The Vasovagal Response and IBD

by Kaitlyn Niznik (New York, U.S.A.)

Fluffy white and pink clouds, in front of a sky that shifts from dark to light blue.

As someone with several medical phobias, I have always been a fainter.  Being in a heightened state of fear and stress is a recipe for disaster that usually leads to me being on the ground.  It takes skill to faint and take out a row of chairs and your mother at the doctor’s office, but I like to think that I’m improving with time and therapy (see my phobias article for details).  However, when I began having digestive issues in college, I started experiencing pre-syncope symptoms frequently during flareups that have lasted to this day.  Doctors always told me it was a vasovagal response, so I have been asking nurses and reading up on research in the hopes of finding some answers.  Though I have not figured out how to completely stop my symptoms, here is what I have found on the subject and some strategies that may help.

IBD can come with a multitude of strange and hard-to-explain symptoms with some occurring outside of the gastrointestinal system.  These extraintestinal manifestations can include feeling faint during a period of intense stomach pain or dizzy during a bowel movement.  The vagus nerve and parasympathetic nervous system connect the gut, heart and brain, causing a plethora of vasovagal symptoms when thrown out of balance.   

For some background information, syncope is a medical term for fainting while presyncope describes the symptoms one experiences when they almost pass out - including dizziness, nausea, blurry vision, weakness, and chills or sweating.  Both syncope and presyncope can be signs of different conditions, but are also strongly attributed to vasovagal syncope. Vasovagal syncope is experienced by around a third of the world and is a common symptom of dehydration, giving blood, standing up too quickly, etc. (Johns Hopkins Medicine, Syncope).  According to Verywell Health, a vasovagal response can have physical triggers, such as straining during bowel movements, stomach illness, and pain, or emotional triggers like anxiety, trauma, fear, or stress (Bolen, 2025).  

**It’s important that if you experience syncope or pre-syncope symptoms that you get checked out by a doctor.  Tests like an Electrocardiogram, echocardiogram, tilt table test, CT, MRI, carotid artery ultrasound, and more can be used to rule out serious heart problems, seizures, or conditions like POTS.**   (Johns Hopkins Medicine, Syncope)

According to the paper “The autonomic nervous system and inflammatory bowel disease,” there is strong evidence supporting the connection and interaction between the central nervous system and the intestines.  When the body is triggered by high stress or chronic stress, it can have a direct effect on our gut’s inflammatory response.  Vagal neurons permeate the gut wall and play an important role in the transfer of information from the gut to the central nervous system and vice versa.  This connection is commonly known as the gut-brain axis.  These sensitive nerve connections can even affect our perception of IBD-associated pain and disease symptoms can be exacerbated (Taylor & Keely, 2007).  Our bodies need to find a balance between the nervous system and gut.  Too much or too little activation can trigger responses in multiple areas of the body and have unforeseen consequences.  

Some common vasovagal response symptoms are:

• Tunnel vision/blurred vision

• Dizziness

• Weakness

• Ringing in the ears

• Cold or clammy skin

• Feeling hot

• Nausea

• A temporary drop in blood pressure (Bolen, 2025)

• Syncope or fainting

• Short term amnesia or confusion upon waking

• Brief convulsions of the limbs (Wang et al., 2024)

What can you do during a vasovagal episode?

• Sit or lie down (injury prevention)

• Put your head between your knees

• Avoid straining 

• Stay hydrated

On top of those tips, this is how I deal with repeat vasovagal episodes:

Firstly, I document everything so I can give my doctor a better idea of what I experience and how frequently.  A smart watch is also useful so I can keep track of my bpm.  There are a few trusted friends and family members that know of my condition and the warning signs.  Of course, it’s helpful if you know your own body’s warning signs - it can help you predict it before it happens.  

I also keep my phone on me at all times in case I need to call for help.  After a vasovagal episode, I give myself time to feel better - usually curling up on the couch with a blanket and some water.  I always use electrolytes to help my body recover faster and I keep heating pads with me since I can feel cold or shaky afterwards.   

Possible forms of treatment that I’ve learned about:

• Medication

• Physical counterpressure maneuvers  (Wang et al., 2024)

• Pelvic Floor Therapy

• Vagus Nerve Stimulation 

• Psychotherapy 

I found it interesting that one medical professional recommended looking into psychotherapy to address the psychosocial component of vasovagal responses.  Having fainting episodes or those revolving around intense pain can be terrifying and that fear can stick around long after the incident ends.  Traumatic memories of pain around bowel movements can cause increased anxiety and escalate vasovagal responses.  Confronting your anxiety and the reasons behind your fight/flight/freeze can help mitigate symptoms.  By always having a plan and knowing the signs, I can better prepare myself to deal with vasovagal responses.   

Works Cited:

Bolen, B. (2025, October 30). Common causes and triggers of the vagal response. Verywell Health. https://www.verywellhealth.com/vasovagal-reflex-1945072 

Syncope (fainting) | Johns Hopkins Medicine. Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/conditions-and-diseases/syncope-fainting 

Taylor, C. T., & Keely, S. J. (2007). The autonomic nervous system and inflammatory bowel disease. Autonomic Neuroscience, 133(1), 104–114.https://doi.org/10.1016/j.autneu.2006.11.005 

Vagus nerve: What it is, function, Location & Conditions. Cleveland Clinic. (2022, November 1). https://my.clevelandclinic.org/health/body/22279-vagus-nerve 

Wang, J., Li, H., Huang, X., Hu, H., Lian, B., Zhang, D., Wu, J., & Cao, L. (2024, April 10). Adult vasovagal syncope with abdominal pain diagnosed by head-up tilt combined with transcranial Doppler: A preliminary study. BMC neurology. https://pmc.ncbi.nlm.nih.gov/articles/PMC11005138/#:~:text=The%20value%20of%20HUT%20combined,the%20adoption%20of%20safety%20measures 

Featured image from Henrik Dønnestad on Unsplash.