Stress can aggravate stomach issues, including constipation. But constipation can also increase stress and make you more anxious.
If you’ve ever been in a stressful situation and had that uneasy feeling in your stomach, then you’re aware of how closely the mind and gut are connected. Our emotions and thoughts directly influence our digestive system.
It works the other way as well. For example, you may have felt the brain fog and fatigue that occurs when you eat too many sugary or processed junk foods.
This relationship may help explain why you get constipated when stressed out. It may also explain why your anxiety symptoms worsen when your digestion stops working correctly.
Constipation can be an unpleasant experience. It involves hard stools that are difficult to pass, bloating, stomach pain, and an overall sluggish feeling.
Clinically, constipation is having fewer than three bowel movements a week. It’s a common condition, affecting 1 in 6 people, according to a 2021 review.
Factors that commonly cause constipation include:
- lack of exercise
- low fiber diet
- medications, including sedatives, opioids, and certain blood pressure drugs
- health conditions, including hypothyroidism and diabetes
There is undoubtedly a connection between anxiety and constipation. But it’s still unclear how the two are causally connected. Does anxiety cause constipation, or does it work the other way?
The brain and the gut are intimately linked by what’s called the gut-brain axis. Trillions of nerve cells lining the gut send signals to your brain about what’s going on with your microbiome, digestion, and overall gut health. For this reason, the gut is called the “second brain.”
The brain also sends signals to the gut. For example, just thinking about your next meal causes the stomach to release digestive fluid in preparation for digestion.
When we’re under a lot of stress, the brain activates our fight, flight, or freeze response, releasing hormones such as cortisol and epinephrine that directly affect digestion and gut function.
These hormones redirect blood flow from the gut to vital organs such as the brain and heart.
There are other ways stress can make constipation worse.
Stress disrupts the gut microbiome and causes bacterial imbalances, also known as dysbiosis. When harmful bacteria take over, they can cause inflammation in the gut, which slows digestion and causes constipation.
When stressed out, your muscles tend to tense up, including the muscles in your gut. These muscles help move food through your system and speed up digestion. But they don’t relax and contract properly when tense, and things can get backed up.
Irritability bowel syndrome (IBS) is a gut disorder that can frequently cause constipation and other unpleasant symptoms, including:
- stomach pain and cramping
- gas and bloating
It’s a relatively common disorder, with the American College of Gastroenterology estimating that about 10%-15% of adults in the United States live with IBS.
While the exact cause is unknown, there are several factors that may play a role in IBS. These include bacterial infections, inflammation, poor immune function, and an altered gut-brain axis.
Stress may also be a contributing factor to IBS. Those with IBS commonly report that their digestive issues flair up under periods of intense stress. This may be because of increased inflammation or high levels of stress hormones.
Strong evidence also points to low levels of the neurotransmitter serotonin. Along with playing a role in mood, serotonin also affects how fast food moves through the gut.
Your body makes more than 90% of its serotonin in special cells in the gut, according to
Interestingly, low levels of serotonin and anxiety often happen together. A
Depression, another mental health condition linked to low serotonin, is also associated with IBS.
Irritable bowel syndrome with constipation (IBS-C)
If stress and anxiety make your constipation worse, you may have irritable bowel syndrome with constipation (IBS-C).
Several treatments can help control symptoms of IBS-C, including:
- stress management techniques, such as meditation
- low FODMAP diet, which eliminates certain vegetables, fruits, legumes, and dairy products that can trigger IBS symptoms
- cognitive behavioral therapy (CBT) to help reduce negative thoughts and anxiety
- antidepressants to help boost serotonin levels and help restore gut motility
- medications approved to treat IBS, including Lotronex (alosetron) and Amitiza (lubiprostone)
Irritable bowel disease (IBD)
Irritable bowel disease (IBD) is another chronic bowel disorder caused by high levels of inflammation that damages the gut. Although it’s a different condition than IBS, it shares many of the same digestive symptoms, including constipation.
But IBD can also cause symptoms beyond the gut, such as joint pain, skin problems, and extreme fatigue.
Like IBS, stress can trigger IBD and coincides with anxiety and depression. A 2015 review found that up to a third of people with IBD also have symptoms of anxiety, and a quarter of them have symptoms of depression.
Common treatments include strong anti-inflammatories and immune-suppressing drugs.
While it’s likely that stress and anxiety can make constipation worse, the opposite may also be true — constipation may lead to anxiety.
When you have a backed-up system, waste doesn’t get adequately eliminated, and inflammation ensues. This causes the gut to send signals to the brain that can trigger anxious thoughts.
Simply worrying about when you will have your next bowel movement can also cause your anxiety to spike. This can lead to a vicious cycle in which stress and anxiety further worsen your constipation.
Constipation can coincide with other mental health conditions, including:
Beyond medication, there are several techniques that may help lower your stress and get things moving. Many of them are simple changes you can try at home.
Cognitive behavioral therapy alleviates stress by identifying negative thought patterns and replacing them with positive ones.
Another form of therapy called biofeedback retrains the muscles to relax and contract properly to assist in bowel movements.
Laxatives can help when you’re having bouts of severe constipation. This can help reduce some of the anxiety associated with being constipated.
But laxatives are only a short-term solution as they can cause you to become dependent on them to go.
Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), may also work for people with IBS-related constipation. These will help balance serotonin levels in the gut and brain to control anxiety and restore healthy bowel movements.
Making changes to your diet may help ease constipation.
Reduce your sugar
Eating too much sugar can make it harder for you to deal with stress and increase your anxiety, according to research from 2019. Sugar can also feed bacteria that cause inflammation in the gut and worsen constipation.
Eat more fiber
Fiber adds bulk to stool and makes it softer, allowing it to pass easier. Soluble fiber found in fruits and vegetables also serves as food for the good bacteria in your gut. This allows beneficial bacteria to multiply and crowd out the harmful bacteria that contribute to constipation.
Here are some lifestyle changes you can try to relieve constipation.
Mindfulness-based meditation is a form of meditation that involves observing your thoughts and emotions as they arise. It teaches you not to judge or react to them but to simply notice them appear and let them go.
Exercise can reduce stress and do wonders for your anxiety. Research from 2020 suggests that light to moderate exercise such as running, swimming, or biking can significantly reduce symptoms of anxiety.
Exercise can also help reduce constipation by improving core muscle strength, which helps keep things moving.
Cardio such as running or biking is the best choice, but even a short, brisk walk can be beneficial in easing constipation.
Yoga can help release tension in the muscles, especially the core muscles involved in digestion. Doing so can help speed up the passage of stool and restore healthy digestion.
Deep, diaphragmatic breathing is excellent for lowering stress levels and relieving tension. Additionally, using your diaphragm to contract and relax the muscles in your core helps stimulate your bowels.
Constipation is strongly linked to anxiety and other mental health conditions. While it’s likely stress can make constipation worse, constipation may also increase your anxiety symptoms.
Stress-reduction techniques such as cognitive therapy, meditation, yoga, and exercise are powerful ways to manage stress-associated constipation.
If your constipation is due to IBS, talk with a healthcare or mental health professional. They can determine the underlying cause behind your symptoms and prescribe medications that can provide relief if necessary.