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Will LEXAPRO for anxiety cause CONSTIPATION?

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I have started experiencing odd bowel movements over the past 6-8 weeks. There has been intermittent periods of good bowel movements over the course of a week or so in this time but predominantly constipation has been the case. I have also ocassionally (maybe once a week) used a laxative to go, sometimes they work and other times not. Generally after I take a good laxative, I may go for 3-4 days after and feel fine, only to find by the end of the week I am not pooping again, so I take a laxative. Also the constipation has not been hard stools I can't get out, there has just simply been no urge to go at all. 4 days and more with no urge. I have no cramping or abdominal pains and the GP has found no abdominal mass on palpation. I do however have increased bowel sounds. When I am passing a bowel motion even after straining it is a very normal formed stool (type 4 on the stool chart). A few episodes early on produced mucous and one time i noticed obvious blood streaks on the toilet paper. The last few weeks has been normal stools (still feeling incomplete though) without blood or mucous. Within the last two weeks I have been put on Lexapro for anxiety (because this is worrying me so much) and have noticed tiredness, loss of apetite at times, anxiety not improving, and my weight a few kilograms less. This has sent me into real panic mode as weight loss with the constipation could signal advanced stages of cancer? Or should I be relating the above symptoms to the side effects of lexapro? Or maybe look at something like inflammatory bowel disease? I am having a colonoscopy in two days as I am so paranoid (I paid lots to go privately). Am i just worrying or do I have genuine concern here for something serious like cancer? I am 23 years old patientold, my grandfather had colorectal cancer at age 70 and is still alive, and my father has had a polyp removed around age 45, as he has regular colonoscopies.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello.
Thank you for posting your query at DoctorSpring.com
I understand your concern.
Please do not worry about cancer since you are too young to develop colon carcinoma.
Though its too early to call it IBS but it does look like IBS- Constipation predominant. The only thing that is going against that diagnosis of IBS is absence of abdominal pain.
Did you have any recent dietary changes? Do you drink enough water?
I need to rule out functional constipation in your case. The blood streaks you noticed can be due to the prolonged straining.
I will advise you to continue laxatives for a period 2-3 weeks continuously without any break. Bulk forming laxatives such as psyllium/ methylcellulose will be better. If the constipation subsides with taking enough water and fiber ( 25-30 g/ day ) within a month then no further evaluation is required.
Please do not worry. It can also occur as a side effect of Lexapro. Is it the first time you have used the drug? And also did you have any prior episodes of constipation?
Regards.


Patient replied :

I cannot recall any major recent dietary changes, however overall my diet has been relatively poor prior to noticing the inability to pass normal bowel motions. I also had changes regarding my employment situation and differing schedules prior to noticing the constipation, however in my opinion this was nothing major and should not have affected my bowel function. I drink lots of water, and as I said I have no issue with hard stools or big stools, it is simply no urge to pass. When I strain it is like nothing is there to come out? Even after 3 days of no bowel motion and normal eating habits. When I can manage to pass (usually after a laxative) it is normal formed solid stool, normal smell, light brown colour etc. No blood (apart from the one episode) or mucous, however the bowel movements I have had in the past month have felt about 50% of what I used to have (in terms of amount of faeces)
I have had constipation in the past, but it usually only lasts a few days or a week and when I eat a good diet for a day or two and increase water and fibre (or have a Metamucil) I go back to normal. I have never been a daily bowel mover, I used to be every 2 days on average, sometimes even longer.
When I had a physical exam from a doctor they said my bowels weren't that full or distended and there was no obvious mass. Also a rectal exam was performed and no sign of disease or poor tissue health or impaction.
I am not overweight (5'11, 163lb) and have improved my diet slowly and have noticed some improvement overall and feeling better (except still constipated), until I started on this Lexapro. The issue I am having now is whether the fatigue, slight weight loss, and lower apetite than normal is due to the Lexapro (YES it is the first time on this drug, however I am only taking 5mg, currently at day 11) or my situation regarding the constipation? The weight loss I could probably attribute to laxative use, eating generally better food and less food recently and also stress and anxiety over the whole situation?
Overall, even now my diet is not strict or great (I probably don't realistically get 25-30g of fibre a day, but I never have), I don't understand why this has happened all of a sudden and for so long this time? Could my body just be going through some changes and now I am intolerant to gluten? Thyroid? Without the persistent abdominal pain/cramping it really counts most of these things out.
What sort of laxatives do you suggest? It got to a point where Fleet Phospho Soda was the only thing that was getting me to go.


