by Ken Goodman, LCSW

Ever wonder why you get “butterflies” in your stomach before doing something stressful? Or why you feel like your stomach is “tied in knots” after an argument? Ever had a meeting with a toilet that went longer than expected and it wasn’t caused by anything you ate?  Stomach problems are one of the most common symptoms of stress and anxiety.

Researchers have identified a powerful connection between the gut and the brain. Like the brain, the gut is full of nerves. It contains the largest area of nerves outside the brain with the digestive tract and the brain sharing many of the same nerve connections.

Whether it’s a single nerve-wracking event or chronic worry and stress over time, stress can exact a physical toll on your digestive system.  When you are anxious, some of the hormones and chemicals released by your body enter your digestive tract, where they interfere with digestion. They have a negative effect on your gut flora (microorganisms that live in the digestive tract and aid digestion) and decrease antibody production. The resulting chemical imbalance can cause a number of gastrointestinal conditions.

Common stress-related gut symptoms and conditions include: 

  • indigestion 
  • stomach cramps 
  • diarrhea
  • constipation
  • loss of appetite 
  • unnatural hunger 
  • nausea
  • Irritable Bowel Syndrome (IBS) 
  • and peptic ulcers

Once you suffer with one of these conditions, the condition itself can become a source of anxiety and greatly impact your quality of life. I have had many patients who experience diarrhea for example, who develop a fear having accidents in their pants which makes them afraid to leave their home or go certain places.  If you experience stomach cramps or indigestion, you might become fearful of these symptoms causing you to limit where and what you eat which could impact your social life.

Six Tips for Reducing Stress and Anxiety

  1. Although stress is a normal part of life and impossible to avoid, there is good news. You can manage your stress so that it reduces its impact on your stomach. Here are six tips that can help you reduce stress AND the related tummy troubles.
  2. Take short breaks and breathe. When done right this can really help. Every couple of hours, stop what you’re doing and do one minute of slow, quiet deep breathing.  You’ll be amazed at the results.  Your breathing should be very slow, silent, and through your nose. Push your stomach out when you inhale and let it deflate as you exhale.
  3. Just say “no.” Trying to do everything and please everybody all the time is a surefire recipe for stress. Know your limits and when you’re close to reaching them, don’t accept additional responsibilities.
  4. Exercise or do yoga. Physical activity is a great way to reduce stress, even if it’s only for fifteen minutes a day. When you exercise your body releases chemicals called endorphins which interact with receptors in your brain and trigger a positive feeling in your body.
  5. Instead of stressing over things you can’t control focus on the things you can control, such as how you choose to react to problems. Your reaction is your choice, including how you react to your stomach issues. Accepting stomach problems will reduce your anxiety and curb your symptoms. Worrying about your stomach, only makes your symptoms worse.
  6. Listen to a guided relaxation exercise daily. You’ll not only feel relaxed while doing it, but most people also experience a sense of calm that lasts for hours afterwards. 

Seek the help of a therapist who specializes in anxiety. It’s often too difficult to deal with chronic worry and complicated anxiety on your own. A skilled Cognitive Behavioral Therapist will know what to do. You can find a therapist at  

It takes effort to reduce stress and its impact on the stomach. These suggestions can work if you implement them correctly and if you make them a daily priority. However, expecting immediate results and 100% absence of symptoms will only increase your frustration and symptoms.  Acceptance of some degree of stomach discomfort is important. 

Finally, take a look at your diet. Certain foods are known to irritate the stomach. Consult a doctor and try the recommended medical treatments. Many stomach disorders cannot be resolved with stress reduction alone. You must address the biological, psychological and social aspects when trying to resolve gut related problems.

ADAA_Ken-Goodman-websize-1.jpgAbout the author:

Ken Goodman, LCSW, treats anxiety and OCD in Los Angeles.  He is the author of The Anxiety Solution Series: Your Guide to Overcoming Panic, Worry, Compulsions and Fear, A Step-by-Step Self-help Audio Program., and Break Free from Anxiety, a coloring, self-help book for anxiety sufferers. Ken Goodman is an ADAA board member and Clinical Fellow. Visit his website.


