Stress does more than make your palms sweat and your brow furrow. For people with ulcerative colitis (UC), an inflammatory bowel disease (IBD), it may increase your chances of having a painful flare.
“Stress is well-known for exacerbating inflammatory bowel disease symptoms,” says Jordan Axelrad, MD, MPH, an associate professor of medicine at New York University’s Grossman School of Medicine and a gastroenterologist at NYU Langone Health’s Inflammatory Bowel Disease Center in New York City. “My patients always tell me that their symptoms feel worse when they’re stressed.”
The neurological link between the brain and the gut, known as the gut-brain axis, may help explain this connection. In addition to triggering IBD symptoms, stress has been linked to changes in the gastrointestinal tract.
Treatment for UC usually involves medications like aminosalicylates, corticosteroids, and immune-system suppressors to address inflammation. But finding ways to manage your stress levels could also relieve some of your discomfort if you have UC. Here are six tips that can help.
1. Try Yoga to Boost Your Quality of Life
Yoga is a mind-body practice that combines breathing and stretching to induce relaxation. Research has shown that yoga and mindfulness — focusing on your present emotions, thoughts, and sensations — also can help relieve symptoms of UC and improve quality of life.
You may find yoga classes at many local gyms and recreation centers or via online resources and apps.
2. Take Deep Breaths to Calm Your Gut
Breathing deeply can help reduce gut pain and cramping from ulcerative colitis, says Sarah Kinsinger, PhD, director of behavioral medicine for the digestive health program at Loyola University Health System in Oakbrook Terrace, Illinois.
“Deep breathing elicits a parasympathetic relaxation response that physiologically helps the body relax by increasing blood flow and oxygen to the gut,” Kinsinger says.
Experiment with different deep-breathing techniques, including diaphragmatic breathing and alternate nostril breathing, to learn what helps you relax.
3. Try Hypnotherapy
Hypnotherapy uses guided meditation, hypnosis, and concentration to achieve a heightened state of awareness. “Gut-directed hypnotherapy can influence gut secretions, reduce pain, and prolong remission in those with UC,” Kinsinger says.
Hypnotherapy may not relieve UC symptoms on its own, but it might help improve your quality of life by reducing stress. Be sure to consult a trained professional if you’re interested in hypnotherapy.
4. Sleep Better to Recharge
Not only can a good night’s rest help you relax and reset, but it may also decrease your stress and lower your risk of a UC flare.
However, research shows that 56 percent of people with IBD have a hard time getting good sleep, especially if they’re older or have active disease.
Adopting sleep-friendly habits can help you sleep more soundly and keep symptoms at bay. Start by sticking to a consistent sleep schedule and avoiding caffeine, bright lights, and screens before bedtime.
5. Exercise
Moderate exercise can keep your bowels working properly and ease tension, which can reduce symptoms of UC.
That said, exercise may be uncomfortable for some people with UC. “However, I encourage them to push through because physical activity can improve fatigue and some disease activity,” Dr. Axelrad says.
The key is finding a type of exercise that you enjoy and that doesn’t exacerbate your symptoms. Ask your doctor about activities that might be most appropriate or comfortable for you. Some UC-friendly options may include walking, rowing, yoga, biking, and swimming.
6. Consider Cognitive Behaviorial Therapy
Axelrad suggests trying cognitive behavioral therapy (CBT), a psychological treatment that focuses on changing thinking and behavioral patterns to better cope with life stressors.
Studies have shown that CBT may have at least short-term psychological benefits for people with UC, though more research on the long-term benefits is still needed.
“It is important that [people with UC] meet with a psychologist at least once to address stress and [the] psychological impact of the disease,” says Lilani Perera, MD, a gastroenterologist and director of the Inflammatory Bowel Disease Center at Tufts Medical Center in Boston. “We strongly recommend integrated care, including CBT, to address psychological needs in IBD.”
The Takeaway
Alongside standard treatments, lifestyle changes like managing stress may help reduce ulcerative colitis (UC) symptoms.
Known stress-busting activities like yoga, deep breathing, or exercise may be helpful for you.
Research suggests cognitive behavioral therapy, a type of talk therapy geared toward changing thinking and behavior patterns to better cope with stress, may help people with UC.
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Resources
Sauk JS et al. High Perceived Stress Is Associated With Increased Risk of Ulcerative Colitis Clinical Flares. Clinical Gastroenterology and Hepatology. March 2023.
Ge L et al. Psychological Stress in Inflammatory Bowel Disease: Psychoneuroimmunological Insights Into Bidirectional Gut–Brain Communications. Frontiers in Immunology. October 6, 2022.
Wilke E et al. Effects of Yoga in Inflammatory Bowel Diseases and on Frequent IBD-Associated Extraintestinal Symptoms Like Fatigue and Depression. Complementary Therapies in Clinical Practice. November 2021.
Chen J et al. The Physiological and Psychological Effects of Cognitive Behavior Therapy on Patients With Inflammatory Bowel Disease Before COVID-19: A Systematic Review. BMC Gastroenterology. December 15, 2021.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Dennis Thompson is a career journalist with 30 years of experience, writing for newspapers in Virginia, West Virginia, Florida, Delaware, and Oregon. He is a senior reporter for HealthDay and covers health news from a consumer angle, taking the latest medical advances and explaining their importance in an approachable way. Thompson holds a bachelor of arts degree in communication studies from Virginia Tech and a master of arts degree in mass communication from the University of Florida. He is an avid cyclist, geek culture enthusiast, and avowed foodie.
