Pandemic stress worsens teens’ gastrointestinal problems

Did you know that the gut and the brain are connected? They’re like best friends, “texting” all day through the gut-brain axis. When the brain becomes anxious, the gut also feels “upset.” Even Merriam-Webster acknowledged the strong connection by adding “hangry” to the dictionary in 2018. The pandemic is like a bully, picking on best friends and making their lives miserable. Gastrointestinal issues are common among teens, and pandemic stress is no friend. Here are some gastrointestinal issues that stressed teens may experience:

Constipation is having less than two bowel movements per week, having stools that are dry, hard, or difficult to pass, and feeling like some of the stool hasn’t passed. Constipation can be caused by a diet that does not contain enough water and fiber or by certain medications (such as iron), medical conditions such as thyroid problems, and stress. Symptoms include abdominal pain, feeling full or bloated, straining to have a bowel movement, and bleeding from anal fissures (tears) from straining.

Gastroesophageal reflux disease (GERD) occurs when food and stomach acid back up into the esophagus. The cause of GERD is the lower esophageal sphincter, which separates the esophagus from the stomach, relaxing at the wrong time or not closing as tightly as it should. GERD that often occurs is called gastroesophageal reflux disease (GERD). Symptoms of GERD include a burning sensation in the chest (“heartburn”), burping, frequent hiccups, vomiting after meals, bad breath, and frequent tooth decay. Symptoms tend to get worse after meals and when lying down. For some people, stress can make symptoms worse.

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that affects the large intestine. The exact cause of IBS is not known, but it is likely a combination of genetics, the immune system and something in the environment that triggers inflammation (redness and swelling) in the tract gastrointestinal. Symptoms include diarrhea or constipation (or both), cramps, abdominal pain, bloating, and gas. IBS is a chronic disease that requires long-term management. Infections, certain foods and beverages, such as milk, chocolate, caffeinated beverages, carbonated foods, and fatty foods, and stress can trigger IBS symptoms.

Gastritis is an inflammation of the stomach lining. Gastritis can be caused by chronic vomiting, overuse of certain medications (such as ibuprofen), alcohol, smoking, abdominal injuries, certain bacterial and viral infections, and stress. Symptoms include abdominal pain, bloating, nausea, hiccups, loss of appetite, dark stools, vomiting blood, or feeling hungry at night or between meals.

Ulcers are painful open sores in the stomach and small intestine. Chronic gastritis, bacterial infections (including H. pylori), certain medications, and smoking can cause ulcers. Symptoms may include weight loss, sudden, sharp abdominal pain, vomiting, bloody stools, and dark stools.

Inflammatory bowel disease (IBD) is the term for two conditions (Crohn’s disease and ulcerative colitis) that cause chronic inflammation of the gastrointestinal tract. Many factors, including genetics and the immune system, contribute to IBD. Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Ulcerative colitis only occurs in the large intestine. The most common symptoms of IBD are abdominal pain and diarrhea, but they can also cause constipation, rectal bleeding, anal fissures, and weight loss. Other problems seen with IBD are skin rashes, eye problems, joint pain and arthritis, as well as liver problems. Stress can make symptoms worse.

When should parents take their teenager to the emergency room? Although many of the above conditions can be treated at home with the help of your primary care provider (PCP), more severe symptoms may warrant taking your teen to the emergency room. Your PCP can help you decide if you need to go to the emergency room. Reasons to go to ED include:

  • Severe abdominal pain may signal a surgical emergency.

  • Pain in the right lower quadrant of the abdomen may be a surgical emergency such as appendicitis or ovarian torsion

  • Abdominal pain accompanied by high fevers can be a serious infection.

  • The inability to eat or drink anything for more than 24 hours can lead to dehydration.

  • Recurrent episodes of blood in the vomiting or stool can signal active bleeding in the gastrointestinal tract.

Trust your instincts. If your child looks seriously ill, go to the emergency room or call 911. For more information on managing stress, visit

Rima Himelstein is an adolescent physician and Sydney Kuzoian is a third-year pediatric resident at Nemours Children’s Hospital, Delaware.

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