Read Ken Goodman's other ADAA Blog Posts:

Ken Goodman also hosts an ADAA webinar on "Overcoming the Fear of Vomiting." Watch the video on ADAA's YouTube channel.

The most common kind of abdominal pain is a stomach- or bellyache, which happens from time to time throughout our lives. People with abdominal pain often double over, clutch their gut, feel nauseated or dizzy, and avoid food and water. The first step to addressing mild stomach pain not associated with a medical condition or trauma is to try to identify and avoid the trigger. For example, overeating or eating rich or gas-inducing food can cause heartburn, distended stomach, and abdominal pain, which can be avoided by practicing dietary changes and moderation. You can also refer to this article which states all the necessary details about abdominal-pain

Thank you Jane! Mine caused me to develop severe ulcerative colitis! At the time I had never thought of me and anxiety or had never heard of colitis! After years of pain and surgeries... the doctors had to remove my large intestine and the other bottom stuff Due to severe colitis. That was 15yrs.ago,now for the last year or so,I have had what I think is what I call white knukling anxiety,really bad the first 3-4 hours of the morning!! I don't know why!!! I have never felt this before! It's worse than before. My primary doctor referred me to a therapist...told me he couldn't help me...
Well,I am looking for someone and information I trust and relate to that I can talk to!! Share information with! Possibly help me find help I need where I live! Sincerely!

Hi Jane Wooda. I too suffer awful. I have GERD so bad it us like having a cold and sore throat 24/7. I also have crippling runs about 4 times a month. I end up on that toilet doubled over and have 6 to 10 bouts in a row. I have been diagnosed with chronic anxiety. I get stuck home all the time. Afraid to eat and leave the house fir fear of accidents not by a toilet. Afraid to drink water. It sounds like you and I are in the same boat.

I have quite a few issues with my body. Mostly inside. After years of suffering!!! I am doing what I can on my own to educate myself, as not one of my doctors through the years has taken me down this road! Now I want to learn what kind of anxiety I have (probably all) and what I can do to heal myself without the meds!! I know I have pretty crippling anxiety mostly every morning! I have had a lot of surgeries for ulcerative colitis, due to stress and anxiety! I have epilepsy due to some stress and anxiety,some neurological epilepsy, PTSD, OCD...well I am only taking Lavella (lavender)for it. It helps a little, enough for now, without having to take more meds. I just cleared my system of clonazepam! Now I'm 53 years old and ready to try help from outside...I don't have people in my life besides my small family! What I learn is from here and my doctor. I desperately need someone to help with experience and knowledge! I can't find therapy for myself!!! I don't even know if I need that.?? More to say...

You can try Ayurveda remedies. It helped me. You can give it a try. Also, don't be worried abt side effects. Ayurveda is more of herbal therapy that's closer to nature.

Thank you for writing this piece, Ken. You gave practical advice I had not been given by medical professionals I have seen for this issue. I am persistent in achieving a higher sense of well-being and will go back to my doctor with this article. One therapy you may or may not be aware of, that I have yet to try, is laughter therapy. Laughter is good medicine and, for my chronic stomach anxiety, maybe good therapy.

Very informative article. I have major anxiety as I have been dealing with PTSD
and OCD for many years. (30 years)

I was in a fatal car accident as a youth and worked as a Paramedic
in a high call volume service.

I exercise and eat well most of the time. I'm fit for my age and still
compete in running events.

When my anxiety gets extreme and prolonged my symptoms start as "butterflies" around my belly button.

Then after a few days I develop diarrhea and loose stools that can last
a long time. Then all of a sudden things are back to normal and unremarkable.

When the GI symptoms are present it is also hard not to think some
catastrophic ailment is to blame.

I have been living with this cycle for over 30 years.
You are not alone!!!

Join the club......I have mine for almost 60 years now......"butterflies" is too kind a word for this condition , I call it "the dentist appointment feeling" , from days when every appointment there was a guaranteed drill torture session without sedation.
These days it's very tempting to solve them with tranqualizers , which still is an epidemic in most of the developed world , I don't care, I solved mine with methadon ; an opioid medication thanks to a friendly doctor .
It seems these anxiety feelings are an integral part of living in an industrialised nation. So just grin, breathe and bear it.....

