Diarrhea is a common digestive condition that affects all of us several times in life. Usually it is short lived. Typically diarrhea strikes in bouts that lasts a few days or weeks at the most. These episodes are marked by loose or watery stool that is passed out more frequently than usual throughout the day. However, in some instances the diarrhea only occurs in the morning which may happen for specific reasons. Diarrhea is a symptom of some underlying condition and is not a disease on its own. The key to treating morning diarrhea is to first identify and then treat the causative condition.
Warning: Medical treatment should be immediately sought for large volume diarrhea or where complications like dehydration are evident.
Why does morning diarrhea occur?
Normally bowel activity decreases while asleep as does the activity of many organs and systems. This is a result of the nervous system stimulation of the bowels slowing down during sleep. Furthermore bowel motility is influenced by body motion like during physical activities such as walking or running. Since a person is stationary during sleep, the lack of physical activity further slows down the movement through the bowels. The urge to defecate is also largely suppressed while asleep.
It is therefore not uncommon for a person to feel the urge to defecate upon waking in the morning and returning to regular activity. People with a good bowel training usually find the need to defecate in the morning. However, these bowel movements are usually not diarrhea. When diarrhea strikes in the morning it may be related to the inactivity of the preceding hours while asleep. This allows for water to accumulate in the colon where it should normally be reabsorbed. Continuous bacterial activity within the bowels while asleep may be another factor.
Causes of Morning Diarrhea
A number of causes of diarrhea are discussed below. While most do not trigger morning diarrhea specifically, the changes in the body that occur during sleep and being awake could make the diarrhea more prominent at a specific time in the day.
Diet and Lifestyle
Morning diarrhea could also be related to certain foods, drinks and stimulants that may be consumed upon waking or prior to sleep.
- Breakfast – food can trigger diarrhea for the same reasons as diarrhea after eating.
- Caffeine – morning coffee could trigger diarrhea when the bowels are irritated.
- Nicotine – morning smoking could hasten bowel motility when the bowels are irritated.
- Fruit – fruit sugar (fructose) may trigger diarrhea in people who have food intolerances/malabsorption.
- Alcohol – alcohol intake, especially if excessive, could trigger diarrhea which may only be evident upon waking.
Infectious agents are by far the most common cause of diarrhea. Usually the diarrhea is not limited to the morning. However, the suppression of bowel motility while asleep may temporarily allay the diarrhea until a person awakens. The microbe or the toxins it secretes causes inflammation of the stomach and bowels (gastroenteritis). Most cases of gastroenteritis are viral and last for short periods of time. It resolve son its own usually within a few days. Bacteria and protozoa are other causes while fungal infections of the bowels are rare.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a functional bowel disorder. It appears to occur due to abnormal bowel motility, either it is too fast (diarrhea) or too slow (constipation). There is no clearly identifiable pathology to the symptoms like altered bowel habit and abdominal cramps. A host of foods and lifestyle factors can trigger or exacerbate the symptoms. There is also a psychological component in many cases of IBS where the symptoms worsen during periods of physical, mental or emotional stress which may be more prominent during the waking hours.
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a chronic condition where there is inflammation of the bowels. It is believed to be due to autoimmune factors, where the immune system attacks the bowel tissue thereby causing inflammation. During acute exacerbations, there is usually diarrhea, mucus in the stool, abdominal cramps and pain. There are various factors that can aggravate the condition, including psychological stress, certain foods and alcohol among other triggers.
The rise in hormone levels during pregnancy can lead to a host of symptoms even beyond the female reproductive organs. These hormones are the cause of morning sickness (nausea and vomiting) which is characteristic of pregnancy. In some women the hormones may also cause diarrhea. Since these hormones tend to peak in the morning hours, hence the term morning sickness, it is possible that diarrhea would occur at this time of the day in women who are experiencing pregnancy-related diarrhea.
Diarrhea may be associated with the use of certain medication. If these drugs are taken in the morning, it could lead to diarrhea. Similarly drugs that have worn off by the morning may also be the cause of diarrhea depending on the underlying condition. Antibiotic-associated diarrhea is another common drug-related cause of diarrhea. Sometimes the antibiotics were used for bacterial causes of diarrhea and the antibiotics cause a continuation of the diarrhea.
Treatment of Morning Diarrhea
Morning diarrhea is a symptom. It is therefore important to identify the underlying disease that causes the morning diarrhea and treat it accordingly. The diarrhea should gradually resolve once the underlying condition is appropriately treated as would other symptoms that may be present. Antidiarrheal drugs like loperamide should not be the first option for treatment unless the diarrhea is persistent despite the underlying condition being treated.
Dietary and lifestyle management may be necessary for chronic disorders where diarrhea is present. This may include:
- Avoiding specific foods and beverages that cause or trigger the diarrhea.
- Limiting the use of stimulants like caffeine and nicotine which may aggravate the diarrhea.
- Increasing fiber intake to assist with forming solid stools.
- Managing psychological and stress if it is a contributing factor for the diarrhea.
Prescription medication should never be discontinued if it is suspected to be the causative factor in morning diarrhea unless a medical professional advises doing so.