Diarrhea: When to See a Gastroenterologist or Psychologist

Diarrhea issues?

Hello Doctor: I used to have normal bowel movements at irregular times every day (normal without any issues).
However, starting in June of this year after losing my job, I began experiencing diarrhea (I have had similar diarrhea issues in the past that varied in severity and duration).
I occasionally experience mild abdominal discomfort at night, which makes it difficult for me to fall asleep (I already have a long time to fall asleep).
Sometimes I feel pain or cramping in my upper or lower abdomen, but I can't pinpoint a specific area of pain.
Usually, passing gas or having a bowel movement (or diarrhea) provides some relief, but occasionally I still feel an incomplete sensation.
The frequency of bowel movements and passing gas has increased to about 3-4 times a day, whereas before it was normal to have one bowel movement.
The consistency has become increasingly loose, even mucous-like.
After around June 28, I don't know if it was due to taking "Shufudai" (a medication), but the cramping and discomfort in my abdomen have mostly disappeared, although my bowel movement situation has worsened...
Currently, the stool is mostly loose, and the subsequent bowel movements are mucous-like (small amounts with no discoloration or blood).
I feel that most of the symptoms occur after meals (with only a few instances upon waking).
My weight (measured once every morning) fluctuates between 77.1 and 76.3 kg, but I feel like I have lost weight.
(In the past two years, I have undergone a colonoscopy, blood tests, stool tests, ultrasound, and blood tests for colorectal cancer.) Additionally, I previously took "Durotine" for a few months.
After losing my job in June, I gradually started to "reduce my medication" (from one pill a day to one pill every three days, and now I have completely stopped for a few days).

-------------------------------- (Thank you, Doctor, for taking the time to patiently read about my situation) ------------------------------
May I ask, Doctor: 1.
Given my current situation, should I return to see a psychiatrist or prioritize seeing a gastroenterologist? 2.
Could this diarrhea be related to medication withdrawal? 3.
Since I have been diagnosed with generalized anxiety disorder by a psychiatrist, could this be related? 4.
Do you recommend any specific tests for me? 5.
Based on your assessment, what do you think is the most likely condition I might have?

Zi Kang, 20~29 year old female. Ask Date: 2024/06/30

Dr. Chen Shidian reply Gastroenterology and Hepatology

It may still be an irritability syndrome.
Management should focus on lifestyle and dietary habits (reducing oil, dairy, and coffee), along with medications for gastrointestinal symptoms and anxiety.
Adjustments can be made based on the response.

Reply Date: 2024/06/30

More Info

It sounds like you are experiencing a complex interplay of gastrointestinal symptoms and psychological stressors, which can often complicate diagnosis and treatment. Let's break down your situation and address your questions systematically.

Understanding Your Symptoms
1. Gastrointestinal Symptoms: You mentioned experiencing diarrhea, abdominal pain, and a feeling of incomplete evacuation. These symptoms can be indicative of several conditions, including Irritable Bowel Syndrome (IBS), which is often exacerbated by stress and anxiety. The fact that your symptoms began after losing your job suggests a possible link between your psychological state and your gastrointestinal health. Stress can significantly impact gut motility and function, leading to symptoms like diarrhea and abdominal discomfort.

2. Psychological Factors: You have a history of generalized anxiety disorder (GAD), which can manifest physically in various ways, including gastrointestinal distress. Anxiety can lead to increased gut sensitivity and changes in bowel habits. The symptoms you describe, such as feeling a sense of urgency to defecate or experiencing abdominal pain that resolves after a bowel movement, are common in individuals with IBS, particularly when stress is a contributing factor.

Addressing Your Questions
1. Which Specialist to See?: Given your symptoms and history, it may be beneficial to consult both a gastroenterologist and a psychologist or psychiatrist. A gastroenterologist can help rule out any organic causes of your diarrhea and abdominal pain, while a mental health professional can address the anxiety and stress that may be contributing to your gastrointestinal issues. A multidisciplinary approach is often the most effective.

2. Could This Be Withdrawal from Medication?: It is possible that your gastrointestinal symptoms could be related to the discontinuation of Durotine (durotine30), especially if you were taking it regularly for an extended period. Withdrawal from certain medications can lead to gastrointestinal disturbances, including diarrhea. However, it is essential to consider other factors, such as stress and anxiety, which can also contribute to these symptoms.

3. Connection to Anxiety: Your diagnosis of GAD is indeed relevant. Anxiety can lead to increased gastrointestinal motility, which may explain your diarrhea. The gut-brain connection is well established; stress and anxiety can trigger or exacerbate gastrointestinal symptoms. Addressing your anxiety through therapy or medication may help alleviate your gastrointestinal issues.

4. Recommended Tests: Since you have already undergone various tests, including blood tests, stool tests, and a colonoscopy, it may be prudent to discuss with your gastroenterologist whether any additional tests are necessary. Depending on your symptoms, they might consider tests for food intolerances, celiac disease, or even a breath test for small intestinal bacterial overgrowth (SIBO), which can also cause similar symptoms.

5. Possible Conditions: Based on your symptoms and history, the most likely conditions could include IBS, functional gastrointestinal disorder, or even a stress-related gastrointestinal issue. It’s also important to rule out any organic causes, especially since you have a history of gastrointestinal symptoms.

Conclusion
In summary, your situation appears to be multifaceted, involving both gastrointestinal and psychological components. It is crucial to approach this holistically, addressing both your physical symptoms and the underlying anxiety. I recommend scheduling appointments with both a gastroenterologist and a mental health professional to develop a comprehensive treatment plan. This may include dietary modifications, stress management techniques, and possibly medication adjustments to help manage both your gastrointestinal symptoms and anxiety. Remember, you are not alone in this, and seeking help is a positive step toward recovery.

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