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.

I have exactly the same too much gas causing fluttering and many many ectopic heartbeats really horrible!

I have the same awful butterflies like my stomach is always twitching plus the heart thumps, it’s so scary just wish it would go away, it’s this awful virus causing so much fear for everyone. I haven’t slept a wink last night and still got the knotted tummy, there must be something out there to help us.

I have had a lot of stress in my life. My stomach has always been affected. It makes you more anxious when you are at work and constantly worry about whether you will have to run to a toilet. Its caused me so much problems in my work, even had to leave jobs as there have been too many meetings I cant deal with it's too embarrassing in turn I get panic attacks again. Think the damage has been done. I thought for years I had IBS not until I went to an acupuncture lady did I realise my stomach issues only happened in stressful situations and mainly at work or places where you dont know well and not being familiar with toilet facilities. Since we have had lockdown because I am home my stomach is so much better and eating whatever I want no issues. Now my worry is going back to work and this nightnare process will start all over again. Surely taking imodium frequently is not good for you but nothing else works long term.

Hi Kelly,
I suffer from IBS and at the moment my stomach cramps have been worse. What does usually help me get a stable stomach is an Activia Yoghurt after lunch every day.

I suffer all of the above also for many years.
I have been finding the Medical medium protocol very good, especially celery juice to kill off bugs in gut. I have come off meds and been able to keep UC at bay with tumeric and glutamine. Have a read up on this info and see if resonates. Good luck

Hi' same thing with me. Could be gerd. I have morning anxiety from morning acid building up. Watch what you eat. Sugar and hard to digest foods also dairy. Hope this helps. 🤗

If you have a good relationship with your primary care provider, and your therapist confirms an anxiety diagnosis he or she could provide your primary with diagnoses, and possibly recommend medical treatment for your anxiety. Sounds like its bad. If you have tried medicines over and over with no relief, perhaps ask about ketamine therapy. Works for PTSD, depression, anxiety, chronic pain, even neuropathic pain. Not a first line treatment though it works miracles in some. Good luck!

I feel sharp pain on the left side of my stomach just below my left rib, is it cause by anxiety?

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.

And ginger root help with any gut pain which may occur due to gas build up and the apple cider vinegar balances the stomach acid also avoid spicy foods completely.. Drink plenty of water and don't stress too much about what's happening and you could try multi vitamins and probiotics and gaviscon double action helps too.. But the main thing is to cut down the stress and understand that its an illness like any other illness and there are others who have much bigger health issues...

i wish to contact you , i suffer this intrusive symptom like a Vertigo, anxiety is like something bad is going to happen.
my doctor put me in Buspar and xanax,. not much help.:(

Just do jogging as long as possible.its great way to reduce stress and anxiety without medicine.i have same problem and I get rid of this.avoid nicotine, tea, and alcohol.

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!

Hi. You people are not alone, I suffer from anxiety, depression, etc. I get heart flutters sometime for awhile then it goes away slowly. I have ptsd and it caused me to have gastritis and let me tell you that it is painful. At first it lasted a half to a day but now it lasted for weeks(I’m two months now still healing). My doctor did CBC and found that I have mild anemia and told me to take iron and prescribed famotidine(2 weeks) and didn’t have to follow up with him. I’m starting to learn about stomach issues and was thinking about asking my doctor to check for ibs or chronic stomach pain. It’s complexed especially when doctors are not much help. But we can overcome our issues and even minimize it. Hope you all find genuine help cause therapies are no help either sometimes. I drink a lot of grass fed beef and cage free chicken bone broth, I eat foods with lots of fiber, I drink a cup of kefir a day,I take digestive enzymes, and it’s okay. But if we can reduce our stress it will help 1/4 of our issues. Peace ✌️ Love ? Happiness ?

