# Difference between IBS and anxiety-induced diarrhea



## packer (Jun 4, 2001)

I was diagnosed about 15 years ago with IBS. I have had barium enemas, flexible sigmoidoscopies and a colonoscopy. Immodium used to help with my diarrhea prominent symptoms, but now even taking up to 4 a day does little. I am also on prozac and xanax for anxiety. I did ask my GI doc what the difference between ibs and anxiety-induced diarrhea was and he looked at me like I was crazy and wanted to know what difference it made to me. The symptoms are the same, he said. I don't think he even really knew what I was talking about. Are there different treatments that will work for one and not the other and also how do I determine which problem I am actually suffering with? Thanks for any help.


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## BackFire44 (Nov 19, 2003)

It might be hard to say exactly "what you have" between the two. Anxiety will make both of them worse. However, anxiety-induced diarrhea is diarrhea that is only due to increased anxiety. That said, certain foods may still wreak havoc on your system. Your system can be already sensitive due to the anxiety and then the harsh foods -- the same ones that aggravate those with IBS -- will further irritate your system leading to symptoms. So, it becomes very difficult in practice to differentiate the two. Xanax or the likes will likely help a little those with IBS and certainly helps those with anxiety-induced diarrhea as any reduction in anxiety should help.So, there is no quick answer, I think. Just be definition anxiety-induced diarrhea comes solely from anxiety while IBS is usually has a host of factors that are assocaited with its onset, but as for diagnosing one as opposed to the other -- there are few differences. BackFire44


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## BackFire44 (Nov 19, 2003)

It might be hard to say exactly "what you have" between the two. Anxiety will make both of them worse. However, anxiety-induced diarrhea is diarrhea that is only due to increased anxiety. That said, certain foods may still wreak havoc on your system. Your system can be already sensitive due to the anxiety and then the harsh foods -- the same ones that aggravate those with IBS -- will further irritate your system leading to symptoms. So, it becomes very difficult in practice to differentiate the two. Xanax or the likes will likely help a little those with IBS and certainly helps those with anxiety-induced diarrhea as any reduction in anxiety should help.So, there is no quick answer, I think. Just be definition anxiety-induced diarrhea comes solely from anxiety while IBS is usually has a host of factors that are assocaited with its onset, but as for diagnosing one as opposed to the other -- there are few differences. BackFire44


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## eric (Jul 8, 1999)

anxiety induced d, would be short term and would be missing the cluster of symptoms in diagnosing IBS.IN IBS, chronic d and chronic activation of the fight or flight mechanisms pcycophysiologically cause symptoms, through the same pathways either conciously or subconciously perceived. This has to do with mast cells that line the gut. The other aspect of this is the cluster of symptoms with IBS, altered motility, viceral hypersensitivity and other symptoms like incomplete evacuation, bloating and distension, mucous in the stools are all a cluster of symptoms found in IBS. Not sure if pain is a part of anxiety indeuced d.Here is some info on it all.This is on IBSThe Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California http://www.aboutibs.org/Publications/stress.html Gut Feelings: The Surprising Link Between Mood and Digestion http://www.ahealthyme.com/article/primer/101186767 There is alsoIrritable Bowel SyndromeClinical Issues Adapted from a radio interview conducted by Bob Enteen, host of Living Without Limits, with Douglas Drossman, MD, UNC Center for Functional GI and Motility Disorders at Chapel Hill North Carolina "What would be an example of new understanding?Well one example is that we're starting to understand how the brain is responding to the pain in IBS. There have been some studies done where they've artificially created a kind of an irritable bowel by placing a balloon to stretch the bowel, and that produces pain. Then they've compared people with IBS to non-IBS, or "normal" individuals. And what they've found is that when you stretch the bowel-and use PET scans to monitor the response-in normal individuals, certain areas of the brain that register pain respond and release chemicals called neurotransmitters that suppress and lower the pain. But it seems that doesn't happen as well in people with IBS. *In fact, in people with IBS another area of the brain responds that is associated with anxiety.* So what we find is that people with IBS, aside from having a bowel problem, may have some difficulty in terms of the way their brain is regulating the pain." http://www.aboutibs.org/Publications/clinicalIssues.html


