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The brain-gut connection in IBS

If you have irritable bowel syndrome (IBS), you’ll be familiar with its troublesome symptoms that can leave you feeling out of sorts for days.

But more and more research is pointing to the connection between your gut and brain. So should IBS management include psychological treatment as well as physical ones?

Irritable Bowel Syndrome
Dr Lisa Das talks about IBS


  • Overview of IBS Overview of IBS

    IBS is a disorder of your digestive system, which can cause repeated abdominal pain, constipation and/or diarrhoea. It’s thought that IBS affects up to one in 10 of the general population.

    Some people battle with symptoms for years, despite endless changes in diet, lifestyle changes and medicines. The cause of IBS, however, isn’t clear, and doctors and researchers are looking to other treatment approaches.

  • Psychological factors of IBS Psychological factors of IBS

    An area that researchers now believe may be overlooked when it comes to IBS is psychological factors. Although IBS isn’t classed as a psychological disorder, it’s closely linked to stress and anxiety. This is because of the ‘brain-gut connection’.

    Research on this connection has revealed that stress and other psychological symptoms can affect your bowel. For example, if you don’t have IBS, you may have experienced the need to use the toilet more urgently or frequently if you’re feeling nervous. And if you have IBS, nervousness or anxiety can make your symptoms worse, or may even cause them in the first place. That’s because your colon is partly controlled by your nervous system, which responds to stress.

    The brain-gut connection works both ways. On one hand, heightening emotions can cause a chemical change in your body, which in turn can affect your digestive system. On the other hand, the uncomfortable and perhaps embarrassing symptoms that IBS can cause might lead to feelings of stress, anxiety or depression. Or make them worse.

  • IBS and mental health - the evidence IBS and mental health - the evidence

    Many people with IBS also have anxiety and depression. In fact, it’s estimated that three out of four people with IBS will have one or more episodes of depression. And over half will develop generalised anxiety disorder.

    People with IBS report a lower quality of life compared to people with other chronic conditions, such as diabetes. And alarmingly, in one study, 38 per cent of people with IBS said they had considered suicide because of their symptoms. These findings highlight that IBS can be much more than a physical disorder – psychological health is equally as important when it comes to treating it.

    The question is whether anxiety and depression are the cause or the effect of IBS. Or is it more complex, where each can make the other worse and therefore create an ongoing cycle?

  • Bowel treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including bowel treatment.

  • Psychological treatments for IBS Psychological treatments for IBS

    If you have IBS, you might find that adapting your diet can help relieve symptoms. There are also medicines available. These include laxatives, antidiarrhoeal medicines (to help relieve diarrhoea) and anticholinergic medicines, which can relieve abdominal pain by blocking spasms of your intestinal muscles.

    However, these therapies only help to relieve symptoms temporarily and may also cause side-effects. Many people who have IBS say that conventional medicines don’t give them the relief they need.

    But in recent years, there has been a shift in thinking about how to treat IBS. Increasing evidence is suggesting that psychological treatments, in particular, cognitive behavioural therapy (CBT), are effective for the management of IBS. Often in combination with changes to your diet.

    Treatments such as psychotherapy and hypnosis have also been shown to be effective for managing symptoms of IBS in the short and long term.

  • Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT)

    CBT looks at your patterns of thinking, as well as your behaviours, and how these may lead to negative emotions or actions. It’s been shown to help with many different mental health issues, such as anxiety, depression, panic, phobias and bulimia.

    CBT can also be applied to physical health problems. And the evidence for CBT and IBS is strong. It helps to reduce physical symptoms by addressing your patterns of behaviour and physical responses to certain thoughts.

    Take the following as an example. If you have IBS and believe that eating food in a public place will always cause you to have diarrhoea, you might avoid social situations. It may also cause anxiety when dining out at a restaurant or a friend’s house. The anxiety that is caused by this thought and behaviour process may then trigger diarrhoea. CBT addresses this thought process to help reduce anxiety in the longer term.

  • Talking to your doctor or finding a therapist Talking to your doctor or finding a therapist

    The evidence suggests that psychological factors are as important as the physical ones when it comes to IBS. It’s important that this aspect of care isn’t overlooked when you see your doctor or a healthcare professional about your IBS symptoms.

    Psychological treatments may well help you manage or even treat your physical symptoms. They can also help you cope with the day to day stress and anxiety that can come with managing a chronic condition. Talk through your options with your doctor.

    However, if you don’t feel comfortable discussing this topic with your doctor, there are other ways to seek help and advice. For example, our Finder tool can help you search for a mental health therapist in your area. Many therapists now have specific expertise in treating people with digestive disorders.

    Don’t suffer in silence or depend on medicines when you’re struck with a bout of IBS. Consider your mental health and wellbeing. It could be the key to reducing and managing your symptoms, and health professionals are available to help you explore this.

  • Symptom diary Recording your symptoms

    Irritable bowel syndrome (IBS) is a common digestive condition, affecting around two in 10 people in the UK. Not only is it an irritable nuisance, it can cause you pain, discomfort and distress. If you think you might have IBS, keeping track of certain factors can help you and your doctor understand what’s happening and take the right action.

