- Diarrhea and anxiety
- What can you do to treat diarrhea?
- Management of IBS-D
- When should I see a doctor?
- The lowdown
Stressful life events such as busy periods at work, the death of a loved one, and relationship difficulties are known to trigger physical symptoms in the body. It’s now also well known that the brain and the gut have a strong connection and share many of the same nerves; this is commonly referred to as the brain-gut axis.¹
For example, have you ever felt butterflies in your stomach after dealing with something stressful? The stomach can be easily affected by stress and anxiety. During times of stress, chemicals and hormones are thrown out of balance.
This change to the body’s environment can disrupt the gut bacteria, resulting in gastrointestinal symptoms.
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Diarrhea and anxiety
Diarrhea is one of the many physical symptoms that can be caused by anxiety. Diarrhea is the term for you when you need to go to the toilet more than three times each day and have loose, watery bowel movements (or ‘poos’). Several different types of diarrhea commonly occur:
Mild or brief diarrhea is generally over within a couple of days and may have been caused by an infection
More moderate diarrhea could be the result of emotional stress, food poisoning, or an intolerance to some types of food
Chronic or severe diarrhea can be caused by medical conditions impacting the gut, like cancer, Crohn's disease, colitis, or irritable bowel syndrome.
Anxiety, therefore, can impact both moderate and chronic diarrhea. Life stressors that cause short-term anxiety contribute to moderate diarrhea.
This type of acute stress is more likely to result in short-term diarrhea, whereas persistent chronic stress causes anxiety and sometimes depression. These changes to the mental state are more likely to be linked to irritable bowel syndrome (IBS).
IBS is a common disorder of the large and small intestine, which causes bloating, abdominal pain and can result in either constipation, diarrhea, or a combination of the two. It’s diagnosed by a doctor after numerous other investigations have been done to rule out more concerning causes for symptoms.
What can you do to treat diarrhea?
If you’re experiencing a short-term bout of diarrhea from a singular nervous event, it will typically clear up on its own, and you can do your best to manage the symptoms at home. Tips for managing your diarrhea during an episode include:
Staying at home
Avoid in-person work or school and stay home as much as possible until the loose bowel movements resolve.
Even if sickness makes this difficult, you should sip water slowly and aim to drink at least 1.5–2 liters, or 6–8 cups per day.
Avoid drinks that are high in sugar
These include sugary soft drinks, fruit juices, and cordials, which may prolong diarrhea.
Avoid gut stimulants like alcohol and caffeine, which may worsen diarrhea. Consume drinks called oral rehydration solutions. These contain electrolytes (salts), sugar to help electrolytes get absorbed, and water. Oral rehydration solutions are helpful to replace salts and water the body loses when you have diarrhea.
Eat small and frequent meals
Also, choose plain foods. These include rice crackers, white bread or bagels, noodles, bananas, apple sauce, peeled potatoes, cooked carrots or pumpkin, cooked eggs, yogurt, and chicken or fish.
Avoid foods high in fiber
Fiber is found in corn kernels, whole grains, nuts, lentils, chickpeas, seeds, and vegetables like broccoli, beans, and peas. Green leafy vegetables are sources of insoluble fiber. Insoluble fiber bulks up stools and can make them pass through the intestine faster, increasing the risk of diarrhea.
Be cautious about soluble fiber
Soluble fiber is found in oats, barley, chia seeds, flaxseeds, psyllium, and some fruits. It acts like a sponge and soaks up water into the intestine. This type of fiber can either have positive or negative effects on bowel movements, either helping to soften stools or reducing urgency.
If you want to try soluble fiber to treat diarrhea, increase intake slowly to avoid other gastrointestinal symptoms like bloating or abdominal pain.
Avoid foods that are high in sorbitol and mannitol
These sweeteners have a natural laxative effect and are best avoided during times of diarrhea. Sorbitol and mannitol can be found in sugar-free chocolate, gum, and mints.
