Nocturnal Diarrhea: Symptoms, Causes, and Treatment (2024)

Diarrhea, with its urgent, loose, or watery stools, can be unpleasant and worrisome at any time of day. Nocturnal diarrhea occurs when you experience diarrhea at night, with symptoms that awaken you from your sleep.

Nocturnal diarrhea can have many causes and can last from a day or two to more than a month, depending on the underlying reason. In some cases, it is a sign of a serious health condition.

This article will talk about the symptoms, causes, and treatments for nocturnal diarrhea and when you should speak with your healthcare provider about your symptoms.

Symptoms of Nocturnal Diarrhea

Nocturnal diarrhea happens at night and may include the following symptoms:

• Loose, thin, or watery stools
• Urgency in bowel movements
• Bloating
• Abdominal pain
• Nausea
• Fever or chills
• Blood or mucus in stool

Severe diarrhea includes many of the same symptoms but lasts for at least four days and, in some cases, weeks. Severe diarrhea and the conditions that may cause it require treatment, often including fluids because dehydration can occur. Symptoms of dehydration include:

• Excessive thirst
• Lower urinary output
• Dry skin and mouth
• Headaches
• Fast heart rate
• Feeling as though you might pass out

Causes of Nocturnal Diarrhea

Some causes of nighttime diarrhea are similar to those that cause mild daytime diarrhea. These cases are usually acute and tend to go away on their own. They include:

• Infections (viral or bacterial)
• Food poisoning
• Food allergies or food intolerances
• Medications, such as antibiotics

What Medical Conditions Can Cause Nocturnal Diarrhea?

In cases of more persistent or chronic diarrhea, another medical condition may be to blame. Below are some medical conditions that might be a possible cause of diarrhea at night.

Secretory Diarrhea

Secretory diarrhea is a type of diarrhea that occurs when water and electrolytes are increased in the intestinal passage. This results in increased secretion and decreased absorption of water and sodium.

These diarrheas are common. Their causes can include bacterial or viral infections, as well as allergens. The secretory diarrhea also can be a side effect of medication (including antibiotics), or due to the dysfunction of bile acids released from the liver.

Symptoms of secretory diarrhea include high volumes of diarrhea that persist at night.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal tract (GI) disorder in which the muscles in the colon (large intestine) are especially sensitive to certain triggers. Symptoms may include:

• Abdominal pain
• Bloating
• Constipation
• Diarrhea

The severity of symptoms varies from mild to debilitating.Most people with IBS do not experience nocturnal diarrhea, but it can occur. Usually, loose watery stools occur during the day. People with IBS who experience nighttime symptoms, including diarrhea, should contact their healthcare provider for medical attention.

What causes IBS is unclear, however, medical experts think causes may include stress, anxiety, or depression, GI bacterial infections, bacterial overgrowth in the small intestines, food intolerances or sensitivities, or genetics.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) involves chronic inflammation in all or part of your digestive tract and refers to several conditions, including Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC).

The main symptoms of IBD are:

• Diarrhea
• Blood and mucus in the stool
• Abdominal pain
• Unintentional weight loss

Some people with IBD experience nocturnal diarrhea in addition to daytime diarrhea. They may experience severe symptoms at times or have periods of remission when they are getting treatment.

The exact cause of IBD is unknown, though risk factors include having a family history of inflammatory bowel conditions, being a smoker, and taking certain medications, such as nonsteroidal anti-inflammatory medications (NSAIDs).

Microscopic Colitis

Microscopic colitis includes two similar, but separate conditions: collagenous colitis and lymphocytic colitis. This condition causes inflammation of your large intestine that can only be seen by a microscope. It leads to a secretory diarrhea type.

Symptoms of microscopic colitis may include:

• Diarrhea that occurs day or night (even when fasting)
• Fecal incontinence
• Abdominal pain
• Unintentional weight loss
• Fatigue
  

The exact cause of microscopic colitis is unknown, though it is more common in females and in older adults. Other risk factors include having certain immune disorders, being a smoker, or taking certain medications.

Diabetes

Diabetes is a condition in which the body is unable to properly use glucose (sugar), resulting in high blood glucose levels.

Though experts are unsure why it is so common, some people with diabetes may experience diarrhea, including at night, if their blood glucose levels are poorly controlled, and if they depend on insulin. Other medications used to treat diabetes, like Glucophage (metformin) and Precose (acarbose), have been linked to causing diarrhea as a side effect.

Additionally, people with diabetes may be more likely to experience nocturnal diarrhea if they have nerve damage in the GI tract known as diabetic neuropathy.

