GENERALIZED ANXIETY DISORDERS AND FUNCTIONAL BOWEL DISORDERS, ARE THEY INTERRELATED?
You can’t heal the body without healing the mind.
Even though I’m not a psychologist, I have developed a deep interest in anxiety disorders because of the nature of my gastroenterology practice. The majority of my patients, approximately 60 – 80% percent were inflicted with what we call in medicine with “psychosomatic gastrointestinal disorders,” such as IBS (Irritable Bowel Syndrome) and various forms of FBDs (Functional Bowel Disorders).
Most of these patients have had multiple and nonspecific GI symptoms like gas, bloating, abdominal pains, diarrhea and constipation, together with the physical and psychological symptoms of generalized anxiety disorders (GED). They were anxious, tense, nervous, irritable, tachycardic and worrisome that something was seriously wrong with them. Other known anxiety disorders such as PTSD, obsessive-compulsive disorders, phobias or social anxiety disorders are usually not associated with functional bowel disorders.
Almost all of these patients have had extensive diagnostic workups, including an endoscopy, blood works and imaging studies that were all normal. Some of them were scolded by their doctors that “nothing was wrong with them” or that “it was all in their head.”
To me, these patients needed a different approach and a lot of TLC. I believed even though the main culprit and triggering somatic (organ related) complaints was the psychological disorder, which manifested in the form of generalized anxiety disorders, that there were also other external contributing factors, such as changes in the colonic microbiome population, stressful lifestyles, diet, antibiotic and medication usage, and environmental factors.
When we look at the involved organ systems in psychosomatic gastrointestinal diseases, we see that all three very essential and complex organ systems are closely connected to each other. They are: The CNS, which is called “the first brain.” The second richest nervous system containing intestines, which is called “the second brain” and billions of live, metabolically active microorganisms with their own unique DNA structures, living in the colon. These organ systems constantly communicate with each other with a very complex molecular language, for the purpose of working together in harmony for proper digestion of food substances, absorption of nutrients, water, essential minerals and vitamins to maintain our normal lives.
It is very possible that there could be miscommunication between these very complex structures and systems that can cause changes in the functioning of different organ systems.
With these ideas in mind, on my own, I developed a three-pronged approach to these patients. I sought the help of a well-trained clinical psychologist to handle the psychological aspects of psychosomatic bowel disorders. Even though this was problematic for some patients. I remember one patient telling me, “doctor I am not crazy, why are you sending me to a shrink?” I would tell them, “she is not a psychiatrist, she is psychologist, she does not prescribe medication.” Her main treatment methods were talk therapy, behavior modification, stress management, exercise and meditation.
I treated most bothersome bowel symptoms symptomatically with proper diet and medications. I also manipulated their presumed dysbiosis of colonic microbiome population with bowel active antibiotic like rifampin, probiotics and a prebiotic rich diet. For continuum of their care, regular follow –ups were a must.
I believe my unique approach to these patients was very successful for most of them, as well as for my own satisfaction.
