Bowel urgency is commonly associated with stress and anxiety. Photo: Rui Santos / 123rf.com
Q: Why do I always have the urge to pass motion when I feel nervous or anxious?
I will break out in cold sweat and if I do not find a toilet in time, I may end up dirtying my trousers. It is usually worse in the mornings.
I am okay if I am at home and not feeling anxious. I am a 38-year-old woman.
A: The condition you have described is bowel urgency, or a sudden irresistible need to have a bowel movement, which is commonly associated with stress and anxiety.
In normal circumstances, there is more active bowel activity on awakening and this explains the urge to empty the bowels in the mornings.
But, when a person is under stress, the "fight or flight system" is activated, leading to the release of hormones that may increase the heart rate, cause sweating and create an urgency to defecate.
When this happens, the normal digestion process is halted and there is rapid emptying of one's bowel contents, which may be watery. In some cases, it leads to faecal incontinence.
Lifestyle modifications may be useful for anxiety-related diarrhoea. You may want to consider keeping a food diary to help you identify foods that may cause diarrhoea, which, in turn, increases the risk of faecal incontinence.
Common food and drinks linked to diarrhoea include dairy products such as milk and cheese, as well as drinks containing caffeine.
It may also be helpful to avoid eating during stressful periods, as eating triggers contractions in the large intestine, leading to the passage of bowel contents into the rectum and an urge to defecate.
When lifestyle changes are made, most cases of anxiety-related diarrhoea will resolve themselves.
However, if you continue to experience faecal incontinence, you should seek medical advice.
While diarrhoea is the most common cause of faecal incontinence, there are other causes.
These include structural defects in the pelvic floor muscles which may occur due to childbirth, previous surgery or radiotherapy, weakness of the anal sphincter muscles, or a reduced sensitivity of the rectum, which is a storage organ for stools.
Depending on the medical assessment, your doctor will do the appropriate diagnostic tests to determine the cause of your incontinence.
Dr Daphne Ang
Senior consultant, gastroenterology and hepatology, Changi General Hospital