Anxiety and Diarrhea - Whats the Cause and How to Stop it?

Can anxiety cause diarrhea?

The gut-brain connection is strong one. Anxiety can take a toll on the digestive system and cause diarrhea. When you are anxious, hormones and signals from the brain enter the digestive tract, causing a chemical imbalance that can interfere with digestion causing diarrhea and other gastrointestinal (GI) symptoms. For those with IBS or other gut-related conditions it may even trigger a flare-up.

If you are experiencing both anxiety and diarrhea, it's a good idea to speak to your doctor about your symptoms. They will be able to diagnose your gut symptoms and find out the root cause. While it may solely be related to anxiety, it's important to check for conditions such as:

• Inflammatory Bowel Diseases – ulcerative colitis and Crohn’s disease
• Diabetes
• Overactive thyroid (hyperthyroidism)
• Poor absorption of certain nutrients (malabsorption)
• Irritable Bowel Syndrome

Why does stress and anxiety cause diarrhea?

There are a few ways anxiety can trigger diarrhea. The first is part of the body's stress response.

Anxiety prepares us to confront a crisis by putting the body on alert (sometimes called fight-or-flight mode), and nerve signals from the brain travel through the body in this response. This causes blood flow to be diverted away from the abdominal organs. This, unfortunately, may cause nausea and diarrhea.

By voiding the bowels in diarrhea, the body prepares for survival. The digestive system suspends to provide more blood flow to parts of the body such as the skeletal muscles and although useful in ancient times, is an unnecessary response in today’s modern world.

‍

‍

Another cause relates specifically to IBS. One study found that people with IBS-D (diarrhea) had higher levels of inflammatories that could affect the way the digestive tract absorbs the water in stools. More stress, can lead to higher amounts of this compound, which in turn stops the body from absorbing water, eventually leading to wet, loose stool.

‍

If you also experience abdominal pain with diarrhea, it might also be irritable bowel syndrome (IBS).

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a gastrointestinal disorder. It is ‘functional’ meaning it is not life-threatening and has no underlying physical disease, and is essentially a disorder of the gut-brain connection. It is very commonly seen in those with anxiety disorder and depression.  However, this is not to underestimate the symptoms of IBS, which may be very real and distressing and include:  

• Diarrhea or constipation

• Abdominal pain, often relieved with passing a bowel motion or wind

• Abdominal bloating

• Cramping

IBS is extremely common, affecting 1 in 7 individuals globally and is more common women. The cause of IBS is not known, but environmental factors such as emotional stress and change of routine may trigger an attack. Studies show that anxiety is strongly associated with IBS – both onset and worsening of symptoms.

Diagnosis of IBS

IBS is diagnosed by the Rome-IV criteria:

Recurrent abdominal pain at least one day per week in the last three months that is associated with two or more of the following:

• Related to defecation
• Associated with a change in frequency of stool
• Associated with a change in form (appearance) of stool.

While IBS is one of the common links between diarrhea and anxiety, it is not the only one, so be sure to talk to your doctor for a diagnosis.

Types of IBS

There are three main types of IBS categories, depending on the types of symptoms you are experiencing. If your anxiety is triggering diarrhea, it is possible you have diarrhea-predominant IBS (IBS-D), the most common form of IBS.

• Diarrhea-predominant IBS (IBS-D): this person experiences diarrhea, first thing in the morning or after eating.
• Constipation-predominant IBS (IBS-C): this person experiences constipation, and abdominal pain and cramping are commonly triggered by eating.
• Mixed IBS (IBS-M): this person experiences alternating periods of diarrhea and constipation.

Is diarrhea common with anxiety & stress?

Diarrhea can be a big part of life for people dealing with daily anxiety and stress. In fact, people with anxiety are more than twice as likely to experience diarrhea than the general population. And studies show that 40 to 60% of those with irritable bowel syndrome (IBS) have generalized anxiety disorder.

‍

The gut-brain link

Whether or not you have IBS, anxiety disorders are linked with diarrhea by the ‘gut-brain axis’. This is the two-way connection between brain and bowels that involves nerves, hormones, and gut bacteria, and a key component of the gut-brain axis is the enteric nervous system (ENS).

The ENS is often referred to as the ‘second brain’ due to its complexity and consists of millions of neurons that surround the digestive tract and control digestion. The ENS connects to the central nervous system, the brain, and spinal cord, and is literally affected by processes in your brain.