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## eric (Jul 8, 1999)

anxiety induced d, would be short term and would be missing the cluster of symptoms in diagnosing IBS.IN IBS, chronic d and chronic activation of the fight or flight mechanisms pcycophysiologically cause symptoms, through the same pathways either conciously or subconciously perceived. This has to do with mast cells that line the gut. The other aspect of this is the cluster of symptoms with IBS, altered motility, viceral hypersensitivity and other symptoms like incomplete evacuation, bloating and distension, mucous in the stools are all a cluster of symptoms found in IBS. Not sure if pain is a part of anxiety indeuced d.Here is some info on it all.This is on IBSThe Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California http://www.aboutibs.org/Publications/stress.html Gut Feelings: The Surprising Link Between Mood and Digestion http://www.ahealthyme.com/article/primer/101186767 There is alsoIrritable Bowel SyndromeClinical Issues Adapted from a radio interview conducted by Bob Enteen, host of Living Without Limits, with Douglas Drossman, MD, UNC Center for Functional GI and Motility Disorders at Chapel Hill North Carolina "What would be an example of new understanding?Well one example is that we're starting to understand how the brain is responding to the pain in IBS. There have been some studies done where they've artificially created a kind of an irritable bowel by placing a balloon to stretch the bowel, and that produces pain. Then they've compared people with IBS to non-IBS, or "normal" individuals. And what they've found is that when you stretch the bowel-and use PET scans to monitor the response-in normal individuals, certain areas of the brain that register pain respond and release chemicals called neurotransmitters that suppress and lower the pain. But it seems that doesn't happen as well in people with IBS. *In fact, in people with IBS another area of the brain responds that is associated with anxiety.* So what we find is that people with IBS, aside from having a bowel problem, may have some difficulty in terms of the way their brain is regulating the pain." http://www.aboutibs.org/Publications/clinicalIssues.html


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## eric (Jul 8, 1999)

It could also be worth reading thisChronic Diarrhea: Could It Have an Everyday Cause? By: W. Grant Thompson, MD, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada IFFGD 1999 http://www.aboutibs.org/Publications/chronicdiarrhea.html


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## eric (Jul 8, 1999)

It could also be worth reading thisChronic Diarrhea: Could It Have an Everyday Cause? By: W. Grant Thompson, MD, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada IFFGD 1999 http://www.aboutibs.org/Publications/chronicdiarrhea.html


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## Sally Jane (Jan 14, 2001)

Packer and Eric, This is very interesting. I was diagnosed with IBS-D many, many years ago with only occasional "bouts". Extreme stress entered my life and I all of a sudden had a full blown case of IBS-D almost every day. After much study, doctors, this board and taking 3 medications I have been able to be "normal" most days if I don't do something stupid like eating something I should not. Today I am having a really bad day. I have been very anxious and upset and it immediately caused the big D. Today (even with the medicine) I have had the altered mobility, took an Imodium, which I rarely ever have to take now,incomplete evacuation and mucous in the stool. I also feel like I ache all over. Although 3 doctors have confirmed that I have IBS and I see a therapist regularly, I am only able to control it when I am fairly stress free and not suffering from extreme anxiety. Confusing, huh?


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## Sally Jane (Jan 14, 2001)

Packer and Eric, This is very interesting. I was diagnosed with IBS-D many, many years ago with only occasional "bouts". Extreme stress entered my life and I all of a sudden had a full blown case of IBS-D almost every day. After much study, doctors, this board and taking 3 medications I have been able to be "normal" most days if I don't do something stupid like eating something I should not. Today I am having a really bad day. I have been very anxious and upset and it immediately caused the big D. Today (even with the medicine) I have had the altered mobility, took an Imodium, which I rarely ever have to take now,incomplete evacuation and mucous in the stool. I also feel like I ache all over. Although 3 doctors have confirmed that I have IBS and I see a therapist regularly, I am only able to control it when I am fairly stress free and not suffering from extreme anxiety. Confusing, huh?


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## gutsgonewild (Jun 27, 2004)

Thanks for the links Eric. I for one never believed my diarrhea was stress induced, I was hit with IBS at a time in my life when everything was going great!







I mean things were really great, then BAM, this curse. The very first doctor I saw said I needed anti-depressants because I was crying in the examination room....that was because I was in EXTREME pain and I told him that, I thought I was dying or something, but that fell on deaf ears and I took the Zoloft he gave me even with my reservations, hoping it would help.







Well guess what I found out Zoloft does for diarrhea proned IBS'ers! LOL It was WORSE! Amazingly enough, the doctor that told me that I was in need of anti-depressents because I was "emotional" (or as I like to call it, feeling like I was being stabbed over and over again in the intestines) and prescribed me the Zoloft has quit practicing medicine.







All I can say about him leaving the profession is GOOD, I wish he would have quit before I saw him!







I hate to sound like a broken record but I cannot stand a doctor who won't actually listen to their patient.


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## gutsgonewild (Jun 27, 2004)

Thanks for the links Eric. I for one never believed my diarrhea was stress induced, I was hit with IBS at a time in my life when everything was going great!







I mean things were really great, then BAM, this curse. The very first doctor I saw said I needed anti-depressants because I was crying in the examination room....that was because I was in EXTREME pain and I told him that, I thought I was dying or something, but that fell on deaf ears and I took the Zoloft he gave me even with my reservations, hoping it would help.







