Life with ulcerative colitis (UC) can be stressful because of the condition’s unpredictable symptoms and the disruption they can cause, among other issues. And stress from any source can influence the course of UC by triggering symptoms and flares. Some research suggests that stress may even trigger the onset of the condition in certain people.
The nervous system and the gut influence each other, says Stephen E. Lupe, PsyD, a gastrointestinal psychologist and the director of behavioral medicine in the department of gastroenterology, hepatology, and nutrition at Cleveland Clinic in Ohio. The gut sends out messages that the brain interprets, but sometimes, the nervous system starts to become abnormally hypersensitive to those signals, he says. “If someone’s experiencing a lot of symptoms … [it] causes a stress reaction, which then makes the symptoms worse,” he says.
Although a busy schedule can put self-care activities on the back burner, prioritizing stress management is especially important if you have UC, says Lupe. Stress-reduction techniques engage the calming parasympathetic — or “rest and digest” — part of the autonomic nervous system (ANS). “This generally helps with GI functioning and how our [ANS] interprets the sensations that come up from the gut. We see a decreased pain response, a decrease in inflammatory hormones being released, and decreased dysfunction in the body.”
Here are some natural ways to manage UC-related stress that you might want to try.
1. Hypnotherapy
Gut-directed hypnotherapy has been in the news recently as a potential complementary treatment for IBD — and small, preliminary studies suggest that it may alleviate inflammation and symptoms in some people, and may even sustain remission in UC.
In gut-directed hypnotherapy, a guided session helps you get into a state of highly focused concentration and relaxation. The therapy, which can be done with a trained practitioner or via prerecorded audio tracks, uses guided imagery, muscle relaxation, and other techniques to help you manage your responses to IBD symptoms that are otherwise out of your control.
As previously mentioned, research on hypnotherapy for IBD is limited, and more studies are needed to confirm the results of previous trials. But gut-directed hypnotherapy has been found to be highly effective in irritable bowel syndrome (IBS), and one study on people with IBD who experience IBS-like symptoms (diarrhea, abdominal pain) while in remission found that the treatment was effective for them as well. While the study was small, it suggests that hypnosis could potentially complement traditional medical treatments in the estimated 35 percent of people with IBD who also experience IBS-like symptoms.
“The brain gets better at figuring out where to place its attention,” says Lupe. “It seems to be activating parts of the brain involved in filtering out some of the noise and decreasing some of the sensitivity in the … nervous system, so that the signals may still be there but not as loud. And it results in deep relaxation, which can help the body function better.”
2. Journaling
You may already be tracking your UC symptoms and diet with a journal. But writing down your emotions and thoughts — journaling in the more traditional sense — may also boost your mental health. Journaling, especially if you’re working with a mental health professional, can help you identify negative thoughts and behaviors, recognize your UC triggers, and prioritize your concerns to find solutions.
When we journal, it’s easier to accept our emotions, says Lupe. “You don’t react to them like they’re happening, but instead as thoughts.” For people with UC who are constantly anticipating pain, journaling may lessen the intensity of the stress response that can be partially responsible for triggering symptoms, he says.
3. Acupuncture
A form of traditional Chinese medicine, acupuncture is the practice of inserting tiny needles into specific points on the body to promote the flow and balance of energy. Research has found that acupuncture may be effective at treating several types of chronic pain. Study findings also suggest that the technique may reduce inflammation and the pain related to it, but high-quality trials are needed to better understand how this works.
Acupuncture might also relieve the symptoms of IBD, which could, in turn, ease your stress levels and disrupt the feedback loop between the two. One research review of four randomized controlled trials that enrolled a total of 228 people with IBD found that acupuncture significantly improved symptoms and also reduced the levels of certain inflammatory markers in the blood. Researchers noted that larger, better-designed studies are needed to confirm these findings, however.
Acupuncture has also shown promise in reducing stress in general; one study of 35 healthy volunteers indicated that it can trigger parasympathetic nervous system dominance — putting the body in a state of rest — and a reduction in physical signs of stress.
For now, there’s not enough evidence to prove that acupuncture is an effective treatment for UC stress or symptoms of the illness. But acupuncture is a low-risk option so long as it’s practiced by a trained (and in most states, licensed) practitioner, so it might be worth trying.
4. Meditation
Mindfulness meditation helps you to focus on what’s happening in the present moment and accept your emotions and bodily sensations without judgment.
