During certain emotional states such as anger, anxiety, fear, excitement, worry, stress, eager anticipation and fear, one may feel certain abnormal sensations in the abdominal area. People often allude to these abnormal gastrointestinal sensations brought about by strong emotions as a nervous stomach. However, the term “nervous stomach” is not a proper medical term for any medical condition.
The signs and symptoms of nervous stomach can arise from any part of the gastrointestinal tract. In some cases, the symptoms may be restricted to one region in the gastrointestinal tract, such as the stomach. In other cases, the symptoms may arise from the entire gut area. The symptoms themselves may either be triggered or aggravated by strong emotions.
The emotions that trigger a nervous stomach need not always be due to a current event. Even memories of old emotional events can elicit symptoms of a nervous stomach. And so can anxious thoughts about the future events that may or may not happen.
Emotional triggers can affect the normal functioning of the gastrointestinal tract by modulating the activities of the autonomic nervous system in the gut (also known as the enteric nervous system). Both sympathetic and parasympathetic stimulation, as well as local reflexes, may be involved.
Apart from the above mentioned psychological causes, the symptoms of nervous stomach can also be caused by physiological problems. For example, irritable bowel syndrome is a common cause of nervous stomach. Functional dyspepsia can also cause symptoms of nervous stomach, albeit less frequently.
Signs and Symptoms
The term “nervous stomach” is very nebulous. A variety of signs and symptoms can be considered as nervous stomach. Furthermore, these signs and symptoms may arise due to a variety of psychological and physiological conditions. Some such signs and symptoms are described next.
- Borborygmi: Borborygmi refers to the rumbling or growling sounds produced in the abdomen due to movement of gas or fluid within the intestine. These growling sounds (also known as borborygmus or stomach rumble) can be heard by placing a stethoscope over the abdomen. In some cases, these sounds may be loud enough to be heard without the aid of a stethoscope. For example, loud borborygmi sounds are frequently audible when one is hungry and has an empty stomach for more than a few hours.
- Belching: Commonly known as burping, belching refers to the act of expelling gas present in the upper digestive tract through the mouth. Eructation, ructus, and erupt are other terms that may be used to refer to belching. Excessive belching may be taken as a symptom of nervous stomach.
- Abdominal bloating: Abdominal bloating refers to a condition in which one has a feeling of fullness or tightness in the stomach. In some cases, there may also be a visible distension or swelling of the abdomen caused by accumulation of gas. A variety of medical conditions can cause abdominal bloating and distension.
- Changes in appetite: A nervous stomach may lead to suppression of appetite.
- Heartburn: Heartburn refers to pain in the chest region that is caused by reflux of acid from the stomach into the esophagus. In some cases, the acid may even reach the throat and the mouth. The pain caused by heartburn is akin to an intense burning sensation in the chest. Acid reflux usually resolves on its own within a few hours. However, acid reflux may be chronic in conditions like gastroesophageal reflux disease (commonly abbreviated as GERD).
- Abdominal pain: A nervous stomach may also be characterized by abdominal pain. In some cases, the stomach may be the source of the abdominal pain.
- Cramps: Cramps in the stomach or the intestine may also occur in nervous stomach.
- Nausea and vomiting: Nausea and vomiting are very commonly seen in a variety of gastrointestinal disorders.
- Flatulence: Excessive gas formation may also characterize a nervous stomach.
- Changes in bowel activity: A nervous stomach may be characterized by changes in bowel activity. Diarrhea, constipation and changes in the urge to have a bowel movement may occur. It is important to stress that people differ in their responses to emotional events. Therefore, not everyone will show similar changes in bowel activity in response to emotional triggers.
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Causes of Nervous Stomach
The sympathetic and parasympathetic arms of the autonomic nervous system control the activities of the gut. Therefore, the visceral reflexes of the gut are not under voluntary control. The autonomic nervous system in the gut can also be influenced by inputs from the cerebral cortex and the limbic system in the brain. Therefore, emotional states can have profound effects on the functioning of the gastrointestinal system.
Under normal conditions, a fight-or-flight response triggered by a stressful event causes sympathetic stimulation of the gastrointestinal system. This leads to an inhibition of the gastrointestinal activity. However, in functional disorders of the gastrointestinal system, a stressful event may cause increased gut activity (such as increased secretion of gastric acid and digestive enzymes, increased peristaltic activity and increased urge to defecate), leading to a nervous stomach.
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A nervous stomach may also be caused by severe pain stimulus. Mass reflex action of the spinal cord can provide an explanation of how severe pain can affect gastrointestinal activity. Pain can cause stimulation of large areas of the spinal cord, which then triggers spinal reflex action that impinges on the gastrointestinal system.
This can lead to various symptoms of a nervous stomach. For example, mass reflex action of the spinal cord may involve activation of gastrocolic, duodenocolic and defecation reflexes, leading to movement of feces into the rectum, increased urge to defecate, and finally, defecation.
When no clear gut pathology is identifiable in case of a nervous stomach, the cause may be a functional disorder of the bowels. Two of the most common examples of functional diseases of the gut that may cause a nervous stomach are irritable bowel syndrome (commonly abbreviated as IBS) and dyspepsia (also referred to as stomach upset or indigestion). The exact cause of these functional gut disorders is not known. However, emotional stress is known to aggravate these conditions. A nervous stomach due to emotional stress may be caused by stimulation of enteric nervous system by the limbic system and the cerebral cortex. Alternatively, the condition may be due to local reflexes elicited by smooth muscle hyper-responsiveness.