Well guess what I found out Zoloft does for diarrhea proned IBS'ers! LOL It was WORSE! Amazingly enough, the doctor that told me that I was in need of anti-depressents because I was "emotional" (or as I like to call it, feeling like I was being stabbed over and over again in the intestines) and prescribed me the Zoloft has quit practicing medicine.







All I can say about him leaving the profession is GOOD, I wish he would have quit before I saw him!







I hate to sound like a broken record but I cannot stand a doctor who won't actually listen to their patient.


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## california123 (Jun 8, 2003)

For me, my diagnosis depended upon which kind of doctor I saw. I had multiple daily D for six months, couldn't leave the house before 11am and often had to race to the bathroom after dinner. Talked to my internist, who had me do the bland diet, no lactose and immodium etc....made no difference. Went to GI--who knew about my stress because my Alzheimer's father is also his patient--and he did tests that came out negative, prescribed many different GI meds--anti-spasmodic, donatal, and others-Made no difference.-HIS DIAGNOSIS WAS IBS-D. At that point, I took a Xanax one day because I was so anxious and miracle of miracles, my D stopped for the first time in 7 months and has never come back--except the day my mother died and extra Xanax stopped it!!!! Went to a psychiatrist and he diagnosed ANXIETY-INDUCED D.He added Effexor because I was depressed too and also because unlike other anti-depressants, Effexor often has constipation as a side effect. But it is the Xanax that keeps the D away. I see the shrink once a month and I am now down to just .25 of xanax once a day and am reducing the Effexor slowly. I truly believe that for many people, if they went to a psychiatrist first they would be diagnosed as having anxiety/stress D and then could try anti-anxiety meds that might well stop the D. And, my D did not stop because of sudden increase in anxiety, but was my body's way of reacting to long-term, chronic stress. Take care.


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## california123 (Jun 8, 2003)

For me, my diagnosis depended upon which kind of doctor I saw. I had multiple daily D for six months, couldn't leave the house before 11am and often had to race to the bathroom after dinner. Talked to my internist, who had me do the bland diet, no lactose and immodium etc....made no difference. Went to GI--who knew about my stress because my Alzheimer's father is also his patient--and he did tests that came out negative, prescribed many different GI meds--anti-spasmodic, donatal, and others-Made no difference.-HIS DIAGNOSIS WAS IBS-D. At that point, I took a Xanax one day because I was so anxious and miracle of miracles, my D stopped for the first time in 7 months and has never come back--except the day my mother died and extra Xanax stopped it!!!! Went to a psychiatrist and he diagnosed ANXIETY-INDUCED D.He added Effexor because I was depressed too and also because unlike other anti-depressants, Effexor often has constipation as a side effect. But it is the Xanax that keeps the D away. I see the shrink once a month and I am now down to just .25 of xanax once a day and am reducing the Effexor slowly. I truly believe that for many people, if they went to a psychiatrist first they would be diagnosed as having anxiety/stress D and then could try anti-anxiety meds that might well stop the D. And, my D did not stop because of sudden increase in anxiety, but was my body's way of reacting to long-term, chronic stress. Take care.


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## eric (Jul 8, 1999)

Stress doesn't cause IBS.After you get IBS, its the same pathways as anxiety induced d.The chronic stress of having IBS triggers the HPA axis, which signals to the gut, which releases histimine and that triggers mast cells lining the gut which they believe also is involved in part of the reason IBSers get pain.If you type in IBS and the HPA axis in the serch here or on the web there is a ton of information on it and the limbic system. Part of this is stress that is not conciously preceived. This is a big part of IBS research right now.Another part of this are patients are more likely to focus soley on the gut as the sorces of all their IBS problems, but in fact the brain is operational in causing IBS symptoms, hence why the vast majority of IBS researchers call IBS a brain gut axis dysfunction.


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## eric (Jul 8, 1999)

Stress doesn't cause IBS.After you get IBS, its the same pathways as anxiety induced d.The chronic stress of having IBS triggers the HPA axis, which signals to the gut, which releases histimine and that triggers mast cells lining the gut which they believe also is involved in part of the reason IBSers get pain.If you type in IBS and the HPA axis in the serch here or on the web there is a ton of information on it and the limbic system. Part of this is stress that is not conciously preceived. This is a big part of IBS research right now.Another part of this are patients are more likely to focus soley on the gut as the sorces of all their IBS problems, but in fact the brain is operational in causing IBS symptoms, hence why the vast majority of IBS researchers call IBS a brain gut axis dysfunction.


