Which Specialist to See for Gastrointestinal and Mental Health Issues?

Gastroenterology or Psychosomatic Medicine

Hello, doctor.
I have been troubled by the following symptoms for over a year and would like to know which specialty I should consult:
1.
Unformed stools: I often feel the urge to defecate but cannot do so (constipation?) or experience diarrhea (not watery, but loose and breaks apart when flushed, appearing scattered).
Almost every morning, upon waking up completely on an empty stomach (without even drinking water), I have diarrhea.
2.
Appetite issues: I cannot determine if I am hungry or not before eating.
I frequently feel dizzy, and only after eating do I realize that I might have been overly hungry or felt my stomach growling.
However, after a few bites, I feel bloated and nauseous, unable to eat much (sometimes after a while, I feel hungry again but still cannot eat much.
Other times, I remain uncomfortable until the next meal time, and if too much time passes, I feel overly hungry but still cannot eat, which is very distressing).
I believe I do not eat too quickly, but I clearly have symptoms of indigestion, as my stools often resemble the original form of the food (even in color and odor).
3.
I tend to be easily nervous, even to the point of anxiety (in social and work situations).
Blood tests show mild anemia (with hematocrit and hemoglobin slightly below the normal lower limit).
The above three points have been my condition for the past year or two (and continue to be).
Prior to these gastrointestinal issues, I experienced unexplained dizziness and visual disturbances for three to four periods, often misreading things (skipping lines, missing words), or combining two words into one when writing (for example, "Arab" = "A拍數數" and counting 57...
58...
59...
30?! I was unaware of this until friends pointed it out).
I consulted a gastroenterologist (only mentioning gastrointestinal issues), and the outpatient doctor said there was no major problem, prescribing digestive aids.
However, the condition keeps recurring, with no resolution.
Should I see a psychiatrist? Or should I go to a neurologist to check if it could be a nerve conduction issue?

Wu, 20~29 year old female. Ask Date: 2018/12/22

Dr. Liao Yaopan reply Family Medicine

Hello, regarding your question, it is still recommended to prioritize an evaluation by a gastroenterologist to rule out or confirm any significant causes leading to gastrointestinal symptoms.
For issues related to anxiety or memory, you may seek assistance from a psychosomatic medicine specialist.
Please note that online consultations are not equivalent to in-person visits and cannot provide a diagnosis or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2018/12/22

More Info

Based on the symptoms you've described, it seems that you are experiencing a complex interplay of gastrointestinal issues and mental health concerns. This situation is not uncommon, as gastrointestinal symptoms can often be exacerbated by stress, anxiety, and other psychological factors.

Gastrointestinal Symptoms
1. Bowel Irregularities: You mentioned experiencing both constipation and diarrhea, which can be indicative of a condition known as Irritable Bowel Syndrome (IBS). IBS is characterized by a combination of abdominal pain and altered bowel habits, including diarrhea, constipation, or a mix of both. The fact that you experience bowel movements that are not well-formed and often feel the urge to go without being able to do so can be frustrating and distressing.

2. Appetite Issues: Your difficulty in recognizing hunger cues and the sensation of fullness after only a few bites can also be linked to gastrointestinal dysmotility or functional gastrointestinal disorders. This can lead to feelings of nausea and discomfort after eating, which may further contribute to your anxiety about food.

3. Digestive Symptoms: The presence of undigested food in your stool and the overall discomfort you feel after eating suggest that your digestive system may not be processing food effectively. This could be due to a variety of factors, including dietary choices, stress, or underlying gastrointestinal conditions.

Mental Health Considerations
Your report of anxiety, especially in social and work situations, along with symptoms of dizziness and confusion, suggests that there may be a psychological component to your physical symptoms. Anxiety can manifest in various ways, including gastrointestinal distress, which can create a vicious cycle where anxiety exacerbates digestive issues, and digestive issues, in turn, increase anxiety.

Recommendations
Given the complexity of your symptoms, it would be advisable to consult with both a gastroenterologist and a mental health professional. Here’s a breakdown of the steps you might consider:
1. Gastroenterology: Since you have already seen gastroenterologists without finding a definitive solution, it may be worth seeking a second opinion or asking for more comprehensive testing. This could include:
- Endoscopy: To rule out any structural issues in the upper gastrointestinal tract.

- Colonoscopy: To examine the lower gastrointestinal tract, especially given your symptoms of irregular bowel movements.

- Motility Studies: To assess how well your gastrointestinal tract is functioning.

2. Mental Health: Consulting with a psychologist or psychiatrist could be beneficial. They can help you address the anxiety and stress that may be contributing to your gastrointestinal symptoms. Cognitive-behavioral therapy (CBT) is particularly effective for managing anxiety and can also help with coping strategies for dealing with IBS symptoms.

3. Neurology: If you continue to experience neurological symptoms such as dizziness and visual disturbances, it may also be prudent to see a neurologist. They can evaluate whether there are any underlying neurological conditions that could be contributing to your symptoms.

4. Lifestyle Modifications: In addition to seeking medical advice, consider implementing lifestyle changes that may help alleviate your symptoms:
- Dietary Adjustments: Keeping a food diary to identify any potential food triggers and focusing on a balanced diet rich in fiber can help regulate bowel movements.

- Stress Management: Techniques such as mindfulness, meditation, or yoga can help reduce anxiety and improve overall well-being.

- Regular Exercise: Engaging in regular physical activity can help improve digestive health and reduce anxiety.

Conclusion
In summary, your symptoms warrant a multi-faceted approach involving both gastrointestinal and mental health specialists. By addressing both aspects, you can work towards finding a more comprehensive solution to your ongoing issues. Remember, it’s important to advocate for yourself in the healthcare system and seek the care that you feel is necessary for your well-being.

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