Do stress or psychological factors contribute to IBS-D?

Question

Hello doctor,

I am a 29-year-old male, 5’8”, 161 pounds. For the past year, I have had loose stools almost every day, usually four to six times and most often in the morning. The first stool is often semi-solid, but the next ones usually turn watery. I also get cramp-like pain in the lower abdomen, and it usually gets better after passing motion.

After some basic blood tests (normal results), my doctor mentioned that this could be IBS-D. I currently take Loperamide when the symptoms worsen, but I would prefer not to rely on it regularly.

I have noticed that diarrhea mostly occurs in the morning. Additionally, when I am traveling or have an important meeting, the frequency increases. Could stress or psychological factors be contributing to this pattern?

I would appreciate it if you could explain what causes IBS-D and whether it can lead to any long-term damage to the intestines.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Your symptoms are consistent with irritable bowel syndrome, with a predominance of diarrhea. Routine testing shows that the intestines are normal, but their function and sensitivity have changed.

The symptoms are often in the morning because of the gastrocolic reflex, a natural digestive reflex of the body. The colon usually kicks in and moves stool along when you wake up or eat breakfast. In people with IBS-D , the response is more intense and faster , causing stool to travel through the colon faster than the body has time to absorb enough water , which results in loose stool . This is why the first bowel movement may be semi-formed, and the subsequent ones liquid.

The cramp-like abdominal pain that improves after passing stool happens as the intestinal muscles contract harder and the nerves in the gut become more sensitive to stretching and gas.

Stress and anticipation, such as those associated with travel or key meetings, can exacerbate symptoms via the gut-brain axis. Emotional stress can lead to increased intestinal activity and urgency. As a result, psychological stress can exacerbate symptoms; yet, IBS is a genuine functional gastrointestinal ailment that is not only "in the mind."

Importantly, IBS-D does not harm the intestines, cause ulcers, or increase the risk of cancer. It typically affects bowel movements and intestinal sensitivity.

The general goal of management is to identify triggers and stabilize gastrointestinal function. Here are some helpful measures:

Avoiding typical triggers such as excessive caffeine, fatty foods, alcohol, and artificial sweeteners.
Conducting a low-FODMAP diet study to pinpoint particular meal triggers
Maintaining regular meals, getting enough sleep, and exercising for stress management.
Using drugs when needed, such as loperamide for urgency, or in some situations, rifaximin or antispasmodic treatments.

Although IBS-D can be upsetting, most people can obtain effective long-term symptom control with the correct combination of dietary changes, lifestyle changes, and periodic medication.

I hope this helps.

Thank you.