Thanks for this. I've been down this road so many times that it really isnt anything "new", but still reassuring to remind myself that the GI issues are stemming, at their root, from anxiety/depression. I use the terms intermittantly as sometimes it's one or the other, but usually some form of blend of both. "Breathe and bear it" is a good approach, even if it sounds harsh. But there are things that help...meditation, exercise, better diet (avoiding the stuff we KNOW is not helping). Most of all, not to beat yourself up over it (maybe we cant stop it from happening but we cant certainly control how we respond to it). And also to recognize that change is the only constant. In my experience (25 years of panic disorder, GAD and periodic bouts of major depression), it does eventually "get better". Try not to obsess or catastrophized over your symptoms. Anxiety is a wicked beast to be sure and can leave you in a vicious circle of worry-symptoms-more worry - more symptoms. Oh, and one thing I also learned over the years is that something as simple as drinking more water helps. Hang in there everyone!

I have developed severe anxiety, with the thought that something like gas is stuck in my stomach and i need to get it out. And cant. Which has thrown me now into 4 day of crippling anxiety. Doc says nothing is stuck. And i am at my wits end.

I'm glad i read this article about anxious stomach. I want to share my story about myself having the same issue. I think?

It's happened when I was in my third year highschool. I ate sweet potato at the same time it's our recitation day. And after that I went immediately in the toilet before class ended. Since then I didn't eat breafast and lunch until i graduate in highschool. I only eat every night, and everyday I went to toilet and make sure to poop, Even though i dont feel like it. But my brain and body told me so :(

It's continue in my college days. It's affect my social life :( i dont hang out with my friends.. HOME SCHOOL that my daily life :/,

and so im working now.... it still the same. although i eat bfast now and i poop everyday but my stomach is getting worst, to the point that i need candies or oitment to calm my stomach, i feel dizziness, vomitting and irritated.

I always declined outing with my co worker. and eating outside because im afraid that i'll might poop huhuhhuhu.

I want to stay AT HOME forever.

I need your help.
what to dooooo?

I am in the exact same boat as you. Mine started after highschool. But very similar story, I was working and didn’t make it to a toilet in time and I just went in a lane way.

Now, that’s all I think about. That it’s going to happen anytime any day without my control.
I do my best to be at home, I feel safe at home.

I try not to eat before I go out, I try to drive, I try to have no others expecting anything of me (lifts) and I feel that keeps me in control of as much as I can.

It's comforting to see that this topic is very recent and that other's struggle with it. I am BRAND NEW to this and is something that has only been happening for a month or so now. I have lost weight and my appetite. It all started with a breakup and stress from work. At the time I woke up and found out about my partner cheating on me, it was 7am. I now wake up every morning at 7am on the dot with stomach issues that I cannot target the reason for. I have since been to the doctors for blood tests 2 times, and stool samples. I came back with a clean bill of health and am going in one more time this week. The problems are still the same. I've been through breakups before and never experienced anything this severe.
I can't sleep in nor fall back asleep after waking at 7am. And my brain is automatically flooded with thoughts of that person. Can this be attributed to trauma or stress from the break up? Should I seek a therapist? Or try a cleanse that can reset my stomach cycle?

Hey Gordon

The same exact thing had happened with me a couple of years ago, when I found out my partner was cheating and for months afterward, I’ve woken up many a day early in the morning with a dull throbbing stomach pain - it for sure is anxiety. For the symptom of the pain to go, I had to get rid of anxiety first and for me a few things worked strongly - 1) A form of active meditation ( rhythmic chanting ) that is part of Nichiren’s Buddhism 2) listening to sleep hypnosis to make sure I sleep happy/relaxed and that started resulting in me waking up happy/relaxed with a light feeling .... apart from these, working out, getting off sugar and eating as much organic produce that I could helped. But what helped THE MOST was by stopping the noise in my head through chanting and short meditations. Hope this helps.