Nutritional management is key in IBS, but the psychological side is equally as important. That is what I am going to talk about in this article.

Having IBS is quite stressful. You may not know what it is causing it and so are unsure what (or if) to eat. You also might be going through dietary change and are having to re-learn what you can and can’t eat. And then there is the worry about having a reaction in public or feeling too self-conscious to wear nice clothes because of problems like bloating.

Usually when you are diagnosed with IBS you are told that stress management is part of managing symptoms. You probably even know it in yourself that your symptoms get worse when you feel stressed, anxious or depressed. What often isn’t properly explained is why this is, and just how big a part of the picture it is.

Stress is subjective – people feel it differently. You don’t necessarily have to feel flustered and anxious to be ‘stressed’. You might just be thinking about an unpleasant task you have to do or mulling over a fight with your partner. These thoughts set off the same cascade of hormones involved in the stress response by the body.

The purpose of the stress response is to get you out of physical danger – because that is what the body believes is happening. Your body will divert energy away from things that aren’t important to save your life, such as your digestion. This causes food to be digested inefficiently, which is a major contributor to IBS symptoms.

Food is supposed to be broken down by the stomach and absorbed into the small intestine. If this is not happening correctly, the food particles are too large and ferment instead of being absorbed. This causes issues like bloating, cramping, gas, constipation or diarrhoea. It is not just what you eat – it is also what you absorb! Even if you are following the world’s best diet, you will still probably have symptoms if your digestion is impaired.

Some specific examples of the impact of stress on digestion are:

* Stress also increases perception to pain, so you might feel heartburn or cramping more acutely

* People who tend to hold their emotions in often experience constipation

* The release of a stress hormone, adrenaline, triggers movement of the bowels which can lead to diarrhoea

One technique to help manage stress is to explore your beliefs on why you feel stressed about a situation. For example, if you feel like you can’t express your emotions, think about why that is. Was there some event in your life associated with a negative outcome when you did express how you felt? Journaling is a great way to explore this and let emotions out.

Some other simple things you can do are:

* Eat mindfully – meaning that you sit down for a meal, chew properly, breathe and focus on the food instead of other distractions or what you must do later

* Practice belly breathing – you can do this in the morning before getting out of bed, at your desk or in the car. It all adds up

* Meditate – try a free app like Insight Timer or YouTube. The meditations start from as little as 1 minute, and the benefits for your mental health are endless

* Practice being present – meaning that instead of doing tasks on autopilot, focus on what you are doing. Look at the piece of food you are cutting up or feel the water on your hands as you wash up. Being present is a form of meditation too.

* Practices like restorative/yin yoga, qi gong and tai chi are all associated with reducing stress. There are plenty of free videos on YouTube if you don’t have time for a class

The take home message here is to make sure you look after your emotional side, as well as the physical side!