Anxiety triggering digestive disorders
Gastro-intestinal problems strongly linked to anxiety are grouped under the term functional bowel disease. The heaviness felt after a meal and the longer time taken to digest a meal are things we ascribe to lack of activity. Patients come with a range of complaints — headache, body ache, knee pain, heaviness of stomach… They ascribe it all to indigestion. But we take the root cause as anxiety.
Organ damages account for one segment of diseases which require investigation and treatment. These are ulcer, black stool, blood in vomit, jaundice, liver damage, pancreas damage, water in stomach. Such conditions have distinct manifestations.
The other group comes with problems like increased belching, flatulence and bloating, but investigation reveals nothing. They are grouped under functional bowel disease. This group does have problems but these cannot be detected through investigation and they are also majorly linked with their state of mind.
A typical example of the functional bowel disease group would be those who have little or no gastric attacks when they are on vacation and complain of a relapse of the symptoms as soon as they are back home.
Some other departments, like orthopaedics, gynaecology and cardiology, also have functional components of the disease. Since there is no end to investigations — endoscopy, colonoscopy, CT scan, ultrasound, blood tests — we have to decide early which patients belong to the functional group and with whom we should proceed with investigations. If an anxiety-prone person manifests symptoms, it is better to give him an anti-anxiety drug at the very start.
Patients with anxiety are mostly staying holed up at home now. Even if they reach us, they can be easily made out from the plethora of protective gear they wear — caps, masks, face shield, gloves... Multiple gemstones on fingers are a similar giveaway for anxiety in men in non-corona times.
Health comes from peace of mind and diet. The food taken should be easy to digest but not so easy also that it adds to body weight. Easy-to-digest diets are carbohydrate-based while those that are less easy to digest are fat-based. Steamed rice is easily digested and also is easy to gain weight with. Deep-fried things like luchi and paratha, are tough to digest, causing a feeling of fullness after a meal, as the fat content is high but even these contribute to weight gain. We need balanced diet of fat, protein and carbohydrate which does not lead to weight gain.
But if you reduce activity, like in the case of most people sitting at home for the lockdown, there would be a possibility to gain weight anyway. The way out is to do aerobic or anaerobic exercises like crunches, skipping or jumping within the confines of home.
Mental fitness is also essential. Otherwise it may lead to anxiety, depression or breakdown. Read books, watch entertaining programmes on TV, connect with friends over phone. One can also do yoga. As soon as you exercise, it diverts you from anxious thoughts and also triggers the release of endorphins, which helps elevate one’s mood. The elderly can do stretching exercises.
In many houses, lot of excess eating is taking place in this lockdown. Eating has to be reduced in lockdown. In terms of volume is to calorie output, steamed rice and roti are same. Rice is easier to digest. But, unlike roti, it is difficult to quantify rice. We recommend rice for one meal and roti for another. There should be a gap of an hour and half or two hours between dinner and lying down.
Deep fried sweets like lyangcha, mishti doi which has a layer of dalda on top, should be avoided.
Extent and manifestation of anxiety vary from people to people. Some start crying, some stop going outdoors, some stop talking to friends... We have to counsel a lot.
People’s complaints are of three kinds — sensation of gas in tummy, excessive belching and downstairs gas that passes through rectum, which we call flatus.
If the stomach tightens with a sensation of gas, it can be due to two reasons — digestion becoming slow due to reduced activity or consumption of gas-inducing food. The latter category includes cauliflower, pulses, leafy vegetables, carrots, beet, vegetables with seeds like beans. Vegetarians complain more of gas than non-vegetarians who have a more protein-heavy diet.
Belching to an extent is normal as we swallow air while eating or talking and that needs an outlet. But when there is too much upstairs gas produced, the reasons can be physical or mental. The physical reason is outlet obstruction due to ulcer, tumour or cancer so that the food cannot get out of stomach downwards.
But 95 per cent people experience excessive belching due to anxiety. In our out patient department, we have people coming who belch so loudly that others move away. One can hear the sound from upstairs.
As for downstairs gas, it is food related. A person can survive without passing stool for three-four days, but no one can survive without passing gas for 24 hours. People come with a single complaint: gas hoyechhe. We have to ask a series of questions to identify what the underlying problem is — whether there has been a change in bowel habits, if there has been weight loss... Cauliflowers grown in Dhapa, identifiable by its milky white colour, are more gas-inducing than those produced elsewhere, with a light yellow tinge.
The more is one’s activity the more the gas passes below.
Constipation is not a single word which defines the patient’s problem. We have to ask the patient what their definition of constipation is.
Doctors have a range of medicines at their disposal to deal with every kind of complaint.
Unsatisfactory stool: Whereby the person goes to the toilet three or four times but never gets the satisfaction of full evacuation. They are unhappy with the quantity or the quality. They fall in the functional group as the dissatisfaction is in their mind. Their body is satisfied. Otherwise they would have experienced bloating or vomiting as well. They have to be given bulk laxative like isabgul as well as in some cases anti-anxiety drugs.
Hard stool: Difficult to evacuate, leading to pain and bleeding. They have to be given stool softeners.
No stool: They evacuate after three or four days. They need stool stimulants.
Words of advice
A person can improve his bowel movement by drinking enough water. Less activity reduces the urge to drink water. Keeping a mask on at work is also an impediment to drinking water at regular intervals. The colour of your urine (yellow or colourless) is the best indicator of whether your body is hydrated or not.
Also have a high-fibre diet with roti and leafy vegetables.
A person defaecating thrice a day is as normal as a person who defaecates thrice a week. We treat only those who complain. We face parents complaining that their child is not passing stool daily. We ask the child if he or she is having a problem. If they say no, we tell the parents to let them be. Parents want their child to pass stool according to their convenience!
Some people are drinking hot water. While I have no comment on whether that helps to fight coronavirus as there is no proof yet, hot water does trigger gastro colic reflex, which produces the urge to defaecate. They can have satisfactory evacuation of bowel.
On the personal front
I am attached to ILS Hospital Salt Lake. I don’t do online consultation as it does not let me see the patient closely or touch him, if needed. We are not admitting Covid patients. Only patients with prior appointments are being allowed in currently, that too with a maximum of one companion.
A screening takes place whereby those with fever are being referred to the fever clinic. They are not allowed to the OPD.
While meeting patients, we are dressed in a disposable gown, glasses, surgical cap, gloves and mask. When we do endoscopy or colonoscopy, we are in full personal protective equipment. We are exposed to oral cavity and therefore aerosols. We are giving anaesthesia to every patient now to reduce retching during endoscopy. Every patient is being taken to be Covid positive unless proved otherwise.
At Sanjeeva Town, where I stay, a Covid-19 protocol has been drawn up which we are following to tackle positive cases reported among residents.