There is such a thing as a stress ulcer, but it’s probably not what you think. This stomach ulcer is caused by severe physical stress, not emotional stress.
Many people associate stomach ulcers with emotional stress. But while you can get a stress ulcer, the cause isn’t emotional. “You can’t worry yourself into an ulcer,” says Brooks Cash, MD, chief of gastroenterology at the University of Texas Health Science Center at Houston.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
“Emotional stress, even severe emotional stress, does not cause any type of ulcer,” explains Dr. Cash. “The term 'stress ulcer' is often confused with other ulcer terms like 'peptic ulcer,' 'gastric ulcer' and 'duodenal ulcer.' Peptic ulcers are ulcers of the upper digestive tract, and they include ulcers in your stomach, called gastric ulcers, and ulcers in the beginning of your small intestine, called duodenal ulcers.”
The Differences Between Ulcers
Peptic ulcers are most often caused by an infection from the common bacteria called Helicobacter pylori or from taking too many nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil or Motrin) and naproxen (Aleve).
“The cause of stress ulcers is different,” says Dr. Cash. “When doctors talk about stress ulcers, we are referring to physiologic stress. This is the type of stress caused by being very ill. Examples include being on a respirator in the intensive care unit, having severe burns or having an infection that has spread to your blood stream, called sepsis.”
To protect your stomach and duodenum from acid, you need a healthy, protective layer of mucous as a barrier. “People under severe physical stress do not maintain a sufficient perfusion with blood and stimulation with food to maintain this barrier,” explains Dr. Cash.
Stress ulcers are dangerous because they can eat away at the surface of the upper digestive system and cause bleeding.
Stress Ulcer Symptoms
While the main symptom of a peptic ulcer is epigastric pain, which is pain underneath your breastbone, the main sign of a stress ulcer is bleeding. This bleeding may cause vomiting of fresh red blood or older blood that looks like coffee grounds. Another sign is tar-like stool caused by blood that who passed through your digestive system, states the American College of Gastroenterology.
Doctors are aware of the danger of stress ulcers in very sick people and will usually treat these patients pre-emptively with medications to coat the stomach and duodenum and to reduce the amount of acid produced in the stomach in an effort to prevent stress ulcers from forming. These ulcers are relatively uncommon, according to a 2015 study published in Nature Reviews, but they can be deadly.
“Treatment for patients who develop a bleeding stress ulcer may involve placing a flexible fiberoptic camera into the esophagus, stomach and small intestine," explains Dr. Cash. "This test is called an esophagogastroduodenoscopy (EGD), and doctors can stop bleeding with a variety of techniques during an EGD." Severe bleeding, though, may require a blood transfusion," he says.
What About Emotional Stress?
Emotional stress can, in fact, cause some digestive symptoms, according to the Canadian Society of Intestinal Research.
You’ve probably experienced the sensation of your stomach churning or feeling slightly sick to your stomach when having a really bad day at work or school. Emotional stress may delay emptying of your stomach or increase movement of fluids and food through your intestines, possibly causing a bout of diarrhea.
Though emotional stress can’t cause an ulcer, if you have a peptic ulcer, it can make your symptoms seem worse. That’s because stress can lower your threshold for any type of pain.
Finally, you could trigger or ramp up your ulcer pain if you give in to stress by smoking or drinking alcohol. Alcohol irritates an ulcer, and smoking can increase your susceptibility to H. pylori infection and even increase the amount of acid produced in your stomach.
- Brooks Cash, MD, chief, division of gastroenterology, hepatology and nutrition, University of Texas Health Science Center, Houston, and Dan and Lillie Sterling professor of medicine, University of Texas McGovern Medical School.
- American College of Gastroenterology: “Peptic Ulcer Disease.”
- Canadian Society of Intestinal Research: “Stress and Your Gut.”
- Canadian Society of Intestinal Research. “Smoking and the Digestive Tract.”
- Nature Reviews: “Stress-related mucosal disease in the critically ill patient.”