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## california123 (Jun 8, 2003)

Hi Eric, You might consider recognizing that people can have D that is DIAGNOSED as IBS-D but is in fact ANXIETY-INDUCED D. For those people, the anxiety/stress does in fact CAUSE the D. Not all D is IBS, as you have long acknowledged, but there is a lot of D that is DIAGNOSED as IBS-D even if it is something else entirely. So for those of us, like me, who actually have anxeity-induced D but have been DIAGNOSED BY A GI as having IBS-D, it can get difficult to determine treatment. So I just want people to realize that a GI diagnosis is not the final word on what they may acutally have. If I had gone with the GI diagnosis, rather than the psychiatrist, I would probably still be incapacitated by my chronic D. Take care.


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## california123 (Jun 8, 2003)

Hi Eric, You might consider recognizing that people can have D that is DIAGNOSED as IBS-D but is in fact ANXIETY-INDUCED D. For those people, the anxiety/stress does in fact CAUSE the D. Not all D is IBS, as you have long acknowledged, but there is a lot of D that is DIAGNOSED as IBS-D even if it is something else entirely. So for those of us, like me, who actually have anxeity-induced D but have been DIAGNOSED BY A GI as having IBS-D, it can get difficult to determine treatment. So I just want people to realize that a GI diagnosis is not the final word on what they may acutally have. If I had gone with the GI diagnosis, rather than the psychiatrist, I would probably still be incapacitated by my chronic D. Take care.


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## eric (Jul 8, 1999)

California, did you have any of these synmptoms?"The Rome II Diagnostic Criteria (a system for diagnosing functional gastrointestinal disorders based on symptoms) for IBS is as follows:At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that is accompanied by at least two of the following features: 1) It is relieved with defecation, and/or2) Onset is associated with a change in frequency of stool, and/or 3) Onset is associated with a change in form (appearance) of stool.Other symptoms that are not essential but support the diagnosis of IBS:Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week); Abnormal stool form (lumpy/hard or loose/watery stool); Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); Passage of mucus; Bloating or feeling of abdominal distension. Upper GI symptoms are commonly reported by IBS patients with 25% to 50% of patients reporting heartburn, early feeling of fullness (satiety), nausea, abdominal fullness, and bloating. Many patients also report intermittent upper abdominal discomfort or pain (dyspepsia). Feelings of urgency, and a feeling of "incomplete" emptying may also be experienced.Many IBS patients also report non-gastrointestinal symptoms such as fatigue, muscle pain, sleep disturbances, and sexual dysfunction. These symptoms may be due to the coexistence or overlap of IBS with another condition such as fibromyalgia, chronic fatigue syndrome, or interstitial cystitis. Symptoms can vary and sometimes seem contradictory, such as alternating diarrhea and constipation."Did you get relief from defication from pain?Did you have discomfort or pain?Did you ever have incomplete evacuation?


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## eric (Jul 8, 1999)

California, did you have any of these synmptoms?"The Rome II Diagnostic Criteria (a system for diagnosing functional gastrointestinal disorders based on symptoms) for IBS is as follows:At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that is accompanied by at least two of the following features: 1) It is relieved with defecation, and/or2) Onset is associated with a change in frequency of stool, and/or 3) Onset is associated with a change in form (appearance) of stool.Other symptoms that are not essential but support the diagnosis of IBS:Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week); Abnormal stool form (lumpy/hard or loose/watery stool); Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); Passage of mucus; Bloating or feeling of abdominal distension. Upper GI symptoms are commonly reported by IBS patients with 25% to 50% of patients reporting heartburn, early feeling of fullness (satiety), nausea, abdominal fullness, and bloating. Many patients also report intermittent upper abdominal discomfort or pain (dyspepsia). Feelings of urgency, and a feeling of "incomplete" emptying may also be experienced.Many IBS patients also report non-gastrointestinal symptoms such as fatigue, muscle pain, sleep disturbances, and sexual dysfunction. These symptoms may be due to the coexistence or overlap of IBS with another condition such as fibromyalgia, chronic fatigue syndrome, or interstitial cystitis. Symptoms can vary and sometimes seem contradictory, such as alternating diarrhea and constipation."Did you get relief from defication from pain?Did you have discomfort or pain?Did you ever have incomplete evacuation?


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## eric (Jul 8, 1999)

Also anxiety induced d is the result of reduced blood flow in the intestines, through the fight or flight mechanism. Which is also super important in IBS research.


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## eric (Jul 8, 1999)

Also anxiety induced d is the result of reduced blood flow in the intestines, through the fight or flight mechanism. Which is also super important in IBS research.


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## Guest (Jul 28, 2004)

Lord, this is all very complicated sounding. I have had IBS-D for 28 years, and for most of those years, I thought I was in a panic-induced state. I would panic from having an attack of the trots in public, and who wouldn't? Then, have anticipatory anxiety when i needed to go to a bathroomless place, triggering another attack. Which came first, the panic or the trots?Oh dear.I just don't know how you weed out all the causal factors. Isn't it all just a matter of trying various remedies and meds until you find a combo that works for you?I am about to start Lotronex, and I am excited about the prospect of maybe ONCE being able to take a trip without feeling scared.Wow!


