related stomach pain: When to see a doctor
Nina Gupta stress stress stomach stomach pain gupta stomach knots
Nina Gupta, MD
Stress can cause knots in your stomach or a temporary bout of diarrhea. What's normal? Gastroenterologist Nina Gupta, MD, explains GI symptoms that might need medical intervention.
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Do you ever feel like there’s a knot in your stomach when you’re worried or stressed? Or do you get butterflies in your gut when you’re nervous?

It’s not unusual. Stress, worrying and anxiety are common causes of stomach discomfort and other gastrointestinal (GI) symptoms. It’s usually temporary and not serious.

However, chronic stress and anxiety can take a toll on the digestive system and could lead to more serious, long-term stomach problems.

If you regularly have an upset stomach, from stress or for any other reason, it’s important to tell your primary care physician. They can assist with reducing stress and identify symptoms of a chronic GI condition. They might also refer you to a gastroenterologist, who can determine if your stomach pain or GI symptoms are related to stress or another condition that requires different treatment.

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Why does stress cause stomach pain and discomfort?

Research has shown there is a strong connection between our brain and our digestive tract through the central nervous system.

The part of the central nervous system that serves the GI tract, called the enteric nervous system, makes a direct connection between the brain and GI system. In stressful or anxiety-provoking situations, it can cause normal physiologic processes to be interpreted as painful.

The brain-gut connection

When we have anxiety and stress, 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 an upset stomach.

People with chronic stress and anxiety may overeat or eat unhealthy foods.

Some of those foods, like products with high amounts of natural and artificial sugar, are often poorly digested and cause stomach discomfort. Chronic stress and anxiety can also lead people to smoke, consume more alcohol or drink large amounts of caffeine — all of which can also cause GI symptoms.

How do I know if my GI symptoms are associated with a temporarily stressful situation, or if it's a more serious condition?

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

How long can stress-related stomach pain last?

It shouldn’t last more than a few hours and should go away when the stressful situation ends. If your upset stomach lasts more than a day, it’s possible that something other than stress is causing your stomach pain and you should contact your doctor.

Can stress cause bloating and diarrhea?

Stress can cause a wide range of GI symptoms, including bloating and loose stool. When you’re stressed, the nervous system sends signals to your gut and intestines, triggering the muscles involved in digestion to go into a “fight or flight” response. They can react by quickly pushing waste through your system, causing nausea, cramping, bloating or diarrhea.

What settles an upset stomach?

Over-the-counter antacids may provide temporary relief. Peppermint is also soothing to the stomach and is available as a capsule or in teas.

What foods should you eat when your stomach is upset?

It’s best to avoid spicy foods, fatty or fried foods, junk food, and anything with a lot of natural or artificial sugar, such as sugary cereals, desserts and sodas. Plain foods like crackers, toast, rice, bananas, broth and water are good options until your stomach settles.

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

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

Can anxiety cause long-term stomach problems?

Normally, stress is temporary, so your GI issues will stop once the stress subsides. However, chronic anxiety can lead to chronic GI symptoms. Stress and anxiety alone do not cause ulcers or damage to the digestive tract, but they can cause ongoing bothersome symptoms. For people with irritable bowel syndrome (IBS), stress and anxiety can cause flares of symptoms such as constipation, bloating and diarrhea. A gastroenterologist can help you treat these issues.

How do I stop stress-related stomach pain?

Identify your stress triggers. See if controlling the stress and anxiety in your life lessens your stomach discomfort. Be mindful of the foods you eat, which can compound anxiety-related stomach pains. Tell your doctor what’s going on so they can evaluate whether stress is actually what’s causing your upset stomach.

How do I reduce stress and anxiety?

There are both emotional and physical ways to reduce your stress and anxiety, including:

Be active and avoid sitting for long periods of time

Take a few deep breaths

When doing a stressful activity, take short breaks

Get at least 7 hours of sleep each night

Eat healthy foods and avoid junk food

Limit alcohol intake

Socialize and laugh

Spend time outdoors

Try a meditation app

Talk to someone about what’s stressing you out, possibly a therapist or a social worker

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 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.

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

As of 2023, the United States Preventative Services Task Force and major GI medical societies recommend that adults at average risk for colorectal cancer begin regular screenings 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.