The gut and brain are closely linked, evident from the feeling of butterflies in the stomach and the experience of having "gut feelings." However, this connection can also cause significant GI problems, including abdominal pain and discomfort, especially due to anxiety or emotional distress. For school nurses who assess many complaints of abdominal pain on any given school day, understanding the link between stomachaches and underlying psychosocial variables and school-related stressors is vital to caring for and supporting students in their care. In part 1 of our blog series, The Business of Bellyaches, we outlined evidence-based assessments of abdominal pain visits to the school nurse and common, non-emergent causes. Part 2 examines acute abdominal emergencies, and here, part 3 takes a closer look at the emotional factors contributing to somatic complaints of abdominal pain in the school setting.

Background

One of the primary functions of the human nervous system is to detect and respond to threats. When a student experiences stress, anxiety, or emotional upset, the body releases stress hormones, including noradrenaline, adrenaline, and cortisol, into the bloodstream, triggering the "fight or flight" response. Consistently elevated stress responses can adversely affect the lining of the digestive tract, causing abdominal discomfort and other symptoms. Additionally, studies have revealed that psychological stress alters the gut microbiome, potentially resulting in an inflammatory response. The relationship between the gut and the brain goes both ways. A distressed gut can send signals to the brain, just as a distressed brain can send signals to the gut. This means that a student's anxiety, stress, or depression can be the cause or the result of stomach or intestinal concerns. 

Signs & Symptoms

When a student experiences emotional distress that manifests as physical symptoms - one of the most common being abdominal pain - it is referred to as somatization. These physical symptoms are real and can be distressing for the child, but there is no medical explanation or physical reason for them. Ambiguous or unexplained abdominal pain, often called a "psychosomatic stomachache," can be severe enough to interfere with daily activities, and it may be associated with other symptoms such as nausea, headache, and fatigue. Emotional stomachaches are more likely to be described as sharp and intermittent versus dull and achy. 

Interventions & Management

The first step in managing psychosomatic abdominal pain is to rule out any underlying physical conditions that may be causing the pain. Once any organic physical causes have been ruled out, it is essential to address the psychological factors that may be contributing to the pain. Here are some strategies that may be effective in managing psychosomatic abdominal pain:

• Encourage the student to talk about their feelings and emotions
• Teach relaxation techniques such as deep breathing exercises, meditation, and progressive muscle relaxation.
• Provide helpful coping skills to manage stress and anxiety.
• Promote regular physical activity and a healthy diet.
• Communicate clearly and consistently with parents.

It is important to note that the treatment of psychosomatic abdominal pain or emotional stomachaches is a collaborative effort involving the child, parents, teachers, healthcare providers, and other school support staff, including school counselors.

Visits to the school health office for vague complaints of stomachache are frequent and sometimes frustrating. But, by taking a compassionate and proactive approach, school nurses can play a critical role in identifying the underlying cause and initiating the necessary support and resources to ease the ache and help students achieve optimal physical and emotional health.