Anxious Stomach: Overview, Causes, And How To Get Rid Of It

At some point in your life, you have likely experienced some level of anxiety about a stressful situation. You might have also noticed that sometimes, anxious symptoms appear in your stomach. 

Feeling anxious in your stomach can include having what feels like “butterflies” or “knots.” These usually subside relatively quickly once the stressful situation, such as a job interview, is removed. 

However, anxiety can also cause more unpleasant and painful symptoms in your stomach. These could include:

• Nausea

• Bloating

• Cramps

• Indigestion

• Changes to your appetite

These symptoms may be more persistent, remaining even after what’s causing your anxiety is gone. If you experience this regularly,  it is important to try and get on top of it as soon as possible, as it can lead to conditions such as irritable bowel syndrome. 

What causes the anxious feeling in your stomach?

The gut-brain connection

There is a very strong connection between our brain and our gut. The thoughts and emotions we experience mentally in our brains, such as stress and anxiety, can be related to our gut,¹ which is we experience anxiety-related symptoms in our stomach.

This happens because we have a long nerve called the vagus nerve,² connecting our brain to our gut. Our gut has over 200 million nerve cells and is controlled by its own nervous system, known as the enteric nervous system. This can respond to signals and hormones from our brain and our central nervous system. 

When our brain detects a stressful situation or a threat, it automatically reacts by going into a “fight or flight”³ mode, a response designed to help us survive. Chemical messengers and hormones, such as adrenaline and cortisol, are released. One of their roles is to send less blood to the stomach and slow down digestion. This can cause the symptoms in the stomach that we associate with anxiety. 

The release of chemicals and hormones in the body allows more blood and energy to go to organs crucial for survival, like the heart and lungs. 

However, our brain can see situations that are not life-threatening as stressful, such as an upcoming presentation or interview or even relationship issues. Since our body perceives this stressor as a threat, it still activates the fight or flight response. 

In chronically stressed or anxious people, this response can remain permanently ‘switched on,’ and cause ongoing anxiety-related stomach symptoms. 

Stress

Stress can also affect the balance of gut bacteria. 

We have about 100 trillion microbes in our digestive tract. Most are bacteria and are important for keeping our gut healthy, regulating our gut-brain connection, and breaking down substances that we cannot digest, such as dietary fiber. It is vital for there to be a healthy balance and diversity of the gut microbiome. 

Because of their importance in regulating the gut-brain connection, these microbes also contribute to anxiety-like behavior⁴ in situations where we experience real or perceived stress. 

The chemical messengers released when we are stressed or anxious can create an imbalance of our gut microbiome, even if this stress is short-term. This can also cause symptoms related to anxiety in our stomach, such as nausea. 

Could the relationship between your anxiety and stomach issues be the other way around?

Just like how our brain can communicate with our gut, our gut can communicate with our brain. Evidence⁵ has shown that your stomach pain or other gastrointestinal symptoms may be contributing to your feelings of anxiety. 

It is believed that gut bacteria can impact the parts of our brain that manage stress and emotional behavior. So, an imbalance of our microbiome can influence stress-related behaviors such as anxiety. This can then begin a vicious cycle where anxiety about stomach pain causes the stomach pain to stick around as a symptom of anxiety. 

How can you get rid of these symptoms?

To get rid of the anxious feeling in your stomach, there are different approaches you can take. This could involve managing the stomach issues or treating anxiety as the root cause of the stomach pain. This can help improve stomach pain and even prevent it from occurring in the future. 

Although these suggestions are practical and evidence-based, it is important to understand that everyone has different experiences, so some approaches may not be effective for you. 

If you cannot manage your symptoms through these strategies, or they last for longer than a few days, you should see your doctor for an evaluation. They will be able to rule out other causes and physical conditions, provide you with mental health support or refer you to a specialist, such as a therapist, psychologist, or gastroenterologist. 

Dietary changes

Caffeine

Avoid caffeine. This can be helpful for two reasons: 

1. Caffeine can cause gastrointestinal problems.

2. Caffeine can worsen anxiety-related symptoms because it increases molecules associated with the fight or flight response, such as adrenaline and cortisol, and blocks a molecule called adenosine, which aids relaxation. 

Improve your gut health

Diet is an important modifier of the microbiota-gut-brain connection. Gut health can be improved by: 

1. Consuming probiotics. These are microorganisms that can contribute to our gut bacteria and help to create a healthy balance. In turn, this can help promote a balance of hormones and neurotransmitters. Also, early studies in mice⁶have suggested that a probiotic effectively reduces anxiety and related gut symptoms by activating the vagus nerve. Probiotics are in foods like yogurt, kombucha, pickled vegetables, and sauerkraut.

2. Increasing fiber intake. We cannot digest fiber, but it acts as the “food” for probiotics and helps promote a healthy balance of gut bacteria. You can find good sources of fiber in whole grains, legumes, and many different fruits and vegetables.

