Nervous Poops: Why A #2 Hits At The #1 Worst Time with Dr. Christine Lee

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host. Today, we're going to chat about nervous poops. Odds are, you've experienced this in your life, and usually at a big moment. Could hit right before an important job interview or some sort of sports event, or maybe even your wedding. Bottom line, that number 2 comes at the number 1 most inopportune time. So why does this happen? And maybe more importantly, what can you do to stop it? That's what Dr. Christine Lee is here to discuss. She's one of the many experts at Cleveland Clinic who join us on the podcast to provide health information that you can use and trust. Now, let's get started before my nerves get the best of me. Dr. Lee, welcome back to the podcast. So glad to see you on again.

Dr. Christine Lee:

I'm so happy to be here. Thank you for the opportunity.

John Horton:

Well, and as usual, we are talking about what seems like is always our topic, which is poop. I feel bad sometimes that I'm always hitting you with these sort of questions.

Dr. Christine Lee:

Oh, don't be. As a gastroenterologist, we do a lot of colonoscopies, so unfortunately, or fortunately, that's where we work at every day.

John Horton:

So today, we're talking about nervous poops or poops linked to anxious times in your life. Help us understand what's going on here.

Dr. Christine Lee:

There are more serotonin receptors in our intestinal tract than we do in our brain. So, in times of stress or anxiety or nervousness, we dump a nervous hormone called serotonin, and it affects the intestinal tract just as much as it affects our brain as far as regulating nervousness or anxiety. And serotonin stimulates the intestinal tract, so it makes your stomach churn, it makes your small bowel move and it promotes contractions in the colon.

John Horton:

And what that's doing then, when that happens, I take it, it just pushes everything along? It gives you that sensation that you have to go?

Dr. Christine Lee:

So it's a stimulant, it activates the intestinal tract, it activates the motility, it activates the colon movement, and sometimes, in doing so, it can cause a lot of cramping and gas pains and quite a bit of abdominal discomfort.

John Horton:

So that's what that feeling is, because I know we've all been just in those really stressful situations where you can just feel, it almost hurts within your gut. So that's just your muscles going a little haywire?

Dr. Christine Lee:

Correct. So, in fact, at high levels, it can make you feel choking, meaning your esophagus muscles spasm, so you feel like you can't swallow anything. You feel butterflies in your stomach cause your stomach's contracting. The pain would be more toward, concentrated on the small bowel and your colon because of all the contractions and gas trapping and peristalsis, so it can cause quite a bit of cramps and gas pain.

John Horton:

Well, and I don't think people really think about your colon as a place where there's a ton of muscles, but it sounds like there's a lot down there that's always working and we just don't even know it.

Dr. Christine Lee:

Right. So the intestinal tract, from mouth to anus, is completely lined of muscle. Your entire esophagus is made out of muscles, stomach, small bowel, colon, all muscular.

John Horton:

So, when that stress hits, I take it, all of that, it contracts or is it almost like a spasm?

Dr. Christine Lee:

Sure. So the serotonin hormone activates and stimulates contractions, so when it contracts and contracts fully, it can cause quite a bit of cramping, pain and discomfort to the patient.

John Horton:

And then, I thought I also saw something about there being a brain-gut axis. How does that fit into everything?

Dr. Christine Lee:

Yes. So the brain has a huge effect in the intestinal tract. When the brain senses a situation where you're sad or nervous or anxious, let's say you have a public speaking event coming up or you have a deadline to meet and you're short on time, you tend to release hormones called serotonin. That serotonin hormone, there's more serotonin receptors in the intestinal tract than you do in your brain, and so, the serotonin stimulates the GI tract in the sense that it can cause spasms and muscular contractions, whether it's in the esophagus, stomach, small bowel or colon. And that can affect gas pains, abdominal bloating and even diarrhea.

John Horton:

And we've all been there with all of those in those stressful situations. So if this is a natural body response, can we control it or stop it from happening?

Dr. Christine Lee:

Well, we can't really stop it from happening, but understanding that some people are more prone to the effects of serotonin than others, some patients are more susceptible to the effects of serotonin, and some people are more nervous in general. So if you find this to be a problem in themselves, you can be proactive and try to prevent these situations or mitigate the effects of it.

John Horton:

OK. Do you have a few tips as to how people can maybe calm your gut or avoid that situation?

Dr. Christine Lee:

So the first tip is easier said than done. Try to not put yourself in stressful situations, avoid stress, stress management and those kinds of things. That's always easier said than done. The second thing is about your body. Make sure that your body's well maintained, meaning, a lot of patients tend to be more constipated in the sense that they don't struggle to have a bowel movement, they go just fine, but they actually leave quite a bit of stool in their colon unbeknownst to them. Now, those folks will be more affected by the serotonin because the colon is locked and loaded, it's ready to fire at any moment. So, if any stimulation occurs, you are going to have problems with diarrhea, crampy pain, and the more stool you have in your colon, you produce more methane gas and more hydrogen gas within your intestines. And therefore, when you do have these spasms or stimulation, you're going to have more crampy abdominal bloating pain and discomfort.

John Horton:

Is there anything as far as dietary where, are there foods you should maybe avoid or things that you should eat to help with the situation?

