# Vasovagal & IBS - Anxiety causing excruciating pain?



## esoterica (Oct 10, 2013)

Hi everyone,

For the last several years, I have been getting incredible stomach aches that lead to vasovagal syncope. The pain comes in waves, and as it intensifies, I begin to experience nausea and hot flashes. My whole body will get like this, and the only thing that makes me feel a tiny bit better during the episode is to lay on the cold bathroom floor with a wet towel on my face. The whole experience is almost unbearable, with hot flashes, nausea, waves of stomach pain, low blood pressure and heart palpitations. When I finally have a BM, it's mostly a hard stool, that is then followed by D. After a bad episode, I feel extremely week, almost as if the life has been drained out of me. I was only getting episodes this bad a few times a year, but it's now progressing to a weekly basis.

I have seen a gastroenterology doctor who put me on 20mg bentyl and recommended a high fiber diet. They ran plenty of tests and found nothing physically wrong with my stomach. The bentyl hasn't really done much for me that I can tell. I have been taking one daily before dinner, but I still get episodes on occasion right after. My attacks only seem to happen around dinner time. During the day I feel fine and almost never have problems. As soon as night time rolls around, my stomach just seems to automatically start hurting. Since I know just how bad the episodes can be, I start to get anxiety when I feel the first wave of cramps. This usually freaks me out and I start experiencing the vasovagal syncope symptoms early on. I'm beginning to think that my anxiety is causing the vasovagal syncope related systems.

For example, a weeks ago I woke up in the morning with some subtle stomach cramps. They were getting a bit worse as time went on, but I didn't have any of the vasovagal symptoms. However, a family member came into my room and told me they weren't feeling well and needed me to drive them to the ER. As soon as I heard that, I immediately felt nauseous and the pain intensified. In about 5 minutes, I was having a full episode on the bathroom floor.

Is my vasovagal syncope caused from excessive worrying? Can my anxiety actually cause me so much physical pain? I'm sorry for the long post, just looking for some advice.

Thanks!


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## Jeffrey Roberts (Apr 15, 1987)

We have seen several people report about a vasovagal response over the years. We don't believe there is any research which specifically involves it and IBS. Hard to say whether it has anything to do with anxiety or stress. I always thought the response was a physical manifestation more than anything.

To help with your anxiety and perhaps pain, have you considered Cognitive Behavioral Therapy (CBT) perhaps in conjunction with a lose dose anti-depressant? There are quite a few studies about this approach. Perhaps you can discuss this with your physician.

Jeff


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## Kathleen M. (Nov 16, 1999)

I'm not certain if anxiety would cause pain all by itself, but it does seem to be able to ramp up pain. Basically the more you worry, the more you focus on the pain so the more the nervous system reports the pain so the more intensely you feel it so the more you worry and so on.

Also could happen with the "maybe I might feel a bit faint" cycle. We probably all have moments where we feel a bit of something but normally you ignore them, but if you are on high alert for anything that may indicate something you could really end up doing a number on yourself from the anxiety feedbacking into the body feedbacking into the anxiety.

Vasovagal symptoms can happen from completely physical things and AFAIK happens to as many non-IBSers as people with IBS. It certainly can feed into anxiety/panic issues. (I have SVT which causes rapid heart rate that luckily doesn't set off a panic reaction in me, but I can see how in anyone prone to anxiety/panic it would hit all the "gonna die now OMG!!!!!!!!" buttons).

The anxiety can be treated and while that may not make all the other things go away, it should help reduce the intensity and frequency of the other things.

If you faint frequently you may need to get that tested to make sure it is just a vasovagal thing and see if it is severe enough to need treatment. My SVT is, and luckily for me it responds well to the medications.


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## IBS is BS (Jul 2, 2012)

The vagus nerve is currently in the spotlight as being the connection between the GI tract and neurological conditions.

It's certainly reasonable to think that your IBS is directly causing the syncope and that it is not an indirect phenomenon.

Have a search on Google Scholar with keywords like IBS and vagus nerve.

