Stress and mental health conditions like anxiety and depression can worsen UC symptoms and contribute to flare-ups. Stress management may help support UC treatment.

If you have ulcerative colitis, you may notice your symptoms may worsen when you experience a stressful event. Stress is one of the factors that contribute to a colitis flare-up, along with:

  • tobacco smoking habits
  • diet
  • environment

Ulcerative colitis (UC) is an autoimmune disease in which the body’s immune system targets healthy cells in the colon (large intestine). This causes inflammation in the colon, leading to ulcerative colitis.

It’s possible to manage symptoms of ulcerative colitis and relieve flare-ups with treatment. However, your ability to manage symptoms of ulcerative colitis may depend on how well you manage stress.

While stress does not appear to cause UC, it can worsen symptoms and increase the likelihood of relapses.

In a 2023 study of 100 participants with UC, researchers found that people who perceived their stress levels as higher had 3.6 times higher odds of a UC flare than people with lower levels of perceived stress.

A 2022 review of research suggests that stressful events can also trigger UC flares and that stress contributes to certain markers of inflammation associated with UC relapse.

In addition to stress, other emotional states like anxiety and depression can also worsen UC symptoms in children and adults.

Another 2022 review notes a relationship between stress during the early COVID-19 pandemic and recurrence of UC symptoms. The authors also suggest that while stress, anxiety, and depression can worsen UC symptoms, UC can also have a negative effect on mental health in some people.

Your body deals with stressful events by launching a fight-or-flight response. This is a natural reaction to stress that prepares your body to flee a high risk situation or tackle a perceived threat.

During this response, a few things happen:

  • Your body releases a stress hormone called cortisol.
  • Your blood pressure and heart rate increase.
  • Your body increases its production of adrenaline, which gives you energy.

This response also stimulates your immune system. This usually isn’t a negative reaction, but it can be a problem if you have UC. A stimulated immune system leads to increased inflammation throughout your body, including your colon. This increase is usually temporary, but it can still trigger a UC flare-up.

Anxiety and depression can also cause other changes that can lead to worsening of UC symptoms. This can include:

  • problems with intestinal barrier function, which affects how your intestines absorb nutrients and protect your body from pathogens
  • changes to your gut microbiome (beneficial bacteria in the gut)
  • intestinal dysmotility, which is how the muscles of the digestive system work to process and eliminate food and waste
  • issues with the immune system and neuroendocrine cells, which are cells that release hormones in response to nerve impulses

In addition to following your prescribed treatment plan, stress management may also help reduce the risk of UC flare-ups.

Some strategies that can help you manage stress include:

  • Meditation: Meditation is a practice that can help you focus your attention and has benefits for stress reduction and mental health.
  • Yoga: Yoga incorporates physical poses, meditation, and breath work and may help reduce stress, reduce inflammation, and improve digestion among other benefits.
  • Biofeedback: You can ask your doctor about biofeedback. This therapy can teach you how to control your bodily functions. As a result, you learn how to lower your heart rate and release muscle tension when under stress.
  • Self-care: Self-care is an important factor in reducing stress. Make sure you get at least seven to eight hours of sleep per night. Learning how to say no can also reduce stress. When you accept too many responsibilities, you can become overwhelmed and stressed.
  • Exercise: Exercise prompts your brain to release neurotransmitters that affect your mood and can help relieve depression and anxiety. Exercise also has an anti-inflammatory effect. Aim for 30 minutes of physical activity at least three to five times a week.

If you may have anxiety or depression, seeking treatment for these conditions may also benefit your UC treatment. This can include:

  • therapy, such as cognitive behavioral therapy
  • medication for anxiety or depression
  • mindfulness-based stress reduction treatment
  • gut-directed hypnotherapy and other psychotherapy interventions

Can stress and anxiety cause ulcerative colitis?

While stress and anxiety do not cause UC, they can worsen symptoms and trigger flare-ups.

How do you manage stress with ulcerative colitis?

If you have UC, stress management techniques, including self-care practices, meditation, yoga, and exercise, may help you better manage your stress levels.

What causes flare-ups in ulcerative colitis?

UC flare-ups typically occur throughout the disease course. But some triggers make increase the risk. These can include stopping your medication, using tobacco, dietary changes, and stress, among other factors.

While stress does not cause UC, it can worsen symptoms and contribute to flare-ups.

Stress management techniques like therapy and mindfulness-based practices like yoga and meditation may help support UC treatment.