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, Break Free from Anxiety, a coloring, self-help book for anxiety sufferers, and the Emetophobia Manual, for those who suffer with the fear of vomit.  Ken Goodman is an ADAA board member and Clinical Fellow. Visit Ken's 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!

Try having a snack before you go to bed and have ginger tea and crackers before you get out of bed.
Cook as much as you can with ginger root.

Thanks for the information! Everyone around me says I stress the out because of my anxiety. I worry about EVERYTHING, I’m told. This in turn causes horrible indigestion belly pain that’s debilitating like I’m in labor. I gave IBS and had two bowel obstructions. I wonder if intense stress/ anxiety is the case . Thanks fir the information on ginger; going to give it a try.

Try lemon balm tea or ashwagandha capsules,they say it helps with lowering cortisol levels,mine is worst in the morning,I literally cant eat without getting nauseous during those days,and ofcourse my IBS D gets activated than,I do take xanax and it helps me a lot to eat and not get malnourished from stomach anxiety,my anxiety gets worse before and during period btw

After a bad stomach upset recently, it has throw my anxiety into overdrive in the mornings too. I'm scared of getting the stomach pains again.

Me too I have Ibs with both C and. D I’ve had general anxiety disorder all my life I’m 61 now literally since I’ve been two.....all it takes is one stressful day and my stomach cramps and bothers me for days a new symptom with this is now neasousness and dry heaving .....It’s pretty horrible always been afraid to travel and also has ruined relationships anxiety destroys a lot ..... has for me all my life pretty much. Also! both my children have it like me my son really bad so as I found out it’s also hereditary apparently.......sigh.

I too have struggled with anxiety all my life and both my kids have it as well. My son really struggles and for many years self medicated with alcohol and has been in treatment for that. It causes a lot of guilt and of course more anxiety 😟

I know exactly how you feel ! I even wake up during the night with a stomach pain and anxiety and I obsess about it all the time. After having Covid19 8 months ago this has been a constant problem

Ok. Sometimes I have stomach pains in the morning sometimes the day or night. I don’t think I’m anxious but I must be. I think my stomach pain makes me anxious. I also have major health issues but I think I’ve accepted them. I am limited in what I can do now but I’m 61 trying to accept it. I have had 2 open heart surgeries. A TAAA surgery and 9 eye surgeries and 3 thyroid surgeries due to cancer. I do take antidepressants and Ativan. Which seems to help. Any other suggestions for this stomach pain. It’s seems dairy and wheat really bother it. This is pretty new in the last two years. Any advice would be appreciated. Thank you.

There is a tea by the brand Bigelow and it is a calming stomach tea, it is peach and ginger. It is amazing for my stomach.

I troble with the same issues, and systoms as well. What you could probably do is, spend time to do some mindfulness, drink calming tea: chamomile, ginger roots. exercise, take a break when you need to, essential oils, such as lavender,

I have the same thing cant sleep to but have alot of stomach issues and i dont know how to calm it down im losing weight to..any advice my anxiety is awful and im exhausted

I understand very well how anxiety can cause stomach upset and loss of appetite or increased appetite. I suffer from
Severe Anxiety and can’t sleep because of it. Try not to stress yourself with arguments.

I too suffer with anxiety i would take 3 xanax a day i learned how to control it but the mind is powerful. It wins me sometimes but I've learned that my kids keep me up and going. But i have troubles with stomach pains bloating and stomach anxiety. And covid anxiety is the worst.

Since you've mentioned the timing of your period, please look into PMDD, see if that fits your symptoms. :)

Try hot herbal tea but on the brake not on the work and think how good is that for your stamac,than take a minute to breathe and slowly start the work and increase step by step carefully by not accepting the stomac to upsetting you.
All in the brain

Don’t suffer alone. Go see a psychiatrist. You can also make an appointment wit a gastroenterologist. I suffered for a long time and finally made the choice to get help.
it take Bentyl for my stomach pain and it also helps to calm my anxiety.

i suffer anxiety due to family stress ...worry a the time. I also have GERD. But recently I stopped drinking ( id always have 2-3 mugs every morning). This has massively helped my GERD and my anxiety is lessened. Obv still have the anxiety and it is more when waken through the night (i dont sleep well) and mornings. I suspect I need to do more physical exercise to tire myself more than mental fatigue.

I made an appointment with a gastroenterologist and he diagnose me with IBS the medicine he prescribed is Bentyl. It really helped to calm my stomach down.

Sir iam 65 years old iam having herd disease some time tension movement.suddenly affected my stomach that time my stomach irritating and also my head is pain for.some.time why sir it is cureravle any medicine for this problem

Hi...for the past week I have been waking extra early than normal..cant sleep and immediately my stomach begins to ache and almost feel like butterflies or a nervous stomach. I then need to use the bathroom which is somewhat loose. It's been happening for a week now...I also think it's due to this crazy virus outbreak we are having now...please help

Hi. Did you get any answers on your stomach ache? I feel like this this week.

Yes I have had GAD General Anxiety Disorder
for most of my life.wake up EVERY morning with anxiety attacks and gives me those butterflies in your stomach. I see a psychologist every week to help with cognitive therapy and take benzodiazepines to keep the anxiety down. I do workout daily and walks which helps. It’s crazy and frustrating sometimes you feel like crying.

yes anxity ever day stomach bloated have bad acid reflex even when planning vacations i get so anxiuos then cortiso flowing in my vains to much in the brain too hope this helps i pray for you and all godbless

I have had pretty bad anxiety recently , never had this before. It starts in am with tremors and a fast heart rate with a warm and burning feeling in stomach. I have been sheltered in with my son for months, we are both high risk. I have a lot of worries about my sons health, and how sad he and I are because of being so lonely .

Everyday anxiety shallow breathing body aches bellyache butterflies in my chest in stomach smh😭😭

I'm having the same problem since august
All the docs I've been yo look at me like I'm mad.... 😭😭😭

I have also been suffering from severe anxiety for years now. Until you, I have not found another person who has that warm, burning feeling in the stomach. I have that and believe it to be stress hormones entering the gastrointestinal tract. My pain is extreme and feels like I am drinking a scalding cup of coffee. No relief. It's every day. Dr's cannot find the cause and have referred me to pain management. Quality of life is poor with this condition. I'm sorry for your loneliness. Many of us are suffering as well. Wishing you the best.

I have this issue really bad. Was put on pantoprazole for an ulcer and prescribed alprazolam which really, REALLY helps anxiety. I take a small piece before bed and a small dose in the morning. It’s a controlled substance but I was really open with my doctor about how it worked for my grandmother (anxiety is really hereditary in my family) - best of luck to you all, this is horrible to experience

I had a very bad time with panic/anxiety symptoms and gut issues a few years ago and it was definitely an over active thyroid Plus hormone Imbalance due to Peri-menopause. I was also very low in Vit D.
Once all levels were balanced I improved (it took a few weeks).
I do however still suffer some anxiety if there is not a toilet in the immediate area 😳
Hope this helps everyone trying to sort out their issues.
I also reduced gluten and dairy and increased raw veg plus take a probiotic everyday.
All has helped symptoms by 90%