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## Guest (Jul 28, 2004)

Lord, this is all very complicated sounding. I have had IBS-D for 28 years, and for most of those years, I thought I was in a panic-induced state. I would panic from having an attack of the trots in public, and who wouldn't? Then, have anticipatory anxiety when i needed to go to a bathroomless place, triggering another attack. Which came first, the panic or the trots?Oh dear.I just don't know how you weed out all the causal factors. Isn't it all just a matter of trying various remedies and meds until you find a combo that works for you?I am about to start Lotronex, and I am excited about the prospect of maybe ONCE being able to take a trip without feeling scared.Wow!


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## california123 (Jun 8, 2003)

Hi Eric,In answer to your question, California, did you have any of these synmptoms?"The Rome II Diagnostic Criteria (a system for diagnosing functional gastrointestinal disorders based on symptoms) for IBS is as follows:At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that is accompanied by at least two of the following features: 1) It is relieved with defecation, and/or YES2) Onset is associated with a change in frequency of stool, and/or YES3) Onset is associated with a change in form (appearance) of stool. YESOther symptoms that are not essential but support the diagnosis of IBS:Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week); YESAbnormal stool form (lumpy/hard or loose/watery stool); YESAbnormal stool passage (straining, urgency, or feeling of incomplete evacuation); YES Passage of mucus; YESBloating or feeling of abdominal distension. NODid you get relief from defication from pain?YESDid you have discomfort or pain?YESDid you ever have incomplete evacuation?NOSo here I was meeting the IBS criteria, but nothing the GI suggested or prescribed worked. But the XANAX did in just one day. So I say if someone is confused by whether the anxiety is causing their D, or the D is causing their anxiety, the easiest way to find out is to take a true anti-anxiety med--Xanax is the most common--and see what happens. I started with .5 twice a day and after a couple of months we reduced it to .25 twice a day. Never had D except the day my mother died and the day of her funeral--extra Xanax stopped it within hours. Those who think Xanax is evil or taking it is a sign of weakness may well never resolve their D if it is anxiety-related...and that can include chronic stress not just full blown crisis. Take care.


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## california123 (Jun 8, 2003)

Hi Eric,In answer to your question, California, did you have any of these synmptoms?"The Rome II Diagnostic Criteria (a system for diagnosing functional gastrointestinal disorders based on symptoms) for IBS is as follows:At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that is accompanied by at least two of the following features: 1) It is relieved with defecation, and/or YES2) Onset is associated with a change in frequency of stool, and/or YES3) Onset is associated with a change in form (appearance) of stool. YESOther symptoms that are not essential but support the diagnosis of IBS:Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week); YESAbnormal stool form (lumpy/hard or loose/watery stool); YESAbnormal stool passage (straining, urgency, or feeling of incomplete evacuation); YES Passage of mucus; YESBloating or feeling of abdominal distension. NODid you get relief from defication from pain?YESDid you have discomfort or pain?YESDid you ever have incomplete evacuation?NOSo here I was meeting the IBS criteria, but nothing the GI suggested or prescribed worked. But the XANAX did in just one day. So I say if someone is confused by whether the anxiety is causing their D, or the D is causing their anxiety, the easiest way to find out is to take a true anti-anxiety med--Xanax is the most common--and see what happens. I started with .5 twice a day and after a couple of months we reduced it to .25 twice a day. Never had D except the day my mother died and the day of her funeral--extra Xanax stopped it within hours. Those who think Xanax is evil or taking it is a sign of weakness may well never resolve their D if it is anxiety-related...and that can include chronic stress not just full blown crisis. Take care.


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## eric (Jul 8, 1999)

