One of the patterns that appears most consistently in the histories of people with IBS is this: symptoms began, or became significantly worse, after a loss.
The death of someone important. A divorce. A friendship that ended. A move that severed a community. The loss of a job, a role, an identity. The particular grief of watching a parent decline. Sometimes the loss is obvious in retrospect. Sometimes it is only clear later, when someone finally connects the timing.
If this is your story, there is a biological explanation for what your gut experienced — and it is not “all in your head.”
What Grief Does to the Body
Grief is not only an emotional experience. It is a full-body physiological event. In the acute phase of loss, the HPA axis activates, cortisol surges, sleep is disrupted, appetite changes, and the immune system shifts. The autonomic nervous system — the system that governs the balance between activation and rest — loses some of its flexibility and tends to stay in a more activated state (O’Connor, 2019).
For the gut, each of these changes is directly relevant. Elevated cortisol increases intestinal permeability and sensitizes the enteric nervous system. Disrupted sleep compounds cortisol dysregulation. Immune activation can alter gut microbiome composition. The result, for people whose gut-brain axis is already sensitized, is often a significant worsening of digestive symptoms in the weeks and months following a loss — or the emergence of IBS-like symptoms for the first time.
Research on adverse life events and IBS consistently finds that significant losses and stressful life events are among the strongest precipitating factors for IBS onset and flares (Tang et al., 2021). This is not a new observation — clinicians have noticed the grief-gut connection for decades. What is newer is the mechanistic understanding of exactly why it happens.
The Grief Nobody Names
Not every loss that triggers IBS is the kind that gets socially recognized. Anticipatory grief — the slow grief of watching someone you love decline before they die — carries the same physiological weight as acute loss, often for longer. Ambiguous losses — the end of a relationship that was never officially a relationship, the estrangement from a family member, the loss of a version of yourself you had hoped to become — are particularly disorienting because there is no ritual for them and often no permission to grieve them fully.
Disenfranchised grief is processed alone, in the body, without the regulatory support of community acknowledgment. The nervous system carries it anyway — and so does the gut.
What Helps
Grief takes the time it takes. There is no protocol for accelerating it, and approaches that try to bypass it tend to embed it more deeply in the body rather than moving it through.
What helps — both the grief and the gut — is creating conditions for the nervous system to process what has happened rather than suppressing it. This means allowing the emotional experience rather than managing it away. It means co-regulation: being with people who can hold the weight of it with you. It means somatic approaches that help the body complete the stress response that grief initiates.
In gut-brain therapy, grief that has been somatized — carried in the gut rather than processed emotionally — is addressed both at the nervous system level and at the relational level. The gut does not need you to be over the loss. It needs the loss to be acknowledged so the nervous system can begin to settle.
If you are grieving and your gut is suffering, those two things are connected. Treating one means attending to both.
About the author
Susan Liddy, MAMFT is a GI Psychotherapist and doctoral candidate in Integrative Health, specializing in nervous system-informed care for IBS and disorders of gut-brain interaction. Georgia residents are welcome to schedule a free consultation at www.susanliddy.com.
For educational purposes only. Not medical or psychological advice. Susan Liddy, MAMFT
References
O’Connor, M.-F. (2019). Grief: A brief history of research on how body, mind, and brain adapt. Psychosomatic Medicine, 81(8), 731–738. https://doi.org/10.1097/PSY.0000000000000717
Tang, H.-Y., Jiang, A.-J., Wang, X.-Y., Wang, H., Guan, Y.-Y., Li, F., & Shen, G.-M. (2021). Uncovering the pathophysiology of irritable bowel syndrome by exploring the gut-brain axis: A narrative review. Annals of Translational Medicine, 9(14), 1187. https://doi.org/10.21037/atm-21-2779
