Irritable bowel syndrome (IBS) and anxiety frequently occur together, affecting how both your digestive system and mental health function. IBS is a disorder of gut-brain interaction, meaning there's disrupted communication between your gastrointestinal tract and your brain, which causes symptoms like abdominal pain, bloating, and changes in bowel habits.
Research shows that the relationship between IBS and anxiety is bidirectional. Irritation in the gastrointestinal system can send signals to the brain that trigger mood changes, while anxiety and stress can worsen digestive symptoms. Understanding this gut-brain connection is essential for effectively managing both conditions.
Key Takeaways
Common co-occurrence: Many people with IBS experience anxiety, and those with anxiety disorders have a two-fold higher risk of developing IBS compared to the general population.
Bidirectional relationship: The gut-brain axis works both ways. Anxiety can trigger IBS symptoms, while gut dysfunction can contribute to anxiety, creating a cycle that perpetuates both conditions.
Comprehensive treatment needed: When IBS and anxiety show up together, it usually helps to tackle them as a team. That might mean tweaking your diet, finding better ways to manage stress, talking things through in therapy, and sometimes using medication for your gut, your anxiety, or both. The goal is to support your body and your mind, since they’re pretty connected.
What Is the Gut-Brain Axis?
The gut-brain axis is a complex, bidirectional communication network connecting your gastrointestinal tract with your central nervous system. This connection involves multiple pathways, including nerves, hormones, immune system signaling, and the gut microbiome.
The enteric nervous system (ENS), often called your "second brain," contains over 100 million nerve cells lining your digestive tract. While this second brain can't balance your checkbook, it controls digestion and communicates constantly with your brain through the vagus nerve and other pathways.
How the Gut and Brain Communicate
The vagus nerve: This major nerve connects your gut directly to your brain, sending signals in both directions about digestion, mood, and stress responses.
Neurotransmitters: Your gut produces many of the same chemical messengers found in your brain, including serotonin, dopamine, and GABA. In fact, about 90% of your body's serotonin is produced in the gut.
The HPA axis: The hypothalamic-pituitary-adrenal axis regulates your stress response, releasing cortisol and other hormones that affect both brain function and gut activity.
The immune system: Inflammation in the gut can trigger immune responses that affect brain function and mood.
The microbiome: Trillions of bacteria living in your digestive system produce metabolites that can influence brain chemistry and behavior.
How Common Is the IBS-Anxiety Connection?
The overlap between IBS and anxiety disorders is substantial and well-documented in medical research.
Prevalence Statistics
IBS affects between 5-10% of the general population worldwide, and the majority of patients report associated psychiatric conditions, particularly anxiety and depression.
Research shows that approximately 40% of IBS patients experience anxiety, while 30% experience depression. It works the other way too. People who deal with anxiety or depression are about twice as likely to develop IBS compared to those who don’t.
Why the Strong Connection?
Research also suggests that IBS and anxiety share similar underlying mechanisms involving dysregulation of the gut-brain axis. These shared connections help explain why IBS and mental health issues often show up together, and why treating one can make the other better too.
How Does Anxiety Affect IBS Symptoms?
Stress and anxiety can trigger and worsen IBS symptoms through multiple biological mechanisms.
The Stress Response and Digestion
When you experience anxiety, your body activates its fight-or-flight response. Research shows that this stress response causes the autonomic nervous system to produce corticotropin-releasing factor, which directly impairs gut function.
In people with IBS, the body’s stress system gets a bit out of balance. That makes the gut more sensitive to stress and slower to bounce back, so even small, everyday stress can set off digestive symptoms.
Physical Effects of Anxiety on the Gut
Altered gut motility: Anxiety can speed up or slow down the movement of food through your digestive tract, leading to diarrhea or constipation.
Increased visceral sensitivity: Stress hormones can make your gut nerves more sensitive to pain and discomfort, amplifying normal digestive sensations.
Changes in gut permeability: Chronic stress may increase intestinal permeability ("leaky gut"), allowing substances to pass through the gut lining that trigger inflammation and immune responses.
Microbiome disruption: Research shows that psychological stress can alter the composition of gut bacteria, which in turn affects digestion, immune function, and even mood.
Diagnosing IBS With Anxiety
Proper diagnosis requires evaluation of both digestive and mental health symptoms.
IBS diagnosis is based on the Rome IV criteria, which include:
Recurrent abdominal pain at least one day per week in the last three months
Pain associated with changes in bowel frequency
Pain associated with changes in stool form or appearance
Symptoms have been present for at least six months
Your healthcare provider will take a detailed history and may order limited testing to rule out other conditions like celiac disease or inflammatory bowel disease.
Mental health evaluation typically includes:
Standardized questionnaires measuring anxiety severity (such as GAD-7 or Hamilton Anxiety Scale)
Discussion of anxiety symptoms, triggers, and impact on daily functioning
Assessment of other mental health conditions, like depression or trauma
Review of how anxiety symptoms relate to digestive symptoms
Treatment Approaches for IBS and Anxiety
Dietary Modifications
Low-FODMAP diet: This eating approach restricts certain fermentable carbohydrates that can trigger IBS symptoms. Research shows it helps many people with IBS reduce bloating, gas, and altered bowel habits.
Regular eating patterns: Eating meals at consistent times and avoiding late-night eating can help regulate both digestion and sleep, which affects anxiety.
Identifying triggers: Keeping a food and symptom diary can help identify specific foods that worsen symptoms.
Stress Management Techniques
Mindfulness meditation: Regular meditation practice can reduce both anxiety symptoms and IBS symptom severity by helping regulate the stress response.
Deep breathing exercises: Diaphragmatic breathing activates the parasympathetic nervous system, promoting relaxation in both the mind and gut.