Your doctor has advised you to have a high fibre diet but wouldn't this worsen your symptoms? If you have a bacterial dysbiosis in your gut then wouldn't fibre make this worse? I don't believe that there has been any convincing research done to suggest that some fibres are impossible be broken down by bad bacteria. And as far as anecdotal evidence is concerned, it's highly likely that prebiotics/fibre are metabolised by the pathogenic bacteria just as easily as the good stuff. Otherwise we'd all be healed by taking fibre. Instead we need to correct the imbalance by faecal transplant or high dose probiotics (something I'm experimenting with now).

Post back with updates. This subject fascinates me. All the best.


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## esoterica (Oct 10, 2013)

Thanks for the replies everyone. The high fiber diet was originally making me very bloated but I've kind of adjusted now. My Doctor originally told me to get between 20-25g of fiber per day. I lowered it to around 10-12g because I was feeling very bloated and gassy. The fiber helps me have a more regulated BM schedule.

These episodes seem to come in cycles for me. For the last two months, I had been doing very well. I didn't have any of the vasovagal episodes and barely needed my bentyl pills. However, they just started up again for some reason and I'm having problems. I've woken up at 4am the last 3 nights in a row with terrible stomach pains and vasovagal syncope symptoms. I immediately took a bentyl and some antacid liquid and managed to fight off the episode. I've been keeping a food journal and can't really pin point what is causing it, which leads me to think that it's anxiety related. Over the last year, I am experiencing the vasovagal syncope symptoms earlier on in the episode. Before, I would experience several waves of stomach pain before finally feeling the vasovagal symptoms when I had a BM at the end of the episode. Now, I am starting to feel the vasovagal symptoms within the first couple waves of cramps. I instantly feel the weird sensation of hot and cold chills on the back of my neck and chest. My heart starts to race, blood pressure drops, and I feel extremely nauseous. When you combine that with the pain from the stomach cramps, the entire episode is excruciating. I think that I'm experiencing the vasovagal syncope symptoms earlier on because I am panicking at the on sight of stomach pain. I know first hand how painful these episodes can be, so my anxiety kicks in when I first feel the pains. I've tried SSRI's and therapists but haven't had much luck yet. Any suggestions?


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## Flax (Jan 31, 2013)

I am following this thread.

It seems like we have some of the same mechanism causing our symptoms - even though your problem seems to be more extreme and frequent. I have problems that progress during the day and are getting on top in the evening, and even at night in periods. I have all kinds of symptoms involving heart, BP and circulation. It appears when my digestion are difficult in one way or another.

I do not experience horrible pain and I have not yet actually fainted.

I have not yet found the answer to why this is happening, but perhaps you find this interesting: http://en.wikipedia.org/wiki/Roemheld_syndrome

I hope you will get better!


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## esoterica (Oct 10, 2013)

Flax said:


> I am following this thread.
> 
> It seems like we have some of the same mechanism causing our symptoms - even though your problem seems to be more extreme and frequent. I have problems that progress during the day and are getting on top at the evening, and even at night in periods. I have all kinds of symptoms involving heart, BP and circulation. It appears when my digestion are difficult in one way or another.
> 
> ...


Thank you, I'll definitely check out that link. I haven't fainted yet from an attack, either. I have gotten extremely close, but I've figured out ways to prevent it during an episode. I really think it's my anxiety that's speeding up the vasovagal process. I will get the waves of stomach cramps, and then my whole body will start to feel extremely warm. At the same time, I will get cold chills behind my neck and chest. It's a hard sensation to put into words, but it's unbearable!


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## IBS is BS (Jul 2, 2012)

I think your symptoms warrant a stronger approach than for most people. Try doing *zero carb* for a week. This will reduce all fermentable products reaching the gut to the degree that your symptoms should noticeably decrease IF they are related to certain bacteria in your gut flora.


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## Ibby (Feb 28, 2008)

esoterica, I don't know if anxiety causes these episodes but there is no way I can keep from feeling anxiety when it starts. I think anyone that feels this pain & knows what's coming would be stressed. By the time the colon spasms, sweating & nausea starts it's too late for me to take a pill. I keep a small table with towels on it by the commode. When I think I am about to faint I lay my head on table which seems to help some. Sometimes a cold wet towel helps. When it's over I'm too weak to walk & when I finally get to bed it takes me about an hour to recover. The older I get the longer to recover.

