Overcoming Social Anxiety and Gas: A Path to Digestive Relief

Desire to completely resolve irritable bowel syndrome (IBS)?

Hello Dr.
Yang,
My issue arises from specific triggers that cause me to feel anxious, leading to a desire to pass gas.
There are two main triggers: 1.
When someone is behind me, and 2.
In crowded places without companions.
When I encounter either of these situations, I start to feel anxious, which then leads to the urge to pass gas.
When I try to hold it in, the situation worsens, making me even more anxious, and consequently, I produce more gas.
I only recently identified these two "situational conditions." Although I attempt to stay relaxed in these scenarios, it often proves ineffective.

I have seen many gastroenterologists in the past, but they only prescribed medications to aid bowel movements, perhaps thinking that smoother bowel movements would reduce gas production.
However, everyone passes gas, right? I have read numerous articles indicating that there is a normal daily gas output for individuals.
My bowel habits have been consistent since childhood, with a bowel movement every 3 to 4 days, and my intake of fruits and vegetables is normal.
Could this be related to psychological factors and autonomic nervous system dysregulation in the gastrointestinal tract? When triggered, I feel anxious, which leads to gas production, and trying to hold it in increases my anxiety, creating a vicious cycle.

This issue began during my senior year of high school due to academic pressure, but after being accepted into university and feeling more relaxed, my acne cleared up, yet the gastrointestinal issues persist.
This problem has troubled me for a long time and significantly affects my interpersonal relationships and willingness to engage socially.
My condition fluctuates; sometimes it’s particularly good, while at other times, I feel like I can’t stop, and I worry I might develop anxiety or mental health issues.
I truly feel helpless; it seems like my life is at a standstill.
Interacting with crowds or socializing presents numerous obstacles, leading me to choose isolation as a passive solution, which makes me feel comfortable, but I genuinely want to resolve this issue!
Could you please advise me on how to seek help effectively to address this distressing problem? Should I focus on diet, gastrointestinal improvement, consulting a psychologist, or a psychiatrist? If my diet remains the same as before the gastrointestinal issues, is it not a primary cause?
Thank you, Dr.
Yang.
Wishing you good health, peace, joy, and prosperity.

Sincerely,
Li

Li Tongxue, 20~29 year old female. Ask Date: 2017/04/29

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Student Li, irritable bowel syndrome (IBS) cannot be completely cured, but symptoms can be reduced or the frequency of episodes can be lowered through medication or changes in mental stress.
You can discuss this with your gastroenterologist and also communicate with a psychiatrist.
Changhua Hospital cares about your health.

Reply Date: 2017/04/29

More Info

Hello, Li. Thank you for sharing your experiences and concerns regarding your social anxiety and gastrointestinal issues. It’s clear that you’ve been through a lot, and I commend you for seeking help and trying to understand your situation better.
From what you’ve described, it seems that your social anxiety is closely linked to your gastrointestinal symptoms, particularly the urge to pass gas when you feel nervous in specific situations. This is not uncommon; many individuals with social anxiety experience physical symptoms that can exacerbate their anxiety, creating a vicious cycle. The anxiety you feel in social situations can trigger gastrointestinal distress, which in turn increases your anxiety, leading to more discomfort.

Understanding the Connection
The connection between anxiety and gastrointestinal issues is well-documented. The gut and brain communicate through what is known as the gut-brain axis. Stress and anxiety can lead to changes in gut motility and increased sensitivity, which can manifest as bloating, gas, and other digestive issues. In your case, the anticipation of being in a stressful situation (like being in a crowded place or having someone behind you) triggers your anxiety, which then leads to physical symptoms.

Steps to Address Your Concerns
1. Cognitive Behavioral Therapy (CBT): Since your anxiety is situational, CBT can be particularly effective. This form of therapy helps you identify and challenge irrational thoughts and beliefs that contribute to your anxiety. A therapist can work with you to develop coping strategies for when you find yourself in triggering situations.

2. Exposure Therapy: This is a specific type of CBT that involves gradual exposure to the situations that cause you anxiety. By slowly and systematically facing your fears, you can reduce your anxiety response over time.

3. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation or deep-breathing exercises, can help you manage anxiety in the moment. These techniques can help calm your mind and body, making it easier to cope with uncomfortable situations.

4. Dietary Adjustments: While you mentioned that your diet is normal, it might be worth exploring whether certain foods exacerbate your symptoms. Keeping a food diary to track what you eat and how it affects your digestive health can be helpful. Foods that are high in fiber, such as fruits and vegetables, are generally good for gut health, but some individuals may find that certain foods (like dairy or gluten) can trigger symptoms.

5. Consulting a Gastroenterologist: Since you have seen multiple gastroenterologists without satisfactory results, it might be beneficial to seek a second opinion or find a specialist who has experience with the gut-brain connection. They may suggest tests to rule out any underlying conditions that could be contributing to your symptoms.

6. Psychiatric Evaluation: If you feel that your anxiety is significantly impacting your daily life, a consultation with a psychiatrist may be beneficial. They can evaluate whether medication might be appropriate for your situation, especially if your anxiety is severe.

7. Support Groups: Connecting with others who experience similar issues can provide emotional support and practical advice. Look for local or online support groups for individuals with social anxiety or gastrointestinal disorders.

Moving Forward
It’s important to remember that you are not alone in this struggle, and there are effective treatments available. The key is to take proactive steps toward addressing both your anxiety and gastrointestinal symptoms. By combining psychological support with medical advice, you can work toward a more comfortable and fulfilling life.

Lastly, I encourage you to be patient with yourself. Change takes time, and it’s okay to seek help along the way. You deserve to feel comfortable in social situations and to enjoy your life without the burden of anxiety and digestive issues. I wish you all the best on your journey to recovery.

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