Califronia, You know its interesting and I am trying more to look into this for my own information as well. Which is in part why I am asking some of these questions to you. I hope that's okay.I have not found that pain is a part of just anxiety induced d yet or that it would be chronic, but pain is a must for IBS of course.I am going to ask some people this soon and see what they say.These two are also interesting."Bloating or feeling of abdominal distension. NO""Did you ever have incomplete evacuation?NO"Because they help support IBS. Of courseSerotonin is involved in the gut and IBS and anxiety.The stress system is involved in IBS, and for some, perhaps very involved.The HPA axis is involved in fighting infection and is the bodies stress system. That is one reason why they believe it is connected to PI IBS and ultimately to IBS.In D IBSers, the mast cells are the end result of the HPA axis in the gut. They believe they might help contribute to the pain from chronic stressors. But its also the system that gives you d through the fight or flight.This I think is a new approach to some of this they are looking at for IBS. Just fyi.Gut. 2004 Jul;53(7):958-964. Related Articles, LinksEffect of a corticotropin releasing hormone receptor antagonist on colonic sensory and motor function in patients with irritable bowel syndrome.Sagami Y, Shimada Y, Tayama J, Nomura T, Satake M, Endo Y, Shoji T, Karahashi K, Hongo M, Fukudo S.Department of Psychosomatic Medicine, Tohoku University School of Medicine, Sendai, Japan. Department of Behavioural Medicine, Tohoku University School of Medicine, Sendai, Japan. Department of Comprehensive Medicine, Tohoku University School of Medicine, Sendai, Japan.BACKGROUND: and aims: Corticotropin releasing hormone (CRH) is a major mediator of the stress response in the brain-gut axis. Irritable bowel syndrome (IBS) is presumed to be a disorder of the brain-gut link associated with an exaggerated response to stress. We hypothesised that peripheral administration of alpha-helical CRH (alphahCRH), a non-selective CRH receptor antagonist, would improve gastrointestinal motility, visceral perception, and negative mood in response to gut stimulation in IBS patients. METHODS: Ten normal healthy subjects and 10 IBS patients, diagnosed according to the Rome II criteria, were studied. The tone of the descending colon and intraluminal pressure of the sigmoid colon were measured at baseline, during rectal electrical stimulation (ES), and at recovery after administration of saline. Visceral perception after colonic distension or rectal ES was evaluated as threshold values on an ordinate scale. The same measurements were repeated after administration of alphahCRH (10 micro g/kg). RESULTS: ES induced significantly higher motility indices of the colon in IBS patients compared with controls. This response was significantly suppressed in IBS patients but not in controls after administration of alphahCRH. Administration of alphahCRH induced a significant increase in the barostat bag volume of controls but not in that of IBS patients. alphahCRH significantly reduced the ordinate scale of abdominal pain and anxiety evoked by ES in IBS patients. Plasma adrenocorticotropic hormone and serum cortisol levels were generally not suppressed by alphahCRH. CONCLUSION: Peripheral administration of alphahCRH improves gastrointestinal motility, visceral perception, and negative mood in response to gut stimulation, without affecting the hypothalamo-pituitary-adrenal axis in IBS patients.PMID: 15194643


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## eric (Jul 8, 1999)

Califronia, You know its interesting and I am trying more to look into this for my own information as well. Which is in part why I am asking some of these questions to you. I hope that's okay.I have not found that pain is a part of just anxiety induced d yet or that it would be chronic, but pain is a must for IBS of course.I am going to ask some people this soon and see what they say.These two are also interesting."Bloating or feeling of abdominal distension. NO""Did you ever have incomplete evacuation?NO"Because they help support IBS. Of courseSerotonin is involved in the gut and IBS and anxiety.The stress system is involved in IBS, and for some, perhaps very involved.The HPA axis is involved in fighting infection and is the bodies stress system. That is one reason why they believe it is connected to PI IBS and ultimately to IBS.In D IBSers, the mast cells are the end result of the HPA axis in the gut. They believe they might help contribute to the pain from chronic stressors. But its also the system that gives you d through the fight or flight.This I think is a new approach to some of this they are looking at for IBS. Just fyi.Gut. 2004 Jul;53(7):958-964. Related Articles, LinksEffect of a corticotropin releasing hormone receptor antagonist on colonic sensory and motor function in patients with irritable bowel syndrome.Sagami Y, Shimada Y, Tayama J, Nomura T, Satake M, Endo Y, Shoji T, Karahashi K, Hongo M, Fukudo S.Department of Psychosomatic Medicine, Tohoku University School of Medicine, Sendai, Japan. Department of Behavioural Medicine, Tohoku University School of Medicine, Sendai, Japan. Department of Comprehensive Medicine, Tohoku University School of Medicine, Sendai, Japan.BACKGROUND: and aims: Corticotropin releasing hormone (CRH) is a major mediator of the stress response in the brain-gut axis. Irritable bowel syndrome (IBS) is presumed to be a disorder of the brain-gut link associated with an exaggerated response to stress. We hypothesised that peripheral administration of alpha-helical CRH (alphahCRH), a non-selective CRH receptor antagonist, would improve gastrointestinal motility, visceral perception, and negative mood in response to gut stimulation in IBS patients. METHODS: Ten normal healthy subjects and 10 IBS patients, diagnosed according to the Rome II criteria, were studied. The tone of the descending colon and intraluminal pressure of the sigmoid colon were measured at baseline, during rectal electrical stimulation (ES), and at recovery after administration of saline. Visceral perception after colonic distension or rectal ES was evaluated as threshold values on an ordinate scale. The same measurements were repeated after administration of alphahCRH (10 micro g/kg). RESULTS: ES induced significantly higher motility indices of the colon in IBS patients compared with controls. This response was significantly suppressed in IBS patients but not in controls after administration of alphahCRH. Administration of alphahCRH induced a significant increase in the barostat bag volume of controls but not in that of IBS patients. alphahCRH significantly reduced the ordinate scale of abdominal pain and anxiety evoked by ES in IBS patients. Plasma adrenocorticotropic hormone and serum cortisol levels were generally not suppressed by alphahCRH. CONCLUSION: Peripheral administration of alphahCRH improves gastrointestinal motility, visceral perception, and negative mood in response to gut stimulation, without affecting the hypothalamo-pituitary-adrenal axis in IBS patients.PMID: 15194643