Fiber made me worse. Stool softeners would probably help. My food allergies, such as choc, peanut butter, milk, will trigger mine. The only thing that ever helped me was when I took Neurontin/Gabapentin for another illness. When I stopped the med my colon problem returned. It's one of those things people have to experience to understand how awful & debilitating it is. With every little colon pain I feel, I'm in fear of what is going to happen. God forbid I'm ever away from home when this happens. I think "histamine intolerance" may also be a factor. Hope you find help.


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## gretel (Nov 16, 2014)

esoterica said:


> Hi everyone,
> 
> For the last several years, I have been getting incredible stomach aches that lead to vasovagal syncope. The pain comes in waves, and as it intensifies, I begin to experience nausea and hot flashes. My whole body will get like this, and the only thing that makes me feel a tiny bit better during the episode is to lay on the cold bathroom floor with a wet towel on my face. The whole experience is almost unbearable, with hot flashes, nausea, waves of stomach pain, low blood pressure and heart palpitations. When I finally have a BM, it's mostly a hard stool, that is then followed by D. After a bad episode, I feel extremely week, almost as if the life has been drained out of me. I was only getting episodes this bad a few times a year, but it's now progressing to a weekly basis.
> 
> ...


I've suffered from this for about 15 years, but only about twice a year. I think mine is caused by sulphites. It happens if I eat almonds or drink wine( which often contain sulphites).


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## Lynda127 (Dec 8, 2014)

I have this too. I have actually passed out from it. Paramedics, ER, complete medical workup. Vasovagel was the diagnosis. Luckily I have a warning in that I see black around the edges of my vision before I faint. Trying to follow a good ibs diet, but I'm still learning, and making mistakes. Have a complication of on umbilical hernia which also causes abdominal pains. Having surgery Jan 2nd to repair hernia so hopeful that will help with the stress and anxiety. Right now am on a liquid diet as any food causes problems. It's hard to "rest"!


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## Flax (Jan 31, 2013)

Can I ask if umbilical hernia means you see a weakness in the abdominal wall on the outside? Like a lump? The reason I ask is that I have a problem area about two inch above the umbilical. Slightly to the left side. The problem is like a internal lump and heavy pulsation. It is not possible to see it on the outside. MRI (without contrast) didn't show anything. It is driving me crazy because this "lump" is definitely involved in my vasovagal episodes. It is so difficult to get any answers and even hypothesis from the doctors.

Good luck with you surgery!


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## Lynda127 (Dec 8, 2014)

Hi Flax, The hernia I have is definitely in the abdominal wall on the outside. It is a lump. Mine is from a previous surgery and where they cut thru the muscle. It tore in the same spot as the surgical scar and at times pushes thru the muscle and is very painful. It will actually change sizes and enlarges when it hurts. I don't feel any pulsation with mine. It is possible to see it very easily from the outside. I also believe the lump is involved but have been told by doctors that they can't imagine how that could be happening. Have they considered an ultrasound? Good luck to you and thanks for the good wishes!


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## Jax629 (Dec 13, 2014)

I was recently diagnosed with IBS after every test known to man. I also experience a vasovagal episode when the cramping starts prior to a bowel movement. It's scary. I explained it to one do core and he said the worst thing that could happen is you pass out, like it was no big deal. I started seeing a new doctor and he prescribed a low dose anti anxiety medication. I used to be afraid of driving, shopping, anything that got me away from my bathroom, but this medicine seems to help. I still get the pain and the urge to have a BM, but the anxiety and vagus nerve reaction is almost completely gone.


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## Flax (Jan 31, 2013)

Happy to hear that you got help that made your daily life better Jax


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## Flax (Jan 31, 2013)

Lynda

Thank you for your reply. We definitively not have (all) the same causes for our problems. It sounds painful. I have not much pain, but more like terrorizing problems.

In addition to the pulsation I have sudden movement in the same spot. Popping, bursting or... I don´t know what to call it in english. But it is of such a character that I loose my breath for a short while.


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## Lynda127 (Dec 8, 2014)

Flax

You're right we do not have the same symptoms for the hernia! I have a friend who had a lot of small tears in her abdominal wall after her pregnancy. She described it in the same way. Eventually she had surgery to place mesh under the tears and has been pain free since then.

Does the sudden movement cause pain? Can you tell if it is on the inside or in the muscle?


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## Flax (Jan 31, 2013)

Interesting to read about the tears in the abdominal wall.

