The grueling hours that came with working at the Middle Eastern–inspired cafe in Warwickshire, England, and constantly needing to test the food she prepared already made her symptoms difficult to control. But facing income loss and unemployment exacerbated her abdominal pain and diarrhea. “The stress of the pandemic triggered my IBS symptoms, and then when I lost my job, that caused more stress, which led to more flare-ups,” Dyulgerova, 24, says. “I also binged on food, especially food that was very processed and not good for my IBS.” Dyulgerova’s experience is not an uncommon one. Research published in the Journal of Clinical Gastroenterology looking at the impact of the pandemic on people with IBS and found that 92 percent of patients reported increased stress and nearly half said they experienced worsening IBS symptoms like abdominal pain, diarrhea, and constipation. “People with IBS are often highly reactive in their bodies to stress, due to the learned association over time between physical sensations and mental distress,” says Jessica Gerson, PhD, senior psychologist at the Inflammatory Bowel Disease Center at NYU Langone Health in New York City. “IBS both exacerbates, and is exacerbated by, difficult situations.”
Stress Damages the Body
Stress affects the gastrointestinal tract in several important ways. “First, it affects the central nervous system by turning the volume up on all the sensations that are there,” explains Stephen E. Lupe, PsyD, a gastrointestinal psychologist and director of behavioral medicine in the department of gastroenterology, hepatology, and nutrition at Cleveland Clinic in Ohio. Stress also activates the body’s “fight or flight” response. When this happens, the body redirects blood flow away from the gut, slowing down digestion, so energy can be diverted to the perceived threat. “With pandemic-related stress, there was a lot of fight-or-flight on top of chronic stress that is naturally there,” Lupe says. “People that I work with who have IBS are the first ones to tell me that when they’re under stress, their gut feels worse. We saw a lot of that happening during the pandemic.”
For Some, Lockdown Came With Relief
While COVID-19 stress exacerbated symptoms of IBS for some people, others had a different experience. One study found that stay-at-home orders actually led to an improvement in symptoms for people with IBS. The researchers hypothesized that this was because these individuals were not exposed to outside stress and were better able to avoid food triggers. Healthcare professionals who specialize in IBS observed this in some of their patients. “One of the biggest responses I saw was relief that they were near their bathroom, that they weren’t going to have to go out and deal with these very complicated symptoms in a public place,” Lupe said. Arielle Leben, RD, at the Inflammatory Bowel Disease Center at NYU Langone Health, observed similar experiences with her IBS patients. “Working from home alleviated the anxiety that many IBS patients have about experiencing symptoms during their commute or in the office,” she says. “Some patients will restrict food intake to avoid feeling unwell in the office or having to use the office restroom.” Of course this strategy can be counterproductive, as it can lead to consuming a lot of food within a short period of time at night, “which can trigger symptoms like diarrhea, bloating, and abdominal pain,” Leben says. She also notes that some of her patients significantly benefited from preparing the majority of their own meals at home and having more flexibility with their eating schedule. “However, there are other patients that may welcome the return to the office and more frequent dining out,” she says. “For some, the increased burden of meal preparation working from home has been stressful and led to increased consumption of convenience or processed foods and less real foods or well-balanced meals.”
Return to the Office and Post-Pandemic Life: How to Manage IBS
Going back to the office and more frequent socializing may pose unique challenges for people with IBS. “Commuting, being in meetings, and so on where it might be harder to use a bathroom might pose concerns,” Dr. Gerson says, adding that anxieties related to eating out or going to a bar with colleagues may return. Lebon recommends reflecting on the past two years to see what healthy habits you can bring into post-pandemic life, as well as what changes you may need to make. “The pandemic and the shift to working from home has forced people to experiment with eating patterns that drastically differed from their pre-pandemic routines,” Leben says. “My advice is to use your experience over the past two years to create the ideal diet and eating schedule going forward.” Here are four tips on how to manage IBS in a post-pandemic world:
1. Bring Meal Prep Into Your Everyday
If preparing your own meals has significantly decreased IBS symptoms, she advises spending extra time meal prepping each week and packing your meals and snacks for the office. This is something Dyulgerova has greatly benefited from. She now works in an office as a nutrition assistant. “I found myself managing my IBS symptoms 100 percent better since I started working in an office,” she says. “I tend to bring my own food prepared at home for lunch and snacks, that I know won’t trigger my IBS.”
2. Be Mindful of Meal Sizes
While diet is unique to each person, generally, the advice for how frequently people with IBS should eat during the day and the size of meals varies depending on which symptoms are dominant. “In general, smaller, more frequent meals are going to be better for patients who have IBS with diarrhea,” Leben says. “However, avoiding grazing in favor of more discrete meal times is better for patients with constipation.” Human bodies have something called the gastrocolic reflex, she explains, which promotes peristalsis, or the movement forward in the colon after being triggered by stimuli, such as when the stomach becomes enlarged when we eat food. “For patients with constipation, sticking to larger, more discrete meals may optimize the gastrocolic reflex and promote postprandial motility,” Leben explains. “However, someone experiencing diarrhea would not want to promote this motility, and thus sticking to smaller, more frequent meals may help prevent this.”
3. Remember to Hydrate
“Many IBS symptoms such as bloating and constipation can be significantly improved when prioritizing water intake,” Leben says. For people whose primary IBS symptom is constipation, increasing fiber in their diet can help. Fiber requires water to be digested comfortably. “There is a very important relationship between fiber and water,” Leben says. “When someone is trying to increase fiber for symptoms of constipation, but they don’t drink enough water, it can backfire, leading to gas, bloating, and abdominal discomfort.” Prioritizing water intake is also very important for people who have diarrhea to prevent dehydration. Leben’s advice is to pack a reusable water bottle to keep at your desk.
4. Develop Stress-Relief Techniques
Finally, if you’re experiencing anxiety around your IBS symptoms, learning to manage those nerves will go a long way in improving your mental and physical health. Research published in April 2021 in the American Journal of Gastroenterology found that people with IBS who reported having stress and anxiety had more severe gastrointestinal symptoms than those who did not have psychological distress. Gerben recommends practicing relaxation techniques, such as deep breathing and mindfulness meditation, and joining a support group or talking to others about your symptoms. “You’d be surprised how common IBS is,” she says. “Don’t be shy about asserting your needs.” If you’re really suffering mentally and emotionally or avoiding activities you want to take part in because you’re afraid your symptoms will be disruptive, it may be time to seek professional help. “Cognitive behavioral therapy can be a great tool to help you manage fears and anxieties related to IBS,” Lupe says. “If you’re at the point where you’re questioning if you should see someone, it’s a pretty good indication that it’s time to reach out.”
