Irritable bowel syndrome (IBS) can mean a host of tricky symptoms - such as diarrhoea, constipation, abdominal cramps, gas and bloating - but it's not just the physical effects that can take a toll.
The common digestive condition can have a psychological impact too, and there's significant overlap with things like stress, anxiety and depression. One 2012 study, published in World Journal of Gastroenterology, suggested around 30 percent of people with IBS experience some level of depression.
"The emotional impact of any digestion issue is huge, and it's no surprise," says Jenna Farmer, who runs A Balanced Belly, dedicated to all things gut health and living with digestive disorders. "It makes things we take for granted - like travel, socialising and working - that bit more difficult, as we worry about finding foods we can eat from a menu, managing symptoms when out and about and finding the nearest loo."
Karen Chambers, a holistic nutritional therapist and founder of Fierce Wellbeing, agrees this is a common experience: "Quite often, when clients with IBS first come to see me, it's clear they develop anxiety over the condition. They have daily concerns of where toilets are situated, can they gain quick access, feeling on edge, worried about eating away from home. That is just some of their many concerns."
IBS can vary in severity, and often people find their symptoms 'flare up' at certain times and settle down at others. The exact causes aren't entirely clear, although some find specific foods trigger symptoms, or an underlying gut infection may be involved. Most of the time though, IBS is diagnosed after ruling out other possible causes, so it's important to see your doctor.
Diet and lifestyle changes can play a vital role in managing IBS, and medications may help soothe symptoms. But thinking about how IBS is affecting your mental wellbeing, and helpful ways of addressing this, is also important. Some people find talking therapies and CBT can be very beneficial, but there's lots you can do yourself, too.
Focus on what you can control, not what you can't
Flare-ups can disrupt your day-to-day life and confidence. It's understandable this can cause worry and frustration - especially when it feels like it's all out of your control. Shifting your focus to think about what you can do to help yourself can make a big difference to mental wellbeing.
"Although we're getting better at talking about gut health, there's still a taboo and it can feel awkward and embarrassing. Understanding the link between your gut health and mental health can be a positive thing, as it can help you work towards strategies that can help manage things," says Farmer, who has the inflammatory bowel disorder Crohn's, so knows what it's like to live with digestive health issues.
Try to understand your triggers
You might not be able to 'switch off' IBS completely, but many find ways of effectively minimising flare-ups. "Even a 20 percent reduction in symptoms can help people feel more at ease and in control, and not a slave to IBS," says Chambers. "I find that once someone gains an understanding of what triggers their symptoms and what steps they should take, they feel empowered."
She notes that "what works for one may not work for another", so find out what's going to work best for you as an individual. Keeping a diary - tracking everything you eat and drink, alongside what you were doing (eating at a table/desk/while on the move), where you are in your menstrual cycle for women, whether you felt stressed or relaxed, etc - can help identify patterns.
Farmer says there are apps that can help with this too, such as Bowelle (bowelle.com). Remember it's important not to make any big changes to your diet without consulting an expert, to ensure you're still getting a balanced diet that's meeting your nutritional needs.
Find a support network and connect with others
"Finding a support network can be really important. Sometimes knowing you are not the only one experiencing this can alleviate anxiety considerably," says Farmer. "Many of us feel like we are the only one that ever gets bloating, diarrhoea or stomach discomfort, but it is so much more common than you think! This is where social media has its advantages, as you can find blogs, Instagram accounts and Facebook posts and chat to people like you."
Similarly, while it's easy for flare-ups to disrupt your social life, keeping up connections and socialising can be vital for mental wellbeing. This doesn't mean forcing yourself to socialise when you don't feel up to it, but if you're worried about flare-ups, telling your friends could help take the pressure off.
Go easy on yourself and prioritise your wellbeing
Make a pact with yourself to prioritise your own wellbeing and relaxation, and simply to be kind to yourself. We all need to manage our stress levels - life will get in the way sometimes but it's about creating habits and doing what we can, when we can. Regular exercise and keeping fit is brilliant for reducing stress, as well as boosting health top to toe and supporting gut health. And don't beat yourself up if stubborn flare-ups are getting you down.
"Never blame yourself. When we're unwell, our brain naturally tries to find solutions and figure out what could have caused it. But IBS has so many causes and sometimes a flare-up can just happen," says Farmer. "The lack of control can be a huge problem; one week you might eat something and feel great, the next day you could eat the same thing and feel awful. Try to accept flare-ups for what they are, rather than beating yourself up and thinking you've done something wrong. It is out of your control, so be kind to yourself and remember it won't last forever."
Make breathing exercises part of your daily routine
There's a wealth of research backing the effectiveness of breathing exercises for helping reduce anxiety, stress and even promoting better sleep and mindfulness. There are loads of apps, YouTube videos and tutorials on simple breathing exercises you can fit into daily life - at zero cost!
"Spending a few minutes a day to focus on deep breathing can really help," says Farmer. "You can even find meditation and yoga exercises specifically for digestive health."
Chambers suggests trying "deep breathing exercises before you eat" too. "Ideally, we should be in a relaxed state before eating, to digest meals properly to gain optimum nutrient absorption. Try taking 15 deep breaths through your nose (inhale for four to five seconds, then exhale for the same) to achieve this relaxed state and calm anxiety. Practise and you can achieve this without anyone noticing," she says.