My lump is not possible to notice on the outside. But my husband can feel it if I guide him. There are no pain involved, only discomfort and it can sett of heart palpitations and speed up my pulse + etc.


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## jdroper (Mar 11, 2015)

I have something similar to this, too. It happens at least once a week where I go to sleep for the night and then all of the sudden I wake up about an hour later in a panic and feel like I have rocks in my intestines. I was diagnosed with IBS in my 20s, I'm 41 now, so now I know it is IBS and I'm having an attack, but when it happens it really freaks me out! Full night panic attack! I get ringing in my ears, sweating, nausea, aura, feeling like I am out of my body, and feeling like I am going to faint and die. I usually run to the bathroom and sit on the toilet with my head between my legs while bearing down. I have never fully passed out, but I have dropped to my knees from low BP and have been really close. I usually have to lie on the cold bathroom floor for about 15 mins after having a small bowel movement to calm my body down. For a long time this caused me to have extreme anxiety, but it only happens at night shortly after I go to bed. I guess at least I am not having it out of the blue any time of day. It is so strange, though. I do experience the "rocks in my intestines" almost daily, but I have not figured out what is causing it, be it food, drink, stress (which I assume is most of it), etc. I've been to MDs, NDs, and mental therapists and nothing has worked to fix this. One MD said I am having a vagal episode with the IBS attack. My theory is that at the end of the day before going to bed I am releasing all my stress and then the IBS attack happens and the cycle starts shortly after falling asleep. I don't wish this on my worst enemy, but I am glad mine has a bit of a cycle that I can predict. If anyone has anything similar and has found a cure, let me know, because it would be really nice to figure this out! I am starting an autoimmunity diet next to see if that helps&#8230;


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## Lynda127 (Dec 8, 2014)

jdroper so sorry you are going thru this! It can make you miserable with all the worrying. IBS is no fun. I have had IBS for probably 40 years but have only had these issues maybe 3 or 4 times.The first time I had the feeling that I would pass out was at a party when I was in college. My belief is that they are related to anxiety and stress. I'm not sure which comes first though, the IBS issues or the anxiety/stress. Seems like a never ending cycle! I have been using some CD's for IBS made by Michael Mahoney. It seems like they help my anxiety levels in a positive way.

Am wondering if you are having a lot of anxiety. Seems like when you go to bed your body relaxes but your mind panics. It is a huge relief to me to know that other people have the same symptoms. The last doctor I saw told me to go ahead and take a Xanax for relief but to not take them for long term. I have also found that peppermint oil capsules help me. Good luck to you and please let us know if you find any relief! Am hopeful that the autoimmunity diet will help you.


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## Suspira44 (Oct 17, 2016)

I'm glad to find this topic, I wish I could find something to help me.

I have been suffering from vasovagal syncope for about 7 years. It definitely for me has an emotional component: a day of having tests at the hospital, out of town guests, travel, visiting someone in the hospital, and at that point It can be set off by any food or liquid. I get cramping, followed by feeling faint and overheated. I have to lie on the floor and I stay there until I absolutely have to get to the bathroom, at which point I have horrendous diarrhea that can last several days. The diarrhea takes away the feeling of fainting but leaves me very weak. Sometimes the attacks are less virulent. This last one lasted three days.

It has happened to me in airports, restaurants, family parties, and here at home. I once could not board a plane because of it and had to get on the next flight - by then it had cleared. When I flew to London recently, I wound up on the floor of the terminal and by the time I arrived in London I was so sick it took me over an hour to get to a taxi. I could go on and on. I've seen paramedics in every city and airport I've been in. It's gotten so that I am afraid to travel or go out to dinner.

I have a muscle relaxant which has helped in the less violent attacks. I can't live this way anymore, that's all I know. I'm supposed to go to LA in November and I don't want to. This once happened to me on a plane and I felt like I was in chains. After an attack like the one I described above, I'm afraid to eat for several days and my stomach rumbles, and I continue to have diarrhea.

I just wrote a message to my doctor; my sister is a nurse and says she has no idea what tests would be performed. Her specialty is colon cancer, which she doesn't think I have. IBS? Diverticulitis? I don't know, but I'm miserable.

Forgot to mention - I am on two antidepressants and blood pressure medication. My blood pressure was 50/x during one incident.


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