Managing Panic Disorder and Gastrointestinal Distress: A Comprehensive Guide

Autonomic nervous system dysfunction panic disorder with abdominal pain?

Bloating that doesn't subside, depression, anxiety, and irritable bowel syndrome (IBS) are indeed concerning.
Since December 31, 2018, I experienced bloating that triggered palpitations, chest tightness, and numbness in my hands and feet.
After visiting the emergency room, the doctor diagnosed it as hyperventilation.
After receiving IV treatment, I returned home, but for nearly three months, I repeatedly experienced palpitations and shortness of breath.
Initially, I thought I had panic disorder.
I consulted a gastroenterologist, and after a complete examination, no significant issues were found, but I did have gastric and intestinal bloating, which has increased abdominal pressure to the point of affecting my lungs and heart, leading to frequent chest tightness, palpitations, and difficulty breathing.
I also experienced pressure in the back of my head, a feeling of dizziness, difficulty concentrating, early awakening, and abdominal and bladder tenderness with bloating.
This has made me easily anxious.
I was hospitalized twice, and the doctors diagnosed me with functional gastrointestinal motility disorder (IBS).
They prescribed anti-anxiety medication and drugs to aid digestion and relieve bloating, but currently, I find it difficult to pass gas, and the medication is not very effective.
I wake up with significant bloating, making it hard to urinate, and the urine output is low.
I have to strain to produce a small amount of soft, mucus-like stool, which leaves me feeling dizzy and uncomfortable.
I really want to avoid the need for a catheter for bowel relief, as I imagine it would be very painful.
I would like to know what I can do about these bloating symptoms.

A Ze, 20~29 year old female. Ask Date: 2019/06/10

Dr. Huang Xiaoxian reply Psychiatry

Dear A-Ze, regarding the bloating you mentioned, it generally arises from excessive air intake or rapid gastrointestinal motility, both of which are often associated with anxiety.
When a person is anxious, they tend to breathe more rapidly, which can further lead to symptoms such as chest tightness and numbness in the limbs.
I recommend seeking an evaluation from a psychosomatic specialist to assess the underlying causes and provide appropriate treatment for improvement.
Wishing you a speedy recovery!

Reply Date: 2019/06/10

More Info

Managing panic disorder and gastrointestinal distress, particularly when they manifest as symptoms like bloating, anxiety, and depression, can be a complex and challenging process. Your experience highlights a common intersection between mental health issues and gastrointestinal (GI) disorders, often referred to as the gut-brain axis. This connection means that psychological stress can significantly impact digestive health and vice versa.

Understanding the Symptoms
From your description, it appears that you are experiencing a range of distressing symptoms, including:
1. Bloating and Gastrointestinal Distress: This can lead to feelings of fullness, discomfort, and pressure in the abdomen, which may exacerbate feelings of anxiety and panic.

2. Panic Symptoms: Heart palpitations, shortness of breath, and feelings of chest tightness can often be mistaken for serious medical conditions, which can further increase anxiety.

3. Cognitive Symptoms: Issues such as difficulty concentrating, early waking, and feelings of pressure in the head can be indicative of both anxiety and depression.

The Role of Anxiety and Panic Disorder
Anxiety disorders, including panic disorder, can lead to physical symptoms that mimic gastrointestinal issues. The body's stress response can cause changes in gut motility, leading to conditions like irritable bowel syndrome (IBS). This can create a vicious cycle where anxiety exacerbates GI symptoms, which in turn increases anxiety.

Treatment Approaches
1. Medication: You mentioned being prescribed medications for anxiety and digestive issues. Common medications include:
- Antidepressants: SSRIs (Selective Serotonin Reuptake Inhibitors) can help manage anxiety and depression.

- Antispasmodics: These can help relieve gastrointestinal cramping and discomfort.

- Prokinetics: These medications can help improve gut motility and reduce bloating.

2. Therapy: Cognitive Behavioral Therapy (CBT) is particularly effective for anxiety disorders. It helps individuals identify and change negative thought patterns and behaviors that contribute to anxiety and panic attacks.

3. Lifestyle Modifications:
- Dietary Changes: Keeping a food diary can help identify triggers for bloating. Consider a low-FODMAP diet, which has been shown to help with IBS symptoms.

- Regular Exercise: Physical activity can help reduce anxiety and improve gut motility.

- Mindfulness and Relaxation Techniques: Practices such as yoga, meditation, and deep-breathing exercises can help manage stress and anxiety.

4. Self-Monitoring: Keeping track of your symptoms, triggers, and any patterns can be beneficial. This can help you and your healthcare provider make informed decisions about your treatment plan.

5. Hydration and Nutrition: Ensure you are drinking enough water and consuming a balanced diet rich in fiber, which can help with bowel regularity. However, be cautious with high-fiber foods if they exacerbate bloating.

When to Seek Further Help
If your symptoms persist or worsen despite treatment, it is crucial to follow up with your healthcare provider. They may recommend further testing to rule out other conditions or adjust your treatment plan. Additionally, if you experience severe anxiety or panic attacks that interfere with your daily life, seeking immediate help from a mental health professional is essential.

Conclusion
Managing panic disorder and gastrointestinal distress requires a multifaceted approach that addresses both the psychological and physical aspects of your symptoms. By working closely with your healthcare team, you can develop a comprehensive plan that includes medication, therapy, lifestyle changes, and self-management strategies. Remember, you are not alone in this journey, and there are effective treatments available to help you regain control over your health and well-being.

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