Traditional medications

Traditional medications can help treat your stomach pain directly or help manage the anxiety causing your stomach issues. 

Common medications for anxiety include selective serotonin reuptake inhibitors (SSRIs), beta-blockers, or sedatives. 

Your doctor must prescribe these medications after a consultation to ensure they will be safe and effective for you.

You could also try over-the-counter medications for stomach issues available at your pharmacy. However, it is still a good idea to consult with a doctor. 

Usually, medications for anxiety are only prescribed as a short-term solution and used in conjunction with therapy so that you can work on treating the psychological aspect of your anxiety. 

Psychological approaches

Psychological treatments, such as therapy, reduce the anxiety responsible for your stomach issues. Even though this approach may not directly target your physical symptoms, they are effective since your gut is so directly connected to brain functioning. 

Cognitive behavioral therapy (CBT)

CBT has been shown to help reduce anxiety and associated gastrointestinal symptoms. This form of therapy teaches you how to manage the interactions between your feelings, thoughts, and behavior. It can involve deep breathing and muscle relaxation to reduce the stress response. 

Relaxation therapy

Relaxation therapy involves learning various techniques to feel more relaxed and have a less intense reaction to stressful situations. These techniques involve progressive muscle relaxation, visualizing relaxing scenes, and listening to peaceful music. It is best for treating gastrointestinal disorders associated with anxiety when used alongside CBT. 

Diaphragmatic breathing

Diaphragmatic breathing is an exercise that modulates the functioning of the nervous system and can influence the brain and gastrointestinal system. This means it can help manage stomach pain associated with anxiety. 

It can:

• Decrease muscle tension, such as in the smooth muscle of the stomach.

• Activate the body’s relaxation response⁷ and lower the ‘fight or flight’ response by stimulating the vagus nerve. 

Try to repeat the following process for ten to fifteen minutes. 

• Find a comfortable place where you can sit or lie down. Relax your muscles. 

• With your eyes closed, place one hand on your chest and your other hand on your stomach. 

• Inhale through your nose for six seconds. Allow your belly to expand, but try to keep your chest as still as possible.

• Hold your breath for two seconds. 

• Slowly exhale through your mouth for six seconds.

Mindfulness meditation

Mindfulness meditation is a mental training practice where you learn to focus your attention on the present moment and accept your thoughts and feelings. It is believed to be effective because we often feel anxious and experience symptoms when looking to the past or the future. 

A study⁸ in people with IBS and anxiety showed that mindfulness meditation reduced their gastrointestinal symptoms and anxious thoughts, and improved their overall quality of life. 

Exercise

Any type of exercise improves hormonal balance and stimulates the release of endorphins that improve mood and decrease stress — in turn reducing the anxiety that can ease your symptoms. 

In particular, yoga is beneficial for improving physical gastrointestinal symptoms and anxiety, including GI-specific anxiety.

Yoga is believed to influence the brain-gut connection, reduce the activity of the sympathetic nervous system that is associated with stress and the “fight or flight” response, and increase the relaxation response. 

Herbs and spices

These are more of a quick fix to help an anxious stomach, so they will not address your underlying anxiety. 

However, science-backed suggestions to ease stomach issues include:

Ginger

Commonly used to relieve stomach aches.

Peppermint oil

This is an “antispasmodic,” which means it can relax the muscles in the gut. It can relieve IBS symptoms, abdominal pain,⁹ cramping and bloating in the stomach, and nausea.  

Iberogast

Iberogast is a combination of nine medicinal plants. Some studies have shown it to reduce gastrointestinal symptoms and treat irritable stomach symptoms such as nausea and cramps. 

Gut-directed hypnotherapy

Gut-directed hypnotherapy is a form of hypnosis, a therapeutic technique that can help manage anxiety or pain. It is a guided process where you learn how to relax, focus, and concentrate on achieving a heightened state of consciousness, which is meant to alter your state of awareness. 

When relaxed in this state, your mind is open to prompts or suggestions for imaginative experiences. Your therapist guides you with metaphors and suggestions directed towards your gut. Suggestions could be made for your stomach pain and symptoms to subside and for a healthy connection to grow between the brain and gut. This type of hypnotherapy aims to prevent you from focusing too much on the discomfort that you feel in your stomach due to your anxiety. 

Scientists don’t know exactly why, but studies have shown gut-directed hypnotherapy to be effective in reducing abdominal pain¹⁰ in adults by 70-80%, as well as having psychological benefits. It also appears to be beneficial for children, with long-term positive outcomes. ¹¹

The lowdown

An anxious stomach can be uncomfortable and prevent you from living your life to the fullest. Fortunately, by treating the stomach pain directly and also managing the root of your anxiety, you can take steps to reduce, get rid of, and even prevent these anxiety-related symptoms in your stomach.