Stress or something else? A checklist before you blame your nerves

Stress really can change how your gut behaves. That's exactly what makes it such a convenient explanation, for you and sometimes for your doctor. A tense month and a bloated belly seem to go together, so the story writes itself.

Often stress is part of the picture. But some symptoms deserve a closer look before anyone chalks them up to nerves. Use this checklist to decide whether it's time to book an appointment, and what to ask about.

Check 1: Is the bloating new, frequent and paired with other symptoms?

In a study comparing 149 women with ovarian cancer with women in a screening program and women referred for pelvic or abdominal ultrasound, certain symptoms were linked with cancer when they were new, present for less than a year, and happened more than 12 days a month (Goff et al., 2007):

• Pelvic or abdominal pain
• Urinary urgency or frequency
• An increase in abdominal size, or bloating
• Difficulty eating or feeling full quickly

These symptoms usually have harmless causes. But if that pattern sounds like you, see your doctor now rather than waiting for a calmer month.

Check 2: Are you 45 or older and behind on colon cancer screening?

The US Preventive Services Task Force recommends colorectal cancer screening for adults aged 45 to 75 who are at average risk (US Preventive Services Task Force, 2021).

Screening is meant for people without symptoms. If you have rectal bleeding or a lasting change in your bowel habits, tell your doctor, because you may need a diagnostic test rather than routine screening. If you have a family history of colorectal cancer, ask whether you should start earlier or be tested differently.

Check 3: Could it be celiac disease?

Celiac disease is a permanent immune reaction to gluten, a protein found in wheat, barley and rye. It can affect much more than digestion. Testing usually starts with a blood test for celiac-specific antibodies, such as tissue transglutaminase, and most adults then need an intestinal biopsy to confirm the diagnosis (Rubio-Tapia et al., 2023).

Celiac testing also appears in guidance on common gut complaints. The American College of Gastroenterology's IBS guideline suggests blood tests to rule out celiac disease in people with IBS symptoms and diarrhea (Lacy et al., 2021), and the American Gastroenterological Association's bloating review notes that blood tests can help rule it out in people with bloating (Moshiree et al., 2023).

Tip: talk to your doctor before going gluten-free. Celiac tests look for your body's reaction to gluten, so cutting it out first can make the results harder to interpret.

Check 4: Does diarrhea come with signs of inflammation?

For people with suspected IBS and diarrhea, the ACG guideline also suggests a stool test called fecal calprotectin to help rule out inflammatory bowel disease (Lacy et al., 2021). Tell your doctor about diarrhea that wakes you at night, blood in your stool, fever or a family history of Crohn's disease or ulcerative colitis.

Check 5: Do you have any of these red flags?

• Blood in your stool, or black, tarry stools
• Weight loss you can't explain
• Anemia or low iron on a blood test
• Symptoms that wake you from sleep
• Trouble swallowing, or food that feels stuck
• Persistent vomiting
• A family history of colon cancer, inflammatory bowel disease or celiac disease

The AGA's bloating review advises abdominal imaging and upper endoscopy for people with alarm features, recently worsening symptoms or an abnormal physical exam, rather than for everyone with bloating (Moshiree et al., 2023). In other words, red flags like these are what change the plan.

Check 6: If everything checks out, is stress part of the picture?

If your doctor finds no warning signs, stress, sleep and daily habits become fair game again, and that isn't a brush-off. The ACG suggests a positive diagnostic strategy for IBS, meaning a diagnosis based on your symptom pattern and a few targeted tests rather than testing for everything first, so appropriate treatment can start sooner (Lacy et al., 2021).

Hormonal changes in your forties can also shift how your gut behaves. Here's what changes in the gut after 40.

What to expect, and how to prepare

For most people with bloating or IBS-type symptoms, the evaluation starts with conversation and an exam, not a battery of scans. Your doctor will ask about your symptom pattern, your family history and any red flags, then decide which targeted tests make sense. Depending on your symptoms, that might include blood tests such as celiac antibodies, or a stool test for inflammation if diarrhea is part of the picture (Lacy et al., 2021; Moshiree et al., 2023).

If you're 45 or older, it's also a good moment to ask whether you're up to date on colorectal cancer screening, even if your symptoms turn out to have a simple explanation (US Preventive Services Task Force, 2021).

To get the most out of the appointment:

1. Write down when your symptoms started and how many days a month they happen.
2. Note what makes them better or worse, including meals, stress, sleep and your menstrual cycle if you still have one.
3. List all medications and supplements, including magnesium, iron and fiber products.
4. Find out your family history of colon cancer, inflammatory bowel disease, celiac disease and ovarian cancer.
5. Say plainly what worries you most, so your doctor can address it directly.

Sources

1. Goff BA, Mandel LS, Drescher CW, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007;109(2):221-7. PMID 17154394
2. US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. PMID 34003218
3. Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology guidelines update: diagnosis and management of celiac disease. Am J Gastroenterol. 2023;118(1):59-76. PMID 36602836
4. Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. PMID 33315591
5. Moshiree B, Drossman D, Shaukat A. AGA clinical practice update on evaluation and management of belching, abdominal bloating, and distention: expert review. Gastroenterology. 2023;165(3):791-800.e3. PMID 37452811

This article is for general information and isn't medical advice. If you have symptoms that worry you, contact your healthcare provider, and seek urgent care for severe abdominal pain, heavy bleeding or vomiting blood.