Stress and stomach pain: When should you see a specialist?

Do you ever feel like there’s a knot in your stomach when you’re worried or stressed? Do nerves make you feel butterflies in your gut? If so, you’re not alone.

As a gastroenterologist, a specialist in the treatment of diseases of the gastrointestinal (GI) tract and liver, I help patients determine if their stomach pain is stress-related or if their symptoms are caused by a more serious condition.

Can stress or anxiety cause stomach pain?

Absolutely. Stress and anxiety are common causes of stomach pain and other GI symptoms.

Should I see a doctor if I get stomach pains when I am stressed?

You should be seeing your primary care physician at least once a year, and you should tell them if you often have stomach pain or GI discomfort.

If your primary care physician identifies symptoms of a chronic GI condition or other warning signs, they may refer you to a gastroenterologist like myself. A gastroenterologist can help determine if your stomach pain or GI symptoms are related to stress, or due to another condition that requires different treatment.

Why does stress cause stomach pain or GI discomfort?

We know through research there is a strong connection between our brain and our gut through the central nervous system. The enteric nervous system — an out-branching of the central nervous system — serves the GI tract, making a direct connection between our brain and gastrointestinal system. That connection can cause normal physiologic processes to be interpreted as painful under stressful or anxiety-provoking situations.

When we’re stressed, hormones and neurotransmitters are released in the body. This can negatively impact gut motility, or the way our intestines and stomach squeeze and move waste through the body. Also, stress can affect the delicate balance of bacteria in our gut, causing GI discomfort.

People experiencing chronic stress may also eat more or eat unhealthy foods with a higher amount of natural and artificial sugar that is poorly digested and causes GI distress. People may also smoke and drink more alcohol or caffeine than normal which can cause symptoms.

How can you tell when GI symptoms are associated with a temporarily stressful situation, or when it's a more serious condition?

Warning signs like weight loss, blood in the stool, black tarry stools or abnormal lab values (that can reveal anemia) can indicate that something more serious is occurring. Any chronic GI symptoms will likely warrant an evaluation from a specialist and additional testing.

Should I be getting screened regularly for colon cancer or other GI tract cancers?

As of 2021, the United States Preventative Services Task Force (USPSTF) and major GI medical societies recommend that adults at average risk for colorectal cancer are regularly screened beginning at age 45.

People who have a family history of colorectal cancer or other GI tract cancers, including stomach or pancreas cancer, or a history of GI conditions like inflammatory bowel disease (IBD) may need routine cancer screening earlier than age 45.

Talk your primary care physician about your risk and ask if you should get tested. 

In general, what conditions do gastroenterologists treat?

Gastroenterologists can evaluate for and treat a wide variety of conditions, including inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), celiac disease, peptic ulcer disease, obesity and more. GI doctors also routinely perform screenings for colon cancer.

My area of specialty is in prevention and early detection of cancers such as colorectal, gastric and pancreatic cancer. I enjoy helping patients, especially those with a family history, understand their risk for cancer while offering genetic testing, screening and more.

Overall, it’s important for patients to openly discuss stress and GI symptoms with their doctors. Primary care doctors can help manage stress and treat symptoms, but in some cases it may be necessary to see a gastroenterologist to evaluate for other conditions.