We’ve all heard that stress is bad for us. Chronic stress can lead to high blood pressure, increased risk for heart disease, diabetes, depression…the list goes on and on. But can it also be making your microscopic colitis worse?
First and foremost, it’s important to know that stress isn’t thought to cause microscopic colitis. However, physical and emotional stress, especially chronic stress, may trigger a flare-up of microscopic colitis symptoms like diarrhea and increase levels of inflammation throughout your body.
Let’s take a closer look at how stress may be making your microscopic colitis (MC) act up.
What Is Stress?
Stress is how your body and your brain react to challenges and demands placed on them. Stress responses are designed to keep us safe when we are threatened by danger and to motivate us to push through difficult situations. It’s supposed to be a short term response to an immediate crisis.
Unfortunately, modern society frequently places such high demands on people, many of us are in a constant state of elevated stress levels. We are always on the move from one task to the next–putting out fires at work, scrambling to get the kids to soccer practice, dealing with difficult friends, etc. Our bodies and brains don’t have a chance to let go and relax. This constant stress can have a serious negative impact on our bodies.
What Happens When You’re Stressed?
When you are stressed, your body kicks in to prepare and protect you from threats or danger. This automatic response is known as the “stress response” or “fight-or-flight” reaction. It is designed to kick your body into high gear so you can either face the threat head on or flee from it. Your strength and stamina increase, your focus is enhanced, and your reaction time speeds up.
When the stress response kicks in, your brain floods your body with hormones, including adrenaline and cortisol. These hormones trigger your body to get ready for action. They get your heart beating faster and send a rush of blood to areas of your body needed most in an emergency such as your muscles and other organs.
In addition, these hormones affect your respiratory system. When the stress response is triggered, you begin to breathe faster. This gets more oxygen into your bloodstream and quickly out to your body. Your blood vessels constrict, your blood pressure rises, and more oxygen-rich blood is diverted to your muscles. This gives you an extra boost of strength to take action.
Other organs also kick into overdrive. Your liver also goes into action producing more blood sugar, which gives you a surge of energy. Your stomach produces more acid. Your muscles tense. Your brain shifts blood flow and activity to “survival” areas of the brain like the amygdala. Stress also revs up your immune system. This helps your body avoid infections and helps wounds heal faster if your injured.
All of these responses are designed to happen very quickly, and then when the threat passes, your body should return to normal. The problem is your brain doesn’t know the difference between “you’re about to be attacked by a bear” and “my boss just moved my deadline up two days.” The stress reaction is the same. And when you stay in that constant state of stress for extended periods, your health suffers.
The Stress/Gut Cycle
There is no denying that living with MC is hard. First, you have to deal with the symptoms of the disease itself such as diarrhea, bloating, joint pain, fatigue, dehydration. All of this is stressful on it’s own. On top of all that, you have to deal with the associated worries of having MC. You have to closely monitor your diet to avoid trigger foods. If your symptoms aren’t under control, then thoughts like “Is there a bathroom nearby?” and “can I make it there fast enough?” are constantly running through your mind. It might have an impact on your job performance, or you might hesitate to make plans with friends.The people around you don’t fully understand what you’re living with. You might not be able to get a good night’s sleep. The potential for stress from your MC can feel endless. And all of this is piled on top of the normal stresses of everyday life.
It’s no wonder people with microscopic colitis and other inflammatory bowel diseases report higher levels of anxiety and depression than those without these diseases. And you guessed it. This creates even MORE stress. It’s a vicious cycle.
Here’s an example of how the stress/gut cycle might work. You wake up on the morning of your big presentation at work. You immediately feel that all-too-familiar churning in your gut, and you sprint to the bathroom. Then your thoughts begin to race. What if you have to go to the bathroom during the presentation? Are you going to be able to even give the presentation? Can you postpone the meeting? Will your boss understand?
With each new thought and worry, your anxiety level rises. To cope with the increased anxiety, your body triggers its stress response. This, in turn, triggers your MC symptoms. And the cycle continues on and on until you can find a way to interrupt it.
How Stress Affects Microscopic Colitis
The human body is a complicated piece of machinery, and trying to understand how everything works is a daunting task. A lot of complex actions and interactions happen in the body when a person experiences both acute (short-term) and chronic (prolonged, long-term) stress. Honestly, not being a researcher or medical doctor makes the stress reaction process incredibly difficult to follow. However, I’m going to do my best to distill this mountain of information down as much as possible so you get a basic idea of how stress might be affecting your MC.
(Most of the following information is taken from an article by J.E. Mawdsley and D.S. Rampton (1). If you would like to read the full article, it can be found here.)
When you feel stressed, your hypothalamus (a part of your brain) kicks your autonomic nervous system (ANS) into action. The ANS is the part of your nervous system that regulates the bodily functions that you don’t consciously have to control such as your heart rate, breathing, pupil dilation, and digestion.
The autonomic nervous system then activates your sympathetic and parasympathetic nervous systems. The sympathetic nervous system (SNS) activates your flight-or-fight response. It sends out a flood of hormones to boost your heart rate, increasing blood flow to your muscles, and makes you more alert and ready for action. It’s like your body’s gas pedal, revving you up for action.