Regular exercise: Physical activity reduces anxiety, improves gut motility, and supports overall digestive health.
Adequate sleep: Poor sleep worsens both IBS and anxiety. Prioritizing sleep hygiene supports recovery of both conditions.
Psychological Therapies
Brain-gut behavioral therapies (BGBTs) are recommended in IBS clinical guidelines globally as part of integrated care.
Cognitive-behavioral therapy (CBT): CBT helps identify and change thought patterns that contribute to both anxiety and digestive symptoms. Research shows CBT improves IBS symptoms and mental health outcomes.
Gut-directed hypnotherapy: This specialized approach uses hypnosis and imagery to calm the digestive system. Studies show it can reduce IBS symptoms by at least 50% in up to 76% of patients, with effects lasting for years.
Acceptance and commitment therapy (ACT): ACT teaches acceptance of uncomfortable sensations rather than fighting them, reducing the anxiety-symptom cycle.
Medications for IBS and Anxiety
Different medications can help address various aspects of both conditions.
Antidepressants: Low doses of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) can help with both IBS pain and anxiety symptoms.
IBS-specific medications: Depending on your primary symptoms, your doctor might prescribe medications that regulate gut motility or reduce visceral pain sensitivity.
Anti-anxiety medications: SSRIs or serotonin–norepinephrine reuptake inhibitors (SNRIs) prescribed for anxiety can also help improve IBS symptoms by affecting serotonin signaling in both the brain and gut.
Gut-directed medications: Some newer medications are designed to work on the gut-brain connection, helping reduce pain and get digestion back on track.
When to Seek Professional Help
Both IBS and anxiety benefit from professional treatment, especially when symptoms significantly impact your quality of life.
Signs You Should See a Healthcare Provider
For IBS symptoms:
Persistent abdominal pain or discomfort
Significant changes in bowel habits
Unintended weight loss
Blood in stool
Symptoms that wake you from sleep
For anxiety:
Persistent worry that interferes with daily activities
Physical symptoms like rapid heartbeat, sweating, or trembling
Panic attacks
Avoidance of situations due to anxiety
Sleep disturbances related to worry
For both conditions:
Symptoms that significantly reduce your quality of life
Inability to work, socialize, or function normally
Depression or thoughts of self-harm
Previous treatments haven't provided adequate relief
Comprehensive Treatment Through Blossom Health
For people dealing with both IBS and anxiety, integrated mental health care can make a significant difference.
Blossom Health provides comprehensive telehealth psychiatry that addresses the mental health aspects of living with IBS. Our board-certified psychiatrists understand the gut-brain connection and can:
Evaluate and treat anxiety disorders that occur alongside IBS.
Prescribe medications that can help with both anxiety and IBS symptoms.
Provide referrals to therapists specializing in gut-brain therapies like CBT.
Coordinate care with your gastroenterologist for integrated treatment.
Offer ongoing support and medication management through convenient virtual appointments.
Getting started is simple. Schedule an appointment at Blossom Health to connect with a psychiatric provider who can evaluate your symptoms and develop a personalized treatment plan. All appointments are covered by in-network insurance and conducted from the comfort of your home.
The Bottom Line
IBS and anxiety are closely linked, and each can make the other worse. Many people with IBS also have anxiety, so treating both at the same time works best. This often includes diet changes, stress support, therapy, and medication.
Medical Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.
Sources
Johns Hopkins Medicine. The Brain-Gut Connection. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-connection
Mayer, E.A., Ryu, H.J. & Bhatt, R.R. 2023. The neurobiology of irritable bowel syndrome. Mol Psychiatry. https://www.nature.com/articles/s41380-023-01972-w
Chen M, Ruan G, Chen L, Ying S, Li G, Xu F, Xiao Z, Tian Y, Lv L, Ping Y, Cheng Y, Wei Y. 2022. Neurotransmitter and Intestinal Interactions: Focus on the Microbiota-Gut-Brain Axis in Irritable Bowel Syndrome. Front Endocrinol (Lausanne). https://pubmed.ncbi.nlm.nih.gov/35250873/
Raskov H, Burcharth J, Pommergaard HC, Rosenberg J. 2016. Irritable bowel syndrome, the microbiota and the gut-brain axis. Gut Microbes. https://pmc.ncbi.nlm.nih.gov/articles/PMC5046167/
Cleveland Clinic. The Gut-Brain Connection. https://my.clevelandclinic.org/health/body/the-gut-brain-connection
Gut Microbiota for Health. Is there a disconnect between how your brain and gut communicate in IBS? https://www.gutmicrobiotaforhealth.com/is-there-a-disconnect-between-how-your-brain-and-gut-communicate-in-ibs/
Stoyanova, M.; Gledacheva, V.; Nikolova, S. 2025. Gut–Brain–Microbiota Axis in Irritable Bowel Syndrome: A Narrative Review of Pathophysiology and Current Approaches. Appl. Sci. https://www.mdpi.com/2076-3417/15/12/6441
Staudacher HM, Black CJ, Teasdale SB, Mikocka-Walus A, Keefer L. 2023. Irritable bowel syndrome and mental health comorbidity - approach to multidisciplinary management. Nat Rev Gastroenterol Hepatol. https://pmc.ncbi.nlm.nih.gov/articles/PMC10237074/
BadGut.org. Brain-Gut Connection and IBS. https://badgut.org/information-centre/a-z-digestive-topics/brain-gut-connection-and-ibs/
University of Michigan Health. Gut-Brain Axis (GBA) and Irritable Bowel Syndrome (IBS). https://www.uofmhealth.org/sites/default/files/2025-03/Gut-Brain-Axis-and-IBS.pdf
