Anxiety Diarrhea (Nervous Diarrhea) – Causes and Treatment

The term bowel habit simply refers to the pattern of bowel movements that is normal for a person. It varies among people. Bowel habit does not remain constant throughout life. It changes with diet, lifestyle and even age. Similarly various diseases and medication may also alter bowel habit. Provided that bowel movements are not more than three times in a day or less than three times in a week, then it is considered to be a normal bowel habit.

Momentary alterations in bowel habit is not uncommon. We have all experienced loose stools, more or less frequent bowel movements or even diarrhea or constipation for a few days to a week or more. Sometimes this can be acute and due to clearly identifiable causes, like watery diarrhea due to viral gastroenteritis. At other times these shifts in normal bowel habit may not occur for clearly identifiable reasons.

What is Anxiety-Induced Diarrhea?

Anxiety-induced diarrhea is a term for frequent bowel movements often with watery stool that arises due to nervousness and anxiety. It may occur with any situation or thought that elicits stress, even if a person does not suffer with an anxiety disorder. Usually the diarrhea is acute and resolves after a few bowel movements or once the cause of the anxity eases or is removed.

The term diarrhea specifially refers to having more than three bowel movements in a 24 hour period. However, the term diarrhea may sometimes be used to describe alterations in bowel habit where the stool becomes loose or watery despite it not meeting the strict definition of diarrhea. However, this alteration in bowel habit along with symptoms like abdominal discomfort seems to be directly related to anxiety in order to be referred to as anxiety-induced diarrhea.

Read more on stress diarrhea.

Causes of Anxiety-Induced Diarrhea

Although anxiety may be the cause of diarrhea, it is important to understand how anxiety and other strong emotional states can alter normal bowel habit.

Bowel Motility

Bowel motility is the movement through the digestive tract, and bowels specifically, which is due to the rhythmic contractions of the bowel wall muscles. This muscle action is known as peristalsis. It is necessary to move food, fluids and wastes through the gut. It is also needed for bowel movements. However, sometimes the movement becomes abnormally fast or slow leading to diarrhea or constipation, respectively.

The coordinated contraction and strength of these contractions are controlled by nerves. This nerve stimulation of the bowel muscles is controlled by the autonomic nervous system, which is not under voluntary control. The limbic system which is responsible for emotions can also influence bowel muscle activity. Therefore anxiety may lead to more frequent bowel movements and exacerbate pre-existing diarrhea.

Fluids and Electrolytes

As discussed above, strong emotional states can increase nerve and muscle activity in the bowel wall. This faster movement also means that there is less time for food to be digested and for nutrients to be absorbed. These nutrients can also draw out more water into the bowels. Similarly the rapid transit may also impair water reabsorption in the colon. Stool remains watery and this also contributes to more frequent bowel movement.

Physical Activity

Anxiety may lead to physical restlessness. It is not uncommon for a person to pace around or need to undertake some physical activity as a means of dealing with the anxiety. This in turn can contribute to diarrhea, especially in people who are typically sedentary with an associated history of sluggish bowel movements or constipation. Strenuous exercise may also lead to diarrhea for many of the same reasons discussed above.

Food and Drinks

Anxiety, like any change in emotional state, can affect dietary habits. While some people may experience a loss of appetite and eat less or skip meals altogether, other people may experience the opposite. It is not uncommon for a person to snack excessively or eat foods that are high in calories. This is typically referred to as comfort eating. The alteration in dietary habits can lead to diarrhea.

Stimulants and Other Substances

Caffeine is a widely used stimulant in the form of coffee and tea. It may be consumed in large quantities as a means of coping with anxiety or to stay awake and alert for situations that may be the trigger of the anxiety. There are several ways in which stimulants like caffeine can contribute to diarrhea. An increase in bowel activity is the main way in which this happens. Nicotine may have a similar effect.

Alcohol is a nervous system depressant but alcoholic beverages can irritate the digestive tract. Illicit drugs, which have different mechanisms of action, may have similar effects as caffeine, nicotine and alcohol. Similarly over-the-counter (OTC) and prescription medication can cause diarrhea as a side effect. Nutritional supplements and herbal remedies used during periods of psychological stress may also be responsible for diarrhea.

Diseases and Disorders

Anxiety as well as other types of psychological stress and strong emotions can aggravate or trigger various diseases and disorders where diarrhea may present as a symptom. However, it usually does not cause the condition. The diseases and disorders that may be associated with anxiety and psychological stress includes:

  • Irritable bowel syndrome (IBS)
  • Inflammatory bowel disease (IBD)
  • Celiac disease

Treatment for Anxiety-Induced Diarrhea

Acute diarrhea due to anxiety may not require any specific treatment beyond supportive measures. However, severe acute diarrhea and chronic diarrhea should be treated. Dietary and lifestyle changes are also important a well as psychotherapy in chronic cases to help coping with anxiety. Apart from antidiarrheals for the short term, medication to treat and manage anxiety may also be needed. This includes anti-anxiety drugs, antidepressants and sedatives.

Read more on drugs to stop diarrhea.

Proper hydration is crucial to prevent complications from severe or prolonged anxiety-induced diarrhea. This requires oral rehydration solutions (ORS). If dehydration has set in and is worsening, then intravenous (IV) hydration may be necessary. Stimulants should be avoided altogether or at least minimized. Do not switch to a liquid diet if there is no vomiting. Instead ensure a balanced diet of bland foods to maintain proper nutrition.

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