Managing Anxiety, IBS, and Smoking Cessation: A Comprehensive Guide

Q: Managing Anxiety, IBS, and Smoking Cessation: A Comprehensive Guide

Hello： Irritable bowel syndrome (IBS) is often associated with autonomic nervous system issues and may itself be a manifestation of autonomic dysregulation. <br>Therefore, please discuss with your physician during your visit to the psychosomatic clinic whether medication adjustme

Nervousness, irritable bowel syndrome, smoking cessation issues?

Hello, Doctor! I have been seeing a psychiatrist for over ten years.
Since last year, I have developed irritable bowel syndrome and autonomic nervous system issues, which make me prone to diarrhea and frequent urges to have a bowel movement.
Initially, I would sit on the toilet and only pass some intestinal fluid, going more than ten times a day.
The hospital prescribed daytime medications: Oxazepam to reduce anxiety, taking half or one tablet each time, and Escitalopram, also half a tablet each time.
However, it seems that these medications only provide temporary relief, and I still frequently feel the urge to use the restroom.
I have also consulted a gastroenterologist, so I am currently receiving treatment from both the gastroenterology and psychiatry departments.
Before these issues arose, I would typically have bowel movements 2 to 3 times a day.
Now, I can go as many as 6 to 8 times, although these are not watery stools but rather formed soft stools.
Occasionally, the gastroenterologist prescribes anti-diarrheal medication, but taking it can lead to discomfort due to blockage.
My condition has been unstable over the past three months, resulting in a weight loss of 5 kilograms and increased fatigue and sleepiness.
In mid-June, I underwent a colonoscopy, during which an inflammatory polyp was removed from the sigmoid colon; last year, three adenomatous polyps were removed.
At night, I take a sedative and a sleeping pill; without them, I really cannot sleep.
I have consulted other doctors who suggested that my psychiatric medications might need adjustment, but these medications make me very thirsty.
If adjustments are made, I may end up drinking a lot of water.
Typically, after I finish a meal, I immediately feel the urge to have a bowel movement.
After breakfast, I usually need to go again about an hour later.
I feel helpless and don’t know what to do! Other people with irritable bowel syndrome may experience both constipation and diarrhea, but I am consistently dealing with diarrhea.
I have previously experienced difficulty in having bowel movements after taking psychiatric medications, requiring the addition of stool softeners, so I am hesitant to make significant changes.
Additionally, I have been smoking for over twenty years and recently want to quit.
I inquired at a nearby clinic, but they do not offer smoking cessation services.
The doctor mentioned that the psychiatry department could help, but since I have a major illness card, I do not need to pay for psychiatric medications.
If I include smoking cessation treatment, would I also need to pay out of pocket like at the clinic, or can I not apply for coverage with my major illness card? When I am anxious, I tend to want to smoke, and sometimes smoking also triggers the urge to use the restroom.
I am at a loss, as I smoke a pack a day, which is quite heavy! Thank you for your assistance, Doctor!

ken, 40~49 year old female. Ask Date: 2016/07/12

Dr. Qiu Junda reply Psychiatry

Hello: Irritable bowel syndrome (IBS) is often associated with autonomic nervous system issues and may itself be a manifestation of autonomic dysregulation.
Therefore, please discuss with your physician during your visit to the psychosomatic clinic whether medication adjustments are necessary to alleviate IBS symptoms.
Additionally, it is important to regularly monitor for colorectal polyps.
Furthermore, smoking cessation is highly encouraged.
If the major illness and injury card does not cover smoking cessation expenses, I hope you can seek treatment for quitting smoking as soon as possible, as it will benefit both your physical and mental health and reduce future economic burdens.
Thank you.

Reply Date: 2016/07/12

More Info

Managing anxiety, Irritable Bowel Syndrome (IBS), and smoking cessation can be a complex and challenging journey, especially for someone with a long history of mental health issues and recent gastrointestinal problems. Your situation is not uncommon, and many individuals face similar challenges when trying to navigate the interplay between anxiety, digestive health, and smoking habits.

Understanding the Interconnection
1. Anxiety and IBS: Anxiety can significantly exacerbate IBS symptoms. The gut-brain connection is well-documented; stress and anxiety can lead to increased gut motility, resulting in symptoms like diarrhea, which you have experienced. The fact that you find yourself needing to use the restroom frequently, especially after meals, is indicative of how anxiety can trigger gastrointestinal distress.
2. Smoking and Anxiety: Smoking is often used as a coping mechanism for anxiety, but it can actually worsen anxiety symptoms in the long run. Nicotine may provide temporary relief, but it ultimately leads to increased anxiety levels when the effects wear off. Additionally, the physical act of smoking can create a cycle of dependency that complicates both mental and physical health.

3. Medication Management: You mentioned taking Oxazepam and Escitalopram. While these medications can help manage anxiety, they may also have gastrointestinal side effects. It’s crucial to communicate with your healthcare provider about how these medications are affecting your IBS symptoms. If you experience increased bowel urgency or discomfort, your doctor may consider adjusting your medication regimen.

Strategies for Management
1. Cognitive Behavioral Therapy (CBT): Engaging in CBT can be particularly beneficial for managing anxiety and IBS. This therapeutic approach helps you identify and change negative thought patterns and behaviors that contribute to anxiety and gastrointestinal distress.
2. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation or deep breathing exercises, can help reduce anxiety levels and improve your overall sense of well-being. Techniques like abdominal breathing can also help calm the gut and reduce IBS symptoms.

3. Dietary Adjustments: Since you experience IBS symptoms, consider working with a dietitian to identify potential food triggers. A low-FODMAP diet is often recommended for IBS patients and may help alleviate some of your symptoms. Keeping a food diary can also help you track what you eat and how it affects your bowel habits.

4. Smoking Cessation Support: Since you are considering quitting smoking, it’s essential to seek support. Many healthcare facilities offer smoking cessation programs that can provide counseling and medication to help you quit. While you may be concerned about costs, inquire about options available under your health coverage. Some programs may be covered, especially if they are integrated with mental health services.

5. Regular Follow-ups: Given the complexity of your situation, regular follow-ups with both your psychiatrist and gastroenterologist are crucial. They can work together to ensure that your mental health medications do not exacerbate your gastrointestinal issues and that your IBS treatment does not interfere with your mental health.

Conclusion
Navigating anxiety, IBS, and smoking cessation requires a multifaceted approach. It’s essential to communicate openly with your healthcare providers about all your symptoms and concerns. They can help tailor a treatment plan that addresses both your mental health and gastrointestinal issues. Remember, it’s okay to seek help and support from various specialists, and making gradual changes can lead to significant improvements in your overall health and well-being. Quitting smoking is a commendable goal, and with the right support and strategies, you can achieve it while managing your anxiety and IBS symptoms effectively.

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