When diarrhea occurs with anxiety or in IBS, the ENS is malfunctioning. There is a disruption to signals controlling motility – the speed of transit of material through the intestines – that may lead to an urgent need to defecate. Hence anxiety may lead to physical digestive symptoms such as diarrhea.

How to stop anxiety diarrhea

If you are experiencing sustained diarrhea (even without anxiety), you should seek immediate medical help if you have:

• Blood in stools
• Rectal bleeding
• Fever lasting three days or more
• Severe abdominal pain
• Vomiting
• Rapid weight loss
• Bowel movements do not relieve pain.

If you do not suffer the above symptoms, treatments for diarrhea and stress-management strategies may improve symptoms. You may still wish to consult your doctor to confirm which treatment is right for you.

Treatments for diarrhea

There are treatments to manage the symptoms of anxiety-related diarhhea as well as treatments, or management programs to treat the root cause.

Treatments to manage the diarrhea symptoms largely involve rehydrating the body. These include:  

• Rehydration. This is important to counteract the dehydration in diarrhea.
• Oral rehydration. To replace lost salts and minerals from diarrhea.
• Medications. Such as antibiotics if the cause is an infection or anti-diarrheal medications.
• Avoiding exercise. As strenuous exercise may further contribute to dehydration.
• Treating disease. If there is a physical basis, such as inflammatory bowel disease.
• Fluid IV replacement. In severe cases to rehydrate the body.

These will ensure your body can recover from periods of dehydration associated with diarrhea. You should consult your doctor to confirm the best treatment for your condition.

Stress-management

As well as diarrhea treatments, stress management strategies may help relieve stress & anxiety, which may be at the root cause of symptoms. Stress management techniques prevent the body from easily being triggered by outside stressors. These include:

• Cognitive-Behavioural Therapy (CBT). This therapy involves a cognitive aspect in helping patients identify thoughts that generate anxiety and a behavioral part teaching them to respond differently to anxiety-provoking situations. These techniques help to lessen anxiety and improve gastrointestinal symptoms.
• Hypnotherapy. The patient first undergoes hypnotic induction, then suggestions are made to address the patterns of thought associated with anxiety. This form of therapy has been shown at least as effective as CBT for treating anxiety disorders, and IBS. It's possible to try hypnotherapy through a mobile app like Nerva or with your local hypnotherapist.
• Mindfulness meditation. This practice of focusing awareness on the present moment has been shown to reduce anxiety and stress scores. IBS symptoms such as abdominal pain and bloating may particularly benefit.
• Yoga. Has been shown to relieve stress and also specific symptoms of IBS that is diarrhea-predominant. Research has shown yoga more effective than anti-diarrheal medication in relieving symptoms.

Lifestyle adjustments

Over a longer period, lifestyle adjustments that may prevent symptoms of diarrhea and include:

• Staying hydrated
• Avoiding alcohol and tobacco
• Getting regular exercise
• Consider a low FODMAP diet
• ‍Prioritizing sleep
• Taking probiotics‍

Recent insights into anxiety and diarrhea

Science has recently illuminated some fascinating links between the brain and the gut. These insights are helping us to understand the connection between diarrhea and anxiety.

Anxiety increases the speed of transit of food through the gut.

‍One study showed that generalized anxiety disorder (GAD) causes physical changes to the digestive system. The transit of food from the mouth to rectum was found to be 14 hours, on average, in anxiety patients – much faster than the 42 hour-average in controls. Anxiety was therefore shown to physically alter speed of transit through the intestines, explaining the link between diarrhea and anxiety.

Remote hypnotherapy reduces symptoms of IBS.

‍Researchers showed that symptoms of IBS improved in 65% of subjects who received hypnotherapy delivered online over Skype, compared to 76% with face-to-face treatment. Although slightly lower, the significant rate of Skype hypnotherapy means access to this form of IBS treatment could be greatly expanded.

The Wrap Up

The nervous system and stomach are intimately linked. It is possible that experiencing anxiety can trigger a flare-up of diarrhea. Anxiety and diarrhea may also be a sign of irritable bowel syndrome. If you experience diarrhea or other IBS symptoms and mental health conditions such as anxiety disorder, there are treatments available to help you manage stressful situations and improve your anxious stomach.  Relaxation techniques may help to improve GI symptoms and improve your upset stomach, with hypnotherapy through apps like Nerva being especially helpful.