Hello.
Thank you for additional information.
So overall you have had poor diet over the past few weeks and even the employment situation can be contributing towards constipation, due to the stress and anxiety. Since there is no blood or mucus, other serious possibilities can be ruled out.
You need to realise that some people are prone towards constipation. And for such people including you, the diet has to be extremely good, and the fiber content has to be adequate. What you can do is obviously have more of fiber rich foods, more of wheat, corn and rice. Also start taking a banana once every night before sleeping. It relieves constipation naturally. Keep having adequate water as you do. For the next 2 weeks, i also want you to have psyllium ( bulk laxative ) every night as it will make your bowel habits more regular.
You should also have probiotic capsules or supplements fortified with probiotics like curd.
Then regarding Lexapro, it does have side effects like loss of appetite, and constipation but it is hard to explain how it is happening after 2 weeks of usage. However it is also true that different people react differently to the same drug. So you can talk to your doctor and stop the drug altogether because there is no chance of colon carcinoma at this age and the same reason should not be the cause of your anxiety.
Or you can switch to some other drug in consultation with your local doctor.
With lifestyle modification and diet changes, i think your situation can be handled. Just continue the medicine along with the diet for 2 weeks and you can expect recovery.
There is a possibility that it can be due to thyroid disorder. And for that you can get your thyroid profile checked and upload the reports.
Feel free to discuss further,
Regards.


Patient replied :

I am going ahead with a colonoscopy tomorrow as I am not going to relax until I can count serious illness out for 100% certainty. For me 99.9% is not going to be enough and if I continue to worry it could make my situation worse. Unfortunately I have also seen reports of even late stage colorectal cancer at my age, albeit exceedingly rare.
However should the colonoscopy reveal nothing sinister, I will look more into lifestyle-based reasons for the constipation and if the colon cleansing I go through tonight doesn't reset my bowels I'll go with your advice of consistently using laxatives for a period of 2-3 weeks and being really strict with diet to see if that improes anything.

Thanks for your help!


Hello.
Yeah it will be good since you can relax after the results.
However i am sure it's nothing serious.
Let me know once you have the reports.
Regards.


Patient replied :

Hi again.
I went in for my colonoscopy after having the prep the afternoon before. Lots of fun that was! The gastroenterologist said that my colon was still quite "dirty"? She said I may have slow colonic transit and therefore the prep should have been done for a few days before as I had not moved my bowels regularly before the procedure. I was still clean enough for a decent procedure so it went ahead as normal.
Anyway, she said there was nothing to worry about, no polyps (or cancer) or inflammation, the colon was in good condition overall. She did take a biopsy but said this was just "routine to say we have been through the whole bowel" and is "nothing to worry about"??? This seemed quite weird, why you would take pathology for no reason?
I am, however, still not convinced that diet and exercise is the only problem here. If not then something else is definitely going on, as I lie here now in bed, I am quite full/stomach quite distended/constipated and I haven't had a BM since I was on the bowel prep for the colonoscopy Wednesday evening/Thursday morning. It is now Saturday night 10pm. I am in no pain, no cramps, bowel sounds appear normal, apetite is good (I'm not so anxious anymore). On the flip side I still feel tired, lethargic, my sleep pattern has been varied, and I am finding I'm getting a little dizzy if i stand too quickly. Overall I just feel a bit below average. This could all be due to the constipation itself or suggest something else is going on. I would have thought by now the Lexapro side effects would have gone away after 2 weeks and with such a small dosage of 5mg. Maybe its worth taking this med out of the equation altogether and seeing if that will change anything.
This is really starting to confuse me. I don't really have any worsening symptoms, just continued constipation which doesn't seem to be improving. I don't know whether I should look further into the medical side of things (i.e. specialist doctors) or maybe persist with natural remedies for a while. It doesn't appear to be anything that could become serious though from the information I have given you?


Hello.
Thank you for your response.

I have reviewed your history and you do not seem to have anything serious.
You seem to have functional constipation like Idiopathic Slow Transit Constipation like the doctor had mentioned. You need to take a good fiber and fluid rich diet as suggested earlier along with the laxative. Hypothyroidism is another possibility for which you need to get a Thyroid profile done. It could explain your other symptoms of lethargy, tiredness etc.

You could also consult a medical gastroenterologist if the thyroid tests are normal.

Regards.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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