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## california123 (Jun 8, 2003)

Hi Eric, Remember, I didn't diagnose my D, a GI did. I know there has been a pain vs discomfort discussion before, but anytime you have ongoing D, there is bound to be discomfort. Out of curiosity, have you ever gone to an anxiety board and looked at their discussion? They talk about their anxiety causing D and a lot of the other problems that get mentioned on this board. But as I have said, I couldn't care less what my diagnosis is, all I want is treatment/medication that works. Now that my stress level has reduced, I am reducing my Effexor and keeping the Xanax at .25 in the morning only--along with yoga, meditation and monthly visits to the shrink. I believe many cases of D can be stopped by the right meds, but I would say a psychiatrist might be the first doctor to see rather than the last. Take care.


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## california123 (Jun 8, 2003)

Hi Eric, Remember, I didn't diagnose my D, a GI did. I know there has been a pain vs discomfort discussion before, but anytime you have ongoing D, there is bound to be discomfort. Out of curiosity, have you ever gone to an anxiety board and looked at their discussion? They talk about their anxiety causing D and a lot of the other problems that get mentioned on this board. But as I have said, I couldn't care less what my diagnosis is, all I want is treatment/medication that works. Now that my stress level has reduced, I am reducing my Effexor and keeping the Xanax at .25 in the morning only--along with yoga, meditation and monthly visits to the shrink. I believe many cases of D can be stopped by the right meds, but I would say a psychiatrist might be the first doctor to see rather than the last. Take care.


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## eric (Jul 8, 1999)

Well that was interesting, I talked to a an expert on this.Anxiety in the majority of people causes c.Anxiety disorders might be associated with other anxiety symptoms also, fatigue, increase muscle tension, possible skin rashes and other symptoms, some of which are a part of IBS anyway.However, it still might cause d also as once the system makes changes in the gut, it gets complicated.The fight or flight in d is the bodies immeadiate responce or it can be delayed till after the threat has resided.But the fight or flight decreases blood flow to the intestines so the end result is c.But still not impossible for D.he did say and I see your heading that way, that the antidepressants should be used short term, so your not on them for life and the focus should be shifted to working on the anxiety naturally, through the methods your using there or others.So that is a good plan your working on.


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## eric (Jul 8, 1999)

Well that was interesting, I talked to a an expert on this.Anxiety in the majority of people causes c.Anxiety disorders might be associated with other anxiety symptoms also, fatigue, increase muscle tension, possible skin rashes and other symptoms, some of which are a part of IBS anyway.However, it still might cause d also as once the system makes changes in the gut, it gets complicated.The fight or flight in d is the bodies immeadiate responce or it can be delayed till after the threat has resided.But the fight or flight decreases blood flow to the intestines so the end result is c.But still not impossible for D.he did say and I see your heading that way, that the antidepressants should be used short term, so your not on them for life and the focus should be shifted to working on the anxiety naturally, through the methods your using there or others.So that is a good plan your working on.


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## california123 (Jun 8, 2003)

Hi Eric, I think antidepressants can be great for some, but the Effexor DID NOT stop my D. The Xanax did right away, and then I dropped the Xanax after I was on Effexor for awhile, but without the Xanax, the D came back. Under times of stress in the past, I used to get D and they called it colitis. But I have had many of the symptoms of stress/anxiety: chronic headaches, ringing in the ear that lasted many months, panic attacks and of course D, which you will find listed as a result of anxiety on virtually every anxiety site, though all GI problems can occur. I feel there is too little attention given to the psychological/emotional factors that can affect the body physically, but I guess that should be expected if all you are looking at is GI research. If people were willing to look at psychiatric research/observations, we might be looking at the problem in a whole different way. Since you are quite interested in research, Eric, have you looked at psychiatric research and see what they have to say? I would be really curious and will spend some time online when I have a chance. Take care.


