Anxiety-Related Issues from Bowel Movements

Anxiety-related issues caused by bowel movements?

Hello Dr.
Chang, thank you for taking the time to address my concerns despite your busy schedule.
Here is my current situation:
1.
My father has esophageal cancer, and there are no other cases within the third-degree relatives.
2.
I have undergone tests (tumor markers for cancer: 0.7 in April 2024; stool tests, abdominal ultrasound, and autonomic nervous system tests from 2022 to 2023 were all normal).
3.
I am currently taking "Duloxetine 30 mg capsules" and have generalized anxiety.
Under my doctor's guidance, I have reduced my dosage from one capsule a day to one and a half capsules every other day.
I started tapering off the medication three to four days ago.
I am naturally prone to anxiety, especially regarding bodily changes.
Regarding my bowel movements:
1.
I have bowel movements once or twice a day, sometimes with unformed stools that pass a small amount of mucus, but most of the time, they are fairly formed, with colors ranging from brown to golden yellow.
2.
Occasionally, I experience abdominal cramping, with audible gas but no foul odor, and the frequency has increased over the past few days.
After bowel movements, the frequency returns to normal.
3.
I do not experience abdominal bloating or pain.
4.
My weight is currently 76.8 kg (measured in the morning), fluctuating by no more than 1 kg.
5.
I consistently drink around 1800 to 2000 cc of water daily and consume very few sugary drinks.
6.
My job requires me to sit at a computer desk for long periods.
7.
Aside from breakfast, I eat at home more than three to four days a week, with minimal dining out.
8.
I experience diarrhea a few days a week, but it is usually about twice a day, after which my bowel movements return to normal.
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My questions are:
1.
I have noticed black or orange-red residue in my stool, which has occurred before and then resolved, causing me anxiety.
Could this indicate bleeding? (See image 1) (I suspect the orange-red/black residue may be related to my recent consumption of watermelon, carrots, and large amounts of vegetables a day or two prior.)
2.
In general, if there is bleeding, would it present as a continuous streak, or could it appear as small bits like in the image?
3.
My stool shape has been quite unusual lately; although formed, it appears irregular.
Could this be related to my emotional state?
4.
I am considering taking B vitamins or probiotics.
Do you think this is necessary, or would you recommend anything else?
5.
Based on the above, what do you think could be the underlying condition? Do I need to undergo further examinations?
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Attached is a photo (showing black residue and some mucus): [link to photo].
I consumed a large amount of cabbage and mushrooms a day or two before this photo was taken.

Chen Xiaodi, 20~29 year old female. Ask Date: 2024/04/30

Dr. Zhang Shuhao reply Surgery

1.
Black or orange-red residue is usually related to food and is completely normal, with no bleeding involved.

2.
If there is suspected bleeding, it may present as black stools, brick-red stools, or stools with blood streaks.
For cases where blood is not visible to the naked eye, a fecal occult blood test can be performed.

3.
Variations in stool shape are very common and do not necessarily indicate a problem.

4.
Probiotics can help with bowel movements, but the specific effects may vary depending on individual constitution.

5.
There are no apparent gastrointestinal issues; however, if concerned, you may consult a gastroenterologist or a family medicine physician for advice.

Reply Date: 2024/04/30

More Info

Understanding anxiety-related issues, particularly as they pertain to bowel movements, can be complex and multifaceted. Your concerns about gastrointestinal symptoms, especially in the context of anxiety and family health history, are valid and deserve careful consideration.

Firstly, it’s important to recognize that anxiety can significantly impact gastrointestinal function. The gut-brain axis is a well-established concept in medicine, indicating that emotional and psychological states can influence gut health. Symptoms such as irregular bowel movements, changes in stool consistency, and abdominal discomfort can often be exacerbated by anxiety. Your description of experiencing bowel movements that are sometimes unformed or accompanied by mucus can be indicative of a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS), which is commonly associated with anxiety and stress.

Regarding your specific questions:
1. Black or Orange-Red Residue in Stool: The presence of unusual colors in your stool can be concerning. Black stool may indicate the presence of digested blood, which can arise from bleeding in the upper gastrointestinal tract. However, certain foods, such as beets, black licorice, or even iron supplements, can also cause dark stools. Orange-red residue could be related to the consumption of foods like carrots or tomatoes. If you notice these colors consistently, especially if accompanied by other symptoms like abdominal pain or changes in appetite, it would be prudent to consult a healthcare professional for further evaluation.

2. Signs of Gastrointestinal Bleeding: Typically, if there is significant bleeding in the gastrointestinal tract, the stool may appear uniformly black or red, rather than having small specks or residues. However, minor bleeding can sometimes present as small amounts of blood mixed with stool or as red streaks. If you are concerned about bleeding, especially given your family history of cancer, it is essential to seek medical advice.

3. Irregular Stool Shapes: The shape and consistency of stool can vary based on diet, hydration, and stress levels. Anxiety can lead to muscle tension and changes in gut motility, resulting in irregularly shaped stools. If your stool is generally formed but varies in shape, it may not be a cause for alarm, but persistent changes should be discussed with a healthcare provider.

4. B Vitamins and Probiotics: Both B vitamins and probiotics can be beneficial for gut health. B vitamins play a role in energy metabolism and can help manage stress levels. Probiotics can improve gut flora balance, which may alleviate some gastrointestinal symptoms. However, it’s best to consult with a healthcare provider before starting any new supplements, especially considering your current medication regimen.

5. Further Evaluation: Given your symptoms and the context of anxiety, it may be beneficial to undergo further evaluation. This could include a stool test to check for infections or blood, imaging studies, or even a referral to a gastroenterologist. Additionally, addressing your anxiety through therapy or medication may also help alleviate some of your gastrointestinal symptoms.

In conclusion, while your symptoms may be related to anxiety and stress, it is crucial to rule out any underlying gastrointestinal issues. Maintaining open communication with your healthcare provider about both your mental and physical health is essential for comprehensive care. Managing anxiety through therapy, lifestyle changes, and possibly medication can lead to improvements in both your emotional well-being and gastrointestinal health.

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