Why You Should Talk About Poop in Therapy

Posted by Sarah Jones

Many of my clients laugh uncomfortably when I ask them about their “poop routine” and digestion in our first few sessions. “Wait, are you serious?” their facial expressions seem to say. “What does poop have to do with my emotions or with therapy?” Well, it turns out that your digestive health and mental health are inextricably linked.

Here’s the science: there is a nervous system lining your intestinal tract, which communicates with the brain to control digestion. From esophagus to rectum, the Enteric Nervous System (ENS) is comprised of over 100 million nerve cells. Emerging research from Johns Hopkins Medicine shows that irritation in the gastrointestinal (GI) system may send signals to the Central Nervous System that trigger mood changes. Such findings underscore the connection within “the gut-brain axis.” In addition, this research indicates that anxiety and depression do not necessarily cause digestive issues, but rather that GI issues can cause the development of anxiety and depression.

So why does this matter? Well, 30-40% of the general population cope with functional bowel issues at some point in their lives. About 25 million Americans report regularly experiencing issues such as bloating, diarrhea, abdominal pain, nausea, constipation, dyspepsia, vomiting and symptoms associated with irritable bowel syndrome (IBS). The majority of people who experience functional GI disorders (50-80%) do not consult a doctor about their symptoms and report taking more days off from work and school. In fact, IBS is reported to be the second leading cause of school and work absenteeism, after the common cold.

It’s clear many people are coping with GI issues and not getting the support they need. Perhaps even you have experienced one or more of these symptoms on a consistent or prolonged basis. If so, you may have noticed fluctuations in your mood, which were hard to account for or understand. You might have developed an eating disorder due to your ongoing gastric issues, as research shows that people with GI issues experience eating disorders at higher rates. Maybe you’ve even been told by a doctor or healthcare provider to go to therapy because your anxiety and/or depressive symptoms were making you sick or causing your eating disorder. I’ve been told this and have also had many clients start therapy for this reason; and they often feel exasperated, misunderstood, hopeless, and experience guilt and shame because they think they are causing their own health issues.

This is where therapy, specifically, GI psychology, can be helpful. The growing field of GI psychology is a holistic approach, which supports patients in managing a wide array of gastrointestinal issues, ranging from encopresis and feeding disorders in infants and children to IBS and ARFID (Avoidant and Restrictive Food Intake Disorder) in teens and adults. This model supports clients in reducing gastrointestinal distress by addressing biological, psychological, social and economic factors, which contribute to their health condition. Through psychoeducation, teaching new skills, and working collaboratively with doctors and nutritionists, therapists are often able to support clients in achieving significant symptom reduction, and even total elimination of gut distress.

So the importance of talking about poop with your therapist is now clear! If you’re interested in learning more about GI psychology or the gut-brain connection, please contact me to set up a consultation or therapy appointment. I specialize in working with clients experiencing DGBI’s (Disorders of the Gut-Brain Interaction), particularly those who have IBS. I am passionate about increasing clients’ understanding of their symptoms and coping skills, and collaborating with healthcare teams in order to support clients in alleviating their digestive issues.

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