Article by Dr Manasa S. BAMS & Dr Raghuram Y.S. MD (Ay)
Stress-induced diarrhea is a common and often distressing symptom that occurs as a result of the body’s natural response to stress and anxiety. When faced with a perceived threat, the body activates its “fight-or-flight” response, a survival mechanism designed to prepare for immediate physical action. This response triggers a cascade of physiological changes, including increased heart rate, elevated blood pressure, and crucially, alterations in digestive processes.
During the fight-or-flight reaction, the body’s resources are redirected away from non-essential functions, such as digestion, to prioritize those necessary for survival. As a result, while digestion in the stomach and small intestine slows, the activity in the colon increases. This imbalance can lead to gastrointestinal symptoms, including diarrhea. In modern times, where stressors are often chronic rather than acute, this response can be triggered frequently, leading to persistent digestive issues.
Understanding the connection between stress, anxiety, and gastrointestinal function is crucial for managing stress-induced diarrhea effectively. By addressing both the psychological and physical aspects, individuals can better manage this condition and improve their overall well-being.
Symptoms
Diarrhea is characterized by loose, watery stools and is often accompanied by abdominal pain, cramping, and an urgent need to empty the bowels. It can be acute, lasting a couple of days, or chronic, persisting for four or more weeks.
Causes
While diarrhea can be caused by various factors, including infections, medications, and certain diseases, anxiety is a significant and often overlooked cause. Anxiety triggers the body’s “fight or flight” response, releasing hormones that affect the gut. This can lead to:
– Increased gut motility
– Imbalance in gut flora
– Inflammatory responses
Mechanism of Anxiety-Induced Diarrhea
The connection between the brain and the gut, known as the gut-brain axis, plays a crucial role in how anxiety can lead to diarrhea. When anxious, the body releases hormones and chemicals that can disrupt the digestive system:
Hormonal Response: Stress hormones such as cortisol and adrenaline can accelerate gut motility, leading to faster movement of contents through the intestines and resulting in diarrhea.
Gut Microbiota Imbalance: Anxiety can alter the gut flora, leading to a chemical imbalance. This imbalance can disrupt normal digestion and absorption processes, causing diarrhea.
Inflammatory Response: Studies have shown that anxiety can increase levels of inflammatory compounds, such as interleukin-1 beta, which can damage the intestine’s protective barrier and impair water and sodium absorption.
Symptoms of Stress-Induced Diarrhea
When stress is the underlying cause of diarrhea, individuals may experience a combination of gastrointestinal and systemic symptoms. These symptoms are part of the body’s response to stress and can significantly impact overall well-being. Common symptoms associated with stress-induced diarrhea include:
Gastrointestinal Symptoms:
– Loose, watery stools: Frequent bowel movements that are loose or watery in consistency.
– Abdominal pain and cramping: Discomfort or pain in the stomach area, often associated with the need to empty the bowels urgently.
Systemic Symptoms:
– Headaches: Tension headaches or migraines may occur as a result of chronic stress.
– Muscle tension: Increased muscle tension, particularly in the neck, shoulders, and back.
– Tiredness: Persistent feelings of fatigue and low energy levels, even with adequate rest.
– Restlessness: Difficulty relaxing or feeling at ease, often accompanied by fidgeting or an inability to stay still.
– Irritability: Increased irritability and a lower threshold for frustration.
– Feeling overwhelmed: A pervasive sense of being unable to cope with daily tasks and responsibilities.
– Sadness or depression: Feelings of sadness, hopelessness, or depression, which may be mild or severe.
– Sleep problems: Difficulty falling asleep, staying asleep, or experiencing restful sleep.
– Change in sex drive: Altered sexual desire, which can either increase or decrease.
Duration of Stress-Induced Diarrhea
Stress-induced diarrhea is generally short-lived, often resolving within two days. Once the stressful situation subsides, the symptoms typically diminish and eventually disappear. However, if diarrhea persists or becomes severe, it’s important to consult a healthcare professional to ensure there are no underlying medical issues contributing to the symptoms.
Management and Treatment
Managing anxiety-induced diarrhea involves treating both the physical symptoms and the underlying anxiety.
