Inflammatory bowel diseases (IBD), Crohn’s and ulcerative colitis, are diseases that are significantly affected by the mental state. The patients with these diseases may experience a worsening of the physical symptoms to the point of a flare-up of the disease. Patients may notice an increase in the symptoms of the disease such as: an increase in the amount in stools, an increased tendency to bleed and a decrease in hemoglobin levels, fatigue and exhaustion. Many times, increasing the symptoms of the disease will itself lead to an increase in stress levels, and thus a “vicious circle” may be created, in which increases in stress levels affect the symptoms and God forbid.
In Israel, approximately 65,000 patients suffer from inflammatory bowel diseases and the number of patients is on a continuous upward trend. The reasons for the development of these diseases are not fully known, but they include a complex relationship between several factors, among them: genetic, environmental factors and factors related to the immune system.
In an article published in 2023,  which examined the interrelationship between mental difficulties and inflammatory bowel diseases and their symptoms, it was noted that there is a mutual influence between inflammatory bowel diseases and mental disorders, such as: anxiety, depression and post-traumatic disorder, which may have a negative effect on the development of the course of the disease. Also, it was found in the article that continuous stress has an effect that may be significant. Prolonged exposure to stressful situations, such as the current situation, harms our optimal functions and also the functioning of our bodies.
A state of stress is essential and important when we have to deal with a temporary threat. But when it comes to a continuous state of stress, there is an unbalanced secretion of hormones and abnormal activation of the autonomic nervous system.
It is known that there are significant interactions between the brain and the digestive system and it has even been found that the digestive system has more nerve cells than the spine. The article also shows that stress has a significant effect on the axis connecting the digestive system to the brain. The stress causes a change in the nerve cells and a change in the functioning of the immune system, resulting in a direct effect on the inflammatory bowel disease and the worsening of the symptoms.
Another axis through which the continuous stress has an effect is the hormonal axis that goes out of balance following the body’s prolonged “fight or flight” response (an evolutionary response that occurs in our bodies in situations of danger), which creates a hormonal chain, which ends in an attack on cells by the immune system and an increase in the inflammatory response.
How do you deal with prolonged stress that affects the course of the chronic disease? Is it possible to find areas of control in situations where the experience is that there is no control?
First of all, it is important to be careful first and foremost about the sequence of drug treatment and medical follow-up. In times of emergency, the person often tends not to meet their basic needs, so, for example, they don’t eat in an orderly manner or skip meals, they don’t make sure they get enough sleep, and there is a tendency to gather and reduce functioning. These are all normal reactions to difficult events, but over time it is important to return to proper self-care. It must be remembered that the disease continues to exist even if we do not “feel like” taking the medicine or making an appointment at the health insurance fund, and it even becomes more sensitive, therefore the patient’s obligation is to continue the routine of medical treatments.
What are the ways to help reduce the stress level?
The first recommendation is maintaining the degree of exposure to the news. There is a correlation between the way we consume media and the level of anxiety, where watching the news/videos increases anxiety at the highest level, followed by listening to the radio, and finally reading the news. Therefore, for those who tend to experience high anxiety, it is recommended to read the news or be connected to alarm alerts, but beyond that not to consume news at all.
The stories and horrors overwhelm us and it is still hard to feel safe. There is no obligation to hear all the stories at once, there is no need to flood our minds with indigestible information. A question we can ask ourselves – is this behavior helping me right now? If the answer is no, you can choose another behavior, for example, reading a book or listening to your favorite music.
As mentioned, a reduction in anxiety levels will lead to a reduction in the cortisol hormone secreted in stressful situations, also, relaxing activities such as listening to music, being around loved ones and sometimes even hugging for at least 30 seconds, will cause the secretion of hormones that have a positive effect on the immune system. These hormones in turn will be able to reduce symptoms of bowel contraction and will lead to a reduction in bowel urgency.
In addition, it is important to perform correct breathing. The body is in constant “fight or flight” mode and since it has nothing to fight or escape from, the energy is trapped inside and the sympathetic system (which irritates the muscles and causes them to contract as well as the contraction of the intestine), will work harder without a “stop button”. Breathing is the key to stopping this situation.
The emphasis in breathing is on expelling the air at twice the rate of its intake. Inhaling air through the nose (rhythm 4) and exhaling through the mouth slowly (rhythm 8). Five breaths will help activate a bypass physical system that regulates the state of anxiety. These in turn will also be able to reduce exits and urgent trips to the bathroom. The activation of the parasympathetic system leads to a reduction in intestinal contraction.
Another recommendation is the understanding that we cannot always control what happens to us, but we can control the way we deal with it. To regain an experience of control and security through routine daily actions, to change thoughts that do not help us (ask ourselves if what I am thinking now really helps me? If not, we choose to give up the thought or replace it with another thought), and increase physical activity such as walking or jogging , for the purpose of releasing the energy. Many times due to the weakness of the body due to the disease, there is difficulty in performing vigorous physical activity, but it is important to perform some kind of mobility, even if it includes partial activation of the body (for example: fists only in the air or walking around the house), these will allow the body to release energy and thus hopefully reduce the the increased disease symptoms.
It is important to remember that the majority of the population will cope well with the situation, and despite the overflow of emotions we are experiencing now, things will return to balance, so it is important to remind ourselves of this. Hope is an important resource and a very powerful force, and even difficult and terrible situations eventually pass.
If the mental distress lasts a long time and includes symptoms that do not go away and harm the quality of life, it is important to contact one of the mental health providers in the community or the health fund. For patients with inflammatory bowel diseases, this is a critical recommendation, because maintaining a normal mental state is essential and may also affect maintaining the state of the disease.
Don’t keep it in your stomach! For advice and guidance, you can contact the hotline number of the association to support Crohn’s and colitis patients 03-7441391, Sunday-Thursday 19:00-22:00. For more information and support services, go to the association’s website www.ccfi.co.il.