An ulcer occurs when tissue in an area of the mouth, stomach, esophagus, or other part of the digestive system becomes damaged. The area gets irritated and inflamed, and creates a hole or sore. Ulcers are at risk of bleeding, so those occurring in the stomach and intestinal tract need to be monitored. We’ll look at the relationship between stress and several types of ulcers, including:

  • stress ulcers: found in the areas of the digestive tract (e.g., stomach, esophagus)
  • peptic ulcers: found in the stomach and in the upper area of the small intestine
  • mouth ulcers: found inside the lips, and on the gums or tongue (mouth ulcers differ from cold sores found on the lips)

Stress comes in different forms. There’s mental or psychological stress, and there’s also physical stress. Certain types of stress may be more likely to affect the different types of ulcers. Many in the medical field disagree as to what actual role mental or psychological stress has in causing ulcers of any type. Much of the research and trials done so far have not been able to clearly answer this question.

But research continues, as there is an increased understanding that the gut and brain interact with each other on a variety of levels. There’s also ongoing research into how stress interacts with the body’s immune system, which may affect healing.

The type of ulcer that is normally referred to as a stress ulcer is believed to be triggered by physical stress. The physical stress can come in some of the following forms:

  • serious long-term illness
  • surgical procedure
  • trauma that occurs to the brain or body
  • serious burns
  • injury to the central nervous system

Other ulcers, such as mouth ulcers and peptic ulcers, may not be directly caused by stress. However, there’s some evidence that mental stress may aggravate them.

Another relationship between stress and ulcers involves the stress caused by the ulcer itself.

Mouth ulcers may be particularly stressful and cause anxiety due to pain and its effects on talking, chewing, eating, and drinking. This social stress adds to any mental stress you may already be experiencing.

Peptic ulcers can be stressful due to the symptoms they may cause. They may also cause you to worry about doing something that may irritate your condition further.

The symptoms for all types of ulcers include pain and an open sore. You will only be able to see the open sore in mouth ulcers. Other symptoms of mouth ulcers may include:

  • burning sensation
  • pain to the touch
  • extreme sensitivity

Your doctor would have to perform an endoscopy to see the ulcers or sores that are within your intestinal tract. During an endoscopy, your doctor uses a specialized device called an endoscope to see the lining of your GI tract and check for any ulcers. The device is a long, flexible tube with a small camera on the end. You are sedated during this procedure.

The most common symptom of peptic ulcers is usually pain. Another problem is internal bleeding. The bleeding may not be significant for some people. However, if bleeding becomes significant, your doctor will have to perform a surgical procedure to stop it. Your doctor will be taking measures to prevent a stress ulcer if you are in the hospital with trauma or serious injury, in the intensive care unit, or in the hospital following some surgical procedures.

Other peptic and stomach ulcer symptoms include:

  • burning sensation
  • heartburn
  • nausea
  • weight loss
  • loss of appetite

Serious complications are not common, but there are some that you should be aware of.

Some mouth ulcers are actually a type of mouth cancer. An ulcer that will not heal even after treatment and occurs on the tongue, between the cheek and gums, or under the tongue, may be a sign of mouth cancer.

An untreated peptic or stomach ulcer may, in some cases, cause the following severe symptoms:

  • loss of appetite and weight loss
  • difficulty breathing
  • lightheadedness or faintness
  • vomiting
  • nausea
  • black tarry stools
  • internal bleeding
  • gastric obstruction

A stress ulcer will most likely occur when you are already under medical care for a major illness, surgical procedure, trauma, or injury. The presence of a stress ulcer adds another complication to your other medical conditions that lead to the ulcer. As with a peptic or stomach ulcer, the most serious complications are internal bleeding or an obstruction.

The treatment for peptic or stomach ulcers depends on the cause of the ulcer. If the ulcer was caused by the H. pylori bacteria, it will need to be treated with antibiotics and acid-blocking medications your doctor will prescribe.

Stomach ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) may be treated with over-the-counter medications or prescriptions recommended by your doctor. These treatments may include:

  • stopping the NSAIDs
  • proton pump inhibitors, which cause your stomach to create less natural acid and help speed healing
  • H2-receptor antagonists, which work much like proton pump inhibitors

Mouth ulcers may be managed with the following lifestyle changes:

  • Avoid certain foods, such as those that are salty, hard, acidic, spicy, hot, or alcoholic.
  • Manage any infections or medical conditions related to your mouth ulcers.
  • Manage your stress levels.
  • Quit or limit the use of tobacco products.
  • Drink through a straw.
  • Brush your teeth gently, twice a day.
  • Take corticosteroids or medicated mouth rinses recommended by your doctor or dentist.

In women, some mouth ulcers may clear up when your hormones change after your monthly period.

Managing stress may be helpful in the treatment of your ulcers. While medical professionals disagree on how much mental or psychological stress affects certain types ulcers, there is some evidence that reducing stress can help.

Stress is believed to limit the function of the immune system. Stress management will also help your overall well-being. You should talk to your doctor about some treatment options for your stress while discussing your ulcer treatment plan. This plan may include talking with a professional counselor or psychologist or possibly taking medications.

Triggers of mouth ulcers may include:

  • viral infection
  • biting or injuring your lip, tongue, or the inside of your cheek
  • changes in hormones for women
  • stress
  • some foods
  • certain medical conditions

Causes and triggers of peptic/stomach ulcers can include:

  • H. pylori infection
  • NSAIDs including aspirin, ibuprofen, naproxen, and others
  • severe stress, major depression, and certain other mental illnesses, perhaps related to the brain-gut interaction

Some of the physical stressors that may cause ulcers include:

  • some surgical procedures
  • severe burns
  • brain trauma
  • traumatic injury to the body
  • a serious long-term injury, usually requiring hospitalization
  • something that causes you to be in the intensive care unit
  • central nervous system injury

For any type of internal ulcer (peptic ulcer, stomach ulcer, or stress ulcer) you should contact your doctor if the pain does not go away after treatment or keeps returning regularly.

You should seek immediate medical attention if you begin to vomit blood, have tar-like or bloody stools, or have a sharp pain the comes on suddenly, and either doesn’t go away or gets progressively worse.

For mouth ulcers, you should see a doctor or dentist if they don’t clear up within two weeks after treating them with over-the-counter medications or if the pain significantly affects your ability to eat and drink.

Overall, ulcers of any type can be managed and treated. It’s important to work with your doctor to find the initial cause as well as what might be triggering it to reoccur or worsen. Once these have been pinpointed, your doctor will be able to give you a treatment plan that will work best for you.