Nighttime diarrhea: Causes, remedies, and signs

Chronic nocturnal diarrhea, a condition that causes persistent and frequent bowel movements at night, can be a sign of various underlying health issues. This article aims to shed light on the possible causes, symptoms, and treatment options for chronic nocturnal diarrhea.

One common cause of chronic diarrhea is Irritable Bowel Syndrome (IBS), particularly the diarrhea-predominant type (IBS-D). IBS often involves dysregulated brain-gut interactions and low-grade intestinal inflammation, and it can be triggered by stress, infections, or gut flora imbalance. Although IBS can cause significant symptoms, it is generally a functional disorder without structural damage.

Another important cause is Microscopic Colitis (MC), an often under-recognized condition that affects older adults (>50 years) and causes non-bloody, watery diarrhea with urgency, including nocturnal stools and sometimes fecal incontinence. Unlike IBS, MC requires a biopsy for diagnosis and is distinct from IBS.

Chronic diarrhea may also arise from inflammatory bowel diseases, persistent infections, medication side effects, coeliac disease, or even malignancy. Stool tests and colonoscopy are often needed if there are alarming features such as weight loss, bleeding, anemia, or a strong family history of cancer.

The symptoms of nocturnal diarrhea include bloating, fever, interrupted sleep, nausea, stomach pain, the urge to pass stool, and diarrhea itself. It is considered an "alarm symptom" in people with IBS.

Chronic nocturnal diarrhea may have a more serious underlying cause, and individuals experiencing this symptom should seek medical attention. Untreated diarrhea can lead to complications, including dehydration, which can cause loss of electrolytes, muscle weakness, abnormal heart rhythms, lightheadedness, nausea, kidney failure, shock, coma, and additional complications when an underlying disorder is responsible for nocturnal diarrhea.

Treatment options for diarrhea may include taking medications, avoiding problematic foods, changing the diet, managing stress, staying hydrated, reducing the intake of caffeine and alcohol, and undergoing surgery in some cases. The specific treatment depends on the underlying cause of the diarrhea.

In conclusion, chronic nocturnal diarrhea can be caused by functional disorders like IBS but also by organic diseases such as microscopic colitis and coeliac disease that require diagnosis and treatment. When accompanied by warning signs (weight loss, bleeding, anemia, family cancer history), urgent medical evaluation, including colonoscopy, is warranted.

References: [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387414/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440632/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222813/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440632/ [5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440632/

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