If you’re struggling to cope with stress, you may want to try mindfulness-based stress reduction (MSBR); programs include in-person and virtual sessions or self-guided, smartphone app-based exercises that teach you to increase mindfulness and relieve stress through yoga and meditation. You can also practice mindfulness alongside cognitive behavioral therapy in mindfulness-based cognitive therapy (MBCT) with a licensed mental health practitioner.
Meditation isn’t about “turning off” your mind, says Lupe. “With meditation, you’re seeing your thoughts and sensations and emotions and not reacting to them,” he says. Allowing them to pass without judgment or attachment can help put some distance between you and stress related to UC symptoms, so that it may have less of an impact on your health.
One research review of studies on people with IBD found that mindfulness-based interventions such as meditation, MSBR, and MBCT were more effective than methods used by control groups. In the short-term, such interventions reduced stress and C-reactive protein, an inflammatory marker in the blood, while increasing mindfulness and health-related quality of life scores. Decreased stress and increased mindfulness was also found on long-term follow-ups.
5. Exercise
You probably already know that regular physical activity can relieve stress, improve mood, and reduce mild anxiety and depression symptoms. This is partly due to the boost exercise gives your overall health and the release of feel-good endorphins when you work out. Despite this, “exercise is probably the least utilized [treatment] we have for anxiety, depression, and stress,” says Lupe.
Exercise produces a cascade of benefits for the body, Lupe says, including decreased inflammation and increased circulation. It can also help maintain a healthy weight and support immune function. These effects are especially important for people with UC, since the immune system plays a central role in promoting the inflammation that causes symptoms and flares.
One research review notes that exercise reduces the risk of flares and fatigue in people with IBD. Other research has indicated that moderate-intensity physical activity is associated with generally positive effects on IBD symptoms and inflammation, while high-intensity or lengthy workouts can cause digestive symptoms or inflammation; more research is needed to confirm these findings, however.
While finding the motivation to work out can seem impossible, particularly if you’re experiencing a flare, starting small — taking a short walk, for example — and going at your own pace can help.
6. Deep Breathing
Taking deep belly breaths is a surprisingly simple and effective way to ease stress and lower your heart rate and blood pressure. This kind of deep breathing, which uses the diaphragm muscle, improves digestion by engaging the parasympathetic nervous system, and it can even reduce bathroom urgency and cramping.
Deep breathing also massages the internal organs around the diaphragm, including the gastrointestinal tract. This can help with pain, diarrhea, and constipation. Taking a deep breath during moments of UC-related stress can also calm the body’s fight-or-flight response.
“Deep breathing activates the parasympathetic or rest-and-digest part of the nervous system,” says Lupe. “It’s taking us out of that threat mode, which can decrease the perception of sensations.”
Focusing your attention on your breathing can also help you relax and cope with pain and nausea, he says.
7. Grounding Techniques
When you have UC, you may spend a lot of time worrying about the future — like whether you’ll struggle to find a restroom at the concert you’re going to next weekend, for example. But anxiety can activate the sympathetic nervous system and put you into fight-or-flight mode, exacerbating symptoms, says Lupe.
If you find your anxiety is taking over, Lupe says it’s helpful to ground yourself in the present moment. He suggests looking around at your surroundings and bolstering your sense of safety by noting five things you can see, four things you can hear, three things you can touch, two things you can smell, and one thing you can taste. “That can get us out of reacting to our thoughts,” says Lupe.
Finally, if your UC symptoms are so overwhelming that they’re getting in the way of your daily activities, find a professional to speak with — whether that’s a therapist or a member of your healthcare team. “A lot of times we won’t talk to people, including even the people who love us. But just talking about what’s going on and being able to feel supported helps,” says Lupe.
The Takeaway
- Stress is common in people with ulcerative colitis (UC) and can worsen symptoms of the illness by triggering a stress response cycle controlled by the gut-brain connection.
- Practicing stress management techniques activates the body’s calming parasympathetic nervous system, inducing a relaxation response, which can decrease symptoms and signs of inflammation.
- There are a number of natural, complementary treatments that may ease UC-related stress, including gut-directed hypnotherapy, journaling, acupuncture, and mindfulness-based meditation.
- Simple lifestyle adjustments like moderate exercise, deep belly breathing, and grounding techniques are also recommended to reduce stress.