    We’ve worked with our doctors, dietitians and mental wellbeing experts to design this symptom diary for you to track your symptoms. When you’re recording how you’re feeling, try to be as accurate, detailed and specific as you can. We recommend that you keep a diary for two to four weeks. This should be enough time to start showing any patterns or identifying any triggers. Share your completed diary with your doctor. Together, you can find out what’s going on and decide a treatment plan that’s right for you.

    Before you start, here’s some advice about the types of things to record.

    Your diet

    • Identify the ingredients. For example if you had a sandwich, was it on wholegrain/wheat bread or white bread? You could take a photo of the ingredient list on any food packaging you buy (if you have a smart phone).
    • Take note of how your food was cooked. Was it baked or fried, homemade or bought?
    • Record all your snacks and don’t forget things like chewing gum.
    • Keep a record of your fluid intake. How much are you drinking and what are you drinking? Also add details if you’ve added sugar and milk to tea and coffee and what your alcohol intake is.


    • Remember, symptoms may not be caused by the food you’ve just eaten, but what you ate earlier that day or the day before, so it’s important to write everything down.
    • Record when your IBS acts up in relation to when you last had something to eat or drink. Also think about if you’re eating too fast or eating regular meals – how long does it take you to eat a meal?
    • Think about your portion sizes – how big or small are they?

    Bowel movements/symptoms

    • Describe the colour, shape and consistency of your stools. You may want to use words like: loose, diarrhoea, pellets, hard lumps (like nuts) or mucus. This stool chart can help you describe them.
    • What’s the nature of your bowel movement? For example, was it complete or incomplete? Did you feel like you were straining to have a bowel movement or did you have an urgent need to go?
    • Record any instances of stains or soiling in your underwear.
    • How frequent are your bowel movements? When do they occur?
    • Do you have wind?
    • Where are you in your menstrual cycle (for women)?

    Your pain

    • Are you in pain (scale of 1 to 5 – with 5 being the most in pain). Is the pain constant or does it come and go?
    • Where does it hurt – your tummy (abdomen), back passage (rectum) etc. 
    • Is your tummy tender to touch, can you describe what if feels like? Is it, for example, dull, sharp, burning, bloated, swollen, cramps, hard or in spasm?
    • Record any other physical symptoms, such as headache or backache, indigestion or bladder problems.

    Your emotional wellbeing

    • Describe how you’re feeling. Use words like happy, fine, down, low, tired, worried, relaxed, scared, upset, angry or helpless.
    • Are there any situations in your daily life that are causing you stress? (Examples might be work, school, family, travel and personal problems.)
    • Are you specifically worried about your IBS? What do you worry about? This could be things like worrying over losing control of your bowels, a lack of sleep, anxiety about not knowing where the nearest toilet is, frustration at your IBS or stress from work.
    • Do you ever cancel meetings, decline social invitations, avoid leaving the house, plan your life around being close to a toilet, or avoid sexual activity? How much of an impact do you think your bowel symptoms are having on your life: not at all, slightly, some, quite a bit, a great deal.

    Your medicines

    • What medicines, if any, are you taking and why?
    • When do you take them?
    • Record any herbal remedies, vitamin or mineral supplements too.

    Your exercise routine

    • How much exercise are you doing? How long are you exercising for and how hard are you working?
    • What types of exercise are you doing? Swimming, brisk walking, cycling etc.
    IBS symptom diary

    Download and print off the symptom diary here.

  • Resources Resources

    Further information


    • Irritable bowel syndrome (IBS). The Merck Manuals., published August 2013
    • Tang QL, Lin GY, Zhang MQ. Cognitive-behavioral therapy for the management of irritable bowel syndrome. World J Gastroenterol 2013; 19(46):8605–10. doi:10.3748/wjg.v19.i46.8605
    • Jones MP, Dilley JB, Drossman D, et al. Brain–gut connections in functional GI disorders: anatomic and physiologic relationships. Neurogastroenterol Motil 2006; 18(2):91–103. doi:10.1111/j.1365-2982.2005.00730.x
    • Irritable bowel syndrome. Anxiety UK., accessed 2 April 2014
    • IBS. NHS Direct Wales., published August 2013
    • Gonsalkorale WM, Miller V, Afzal A, et al. Long term benefits of hypnotherapy for irritable
    • bowel syndrome. Gut 2003; 52:1623–29
    • Wilson S, Maddison T, Roberts L, et al. Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome. Alimentary Pharmacology and Therapeutics 2006; 24(5):769–80
    • Cognitive behavioural therapy. Royal College of Psychiatrists., published July 2013
    • Reme SE, Stahl D, Kennedy T, et al. Mediators of change in cognitive behaviour therapy and mebeverine for irritable bowel syndrome. Psychol Med 2011; 41:2669–79
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  • Author information Author information

    Produced by Alice Rossiter, Bupa Health Information Team, April 2014.

    Symptom diary produced by Natalie Heaton, Bupa Health Information Team, December 2014.

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