Dr. Christine Lee:

So if you do some literature search, you're going to be overwhelmed with different opinions. Some sites will say eat high fiber foods so that you have less stool in your colon, some sites will say don't eat high fiber foods 'cause they tend to produce more natural gases. And so, the bottom line is, you have to figure out what works for you as far as making sure your colon stays as empty as possible. And the number one factor that can help in this scenario is exercise actually, and exercise in a way that it involves your mid-core. So core body strengthening exercises help strengthen your intestinal muscles so that when you do have a bowel movement every day, you get more out, leaving less behind. The less you keep retained, you'll have less episodes of the bloating, gas, cramping, and diarrhea effects.

John Horton:

Well, because that all happens, it sounds like as stuff builds up in there, if it just sits, nothing good happens.

Dr. Christine Lee:

No good thing ever comes with stool. So when you make bodily waste, you want to get rid of it. The more you keep inside, you can develop diverticulosis, diverticulitis, bacterial overgrowth, you can even get bowel obstruction. So you want to make sure that you do a high-quality job in getting rid of the waste. That way, in times of stress or nervousness or anxiety, you have less of the unwanted side effect of the cramping, bloating, diarrhea, urgency and all those abdominal pains.

John Horton:

Are there any over-the-counter medications that people might be able to use if you know you're going to be in one of those stressful situations, and you just want to make sure you don't have an unfortunate incident?

Dr. Christine Lee:

So, there's quite a bit of over-the-counter medications, anything from Phazyme or Gas-X that helps eliminate gas, to laxatives that help eliminate stool so that you have less bulk inside, and then to all the way to teas and peppermint oil to have a soothing effect. But the one that really works the best is to make sure you get rid of the waste in your body: exercise regularly, and have a well-rested good night's sleep so that your body's in the best condition that it can be when you're going through times of stress and nervousness.

John Horton:

Well, I think you said earlier when we were talking, nobody ever comes in complaining about having too clean of a bowel system, so this would follow that advice.

Dr. Christine Lee:

Full of stool does no one good. It can cause constipation, it can cause diverticulosis diverticulitis, it can cause small bowel bacterial overgrowth, it can cause even a bowel obstruction. So you want to make sure that you keep your colon as clean and empty as possible. And so, to do that, the things that can help you achieve that is eat a high fiber diet, exercise regularly, avoid sedentary lifestyle. Prolonged sitting is a risk factor for constipation, and so you want to make sure that you stay active and keep things in motion, and that will help keep your colon in motion and leave less stool behind.

John Horton:

That all sounds great. People worry about things being more than what they think it is. So if you have a nervous poop, could that be a symptom of irritable bowel syndrome? I take it, it's easier for you to say, you say it all the time, I'm struggling.

Dr. Christine Lee:

So irritable bowel syndrome means that you don't have an organic disease, per se, meaning you don't have colon cancer, you don't have Crohn's disease or an autoimmune disorder, your colon itself is normal. However, it's sensitive. It's sensitive to outside factors, whether it's hormonal or stress or any medications, it's more sensitive to those agents. And therefore, nervous stomach affects everyone, but if it's to a degree and frequency that is affecting your lifestyle, then that classifies the diagnosis of irritable bowel syndrome.

John Horton:

So if it's something that's happening frequently or over and over again, go in and talk to somebody.

Dr. Christine Lee:

Absolutely. Absolutely, because there are some medications we can prescribe when indicated to help you improve your colon health, so that when you do have these situations that are unfortunately frequent, where you're nervous and you have these irritable attacks that you have, we can dampen or lessen the unwanted side effects of it.

John Horton:

Well, and that leads us into our last question, which is just that it sounds like nervous poops are something that are fairly common, but should people be concerned if they have them, or is that just part of the human condition?

Dr. Christine Lee:

Well, it's a part of the human condition. However, if it's affecting your lifestyle, meaning, the degree is so severe that it's impacting your lifestyle in a negative way, then I would strongly recommend that you do see a gastroenterologist, because we may be able to help you mitigate a lot of those symptoms.

John Horton:

Anything else that we missed? We covered so much ground, but doctors always seem to have a little extra wisdom they can throw out there.

Dr. Christine Lee:

It's difficult because every patient's a little bit different and unique and not, what's OK in some person may be an alarm feature in you. So, I always say, to the patients, no one knows your body better than yourself.” So if it's a new symptom that's new to you, then I would make sure you see your primary care doctor or gastroenterologist and just make sure that that is not an alarm symptom. So, in general, the alarm symptoms we look out for is unexplainable weight loss, persistent bleeding, not just once, but you've seen a couple of times, anemia or drop in blood counts, fever, nausea, vomiting, symptoms that don't resolve by itself, but stay. Those are the classic alarm symptoms. But what we also see is, even if it's not a classic symptom, but it's new to you and you know your body best, it's best to seek a professional and just make sure that you get that checked out.

John Horton:

Great advice as always, Dr. Lee. Thank you very much for joining us today and looking forward to having you back.

Dr. Christine Lee:

Thank you for having me.

John Horton:

Stress and feeling jittery can affect you in a lot of ways, including a trip to the restroom. Bottom line, nervous poop is perfectly natural. To turn a familiar phrase a bit more family friendly, it happens. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts, or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.