IBS and PTSD: When Trauma Traumatizes Your Gut

In our last blog, we talked about the ways that stress affects gut health in those with IBS and IBD. In this blog, we’ll explore the relationship between IBS and PTSD.

If you aren’t familiar, PTSD is short for Post Traumatic Stress Disorder. PTSD is a disorder that happens to some people who experience trauma, shock, or a dangerous situation.

When someone has PTSD, their nervous system is stuck in sympathetic mode (1). This is your fight or flight system and results in the release of stress hormones. You can learn more about that here.

Irritable bowel syndrome (IBS) is an exceedingly common yet often misunderstood gastrointestinal condition. Although the cause of IBS is not clear, it is known to be influenced by altered gut microbiota, pain in the organs of your chest, abdomen and pelvis, medically known as visceral hypersensitivity, inflammation, gut-brain interactions, and the hypothalamic-pituitary-adrenal-axis, or the HPA axis.

Throughout the years, research has continued to find links between IBS and PTSD. A 1996 study found that 44% of IBS patients had a history of trauma, and 36% were diagnosed with PTSD (2). A recent study found that IBS was prevalent among military veterans, with rates near 30%, and was more likely in those diagnosed with PTSD (3).

Multiple studies have confirmed that IBS is significantly more common in adults who were victims of childhood abuse (4).

So, we know the connection between IBS and PTSD is strong. What causes this to happen? Let’s take a look.

IBS and PTSD: An imbalanced brain-gut axis

Amazingly, your gut has its own nervous system and is home to 500 million neurons that control gut muscle function, blood flow, and even influence the immune system. This special nervous system, called the enteric nervous system, is also directly linked to the brain. This link creates a bi-directional connection known as the gut-brain axis.

Beyond the anatomical connection between these two systems, several other systems mediate and influence this relationship, including the immune system, the endocrine system, and even metabolism and the HPA-axis (5).

Early research on the gut-brain axis showed us that simply introducing specific gut bacteria to test animals would result in immediate anxiety!

Later, researchers found that certain strains of probiotics were effective at reducing symptoms of anxiety and depression in adults.

The science also shows that the gut microbiota influences the HPA axis and our reaction to and perception of stress (5). This connection is key when it comes to IBS and PTSD.

It is thought that IBS and PTSD share a commonality of a hyper-vigilant nervous system response. Those with IBS may have visceral hypersensitivity, meaning they very easily feel everything that is going on in the gut. Gurgles and gas that might be a passing nuisance to someone without IBS may feel unbearable to someone with IBS. Similarly, those with PTSD are thought to have a hypersensitive sympathetic response to traumatic triggers resulting in long-term symptoms (6).

Research on adults with IBS and early life trauma shows that adults who experience childhood trauma have an exaggerated HPA response after exposure to a visceral stressor (in this experiment, sigmoidoscopy, or a diagnostic test of the sigmoid colon, was used to mimic the visceral stress that might be normally caused by IBS). This was illustrated by an increased level of cortisol that did not return to baseline as it did in control subjects. Cortisol is your body’s main stress hormone, and chronically high cortisol increases inflammation and hurts the gut. For those with IBS, this heightened cortisol response directly correlated to symptom severity (7).

The microbiome is also a key player in developing IBS and PTSD. A new study published in 2022 found that early life trauma may alter the microbiome, making it much more likely to have increased inflammation and develop PTSD later in life. In this study, researchers were able to identify 66.4% of those with PTSD just by looking at their gut microbiota (8)!

When it comes to IBS, increased inflammation, stress, and altered gut microbiota are all recognized as major factors that influence the disease.

PTSD influences the likelihood of developing IBS, as well. A meta-analysis of 648,375 individuals determined that PTSD is a significant risk factor for IBS, where those with a history of PTSD were almost three times as likely to develop IBS (pooled OR: 2.80, 95% CI: 2.06 to 3.54, p<0.001) (6).

If you need more info about stress and gut health, be sure to check out these blogs here and here.

IBS and PTSD: Adverse childhood experiences and the gut

In the 1990s, the CDC and a group of healthcare researchers found a direct link between childhood trauma and chronic disease in adulthood.

Childhood trauma is referred to in the literature as “adverse childhood experiences” and includes parental divorce/separation, abuse (emotional, physical, and sexual), physical and emotional neglect, household mental illness, household substance abuse, and household incarceration.

In recent years this list has been expanded to include bullying, racism, community violence, neighborhood safety, and living in foster care.

A 2016 study showed that adults who experienced childhood trauma were twice as likely to have IBS (OR=2.05 [95% CI: 1.21-3.48], p=0.008), and severity of trauma positively correlated with IBS symptom severity (9).

In this particular study, those who experienced household mental illness and emotional abuse were the most likely to have IBS in adulthood (9).

Multiple studies have found that nearly half of those who were victims of sexual abuse during childhood will develop IBS during adulthood (10). In one study, 38% of those with IBS reported experiencing childhood sexual abuse (10). In comparison, only 9% of those with IBD and 11% of those with other GI disorders reported childhood sexual abuse (10).

IBS and PTSD: Detraumatize your gut

The good news is: that you can take huge steps toward healing IBS and PTSD. Keep reading to learn about simple, research-based ways to detraumatize your gut.

Mindfulness-based stress reduction (MBSR)

MBSR is a therapy that teaches mindfulness and meditation. Mindfulness is the practice of intentionally focusing on the present while keeping a non-judgemental and neural mindset. This is intended to cultivate feelings of curiosity and compassion and limit feelings of overwhelm and negativity.

MBSR is a promising treatment for both IBS and PTSD. In a 2016 trial, veterans with both IBS and PTSD found significant relief after attending an MBSR group for 8 weeks. Four months later, only 40% met the criteria for IBS, and only 77% met the criteria for PTSD. This is noteworthy, considering the baseline was 100% for both IBS and PTSD (11).

Flotation therapy

Flotation therapy has been around since the 1950s. Originally invented by John C. Lilly as a tool for exploring ways to expand human consciousness, flotation therapy has recently entered the mainstream of alternative therapies.

There are now hundreds of recreational float centers, and chances are, if you live in a larger city, there is one near you. Floating involves floating in a warm pool of salty water in a dark and quiet room. The salt makes you super buoyant, so you easily float safely on top of the water.

Flotation therapy is an easy way to enter a relaxed, meditative state, even for those who have trouble meditating. After floating, most people can expect a decrease in blood pressure, a reduced heart rate, and a decreased level of plasma cortisol (12).

For those with PTSD and severe anxiety, floating can be a wonderful stress relief tool. A small study of 50 participants with severe anxiety disorders, including PTSD, found that one 60-minute float session significantly reduced feelings of anxiety, depression, negative affect, muscle tension, and pain and significantly increased feelings of serenity, happiness, relaxation, and well-being (p<0.0001, all) (12).

Find your people

Social connection has protective effects on both IBS and PTSD. Studies have found that perceived social support is inversely related to stress, pain, and IBS symptom severity (13). Similarly, support from friends and family has a protective effect on the severity of PTSD symptoms (14).

Reach out to family and friends, and make time for connection, whether it be a coffee date or night out. If you need a better support system, look for peer support groups or join a recreational group of like-minded folks.

References