Can Stress Really Give You an Ulcer?

Most people believe it can, but the answer is more complicated. Here's what you need to know about this condition and how to treat it.

Can stress cause an ulcer?

Although your mom may have warned you as a child that excessive worrying could burn a hole in your stomach, she was on shaky ground, scientifically speaking. She’s right about the pain and discomfort that can accompany stress and anxiety; it’s just not necessarily an ulcer that’s to blame.

According to Dr. Dan Sadowski, a professor in the faculty of medicine at the University of Alberta, people under stress often simultaneously experience dyspepsia, or indigestion, which leads to belching, bloating and burning pain. Although stress isn’t a direct cause of that indigestion, the flood of cortisol that’s triggered by our body’s response to stress causes you to feel the pain more keenly. And, on top of that, when we’re stressed we may be apt to drink more alcohol, which exacerbates the problem. (Read up on what booze does to your body.) Thankfully, in the majority of cases, you can successfully treat dyspepsia symptoms with over-the-counter antacids.

So if stress doesn’t cause ulcers, what does?

A stomach ulcer, which is a small sore in your gastrointestinal tract, has two main causes. One is the use of non-steroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen or naproxen—which are commonly prescribed for pain relief. While they’re safe in the short term, if used over a long period of time for chronic conditions like migraines, arthritis or back issues, they can lead to irritation and erosion of the stomach lining—ultimately causing an ulcer. This can occur in as little as two months, or even less.

The second main cause of ulcers is an infection with Helicobacter pylori (H. pylori), a common bacterium found in the stomach lining that spreads through contaminated food and water or direct contact with someone who has it. According to Dr. Christopher Teshima, a gastroenterologist at St. Michael’s Hospital in Toronto, the infection usually occurs in childhood, although only 20 per cent of infected children have symptoms. Most cases of H. pylori—which is also a risk factor for cancer—will never cause an issue, with only 10 to 15 per cent of infected Canadians developing an ulcer. Infections are more common in countries with inadequate water sanitization, and seniors are more vulnerable.

How do you know if you do indeed have an ulcer?

The most common symptom of a gastric ulcer is a gnawing or sharp pain midway between the breastbone and navel—the sensation of acid burning the area of the stomach where the ulcer is located. Confusing matters, ulcers can cause dyspepsia. However, if it’s an ulcer, you’re more likely to experience pain at night and see black, bloody or tar-like stools.

If you’re experiencing ulcer-like pain, see a doctor to test for H. pylori. If you’re vomiting blood or having black stools, this could indicate an ulcer is bleeding, which is considered a life-threatening emergency and requires an immediate trip to a hospital. At the ER, a doctor will scope your stomach and cauterize the bleeding. (Find out what your poop can reveal about your health.)

How is an ulcer treated?

If your ulcer is NSAID-related, your doctor will likely advise you to reduce your dose, choose an alternative medication such as acetaminophen, or opt for exercise and physical therapy. Often, patients will be prescribed a proton-pump inhibitor (PPI), which lowers the levels of acid in your stomach.

If symptoms continue, an endoscopy, or stomach scope, can be performed to rule out another condition, like cancer. For many H. pylori infections, a two-week course of a medication that combines antibiotics, an antifungal and a proton-pump inhibitor will usually clear the bacteria, though some patients may need to take the drug for a few months.

To ease symptoms in the meantime, antacids and over-the-counter acid blockers can help.

Next, check out 10 ways to improve gut health.