Bowel Issues: Anxiety and Gastrointestinal Health

Bowel movement issues

Hello Doctor: I have been experiencing intermittent bowel issues for quite some time.
I wonder if this is related to the anxiety I developed while caring for my father, who had esophageal cancer, about 4 to 5 years ago.
I'm not sure what to do...
Around September, I started having diarrhea, going about 1 to 3 times a day, sometimes even 4 times.
Prior to this, I had a regular bowel movement once a day, although the timing was inconsistent.
I remember having similar issues before, but they usually resolved within two weeks.
At that time, I was taking medication from a psychiatrist, and I'm unsure if that influenced my condition.
However, this time, the diarrhea has persisted for over a month or two.
The diarrhea has presented in a few ways:
1.
On the same day, the first bowel movement is formed, odorless, and looks normal, but the second and third movements gradually become more liquid, mushy, or even mucus-like (lasting about a week).
2.
After the Mid-Autumn Festival (after three days of eating meat), the bowel movements started normally but became soft and mushy towards the end, with colors ranging from dark brown to normal yellowish-brown.
I consulted both a traditional Chinese medicine practitioner and a Western medicine internist.
The TCM doctor suggested it was gastroenteritis, while the Western doctor performed an abdominal ultrasound and an ECG, stating there were no issues, although my heart rate was somewhat elevated (I have noticed a few instances of a fast heart rate in the past).
Current situation:
1.
I feel anxious in the morning upon waking (about 5-10 or higher).
2.
I occasionally experience lower abdominal pain before bowel movements, which improves after passing gas.
3.
My bowel habits seem cyclical; some days I go three times, while other days just once (I'm unsure if the medication is affecting this).
4.
During medication, I had one instance of diarrhea with three bowel movements in a day.
5.
The frequency (from once to three times a day) and consistency (from normal soft stools to mucus) vary, but there is no unusual odor, and I do not see any visible blood.
6.
Sleep: It takes me a while to fall asleep (about 30 minutes), but I do not wake up during the night.
7.
Heart rate: I feel it is fast and noticeable.
8.
I had a fecal occult blood test done this year (around 50), and the doctor said there were no issues.
9.
I previously experienced tightness in the upper abdomen, but it improved after seeing a TCM practitioner; I no longer have that issue, although I occasionally feel tightness in my abdomen and only pass gas before bowel movements.
10.
My weight fluctuates but averages around 74.3 kg, ranging from 73.6 to 75.0 kg (measured in the morning).
-----------------------
1.
I am unsure if my anxiety (frequent heart palpitations and diarrhea) could be causing these symptoms?
2.
Based on your initial assessment, is there a possibility of a serious illness? (I am worried)
3.
Do I need to seek further medical attention? Would a larger hospital be better? (I have only been to small clinics before)
4.
Should I consult both a psychiatrist and a gastroenterologist simultaneously? (I have previously been evaluated and diagnosed with anxiety) I stopped taking medication after the end of July this year.
Thank you, Doctor, for taking the time to listen to my concerns amidst your busy schedule.

Xiao Kang, 20~29 year old female. Ask Date: 2023/10/03

Dr. Chen Bozhang reply Family Medicine

Hello, it is recommended to seek medical attention at a regional or higher-level hospital for a comprehensive evaluation.
You may visit the Department of Family Medicine, Hepatobiliary and Gastroenterology, or the Department of Colorectal Surgery.
Thank you.

Reply Date: 2023/10/03

More Info

Your concerns about gastrointestinal issues, particularly in relation to anxiety and stress, are quite common and can be quite distressing. Based on your description, it seems that you have been experiencing a range of symptoms including diarrhea, abdominal pain, and feelings of anxiety, which may be interconnected.
Firstly, it is important to understand that the gut-brain connection is a well-established phenomenon in medical literature. The gastrointestinal system is sensitive to emotional states, and stress or anxiety can significantly impact gut function. This is often seen in conditions like Irritable Bowel Syndrome (IBS), where stress can exacerbate symptoms such as abdominal pain, bloating, and changes in bowel habits. Your history of caring for a family member with cancer may have contributed to increased anxiety levels, which could be influencing your gastrointestinal symptoms.

From your description, it appears that your bowel movements have become irregular, with episodes of diarrhea that vary in consistency and frequency. This fluctuation can be indicative of IBS, especially if there are no other alarming symptoms such as blood in the stool or significant weight loss. The fact that your stool can be normal one moment and then become loose or mucous-like suggests a possible functional gastrointestinal disorder rather than a structural one.

Regarding your concerns about serious underlying diseases, it’s reassuring that you have undergone some diagnostic tests, including an abdominal ultrasound and a stool test for occult blood, which have not indicated any major issues. However, if you continue to experience symptoms or if they worsen, it would be prudent to seek further evaluation, possibly from a gastroenterologist. They can conduct more specialized tests if necessary, such as a colonoscopy, especially if there are any changes in your symptoms or if you have a family history of gastrointestinal diseases.

In terms of managing your symptoms, addressing your anxiety is crucial. Since you have previously been on medication for anxiety, it may be beneficial to consult with a mental health professional to explore options for managing your anxiety, whether through therapy, medication, or a combination of both. Cognitive-behavioral therapy (CBT) has been shown to be effective for individuals with anxiety and can also help with gastrointestinal symptoms.

Additionally, lifestyle modifications can play a significant role in managing both anxiety and gastrointestinal symptoms. Here are some strategies you might consider:
1. Dietary Adjustments: Keeping a food diary can help identify any food triggers that may exacerbate your symptoms. A diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) has been shown to help some individuals with IBS. Incorporating more fiber gradually can also aid in normalizing bowel movements.

2. Stress Management Techniques: Practices such as mindfulness, yoga, and regular physical activity can help reduce stress and improve overall well-being. Techniques like deep breathing exercises can also help manage acute anxiety episodes.

3. Regular Sleep Patterns: Ensuring you have a consistent sleep schedule can improve your overall mental health and help regulate your gastrointestinal function.

4. Hydration: Staying well-hydrated is essential, especially if you are experiencing diarrhea. Electrolyte solutions can be beneficial if diarrhea persists.

5. Follow-Up Care: Since you mentioned that you have previously seen both gastrointestinal and mental health specialists, continuing to engage with these professionals can provide you with a comprehensive approach to managing your symptoms.

In conclusion, your symptoms appear to be linked to anxiety and stress, which can significantly impact gastrointestinal health. It is advisable to continue seeking medical advice, particularly if symptoms persist or worsen, and to consider a holistic approach that addresses both your mental and physical health. Remember, you are not alone in this, and many individuals experience similar challenges. Seeking help is a positive step towards finding relief and improving your quality of life.

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