Constipation After Diarrhea – Causes and Treatment

Constipation seems like the farthest possibility during and just after diarrhea. In fact it can at times be a welcome relief after diarrhea but constipation is equally disturbing in its own right. There are many reasons why constipation is more likely to arise after diarrhea in some people. Sometimes it is directly related to the various therapies used to remedy diarrhea. However, if constipation persists for weeks or months after an acute bout of diarrhea, then it should be considered separately and is possibly unrelated to the preceding diarrheal illness.

It is important to understand why and how diarrhea occurs in order to further understand why constipation may occur afterwards. Firstly there are many possible causes of diarrhea. Most cases of acute diarrhea are due to infections, like viral gastroenteritis, or with exposure to microbial toxins as is the case in food poisoning. Even irritation of the bowels caused by everyday foods can cause diarrhea. Sometimes diarrhea is due to an acute flareup of a chronic bowel condition like with inflammatory bowel disease (IBD).

Secondly, diarrhea can occur as a result of different mechanisms. It may be a result of rapid bowel movement when the gastrointestinal tract is hyperactive even in the absence of any irritation of the intestinal walls. Then it may be due to excess water in the bowels either because there s high solute concentration in the bowel lumen drawing out water, or the body pushes out more water into the lumen than it reabsorbs. Lastly diarrhea can occur when the bowel walls become irritated and inflamed often due to an infection.

Chronic diarrhea is rare. Most of the time diarrhea is acute in nature meaning that it arises suddenly, is intense and resolves a short period thereafter. Often treatment is not necessary for the diarrhea apart from supportive measures like rehydration and bed rest. Resolution of the diarrhea is often followed a stabilization of bowel movements within a few days. However, if other extremes of bowel habit arises like constipation, then intervention may be necessary.

Causes of Constipation After Diarrhea

The exact causes of constipation after diarrhea may not always be easy to identify. Even with measures to counteract possible causes, the constipation assists. However, it should be short-lived lasting for a few days at most. The more likely reasons for constipation of diarrhea may include:

  • Lack of bulk in the bowels as all solid material is evacuated during the course of diarrhea. This is further compounded by not eating solids during diarrhea or significantly restricting meal size as a result of the diarrhea.
  • Repetitive use of antidiarrheal medication, especially in high doses. This can reduce normal bowel motility and prevent the anal sphincter from relaxing to open during the course of a normal bowel movement.
  • Inadequate water content within the bowels usually related to the preceding diarrhea that often leads to dehydration. It is well known that insufficient water in the bowel lumen is a major contributor to constipation even without the backdrop of diarrhea.
  • Alterations in the bowel bacteria populations (normal intestinal flora). Often with diarrhea the “good” bacteria reduced and “bad” bacteria set it. Once this is resolved the normal intestinal flora may take some time to restore.
  • Certain chronic conditions where diarrhea and constipation may alternate, like in mixed-type irritable bowel syndrome (IBS) where there are episodes of constipation followed by diarrhea and vice versa. It may also occur in inflammatory bowel disease (IBD).
  • Hemorrhoids and similar complications can arise with diarrhea. This can lead to anxiety about defecation due to the pain and bleeding that may occur. In these cases the constipation are due to psychogenic causes.

There are many other causes of constipation which may be unrelated to diarrhea. The constipation may simply be exacerbated after a diarrheal illness. The measures below may still be relevant to constipation that is not associated with diarrhea but it is important to seek medical advice.

Treatment for Constipation After Diarrhea

Usually the constipation will resolve spontaneously within a few days and no specific treatment is required. However, if it is severe or persistent then a few simple measures can help. Laxative should be avoided and only considered if a doctor approve this approach. While some steps like avoiding anti-diarrheal medication is obvious in order to restore normal bowel habit, some of the other remedies may be less so yet equally effective. Always speak to a doctor if the symptoms do not resolve.

Increase Fluid Intake

This is the first and foremost step. Not only may it help to restore normal bowel motility and ease constipation, but it can also help to remedy dehydration that may be lingering from the diarrhea. Drinking large amounts of plain water can lead to problems, from a recurrence of diarrhea to ‘water logging’. Therefore rehydration needs to be done gradually and with the use of oral rehydration solutions (ORS). Maintaining a normal water intake of 68 ounces daily (about 2 liters) is sufficient and should be consumed gradually throughout the day.

Consume More Fiber

Fiber is essential for bulking up stool by absorbing water in the gut. This can help with stabilizing bowel motility and eventually restoring normal bowel habit. Fiber supplements are not immediately required. Simply eating high fiber foods will suffice. This includes fresh fruit, crunchy vegetables and bran cereal among other foods. It should be incorporated into a balanced diet and it is important that sufficient water is also consumed.

Partake in More Physical Activity

Physical activity plays an important role in maintaining normal bowel motility and expediting the movement of the bowel content. Therefore constipation is more often seen with a sedentary lifestyle. Do not undertake strenuous physical activity immediately as the body may still be recovering from the diarrheal illness even if the diarrhea has stopped. A brisk walk or swimming a few laps may suffice in assisting with bowel motility without causing undue strain.

Include Probiotic Yogurt in the Diet

Restoring the normal bowel bacteria may at times require outside intervention in the form of probiotic supplements or live culture yogurt. It should be consumed in small quantities on a frequent basis. A large intake of dairy can at times trigger diarrhea which should be avoided.  Supplements may often be the better choice as these capsules contain spores of the bacteria and fungi that constitute the good bowel microbes. These spores germinate in the bowel and restore the normal microbial population within days.

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