Other medical conditions that can cause nocturnal diarrhea include:

• Hyperthyroidism (increased function of the thyroid gland)
• Surgical resection of small or large bowel resulting in a decrease in the absorptive surface of the bowel: If the resection in the small bowel is long, it can result in a condition called short gut syndrome.
• Tumors which are rare but can occur in the gastric or endocrine system and lead to diarrhea
  
• Stress and its mental health impacts are closely linked with digestive health, though the relationship is not always well understood. Some studies demonstrate how stress can lead to diarrhea, nausea, and other gastrointestinal symptoms.

How to Treat Nocturnal Diarrhea

In many cases, diarrhea goes away on its own after a few days, usually without any treatment. However, some treatments may be appropriate to help decrease symptoms of mild diarrhea and prevent complications from occurring. These include the following:

Stay Hydrated

As with any type of diarrhea, it’s important to stay hydrated. Drink plenty of fluids at the first signs of diarrhea to prevent dehydration, including water and other beverages that have nutrients and electrolytes (minerals that carry an electric charge), such as sports drinks, fruit juices, and broth.

Foods and Beverages to Avoid

Research has shown that, in most diarrhea cases, restricting your diet does not help to treat it. Additionally, most experts do not recommend fasting when you have diarrhea. However, avoiding certain types of foods and beverages might help, including:

• Alcohol
• Caffeinated beverages and foods
• Drinks and foods containing fructose
• High-fat or greasy foods
• Spicy foods
• Fruits such as apples, peaches, and pears
• Foods and beverages containing alternative sweeteners such as sorbitol, mannitol, and xylitol
• Dairy products containing lactose if you are lactose intolerant or are sensitive to lactose

Medications

Short-term diarrhea usually goes away on its own and does not require any medication. If you are experiencing persistent, chronic diarrhea, talk to your healthcare provider about possible medications to help ease symptoms.

In some cases, medications such as antidiarrheal drugs or antibiotics may be recommended, while other medications might be more suitable if the cause is due to a medical condition.

Manage Stress

Managing stress and anxiety may help reduce diarrhea in some cases. Research has shown that symptoms of IBS, including diarrhea, may be made worse by psychological distress.

Practicing relaxation techniques, meditation, or walking are all examples of how someone might manage stress.

Can IBD Be Treated?

Inflammatory bowel disease can be treated, but the approach will depend on the individual. It also will depend on whether the IBD treatment aligns withCrohn's diseaseorulcerative colitis.

Over-the-counter products, including anti-diarrheal drugs, are used along with prescription medications to treat IBD. Diet and lifestyle changes also are part of a treatment plan. In more serious cases, surgeries like proctocolectomymay be needed.

Can Microscopic Colitis Be Treated?

Treatment for microscopic colitis may be needed in cases where the symptoms don't get better on their own, or changes like stopping the use of NSAIDs haven't worked. Fiber supplements or anti-diarrheal drugs may help.

In more serious cases, antibiotics and other medication options may be considered.

Complications Associated With Nocturnal Diarrhea

Bouts of diarrhea can lead to complications:

• Dehydration (not having as much water as your body needs)
• Unintentional weight loss
• Weakness
• Electrolyte imbalances, (disturbances of the balance of mineral ions in your blood, such as sodium and potassium)

When to See a Healthcare Provider

Seek medical help if you experience any of the following symptoms associated with nocturnal diarrhea:

• Signs of dehydration such as decreased urination, dark or amber-colored urine, extreme fatigue or weakness, extreme thirst, or dry mouth
• Blood or pus in your stool
• Long-lasting or high-grade fever
• Significant abdominal pain
• Diarrhea lasting several weeks

How Is Nocturnal Diarrhea Prevented?

You may be able to avoid episodes of nocturnal diarrhea by taking steps toward prevention, like managing stress and limiting your caffeine intake. You also can avoid foods that you know tend to cause diarrhea symptoms.

Yoga and meditation may help to reduce stress levels related to diarrhea. You also can avoid exercising late in the day (try the morning) and try not eating a few hours before it's time to sleep.

Summary

Nocturnal diarrhea is a condition of loose, watery stools that occurs at night and can disrupt your sleep. It may simply be a bout of mild diarrhea that clears up within a day or two.

Acute, mild cases can often be safely treated at home and will go away on their own. However, if you experience nocturnal diarrhea on an ongoing basis, you may have a serious medical condition.

If your nighttime diarrhea doesn’t go away and you notice other symptoms, contact your healthcare provider to determine the root cause of your health problems. They can provide an accurate diagnosis and help you to find the best treatment for your symptoms and condition.