Management of IBS-D
Physical and emotional stress are common triggers for IBS. If you experience IBS, you may have IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), or IBS with both constipation and diarrhea (IBS-A).
It’s important to find a way to manage IBS-D, as frequent diarrhea can negatively impact your quality of life. You might have heightened anxiety from a fear of urgently needing to use the toilet or not being able to control your bowel movements.
People who experience panic attacks, anxiety, or depression are more likely to have IBS² than those without mental health struggles.
With this being the case, psychological treatments have proven effective in reducing symptoms of IBS-D. Psychological treatments can include the following:
Cognitive behavioral therapy
Psychodynamic interpersonal therapy
Two-thirds of people² who suffer from IBS-D believe food is a contributing cause to their symptoms. There are several potential contributing factors, which include, but are not limited to:
Inability to absorb nutrients from carbohydrates
Fermentation of foods in the gut
Diet is of particular importance to those who suffer from anxiety or depression, as its impact is thought to be greater² than it is for people without these conditions. It’s helpful to work with a dietitian or nutritionist to identify foods that may be contributing to diarrhea. This will ensure you’re not eliminating food without reason.
Common dietary culprits include milk products containing lactose, high-fat foods, alcohol, caffeine, sorbitol, and gas-producing foods like cabbage, beans, lentils, and broccoli, to name a few.
A low FODMAP diet is a common strategy used to identify and manage symptoms of IBS-D. FODMAP stands for Fermentable Oligo-, Di-, Mono-saccharides And Polyols.
FODMAPs are a group of short-chain carbohydrates that aren’t well digested by the body. Instead, they get fermented (broken down) by bacteria in the gut, and this causes pain, bloating, nausea, and changes to bowel movements.
You should undertake the low FODMAP diet with the guidance of a dietitian. It involves avoiding all foods that contain FODMAPs for around six weeks and then reintroducing the carbohydrates one at a time to establish the cause of the symptoms.
Specific restricted carbohydrates include fructans, galactans (galacto-oligosaccharides), polyols (including sorbitol, mannitol, xylitol, and maltitol), and foods with lactose and excess fructose.
Medications, such as loperamide, are backed by strong evidence for improving symptoms of diarrhea in people with IBS-D. Loperamide reduces the speed at which food and fluid pass through the intestine and changes the electrolyte/water balance in the gut, and it leads to firmer stools and a reduced frequency of movements.
Some good evidence supports the use of antidepressants in reducing IBS-D symptoms. How does this work? We know that people who experience psychological distress feel more pain with IBS-D.³ Therefore, psychological distress can either decrease or increase the pain symptoms of IBS in the gut.
Antidepressants can help restore a normal connection between the gut and the brain. People with IBS-D who have taken antidepressants have reported significant reductions in their diarrhea. Antidepressants are mostly used in more severe cases of IBS-D.
Another drug that’s been shown to be effective in reducing the frequency of diarrhea and its urgency in women is Alosetron. Like loperamide, it works to reduce the speed at which food and fluids pass through the intestine.
Cilansetron, a similar drug, is still being researched for its use in IBS-D. From initial studies, it’s thought to be effective in both men and women.²
When should I see a doctor?
If you have ongoing diarrhea and it’s impacting your day-to-day life, then seeking the support of your doctor will help. It’s also recommended to seek medical support if you have any of the following symptoms:
Blood or mucus in your stool
Diarrhea that keeps you up at night
Unintentional weight loss
When you suffer from anxiety, the stress on the body can cause changes to hormones and chemicals, which result in changes to the bacteria in your gut. These changes can cause diarrhea.
If you or someone close to you suffers from short-term or chronic diarrhea, it may significantly impact your life. However, several lifestyle changes can help prevent or reduce diarrhea.
Taking the time to work through your anxiety with a qualified professional and assessing your diet with a dietitian are two great places to start to get your brain and gut healthy and balanced again.