Can Stress Cause Diarrhea or Chronic Diarrhea?

Key takeaways:

• Your diarrhea can be a result of numerous causes, including stress and other conditions.
• If you experience certain alarming features, it suggests a more serious cause of diarrhea that may prompt urgent evaluation from a healthcare professional.
• Numerous factors can affect the specific cause of your diarrhea, including previous medical history, family history, recent travel history, and more.

Your body's stress response is a normal and healthy reaction that ensures that your body and organs function properly as a reaction to unexpected situations. It involves multiple organ systems, including the nervous system – your brain and central nervous system, the endocrine system – the system that controls your hormones, and the immune system – responsible for helping you fight off possible infections.

These systems work together leading to several changes in your body, including increased heart rate and blood pressure, energy, and blood sugar levels, while limiting the use of other systems that are not as important, such as the digestive, reproductive, and growth systems.

However, if this stress response is maintained for a prolonged period due to ongoing stress, it can lead to unwanted symptoms including diarrhea.

Is it normal to experience diarrhea when stressed or anxious?

You may experience various symptoms when stressed or anxious, including diarrhea. Although you may not have experienced diarrhea when previously stressed, your diarrhea may have developed in response to significant or prolonged stress.

How stress can cause diarrhea

As previously discussed, stress can lead to numerous changes in the body.

Because your body prioritizes organ systems utilized in the stress response, it diverts resources away from the digestive system. This along with the changes in the immune system and hormones as part of the body’s stress response can affect your gastrointestinal tract’s ability to digest and filter out harmful bacteria.

Additionally, a connection between your brain and your gut helps communicate between these two important organs, also known as the gut-brain axis. The brain uses neurotransmitters which lead to the secretion of hormones that exert effects on the gut.

However, repeated stress can cause negative changes in this axis that can lead to worsening symptoms in response to stress.

How to tell the difference between diarrhea from stress and other causes of diarrhea

Typically, stress-induced diarrhea is a relatively mild symptom that will get better on its own within a few days.

Although it can be difficult to distinguish whether your diarrhea is solely due to stress or related to other causes, there are features that may suggest a more serious underlying cause of your symptoms and diarrhea which will be discussed later in this article.

Other common causes of diarrhea

Although your diarrhea may be induced by stress, there are other reasons you may be experiencing diarrhea. Before discussing these other possible causes, let’s first define diarrhea. Diarrhea is defined as a change in stool consistency to looser stools compared to normal.

Additionally, diarrhea is defined as having 3 or more of these looser consistency stools daily. Refer to this Bristol stool chart to classify your stools. Stools that look similar to those between types 5 and 7 meet the classification of diarrhea. Now that we know what diarrhea is, some other common causes of diarrhea are discussed in further detail below.

Irritable bowel syndrome (IBS)

Irritable bowel syndrome, also known as IBS, is a common functional gastrointestinal disorder.

This means that there is no underlying anatomical, structural, or biochemical change causing symptoms; however, this does not make the symptoms any easier to deal with. IBS accounts for 25 to 50% of all referrals to gastroenterologists, doctors who specialize in the gastrointestinal tract and digestive system. Patients with IBS may experience multiple symptoms, including stomach pain and changes in their bowel movements.

Patients with IBS often report that they experience fluctuations between diarrhea or loose stools, and constipation (pellet-like hard stools). If you’re not sure if your stools classify as diarrhea or constipation, refer to the Bristol stool chart. Patients with IBS often note mucus is mixed into their stools. Patients with IBS may also experience urgency, the sudden sensation of needing to use the bathroom, and even tenesmus, which is the sensation that you need to go even if there is no stool to pass.

IBS symptoms can be worsened in the setting of stress. If you experience any alarm features listed later in this article, it is unlikely that your diarrhea is due to IBS.

Gastroenteritis

Another common cause of diarrhea is gastroenteritis, a condition that describes inflammation of the gastrointestinal tract. Gastroenteritis can be caused by both viruses and bacteria, and some factors can increase your likelihood of developing gastroenteritis, including consumption of contaminated water or food, exposure to other sick contacts, or recent travel history to a location where there is an outbreak of gastroenteritis or less sanitation.

With gastroenteritis, you may experience accompanying symptoms of abdominal pain, nausea, and vomiting along with your diarrhea. Your risk of gastroenteritis may also be higher if you have recently experienced a cold or if you have any other medical conditions that can affect your immune system.

Foods, medications, and other ingestions

Your diarrhea may be due to food, medications, or other ingestions. As discussed above, eating contaminated foods or liquids may increase your risk of developing gastroenteritis but can also lead to symptoms of food poisoning which overlap with the symptoms you’d experience with gastroenteritis. Numerous medications can lead to diarrhea as well, including antibiotics, some antidepressants, some medications for heartburn, immunosuppressive medications, and chemotherapy drugs.

If you recently started taking any new medications and notice that your symptoms occurred during this time, speak with your primary care provider to see if you should stop taking that medication or if any medications you are taking may be causing your diarrhea.

Food sensitivities and malabsorptive syndromes

Food sensitivity reactions and malabsorptive syndromes can also cause diarrhea. Even if you have no previous history of allergic reactions or other symptoms after eating a specific food or type of food, food sensitivity reactions can develop at any time. More severe symptoms and responses may also reflect an underlying malabsorptive syndrome, where your body cannot properly digest and absorb the nutrients from a specific type of food.

