Traveling to see family for the holidays can be a gut-wrenching experience for the approximately 15% of the population living with Irritable Bowel Syndrome (IBS). The stress—from families who do not accommodate or understand individual’s dietary needs or stress arising from family conflicts—rachets up their anxiety and worsens symptoms.

Stress can amplify pain and even change the natural composition of our gut microbiome (the bacteria, viruses and fungi that inhabit our digestive systems), according to a Northwestern Medicine medical social scientist and clinical psychologist.

Tiffany Taft is a research associate professor of medicine in the gastroenterology and hepatology division at Northwestern University Feinberg School of Medicine and a clinical psychologist at Northwestern Medicine, where she specializes in the psychological impacts of chronic digestive diseases.

Taft explains that stress over the holidays for people with IBS goes “above and beyond” typical holiday stress for multiple reasons and talks through strategies to manage and cope with the stress—and as a result, manage IBS symptoms.

Why are holidays so stressful for people with IBS?

Tiffany Taft: People living with IBS often say the holidays are especially stressful, above and beyond the typical holiday stress most people report having. The reasons are multifaceted.

Some people have family members who arent very understanding or supportive about IBS, so they may worry or be anxious about asking for changes to the holiday menu because of dietary needs. The risk of having an unpleasant conversation or even argument may be enough to motivate a person to just suck it up and eat foods that they know will likely make them feel ill.

Traveling can be stressful for patients, including worries about having symptoms while flying or driving long distances. In short, the holidays can place a spotlight on a persons IBS and strategies the person may have to keep IBS symptoms in check may become compromised, which can become incredibly stressful.

How does stress affect the gut?

Stress directly affects IBS through the gut-brain axis, which includes parts of the brain that are part of the bodys fight-flight-freeze response. Stress can amplify pain, alter the motility of the gut—either speed up or slow down, depending on the person—and change the composition of the gut microbiome.

As a result, symptoms can become more severe. For some people, this can mean more frequent trips to the bathroom, and for others, less; many will experience increased stomach pain and cramping, bloating and increased urgency to “go.”

How does one cope with those stressful feelings?

Managing holiday stress is a challenge. Practice relaxation strategies that work for you before the holidays are here. This can be meditation with an app, taking some deep breaths, visualizing a relaxing place for you—a beach vacation, a hike in the woods, a comfortable bed—all can bring down stress in the body. Cue up a favorite song. Stretch. All these things can be effective, its finding what works best for you.

Identify unhelpful, catastrophic thinking. This isn’t the power of positive thinking, rather, taking away the power negative thoughts can have over how we feel. If you notice you’re thinking, “What if grandma doesn’t understand my IBS diet, and she’s going to get so mad,” that may very well be true. Instead of repeating the “what if” over and over, lean into it. What can I do if it happens? Make a list of possible ways to solve the problem the “what if” poses.

When we worry, we tend to forget how much weve already navigated in life, or in life with an illness like IBS. Grandma can get angry, and you can handle it.

Are there ways to know when you’re getting stressed?

Our body will give us physical cues when were stressed out. Are my shoulders up by my ears? Am I clenching my jaw? Do I feel tension across my chest? Pay attention to these and take five minutes to try to relax.