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## california123 (Jun 8, 2003)

Hi Eric, I think antidepressants can be great for some, but the Effexor DID NOT stop my D. The Xanax did right away, and then I dropped the Xanax after I was on Effexor for awhile, but without the Xanax, the D came back. Under times of stress in the past, I used to get D and they called it colitis. But I have had many of the symptoms of stress/anxiety: chronic headaches, ringing in the ear that lasted many months, panic attacks and of course D, which you will find listed as a result of anxiety on virtually every anxiety site, though all GI problems can occur. I feel there is too little attention given to the psychological/emotional factors that can affect the body physically, but I guess that should be expected if all you are looking at is GI research. If people were willing to look at psychiatric research/observations, we might be looking at the problem in a whole different way. Since you are quite interested in research, Eric, have you looked at psychiatric research and see what they have to say? I would be really curious and will spend some time online when I have a chance. Take care.


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## eric (Jul 8, 1999)

colitis is an old name for IBS."But I have had many of the symptoms of stress/anxiety: chronic headaches, ringing in the ear that lasted many months, panic attacks and of course D"All things that can happen in IBS as well though."I feel there is too little attention given to the psychological/emotional factors that can affect the body physically,"SO do I, it is a total shame. This bb talks mainly on only pathogens and only the gut 99 percent of the time.Its a problem for sure in IBS and also anxiety disorders, either with or without IBS.They are starting to figure it all out though and are getting somewhere."psychological/emotional factors that can affect the body physically"One of the least things talked about here and a major influnce in IBS and symptoms for the majority of IBSers.I research it all the time, both the gut and brain.You should read this first if you haven't yet. It is an expert on IBS and a top neurogastroenterologist studying these connections. Neuroviceral studies.The Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California http://www.aboutibs.org/Publications/stress.html homeostasis.Read this page on Allostasis and the Good Stress Response you have to scroll down a little. http://216.109.117.135/search/cache?p=park...EBDFB1A45&icp=1 and this http://www.mindbodymed.com/EducationCenter/fight.html The fight or flight is crucial in understanding it all.


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## eric (Jul 8, 1999)

colitis is an old name for IBS."But I have had many of the symptoms of stress/anxiety: chronic headaches, ringing in the ear that lasted many months, panic attacks and of course D"All things that can happen in IBS as well though."I feel there is too little attention given to the psychological/emotional factors that can affect the body physically,"SO do I, it is a total shame. This bb talks mainly on only pathogens and only the gut 99 percent of the time.Its a problem for sure in IBS and also anxiety disorders, either with or without IBS.They are starting to figure it all out though and are getting somewhere."psychological/emotional factors that can affect the body physically"One of the least things talked about here and a major influnce in IBS and symptoms for the majority of IBSers.I research it all the time, both the gut and brain.You should read this first if you haven't yet. It is an expert on IBS and a top neurogastroenterologist studying these connections. Neuroviceral studies.The Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California http://www.aboutibs.org/Publications/stress.html homeostasis.Read this page on Allostasis and the Good Stress Response you have to scroll down a little. http://216.109.117.135/search/cache?p=park...EBDFB1A45&icp=1 and this http://www.mindbodymed.com/EducationCenter/fight.html The fight or flight is crucial in understanding it all.


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## california123 (Jun 8, 2003)

Hi Eric,thank you for all the analytical/reserach posts. I have to say that I find the connection between stress/anxiety and D to be so obvious..almost everyone has experienced it..that I am amazed that people are still spending all their time and efforts looking at the GI explanation. Believe me, I am not the one you need to convince, it is the many others on this site who say that stress COULDN'T BE THE CAUSE BECAUSE THAT WOULD MEAN IT IS "ALL IN MY HEAD" when I counter well it may all be caused in your brain but that doesn't mean your physical symptoms don't exist. Take care.


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## california123 (Jun 8, 2003)

Hi Eric,thank you for all the analytical/reserach posts. I have to say that I find the connection between stress/anxiety and D to be so obvious..almost everyone has experienced it..that I am amazed that people are still spending all their time and efforts looking at the GI explanation. Believe me, I am not the one you need to convince, it is the many others on this site who say that stress COULDN'T BE THE CAUSE BECAUSE THAT WOULD MEAN IT IS "ALL IN MY HEAD" when I counter well it may all be caused in your brain but that doesn't mean your physical symptoms don't exist. Take care.


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## eric (Jul 8, 1999)

Cal, its important to remeber though IBS is not "in the head". There are gut issues as well as brain issues, that need to be sorted out and its there connections. They are both operational though to cause the symptoms.A lot of people view it as some sort of competition, but its just the way things work.Your welcome I found more newer stuff also I will post soon.


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## eric (Jul 8, 1999)

Cal, its important to remeber though IBS is not "in the head". There are gut issues as well as brain issues, that need to be sorted out and its there connections. They are both operational though to cause the symptoms.A lot of people view it as some sort of competition, but its just the way things work.Your welcome I found more newer stuff also I will post soon.


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