Numerous malabsorptive syndromes exist, including lactose intolerance, where patients cannot digest and absorb lactose-containing foods, such as cheese, milk, and other dairy products, and Celiac disease, where patients cannot digest and absorb gluten-containing foods.

With malabsorption syndromes, you may experience accompanying symptoms of weight loss, and different from IBS, you may also experience greasy, pale, or foul-smelling stools.

When to see a doctor about stress and diarrhea

Diarrhea is a frustrating symptom to deal with that may be worsening your stress and anxiety.

You should see a doctor if:

• Your symptoms occur more often or the frequency of your bowel movements continues to increase despite the use of treatment options described in this article.
• You notice weight loss.
• You have significant changes in appetite.
• You experience significantly worsening abdominal pain.
• You have any of the following alarm features: symptoms beginning after 50 years of age, rectal bleeding, pain or diarrhea during the night, fever, or have a first-degree relative with IBD or colorectal cancer

You should go to the emergency room if:

• You vomit up blood.
• You notice bright red blood in your bowel movements.
• You experience loss of control of your bladder or bowel.
• You experience sudden dizziness that does not resolve.
• You experience ongoing palpitations - the sensation of a racing heart, that does not resolve.
• You are unable to keep anything down, including food and liquids, due to ongoing nausea, vomiting, or diarrhea.
• You develop seizures.

Question to ask your doctor about stress and diarrhea

• Should blood work, stool studies, or other workup be done?
• Is there an indication to obtain any imaging, such as CT or MRI?
• Is there an indication to obtain an endoscopy: esophagogastroduodenoscopy (EGD) or colonoscopy?
• Are there other resources that may help with effectively dealing with and minimizing stress?

How to treat or get relief from diarrhea while experiencing stress

Your diarrhea may be further worsening your stress, and that in turn may be further worsening your diarrhea.

Fortunately, there are some treatment options you can try at home to help with your symptoms. If you notice that your symptoms are persistent or getting worse despite these treatment options, speak with your primary care provider.

Stress management and lifestyle modifications

Stress is unfortunately unavoidable no matter what. It is easy in theory to minimize stress. Realistically, this is not a simple task. If you notice a pattern of symptoms while experiencing stress, please speak with your primary care provider.

They may know additional resources that can help reduce and effectively deal with stress, including mental health resources such as counselors or therapists. Other lifestyle modifications such as meditation, increased physical activity, proper hydration and sleep can help you minimize and more effectively deal with stress.

Dietary modifications

Adding fiber is a simple and effective dietary change that can help you form better stools and improve your diarrhea. Although there are fiber supplements available, getting more fiber through your diet by eating fiber-rich foods, such as beans, whole grains, certain fruits and vegetables, and nuts is a healthier way to get more fiber.

If you notice that your symptoms occur or worsen after eating a specific food or group of food, reducing or completely eliminating those foods from your diet may help with your symptoms. One dietary change that has been helpful for some patients with IBS is called a low FODMAP diet, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

These are short-chain carbohydrates which may cause symptoms in certain individuals. Some examples of high FODMAP foods that you should avoid include dairy-based milk and yogurt, wheat-based products, beans, lentils, some vegetables such as artichokes, asparagus, onions, and garlic, and some fruits, such as apples, pears, and peaches. This diet is clearly restrictive, so it is important to note that it is not a permanent fix, as it is used to better identify specific foods that may be causing your symptoms.

You may not need to continue with whatever dietary changes you do make, as there are other factors that may be affecting you and your symptoms. It can be helpful to keep a log of what you have eaten, how you feel and any changes in symptoms based on the dietary changes you have made, in addition to the levels of stress you are experiencing during this time. If you notice some of the alarm features noted above, speak with your primary care provider.

Over-the-counter medications

Fortunately, there are also over-the-counter medications you can take that may help with your diarrhea. You can try taking medications like Pepto-Bismol or Imodium which can help with your symptoms.

Speak with your primary care provider to see if there are other medications that you can obtain a prescription for that may help with your symptoms if you notice that the treatment options above are not working.

Frequently asked questions: stress and diarrhea

Here are some frequently asked questions regarding stress and diarrhea.

How long can diarrhea from stress last?

Diarrhea from stress typically lasts for a few days and should improve without any treatment. If you notice that your symptoms are lasting longer than this or getting worse, speak with your primary care provider.

What if you’ve been experiencing stress and diarrhea for weeks or months?

Stress can persist for weeks or months, but even with ongoing stress, your diarrhea should improve during this time. If you notice consistent diarrhea for weeks or months with limited improvement or worsening symptoms, speak with your primary care provider to see if additional workup should be completed to assess the cause of your symptoms.

How can you prevent diarrhea from stress?

Minimizing and more effectively dealing with stress can help prevent any symptoms due to stress, such as diarrhea. This may not always be practical, but lifestyle modifications and even talking with other friends and loved ones can help minimize the negative effects of stress.

Diarrhea and stress, a bad combination

Although stress may be unavoidable, it doesn’t help if you’re experiencing diarrhea with it. If you experience worsening or prolonged symptoms, speak with your primary care provider for further evaluation.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Pallabi Sanyal-Dey, MD.

Sources

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familydoctor.org. “Optimizing Your Gut Health: Tips, Myths, and the Gut-Brain Connection.” familydoctor.org, 18 Dec. 2023, familydoctor.org/optimizing-your-gut-health-tips-myths-and-the-gut-brain-connection.

Robyn. “Bristol Stool Chart.” Continence Foundation of Australia, 9 Feb. 2024, www.continence.org.au/bristol-stool-chart.