I have a similar story to yours and its a viscous cycle. Meds for depression work to a point but sometimes they add to existing stomach problems.
I find if l walk especially in the country alone with my dogs it helps calm things. Hioe you feel better soon. 😊

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 exactly the same. Sadly I've suffered for three years of gnawing pain in the stomach which happens worse in the morning then lessens throughout the day. Nothing works in the long term. It's developed into severe OCD and anything can start it off. Since 2016 I've had to compulsions from whistling loudly to killing people. The latest is seeing dead dogs (don't ask, I can't tell you why) :'(

I'd love, like you, to know of a remedy as the Doctor can't find anything. "All in the mind" he say's which doesn't help and states the bloody obvious. There are good days and bad but getting through it. I'm paying attention to one obsession - trying to overcome it.

During my stomach “panic attacks” I feel it tightening and the only way to relieve it is with a burp which I can’t do at that time. When I’m calm I burp fine. Doctor says it’s all anxiety as I’m tensing the muscles when they should be relaxed. This is the worst of all my anxiety symptoms and I’ve had just about all of them.

So I can relate.!!

I have experienced gut anxiety for prolonged periods, the latest being 18 weeks in duration. Regular PPI's and H2 blocker don't work. Ive seen a nutritionist and modified my diet. In essence anxiety feeds into the gut brain axis' which perpetuates the condition. EMDR therapy has had remarkable results.

Eye Movement Desensitization and Reprocessing (EMDR) therapy is an interactive psychotherapy technique used to relieve psychological stress. ... During EMDR therapy sessions, you relive traumatic or triggering experiences in brief doses while the therapist directs your eye movements.

This is the same as what I’m experiencing now and hearing from you of how you dealt with it gave me comfort that it’s not just me who experiences the same symptoms. Thanks for sharing

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.

I have the same symptoms as you and I’m still a freshman in high-school and I always feel sick when I go to school and I never hang out with my friends outside of school because I’m afraid my stomach will start to hurt and I never go out with my family either.

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.

Having just come out the other side of a very anxious time in my life, which lasted about three months, I can’t understand why anxiety medication is not considered a great remedy fir this crippling illness. Yes I can do toga, say no more often etc but anxiety is often an illness related to an imbalance in hormones and needs medication to get us back in balance. My anxiety was becoming unbearable with racing heart rate, nausea, lethargy and feeling faint and really uncomfortable doing the most mundane activities like going to the shops or to work. Go to a trusted GP and try an anti anxiety medication. If one doesn’t work fir you try another until you get back to feeling normal again, like I did. After six months on meds, I am off them and feeling great, and I know if I need meds again, I have a solution.

I have had this issue where it hurts right below my stomach. I looked on a website and it shows my small intestine. I think I have irrital bowl syndrome. Please reply if u have a idea what's wrong.

I understand that anxiety can cause issues with stomach problems, but can it also work the other way? I have issues with chronic bowel inflammation, which seem to correlate with some anxiety issues. However, it seems to me like the episodes of inflammation precede the anxiousness. I have discussed this with my physician, and he's prescribed to medication for anxiety symptoms. I plan to talk with him about whether or not my suspicions might be correct, but would like to know a bit more before I do, just to avoid having a pointless conversation.

I have had stomach problems that came and went, but now it seemed to have gotten worst. I started my own businesses and my wife is pregnant. I've never had stomach pain just a tight feeling on the upper left hand side. Now that feeling has spread to the lower side of stomach. I have a family history of IBS and Ulcers. So my question to anyone have they had the same symptoms. Now I get a lot of diharea and constipation. I also wake up every morning with anxiety and feeling scared.

I feel you totally. My issue is that im still in a introduction with my therapist and for sure i have an anxiety. Issue is that i have gases in my stomach every night. Wierd thing is that only occurs after 9 pm and i dont know how to co control it. Ill guess ill change my diet and try to exercise a bit..

I lost my husband 12 months ago, my 14 yr old dog, and now had to sell my much loved house. I have IBS, chronic nerve pain, and can’t do things to help stress like walking, gym etc because of back pain. Tried everything. Now have wind like pain middle upper abdomen and scared it’s serious. Have to turn down invitations because I never know when Diarrhea will strike. Life is just an existence and no one understands how lonely it can be. I hope my fellow sufferers can have a good Christmas despite the crippling anxiety.

Sorry to hear of your loss Dorothy. We lost my Stepdad a year ago too. I deal with this stomach pain daily. I am wondering if removing my stomach would help? I’m at a loss, of what else to do.