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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 ADAA.org.  

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.

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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 https://www.everydayhealth.com/abdominal-pain/guide/

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.

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.

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

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.

Yup me tooooo it’s stress I am eating ginger candy chews & juicing also doing juicing 💕

I’m having the same exact thing, mine is in the morning and night and I seem to be kind of spitting up after I eat a little bit. And I feel very strange after I drink fluids.

Just a thought but having read a lot about Covid 19 virus symptoms it has been shown that some people do have feelings of anxiety and gastrointestinal problems like diarrhoea, nausea and stomach cramps. Everyone has different symptoms from just what I described with nothing else to more flu symptoms of dry cough, temperature, body aches to severe respiratory problems.

I have had like weird butterfly sensations after i’ve eaten with like a dull ache can’t explain it has anybody had this it makes my stomach feel strange.

I feel the same way it sucks I also feel a sense of lonelyness and discomfort, something I can't control, I feel vulnerable.

Try guided meditation on apps..it really helps to calm.down and breadthing excercices

I have been feeling the same way my stomach is in knots. Sometimes it's bothering me bubbling a lot. It feels so nervous inside my stomach. When I go to bathroom many times it's very loose. Also at times I don't want to eat much at all. That is not like me I'm a major foodie I'm usually always eating. I know it's this Corona Virus that has me like this. I'm so stressed about me or my family getting it's messing up my stomach.

I have the worst right sided stomach pain. It's def this virus that has my anxiety through the roof!

I have the same issues with more pain on lower right side. At first I thought maybe my appendix, but no fever and comes and goes. I have had such anxiety so after reading the feeds it sounds like stress is causing the anxiety and all these stomach/intestional issues. I drink tea with ginger and do meditation which helps.

Hi... I can relate to you, the same thing is happening to me I went to the doctor and I got some muscle relaxers. Today is my 2nd day taking them and I’m feeling the same way. I think it’s because of everything that is going on.

I’ve had the same stomach issues for a week. My anxiety is through the roof and not being able to get to the gym is not helping. It’s nice to feel like I’m not alone.

Because of this virus outbreak my anxiety starts thats why a lot of Bad things that happen to me like constipated, feeling that i have diahrrea, stomach ache, Insomnia, and loss of appetite :(

I hear you. I was okay for the first 2 weeks of social isolation but now my anxiety is over the top. My adult son had to come home as he has no work, no money and he already has anxiety, my youngest is living in London, England and I am worried about him. I find I have stomach cramps depending on what I eat, I actually have lost my appetite and I have loose stools. Not sure whether to up my Effexor

Hi Northern girl,
How long do your cramps last when you have them? I've had the same thing but I can't figure out if it's just stress induced or more. Doesn't seem related to any certain types of foods and sometimes lasts for hours. Then I start worrying about it and I'm sure the anxiety/cortisol just makes it worse and worse. Can't get into a GI doctor until mid-May and basically living off pepto & ibuprofen & it's impairing my work since it often starts after 2 PM for the first time. Hope you're feeling better.

Hi, I’m experiencing cramps, especially after running. It feels like menstrual cramps and I almost faint & have thrown up when really bad. I exercise for a living, so this just started. I do believe it’s from high cortisol levels because I am stressed out right now over multiple things. I eat fresh ginger and eat healthy. Please let me know if you find a supplement or tea that might reduce cortisol.

I am a 31yrold male from the uk never experienced anxiety before and I am exactly the same no appetite ( I love food) stomach is constantly churning.

Has anything helped im having this issue now but my mouth gets so dry while its happening

Yes me too, I think it's anxiety with the dry mouth from a mix of gastric issues and worrying about this virus. Also feeling tired and shaky or tremble.

How’s your anxiety and your stomach? Ten days ago I started getting stomach issues and I went to the doctors and he said something triggered it. I think it was stress. I’m on day 12 and still the same but a little better. Do you think it’s from the stress of this virus ?

I’m curious if you were able to work. My son says he can’t work most days because of his anxiety causes so much stomach issues. Were you able to take something that worked for you or did you work it out another way?

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.

Try touching your toes it solved my stomach issues cause due to anxiety. Stand straight join your legs raise your arms straight then keep moving slowly downward try to touch toes 25-30 times i did that for like a week and it had great results.

Ive suffered from IBS D since my late teens. I avoid gas causing foods but if im not sure if a certain food will cause gas i take Beano (TM) or the generic before i eat. I always have Gas X (TM) pills in my purse. Google gas causing foods It really helped me Also try to treat yourself like you are your own Mother Dont allow stressful people, media or situations in your life GOD bless you Pray this helps

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