The parasympathetic nervous system (PNS), sometimes called the “rest and digest” system, functions like your body’s brake. The PNS mostly functions to stop your body’s stress response and bring things like your breathing, heart rate, and blood sugar levels back to normal. But during stress, it also slows down or alters bodily functions not necessary to immediate survival, such as your reproductive system and digestion.
Neurons from the sympathetic and parasympathetic nervous systems then trigger the enteric nervous system (ENS). The ENS is the gut’s nervous system. It controls all the functions of the gastrointestinal tract including motility, hormonal function, and circulation.
In a healthy person, these nervous system responses function smoothly and efficiently. Your body gears up for action, you handle the stressful situation, and then your body returns to normal. This isn’t necessarily the case with people with microscopic colitis.
Studies suggest that the autonomic nervous system may not function normally in a person with microscopic colitis or other IBDs (irritable bowel diseases). In particular, the HPA axis may be altered. The HPA axis refers to the interaction between the hypothalamus, the pituitary gland, and the adrenal glands.
Many of the hormones and neurotransmitters released during stress response can trigger inflammation in the body. Inflammation is one of the primary causes of microscopic colitis symptoms. The HPA axis is supposed to monitor and regulate this reaction by releasing anti-inflammatory agents such as cortisol. In people with microscopic colitis, this action either doesn’t work right or it doesn’t produce the same anti-inflammatory affects.
Another factor that can contribute to increased inflammation in the gut is stress seems to increase intestinal permeability. This allows bacteria in the gut to interact more deeply with the mucosal layers of the colon, triggering inflammation.
Other physical changes which occur during stress reactions which may worsen microscopic colitis symptoms include an increase in colonic motility, meaning the muscles in your colon are squeezing harder and moving waste through faster; an increase in water and ion secretion; and an increase in colonic mucus secretion.
It also appears that the chronic stress of dealing with having microscopic colitis might make people with the disease more vulnerable to the affects of acute (short-term) stress. It may take less to trigger a stress response, and when it is triggered, the effects are worse.
How a person copes with stress may also affect their microscopic colitis symptoms. When you’re rushing around trying to get all of your to-do list taken care of, you might decide to swing through a drive-thru for a quick bite. Chugging down coffee to stay alert may also exacerbate symptoms. Many people may resort to smoking, drinking alcohol, or even taking drugs to cope with their stress–all of which have been linked to triggering and worsening MC symptoms.
| Summary: |
|---|
| -Stress may trigger inflammation in microscopic colitis patients because of increased intestinal permeability and an abnormal HPA axis and autonomic nervous system reaction -Symptoms may be worsened by increased intestinal motility, increased water and ion secretion, and increased colonic mucus secretion -People with microscopic colitis may be more easily affected by acute stress than people without MC -Many “typical” ways of coping with stress such as eating junk food, smoking, and using caffeine can all trigger a flare-up of microscopic colitis |
Stress Management Techniques
Because stress can have such a strong impact on microscopic colitis, it’s important to learn how to manage it effectively. The following are some suggestions for getting your stress under control. Keep trying until you find a technique that works for you:
Practice Deep Breathing – Breathe in slowly and deeply through your nose. Feel your belly rise. Slowly exhale. Repeat 3-5 times. Deep breathing tells your brain to calm down and relax.
Yoga – People with IBD have reported a reduction in symptoms when they regularly practice yoga.
Moderate Exercise – Moderate exercise such as taking a brisk walk can reduce stress. You might want to avoid intense exercise, as it can increase inflammation.
Meditation – Meditation triggers the body’s relaxation response. There are many good apps available to help with guided meditation.
Join A Support Group – One of the most stressful factors of having microscopic colitis is feeling isolated. Finding a group of people who understand what you’re going through and sharing your problems can take a load off your shoulders.
Pursue A Hobby – Having an activity that you enjoy can help your mind focus on something other than your problems.
Cognitive Behavioral Therapy – With CBT, a licensed mental health professional gives you the tools and skills to change the way you react to stress.
Plan Ahead – If you have to be in public places for an extended period and you’re worried about your symptoms, try planning ahead to take some stress off. Find out where the bathrooms are located. Take a change of underwear. Take a pack of moist wipes with you. Discuss your concerns with the people you are with so they are in your corner to lend a hand. Anything potential issues you can address ahead of time might bring some relief.
Set Realistic Goals For Yourself – If you are having a flare-up, the odds are you’re not going to able to function at 100%. You might only be able to get a couple of things done in a day. Don’t make yourself a list with fifty tasks on it.
Cut Yourself Some Slack – You have a chronic disease. You have good days and bad. Just do the best you can each day, and don’t beat yourself up if you didn’t get to everything. Be proud of what you WERE able to accomplish.
This is by no means an exhaustive list of things you can do to reduce stress. And there is no “one size fits all” solution. You have to find what works for you. You may even have a different types of relaxation techniques for different types of stress.
How you control your stress doesn’t matter. What matters is getting it under control. Controlling your stress may just be the key to controlling your microscopic colitis.
(1) Mawdsley, J E, and D S Rampton. “Psychological stress in IBD: new insights into pathogenic and therapeutic implications.” Gut vol. 54,10 (2005): 1481-91. doi:10.1136/gut.2005.064261
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