneni advised following a low FODMAP diet. It’s a diet that removes specific kinds of carbohydrates that would irritate the GI tract. Research shows that up to 86% of people with IBS show an improvement in their IBS symptoms. Compared to other diets, it has been ranked as the best method for reducing abdominal pain, bloating, and disruptions in bowel movement.

What about the other one-third of patients who need a bit more intensive treatment? Dr. Surapaneni recommended those with a mental health condition and IBS would benefit from cognitive behavioral therapy and gut-directed hypnotherapy where a therapist puts you into a relaxed hypnotic trance where a therapist would give you gut-related imagery and suggestions. The ultimate goal is to strengthen the gut-brain connection.

If these do not work, your doctor may opt for pain relievers and anti-spasm medications to alleviate IBS discomfort. They could also prescribe anxiolytics or antidepressants to relieve the mental health symptoms.