title: Daily stress and gastrointestinal symptoms in women with irritable bowel syndrome.
abstract: BACKGROUND
  Stress has been implicated as contributing to the initiation and exacerbation of bowel and discomfort symptoms in patients with irritable bowel syndrome (IBS).
  
  
  OBJECTIVE
  To examine the relationships of daily self-reported stress to gastrointestinal (GI) and psychological distress symptoms both across women and within woman in a comparison group of women without IBS and among subgroups of women with IBS.
  
  
  METHODS
  Women with IBS (n = 181; age = 18-49 years) who were divided into subgroups based on bowel pattern (constipation, n = 52; diarrhea, n = 67; alternating, n = 62) were compared to a group of women without IBS (n = 48). Self-report stress measures; abdominal (abdominal pain, bloating, and intestinal gas), bowel pattern (constipation, diarrhea), and intestinal gas; and psychological (anxiety and depression) distress symptoms were obtained daily over 1 month. Across-women and within-woman analyses were used.
  
  
  RESULTS
  There were significant across-women correlations among mean daily stress, psychological distress, and GI symptoms in the total IBS group and the IBS bowel pattern subgroups. The across-women relationships between daily stress and GI symptoms were diminished when anxiety and depression were controlled in the analyses. Within-woman analyses showed little evidence of relationship between day-to-day variations in stress and day-to-day variations in GI symptoms; however, stress was strongly related to anxiety and depression.
  
  
  CONCLUSIONS
  Gastrointestinal symptom distress is associated with self-reported stress in women with IBS. Psychological distress moderates the effects of stress on GI symptoms. The IBS treatment protocols that incorporate strategies that decrease stress and psychological distress are likely to reduce GI symptoms.
authors.affiliation: Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA 98195, USA. vhertig@u.washington.edu
authors.forename: Vicky L
authors.initials: VL
authors.lastname: Hertig
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Cain
authors.forename: Monica E
authors.initials: ME
authors.lastname: Jarrett
authors.forename: Robert L
authors.initials: RL
authors.lastname: Burr
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Heitkemper
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D002908:Chronic Disease; D003248:Constipation / Q000453:epidemiology / Q000523:psychology; D003967:Diarrhea / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005414:Flatulence / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D013312:Stress, Physiological / Q000453:epidemiology*; D013315:Stress, Psychological / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology