When you have ulcerative colitis (UC), you’re looking for every opportunity to keep symptoms under control. To that end, you’ve probably heard your doctor say a thousand times that it’s important to lower the stress in your life. So how exactly does stress impact your UC? And is stress really always a bad thing? We asked the experts to explain the role of stress on chronic conditions like UC. Here’s what they told us.
What Is Stress?
Stress happens to all of us. And thanks to COVID, it’s been something of a constant for the past two years: According to the American Psychological Association, two in three adults say they have experienced increased stress over the course of the pandemic. In theory, a rise in stress isn’t such a bad thing. After all, stress is a normal human reaction that is designed to help us adjust to new situations. When we are feeling stressed, we tend to be more alert and ready to take on the next challenge. Stress in small doses makes us work a little bit harder and faster when we need to, like when we have a tight deadline looming or need to figure out last minute childcare.
Understanding the Stress Response
If someone asked you to describe what it feels like to be stressed, you might describe being on edge or like any minute, the other shoe will drop. But stress is more than an emotional reaction—there are important physiological changes that happen when you are feeling stressed, too, says Lindsay Bottoms, Ph.D., head of the Center for Research in Psychology and Sports Science at Hertfordshire University in Hertfordshire, U.K. “Our body responds to stress by releasing hormones which increase our heart rate and our breathing and tense our muscles,” she says. “Stress essentially prepares us to fight or run away, which is why it is known as the ‘flight or fight’ response.” In cases of imminent danger, this stress response is invaluable, providing the energy to get away from dangerous situations.
How Stress Can Cause Inflammation
In cases of ongoing tension or conflict, however, prolonged stress can wreak havoc on your body, primarily through an inflammatory response. “Along with other physical changes, stress causes the body to produce the hormone cortisol,” says Bottoms. “If we are under continuous stress, our body can produce cortisol levels that are too high, which can then impair the inflammatory response.” In the short term, says Bottoms, cortisol can actually help regulate inflammation, but with chronic stress, the body stops responding, allowing inflammation to escalate. “The body’s systems are often interlinked,” she explains.
How Stress Affects UC
If you are living with ulcerative colitis, stress talk gets elevated to a whole new level. That’s because UC is an inflammatory bowel disease that already causes inflammation in your digestive tract. So, when you are experiencing stress, it can trigger even more inflammation in your body, leading to a worsening of UC symptoms. “Stress affects UC as it would any chronic illness,” says Loren Brook, M.D., a gastroenterologist at the University of Cincinnati College of Medicine in Ohio. “Stress may increase your chances of flares and is known to weaken the immune system.”
“When you are stressed, the increase in cortisol can increase the pro-inflammatory cytokines and therefore cause increases in inflammation of the gut which has a negative effect on UC,” says Bottoms. “This also means your general immune system is not as effective and may struggle to fight against other illnesses as well.”
Can Stress Cause UC?
UC develops through interactions among genetics, environmental factors and gut microbiota. That part we have a handle on. The waxing and waning of the disease symptoms (a.k.a. relapsing and remitting) indicates there may be other factors at play including psychological stress. The jury is still out on whether stress can cause UC, but there are signals from the UC research community that an answer might not be too far in the distance.
For example, there is growing evidence from different studies suggesting that stress can act to promote relapses in inflammatory bowel disease according to the journal Frontiers in Pediatrics. There are also mice studies that show white blood cells are significantly increased after stress. Gut microbiota is also dramatically changed after stress, with more inflammation-promoting bacteria as reported in the journal Proceedings of the National Academy of Sciences. Researchers believe that the results of the mice studies show chronic stress disturbs gut microbiota, triggering immune system response and facilitating colitis. While there is still a lot to learn about whether stress can cause UC, there is one thing we know for sure: When we experience prolonged stress, multiple systems of our body are impacted and usually not in a good way.
Keeping Stress From Making UC Worse
Of course, understanding the role of stress in UC is one thing; doing something about it is another. “Small lifestyle tweaks to your day-to-day life may help,” says Dr. Brook, who suggests adding the following into your week to put stress in its place:
Focus on balanced nutrition
Sleep 7-8 hours per night
Talk to your employer if accommodations are needed
Listen to your favorite music
Incorporate yoga into your weekly routine
UC is a complex disease that impacts more than just your intestine. The exact relationship between stress and UC is being worked out, but there is reason to believe that an increase in stress equals an increase in UC symptoms. The good news? You can play an active role towards feeling your best by weaving in small lifestyle modifications that are known to reduce stress and improve your physical and psychological wellbeing.