Can Stress Cause Diarrhea?

Many people often think of diarrhea only as a sickness, but stress and anxiety can also cause diarrhea. You might "stress poop" from time to time, such as before giving a big speech or running a race. Stress is a normal reaction to situations that make you nervous, and it may cause gastrointestinal (GI) symptoms. Your gut has millions of nerve cells that are sensitive to mood changes.

Not everyone gets the nervous poops, so why is it that some do? Read on to learn how stress can cause diarrhea and ways to prevent it.

What Is Stress?

Stress is your body's reaction to a situation or thought that brings up negative feelings like anger or nervousness. The "fight-or-flight response" is your body's reaction to stress. Your body releases stress hormones, such as adrenaline and cortisol, into your blood. As a result, your blood pressure, blood sugar, and heart rate increase.

Those changes give you the energy to engage with a stressor, such as an approaching due date at school or work. Some people have long-term (chronic) stress. Your body will frequently prime itself for stress, even without a perceived danger.

Long-term stress may cause complications like:

• A weak immune system
• Frequent headaches
• GI distress
• Persistent feelings of anger and sadness
• Poor sleep quality

You might develop long-term stress after a traumatic event, such as an accident, natural disaster, or war. That's known as post-traumatic stress disorder (PTSD).

Why Can Stress Cause Diarrhea?

The "brain-gut connection," or the enteric nervous system, is like a "little brain" in your gut. The enteric nervous system connects to, but is separate from, your central nervous system. Your gut contains about 100 million nerve cells, which help control digestion.

Research has shown that the "big brain" in your skull constantly communicates with the "little brain" in your gut. Your mood may affect your stomach, and gut problems may affect your mood. Stress activates nerve cells that contain corticotropin-releasing factor (CRF). Corticotropin is a hormone that links to how much cortisol is in your body at any given time.

People react differently to an extra wave of stress hormones in their gut, Carolyn Newberry, MD, a gastroenterologist at Weill Cornell Medicine, told Health. Some people have diarrhea, while others have constipation. You might have bloating, nausea, stomach pain, or a mix of symptoms.

Those symptoms are part of your body's flight-or-fight response. Stress hormones make food move more quickly through your gut than normal. Your body prioritizes shunting energy to your muscles when it perceives danger. As a result, your body shuts down bowel movements.

Your colon does not have enough time to absorb water from food waste when it starts back up, Lisa Ganjhu, DO, a gastroenterologist at NYU Langone Health, told Health. Too much water leads to loose, watery stools.

Risk Factors

There's a chance that a nervous stomach points toward an underlying health problem. Of note: Not everyone who has stress-induced diarrhea has an underlying gut disorder, like inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).

IBD causes inflammation of the GI tract, resulting in bleeding and ulcers. The exact cause of IBS is not known. Some evidence suggests that a sensitive enteric nervous system results in cramps, constipation, and diarrhea.

There are strict criteria for an IBS diagnosis, said Dr. Ganjhu. You must have at least three days per month for three months with two or more symptoms, including:

• Abdominal pain that goes away after a bowel movement
• Changes in how frequently you have bowel movements
• Changes in the appearance of your stool

You likely do not have IBS if your stress-induced diarrhea is less frequent than that. Still, IBS and other gut disorders can certainly cause a sensitive stomach during stressful times.

How To Treat Diarrhea Caused by Stress

You can typically treat stress-induced diarrhea at home with diet changes, fluids, and over-the-counter (OTC) medicines. Treatments include:

• Eating bland foods: These include bread, crackers, and pasta. Make sure you transition back to a balanced, nutrient-rich diet when your stomach feels better.
• Replenishing lost fluids and electrolytes: Drink plenty of water, fruit juice, salty broths, or sports drinks to prevent dehydration. Avoid caffeine—including coffee, energy drinks, and soda—which may worsen symptoms.
• Taking medicine: Imodium (loperamide) and Pepto-Bismol (bismuth subsalicylate) treat diarrhea. You might need other medicines, such as an antibiotic or laxative, if you have an underlying GI disorder.

How To Prevent Stress-Induced Diarrhea

Keeping stress-induced diarrhea at bay has a simple answer that's not so simple to achieve: Avoid stress. Try working on coping mechanisms that help you deal with stress and anxiety.

Ways to manage stress include:

• Accept the things you cannot control: You might not be able to change your workload. Still, you can look for ways to relax while working, like breathing exercises.
• Avoid stressful situations if possible: Remove yourself from situations that give you anxiety. Learn how to say no to others and set limits.
• Eat a balanced diet: Limit sugary food. Instead, increase your intake of fruits, lean proteins, low-fat or nonfat dairy, vegetables, and whole grains.
• Get a good night's rest: Seven to nine hours per night are essential to give you enough energy and help your body reset.
• Make time for your hobbies: Hang out with family and friends, listen to relaxing music, read a book, or watch your favorite TV show.
• Practice relaxation techniques: Deep breathing, meditation, and yoga help lower your blood pressure and heart rate if you are stressed.
• Stay active: Regular physical activity—about 30 minutes per day, five days per week—helps you release energy. Exercise also releases chemicals that improve your mood.
• Try to focus on positive thoughts: This is, of course, easier said than done. If you're having negative thoughts, take time in your day to try to focus on some positive thoughts, too.

Some behavioral changes might help, especially if your typical response to stress is to do things that worsen diarrhea. Those behaviors include drinking coffee or eating fatty or sugary foods. You might adjust your diet if you anticipate a stressful situation. Focus on soluble fibers, like plain oatmeal, apples, and bananas.

When To Contact a Healthcare Provider

Consider seeing a healthcare provider if you notice differences in your gut health. You likely will not get sick from stress-induced diarrhea. Still, frequent diarrhea might point to an underlying health problem like IBD or IBS.

Talk to a healthcare provider right away if you have severe symptoms like:

• A fever of 102 degrees or higher
• Bloody stool
• Dehydration
• Diarrhea that lasts longer than two days or, in children, 24 hours
• Severe abdominal and rectal pain
• Stool that is black and tar-like or has pus

Those symptoms may indicate a more serious gut illness. Otherwise, a nervous stomach is not something to worry too much about.

A Quick Review

Stress and anxiety are common causes of diarrhea. Diarrhea may occur as a result of your body's fight-or-flight response, which releases stress hormones that affect your gut. Minimizing your stress levels helps prevent stress-induced diarrhea. Avoid stressful situations if you can, and practice relaxation techniques that help calm you down. 

Drink plenty of fluids and pay attention to your diet if you have acute diarrhea. Caffeine and sugary foods might worsen your symptoms. Instead, opt for fiber-rich options like fruit and plain oatmeal. Consult a healthcare provider if you have abdominal pain and frequent diarrhea or other severe symptoms like bloody stool.