Anxiety and Inflammatory Bowel Disease

What is the relationship between anxiety and depression and inflammatory bowel disease? A recent study published in Inflammatory Bowel Diseases and summarized by the Crohn’s and Colitis Foundation looked at the impact of anxiety and depression on patients with IBD. It found that IBD patients with anxiety and/or depression reported their symptoms to be more severe and to have higher levels of inflammation. This study got me thinking about my own relationship with anxiety and IBD.

I have struggled with anxiety all my life, both social and general anxiety. I have come a long way in managing it, but the way it interacts with my ulcerative colitis is complicated and confusing.

After I had been on Entyvio for awhile and my ulcerative colitis was in remission, I finally understood what “normal” feels like. I experienced what it was like to have just one or two perfectly formed bowel movements a day with no pain or urgency or blood. And I realized that the last time I had experienced that was in high school, despite not being diagnosed with ulcerative colitis until I was 27.

Why wasn’t I diagnosed earlier? Unlike many people with digestive disorders, it wasn’t because I was misdiagnosed or ignored by doctors. I never told a doctor what I was experiencing. I didn’t realize it wasn’t normal. Sometimes I thought it was something I ate. More often, I thought it was anxiety.

When my parents dropped me off at the dorm after breaks and I found myself running to the bathroom, I thought it was anxiety from being back at school. When I interned on Capitol Hill during college and found myself having many bowel movements throughout the day, I thought it was the stress of having a job where I had to answer phones all day. When I moved cubicles at my first job and had to use the bathroom all afternoon, I blamed anxiety at being in a new situation.

I definitely have anxiety, and I’m sure it made things worse or triggered my symptoms. But I’m also sure that I had ulcerative colitis at the time and ignored it.

I was finally diagnosed when I went to the doctor because I had been feeling exhausted all the time. It didn’t feel like normal tiredness. I was getting enough sleep and still feeling completely drained. I happened to mention that I also regularly had blood in my stool. By that time, my mom had been diagnosed with Crohn’s disease, although I didn’t really know what that was. When I told that to my primary care physician, she immediately referred me to a gastroenterologist and I was quickly diagnosed with ulcerative colitis.

But even after I was diagnosed, I still wrote off my symptoms as anxiety. When I would run to the bathroom before a meeting at work and sometimes not make it in time, I drove myself crazy trying to figure out if anxiety was causing my symptoms or if my symptoms were causing my anxiety. It was impossible to disentangle the two.

It was only once I was in remission that I realized how much of what I dismissed as anxiety was actually ulcerative colitis. I realized that except for something major that would make anyone anxious, I never had to use the bathroom before meetings. I realized that anxiety does not cause blood or accidents. That maybe should have been obvious, but anxiety is sneaky. It makes me doubt myself. It makes me think that I am the problem: I just need to learn how to better control my anxiety, and I won’t be so sick.

If I could go back in time to when I was in college, to my first job, to after I had ulcerative colitis but before it was well-controlled, I would tell myself: You can have anxiety and also be sick. Trust yourself. Just because you are anxious doesn’t mean you should dismiss everything else that is happening to you.

I’m glad to see that the relationship between anxiety, depression, and IBD is being studied. I hope additional research will continue to be done and that physicians will recognize the interactions between physical and mental health and the importance of addressing both.