Beyond Chronic Stress: Daily Stress Is Associated With Symptoms in Irritable Bowel Syndrome

Stress is a central factor in the pathophysiology of irritable bowel syndrome, yet little is known about how stress and symptoms fluctuate together in daily life. This study characterized real-world associations between momentary stress and symptom severity in irritable bowel syndrome, including whether stress predicts later symptoms and vice versa.

This was a prospective observational study conducted during the baseline phase of a randomized clinical trial among adults meeting Rome IV criteria for irritable bowel syndrome (N = 357). Participants completed self-report measures of chronic stress and irritable bowel syndrome symptom severity, followed by a 7-day ecological momentary assessment with 3 surveys per day assessing momentary stress and symptom severity.

Individuals with higher average stress during the ecological momentary assessment week experienced greater irritable bowel syndrome symptom severity, and times of elevated stress relative to their usual level were linked to worse symptom severity, independent of chronic stress and symptom severity (both P < .001). A prospective stress-symptom association emerged during the afternoon-to-evening period; afternoon stress was associated with greater evening symptom severity (P = .002) and afternoon symptom severity was associated with greater evening stress (P = .04), whereas associations during the evening-to-next-morning transition were disrupted or inverse.

Stress and symptoms are closely linked within the same moment, but also prospectively, particularly later in the day, among adults with irritable bowel syndrome. These findings highlight the dynamic nature of daily stress-symptom relationships and underscore the potential value of within-day stress management interventions for improving symptom control in irritable bowel syndrome.