Even people who don't have IBD will get an upset stomach when stressed or nervous. That whole "butterflies in the stomach," and urgent need to "go" is actually pretty natural and normal. In fact, a gastroenterologist once told me that the gut is the center of the body and the gauge of our emotions. Even people without IBD or IBS, he told me, will have an increase in bowel movements and diarrhea when stressed.

So, throw a little IBD on top of the stress and what's a patient to do?

First, learn to recognize when the amount of stress entering your life is inordinate and excessive. I used to have a hard time realizing how much stress I was experiencing in a situation until the stressful situation had passed and my body reacted - usually badly with diarrhea and a wicked headache. But, by really tuning in and learning to "listen" to my body I can now realize my body's signs which tell me I am under a larger than normal amount of stress. Some signs I now recognize include:

1. my cheeks will get hot and flushed, almost as if I have a fever

2. I might feel lightheaded

3. I might feel queasy or nauseous

4. I can feel slightly claustrophobic, and if I don't get some control over the stress before it becomes overwhelming then...

5. I will end up with diarrhea and have to use the bathroom repeatedly (every 10 or 20 minutes).

I try not to get to #5. Instead, once I realize that I'm seriously stressed I try to combat it before it hits my gut. If the stress is coming from something that needs to be done I have finally learned how to delegate, all or some of the tasks, and to not feel guilty about it, or reorganize, or cancel plans, if needed. If it's a situational type of stress like having to get on an airplane or having a meeting in public I try to maintain as much control as possible. In the case of traveling by air - I gather together my iPod, books, magazines, reserve an aisle seat near the back of the plane where the bathroom is, eat a bland diet for a few days before I leave so as not to aggravate things, and do a little extra meditation and rhythmic breathing (for more information read Elizabeth's post on How to Travel Successfully with IBD). In the case of a lunch meeting or meeting at a client's office - I always drive my own car, arrive a few minutes early to identify the bathroom situation, never eat anything risky, and make sure I'm fully prepared for the meeting so there is no need for fear or apprehension to creep in.

Second, learn how to help yourself relax. When you get stressed or tense (as my dad calls it) do you know what helps you to calm down and feel more relaxed? Take a few minutes and think about this. . . maybe even wright down on a piece of paper three (3) things you can do that helps you to de-stress. It might be sitting outside in the sunshine for 10 minutes and breathing deeply; or listening to your favorite music; reading a book; taking a short or long walk; going for a jog; having a cup of tea; or working it out physically at the gym or on the tennis court. Some people even find visualizations helpful - for example, close your eyes, focus on the tension in your body and try to "see" where it is - your arm, your head, your stomach - and then use whatever means you want to get rid of it - take your hand and pretend to grab hold of the tension and throw it away, or stomp on it, whatever works for you to combat and release that stress from your body.