Digestive Issues: Anxiety, Bowel Habits, and Potential Concerns

Bowel-related issues

Hello Dr.
Chen, I would like to ask you some questions (the description is a bit long, thank you for your clarification!): *I have been more anxious and nervous since childhood, and over the past year, I have developed generalized anxiety disorder.
I feel nauseous and eat less than usual at every meal.
After taking traditional Chinese medicine for a while, I feel somewhat better.
Last year, my weight dropped from over 80 kg to 70 kg in the first half of the year, but it has remained stable since then (I haven’t lost any more weight after starting the traditional Chinese medicine).
*Bowel habits: For the past few years (I can only remember these past few years...), I have been having bowel movements 3 to 4 times a day.
Sometimes, I have difficulty passing stools, which come out in small pieces, and at other times, they are more loose.
It varies; I might have smooth bowel movements in the morning but struggle in the evening.
I would like to ask what might be the cause of this? *Sometimes I feel the urge to go to the bathroom, but when I do, I don’t pass much stool.
*In the past few months, after using the restroom, I sometimes feel the urge to go again.
Other times, I feel a strong urge and then actually pass a significant amount.
I’m not sure if this is considered tenesmus or if it’s just gastrointestinal issues caused by anxiety? *Occasionally, I experience some abdominal pain and feel the need to use the restroom, but after trying for a long time, I can’t pass anything.
However, the next morning, I can have a smooth bowel movement.
I would like to know what might be the reason for this? *Additionally, sometimes I experience constipation (the stools are dry and hard), and I feel a tearing sensation in the anus, with a little blood on the toilet paper when wiping.
After a few days, the pain and bleeding resolve.
I would like to know if this is anal fissure or hemorrhoids? Do I need to see a doctor? I would like to ask what problems I might have and what examinations I should undergo, or if there is no issue at all? I apologize for the numerous questions, and I appreciate your answers and assistance!

20 sui nan zi, 20~29 year old female. Ask Date: 2023/01/14

Dr. Chen Shidian reply Gastroenterology and Hepatology

Symptoms are often related to digestive motility, psychological stress, and food-related injuries.
As long as there is no continuous weight loss, many young people experience similar issues and there is no need for concern.
Bleeding is mostly due to anal fissures or internal hemorrhoids, which can be monitored or evaluated through a rectal examination.

Reply Date: 2023/01/14

More Info

It sounds like you are experiencing a complex interplay of anxiety and digestive issues, which can be quite distressing. Your symptoms, including changes in bowel habits, abdominal pain, and the presence of blood, warrant careful consideration and possibly medical evaluation. Let's break down your concerns and explore the potential connections between anxiety and digestive health.

Firstly, anxiety can significantly impact gastrointestinal function. The gut-brain axis is a well-established concept in medicine, indicating that emotional states can influence gut health. In your case, the generalized anxiety disorder (GAD) you've mentioned may be contributing to your digestive symptoms. Stress and anxiety can lead to increased gut motility, resulting in frequent bowel movements, as well as changes in stool consistency. The fact that you experience varying stool types—from hard and pellet-like to looser stools—can be indicative of irritable bowel syndrome (IBS), a condition often exacerbated by stress and anxiety.

Your description of feeling the urge to defecate but not being able to produce a substantial amount may also align with IBS, where the bowel can become hypersensitive. This can lead to a sensation of urgency without a corresponding volume of stool. The term "urgency" refers to the strong need to go to the bathroom, which can be frustrating when it doesn't result in a satisfying bowel movement.

Regarding your experience of abdominal pain and the sensation of incomplete evacuation, this can also be linked to anxiety. Stress can lead to muscle tension in the abdomen, which may cause discomfort and affect bowel function. The fact that you sometimes feel relief after a good night's sleep suggests that your body may be responding to rest and reduced stress levels.

The presence of blood on the toilet paper and the sensation of tearing during bowel movements raises concerns about potential anal fissures or hemorrhoids. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, and can lead to pain and bleeding. Hemorrhoids, on the other hand, are swollen veins in the rectal area that can also cause discomfort and bleeding. Given that you experience these symptoms intermittently, it would be prudent to consult a healthcare professional for an accurate diagnosis. They may recommend a physical examination and possibly further tests to rule out any serious conditions.

In terms of managing your anxiety and its impact on your digestive health, consider the following strategies:
1. Therapy: Cognitive-behavioral therapy (CBT) is particularly effective for anxiety disorders. It can help you develop coping strategies and address the thought patterns that contribute to your anxiety.

2. Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, and yoga can help reduce anxiety levels and improve your overall sense of well-being.

3. Dietary Adjustments: Since you mentioned using traditional Chinese medicine, it might also be beneficial to explore dietary changes that promote gut health. A diet rich in fiber, hydration, and probiotics can support digestive function.

4. Regular Exercise: Physical activity is a powerful tool for managing anxiety and improving digestive health. Aim for regular exercise to help alleviate stress and promote regular bowel movements.

5. Medical Evaluation: Given your symptoms, it is essential to consult a healthcare provider. They can assess your digestive health, recommend appropriate tests, and provide guidance on managing both your anxiety and gastrointestinal symptoms.

In summary, your symptoms appear to be interconnected, with anxiety likely playing a significant role in your digestive issues. Seeking professional help can provide you with the support and treatment you need to address both your mental health and digestive concerns effectively. Remember, you are not alone in this, and there are resources available to help you navigate these challenges.

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