Diarrhea and anxiety/panic...How do I cope?

I have a HUGE dilemma. I have been unemployed for a couple months, and was recently offered what most people in my field would consider a dream job with a top tier company. I unfortunately do not think I will accept the offer because I have too much difficulty dealing with anxiety.

I will try to keep this as short and to the point as possible. I have been dealing with panic attacks and anxiety since my early twenties, and I am now 30. The biggest issue is that my anxiety cause me to have sudden uncontrollable bowel movements.

Most of the advice is to slowly expose your self to situations that cause panic. For me this would be car rides, elevators, meetings, anywhere with crowds. How can I expose myself to a car ride with people when there is a legit possibility of me going to the bathroom either in the car or on the side of the road?

A mix of Imodium and Ativan is usually my answer, but the imodium mixed with stress backs me up so bad that it just cause worse problems down the road.

Is anybody else dealing with this? I NEED to take this job, but I don't know what I would do if I crapped myself riding in the car with a bunch of new coworkers. In these situations I seriously have like a 5 min window to find a bathroom. This has lead to me using some very unconventional places as bathrooms.

Can you make an appointment with the person who prescribes your Ativan and discuss this problem? Perhaps you could talk about trying an anti-depressant. Anti-depressants are sometimes prescribed for people with IBS-type symptoms alone because there are so many nerve endings in the gut that digestive problems can be helped significantly by taking an anti-depressant. And, obviously, the hope would be that your anxiety would respond favorably to the anti-depressant too. So it could kill two birds with one stone.

However, one potential downside is that some people experience digestive probs when they begin taking an anti-depressant, while their body adjusts (the last thing you need!!), but this is usually temporary. So not sure of the time frame involved in terms of when you would have to start this new job.

I really hope you can find a way to take this job and make it work. It sounds like a great opportunity. Wishing you the best!

Yeah a spastic bowel can be part of anxiety often as the gut is also part of our nervous system(http://en.wikipedia.org/wiki/Enteric_nervous_system).
An AD might help. I doubt it would pop out very soon if at all.
You might find that telling the employer you "wrestle with stomach issues at times" might in itself relieve some anxiety. I wouldn't mention anxiety proper so much as just IBS flares from time to time.
Antispasmodics can be tried but it might be best to meet with your doc and see if taking 1/2 immodium with ativan for the first week or two so you can get through the hardest part(getting started and used to everything) then begin a taper off. Think of the 1/2 dose in the AM and a preventative and temp measure.
Starting the AD might be best put off as it might cause a temp spike in anxiety(sometimes) but that's left to you and the doc. In my humble opinion an ssri or other AD should be tried for most folks having anxiety issues if they need medication. They are cheap(if generic), well tolerated, non habit forming and might help a great deal. If they don't help enough you can drop them or tapper off.
The AD will often help with anticipatory anxiety as well.
So being open with the employer might help, changing meds abit and having the faith to "give it your best try" and see what happens. I've found it's never as bad as you feared and you'd be surprise what you can do once you get busy with the task at hand instead of anxiety(getting busy can really reduce anxiety and can be very therapeutic). Seriously you owe this to yourself to try. The absolute worst case scenario of having to exit the job is not the end of the damn world. Employers will try to accommodate you as we all have issue from time to time being it health, family, car problems, etc, so don't make a bigger deal of this than you have to. I know as an anxious person you are likely very conscientious but I think you owe it to yourself to try. I bet you'll will be OK if you do have a few bumps in the road but ultimately you make it and you might be exactly what the boss needs! PM me any time, Alankay

Thanks for the replies. I have tried to respond 3 times now, and for some reason it does not post. I have tried many AD's as well as anti spasmodics and meds just do not seem to be the answer.

Sorry to hear that the neither the ADs you have tried nor the anti-spasmodics helped. Since conventional treatments haven't worked, have you considered any kind of alternative therapy at all? Maybe something like hypnosis? Or perhaps some sessions with a naturopathic doctor? Homeopathy and other forms of complementary medicine really help some people.

It sounds like you are working with a therapist already because you talk about exposure therapy, but perhaps a different counselor could recommend some other approaches?

Really hope you find some relief from this problem!

I have had similar anxiety related IBS. After several years I finally had success with Endep, one of the old tricyclic ADs. The newer SSRIs don't usually help with this type of problem. Only a very small dose is needed so there isn't many side effects. I only take 5mg and it has really helped. I personally don't recommend a Naturopath because they are expensive and it is very hit and miss. Monash university have developed the 'fodmap' diet which can help give clues about what in your diet may be aggravating the condition. It is an evidence based system which is a big tick for me and I also found that very helpful in settling things down. Good luck.

How much does the ativan help?? You may have to lean on it if it helps allot so talk with you doc on this and how important it is to get back to and used to work. Alankay