Life with ulcerative colitis (UC) can be nerve-racking. You may worry that you won’t be able to get to a bathroom in time, or that pain will prevent you from doing everyday activities.
Unfortunately, anxiety often goes hand in hand with UC. More than 1 in 3 adults between the ages of 18 and 60 with UC have anxiety, which is almost twice as high as the U.S. national average.
“The relationship between anxiety and ulcerative colitis goes both ways — people with UC are more likely to be anxious, and anxiety itself can worsen symptoms of UC,” explains Taryn Lores, PhD, a health and clinical psychologist at the Inflammatory Bowel Disease (IBD) Center at Mount Sinai and the Icahn School of Medicine in New York City.
Here’s a closer look at the link between anxiety and ulcerative colitis, as well as ways to manage the stress of both conditions — and thrive.
What’s the Relationship Between Ulcerative Colitis and Anxiety?
Ever got butterflies in your stomach before a big presentation or event? If you have, you already know that stress and anxiety can trigger gastrointestinal (GI) symptoms. It’s particularly true if you have UC.
Research shows that both anxiety and depression raise the risk of flare in patients with inflammatory bowel diseases. People with UC who experience severe anxiety are actually 46% more likely to get a flare, according to a 2025 study published in the Journal of Crohn’s and Colitis.
“Anxiety is actually often the first symptom of a flare,” says Stephen Lupe, PsyD, director of behavioral medicine for the Department of Gastroenterology, Hepatology, and Nutrition at the Cleveland Clinic. “We think that the start of these flares causes an alteration in the gut microbiome, which produces chemicals that trigger anxiety.” It goes the other way, too. “The more symptoms you have, the more anxious you feel,” Lupe explains.
The relationship between your brain and gut is complex. “Your gut sends nerve signals up to your brain and central nervous system,” says Lupe. Your brain then fires back, which in turn affects your gut’s function. If you are stressed or anxious, your body also creates pro-inflammatory chemicals known as cytokines, which can also affect your GI tract, points out Lupe.
Anxiety can indirectly affect your ulcerative colitis, too. “If you are very stressed and anxious, you may be less likely to eat a healthy diet, get enough sleep, and stick to treatment, which can trigger a flare and worsen symptoms,” says Lores.
That doesn’t mean that you should blame yourself for your UC. “We don’t think anxiety alone can trigger a flare,” says Lores. “It’s a bunch of factors that work together.”
Does Treating Anxiety Actually Improve Ulcerative Colitis?
If you treat anxiety, you may notice that your ulcerative colitis symptoms improve. “It takes some weight off your gut,” explains Lupe. “Inflammation levels often go down because when you are more relaxed, your body spends more time in a rest and digest state, which is more soothing to your gut.”
Anxiety treatment may also improve UC in a way. “If you are less anxious, you are more likely to take your medication on time, which is important to manage your UC effectively,” says Lores. It can also help you deal with certain known UC triggers, such as stress.
Safe Anxiety Treatments for People With UC
There are many good treatments out there that will help ease your anxiety when you have UC. Some may also help your symptoms of UC as well.
Mind-body therapies. Mindfulness-based activities such as yoga, deep breathing, and meditation can also help improve symptoms of both anxiety and ulcerative colitis, says Lupe. “They allow your parasympathetic nervous system, which you need to rest and digest, to take over,” he explains. They relieve stress, improve quality of life, and also lower the frequency and severity of UC flares, according to a 2022 review published in the journal Inflammatory Bowel Disease. Techniques you can try include:
- Belly breathing: Take slow, deep breaths whenever you feel stressed and anxious. You can do it anywhere, whether it’s in your car, at your desk, or at home.
- Muscle relaxation: Tense up different parts of your body. Start with your toes and go all the way up to your head. Do each muscle once at a time, then relax them.
Regular exercise. Physical activity boosts endorphin levels, which helps improve your mood and relieve stress and anxiety, says Lupe. Moderate activity exercise, like brisk walking, can also help ease inflammation associated with ulcerative colitis and improve symptoms.
Aim to exercise for 30-60 minutes at least three times a week. If you’re not active already, increase your activity gradually, with gentle exercise like walking or gardening.
Gut-directed hypnotherapy. This treatment uses hypnosis to target the connection between your gut and brain. “It works both to calm your mind and your GI tract,” Lupe says. “It puts your body into a deeply relaxed state, which not only helps with anxiety but also decreases UC symptoms like pain and diarrhea.” Research suggests that it may also help you maintain remission.
Talk therapy. Psychologists who specialize in GI problems suggest two main kinds of talk therapy: cognitive behavioral therapy (CBT) and acceptance and commitment therapy. “They both help you address the thoughts and anxieties that surround living with IBD,” explains Lupe. “It doesn’t help to tell someone with UC who is anxious to just relax. We can’t make you change emotions. We want to work with you to find ways to accept how you feel, distance yourself from negative thoughts, and set your own standards for your values and how you meet your goals."
A 2025 study published in the Journal of the American College of Gastroenterology found that both types of therapy helped improve mood and anxiety in people with IBD.
Medications. The same medications often used to treat anxiety — such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) or sertraline (Zoloft) or serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) or venlafaxine (Effexor) — may help with UC symptoms, says Lores. “They work on the brain-gut axis, which may help calm down symptoms,” she explains. Some research also suggests they may ease gut inflammation.
Why Do Young Adults With UC Have a Higher Risk for Anxiety?
Young adulthood is an anxious time in general. “It’s a turbulent, rocky period in life,” says Lupe. “You may make a transition to college, or to the workplace. There’s so much to adjust to and navigate. Throw ulcerative colitis into the mix, and it’s even harder.”
Your late teens and 20s are also a social time of life, but that can be hard if you have UC. “A lot of my younger patients say that they just don’t feel comfortable when they go out because they always need to have access to a restroom,” explains Lupe. “It’s easy to stay home and isolate, which can make anxiety worse.”
Talking to Your Doctor About Anxiety and UC
Don’t let anxiety take over your life if you have UC. Talk to your doctor about it, and ask for a referral to a mental health professional who can address your anxiety and suggest ways to manage your ulcerative colitis. “The good news is many medical centers that treat UC have integrative mental health services where they have a psychologist on staff to work with you,” says Lores.
The Rome Foundation, an organization that provides info about GI disorders such as ulcerative colitis, also has a website where you can look up names of GI psychologists in your area. You can find one here.
Remember, it’s normal to feel anxious when you live with ulcerative colitis. An occasional moment of stress and anxiety is OK, but if you feel these symptoms frequently, get help. Talk to your doctor if you notice any of the following for more than two weeks:
- Feeling nervous or anxious
- Not being able to stop worrying
- Trouble relaxing
- Being so restless that you can’t sit still
- Becoming easily annoyed or irritated
“Anxiety is common when you have UC, but you can manage it,” reassures Lores. “Don’t let it stop you from living a full life.”
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