Treating Diarrhea
Hydration: Drink plenty of water and consume electrolyte-rich fluids such as fruit juices and soups to prevent dehydration.
Diet: Eat bland, easily digestible foods like rice, pasta, and bananas. Avoid rich, spicy, or fatty foods that can irritate the gut.
Medications: When managing diarrhea, particularly when it is chronic or severe, various medications can be prescribed to alleviate symptoms and address underlying causes. Here are some commonly used medications for treating diarrhea:
Antidiarrheals: Over-the-counter medications like loperamide can reduce the frequency of bowel movements. These should be used cautiously and are not suitable for long-term use or for children.
Antispasmodics: These medications help reduce the frequency of contractions in the muscles of the intestines, slowing down the movement of stool. This can provide relief from diarrhea by allowing more time for water to be absorbed from the stool. Commonly prescribed antispasmodics include:
- Hyoscyamine (Levsin)
- Dicyclomine (Bentyl)
Bile Acid Sequestrants: These medications work by binding to excess bile acids in the intestine, which can otherwise cause diarrhea. By sequestering bile acids, these drugs help to reduce the frequency and severity of diarrhea. An example of a bile acid sequestrant is:
- Cholestyramine (Questran)
Alosetron Hydrochloride: Approved by the Food and Drug Administration (FDA) for the treatment of irritable bowel syndrome (IBS) with diarrhea as the primary symptom, Alosetron hydrochloride (Lotronex) is specifically indicated for use in females. According to the Anxiety and Depression Association of America (ADAA), females are more likely to experience IBS symptoms than males, making this medication particularly beneficial for them.
Key Points to Consider
Medical Guidance: It is crucial to consult a healthcare provider before starting any medication for diarrhea to ensure it is appropriate for the individual’s specific condition and symptoms.
Side Effects: Like all medications, those used to treat diarrhea can have side effects. Patients should discuss potential risks and benefits with their doctor.
Follow Instructions: Patients should follow the prescribed dosage and instructions carefully to achieve the best results and minimize side effects.
Using these medications under the guidance of a healthcare provider can help manage and alleviate the symptoms of diarrhea, improving quality of life for those affected.
Managing Anxiety
Identify Triggers: Keeping a stress diary can help identify and manage specific triggers.
Relaxation Techniques: Practice breathing exercises, meditation, yoga, and other relaxation techniques to reduce stress levels.
Healthy Lifestyle: Regular exercise, a balanced diet, and sufficient sleep can help manage anxiety.
Avoid Quick Fixes: Refrain from using alcohol, tobacco, or other substances to cope with stress, as these can exacerbate anxiety and digestive issues.
Support System: Seek support from friends, family, or a therapist to discuss and manage stressors.
When to Seek Medical Attention
Most cases of diarrhea are harmless and self-limiting. However, medical advice should be sought if:
– Diarrhea persists for more than two days in adults or 24 hours in children.
– There are signs of severe dehydration.
– Stools contain blood, pus, or appear black or tarry.
– Severe abdominal pain accompanies diarrhea.
Anxiety can significantly impact digestive health, leading to symptoms such as diarrhea. Understanding the connection between stress and gastrointestinal function is essential for effective management. By addressing both the physical and psychological aspects, individuals can better manage anxiety-induced diarrhea and improve their overall well-being.
Ayurveda Understanding of Stress or Anxiety Induced Diarrhoea
Ayurveda has explained Bhayaja and Shokaja Atisara amongst the types of atisara – vis-à-vis diarrhoea.
Bhayaja atisara is caused by bhaya – fear. Anxiety is also a type of excessive or abnormal fear. Enormous stress can cause anxiety. Anxiety is the body’s response to stress.
Shokaja Atisara is caused by grief. Too much stress can cause periods of depression or anxiety. Grief is a part of these conditions. Too much grief can build up stress and this stress might cause anxiety. Shoka is said to cause agnimandya – sluggishness of digestive functions and consequent indigestion which in turn can cause diarrhoea.
Manasaha Sadanam – i.e. sluggishness or imbalance of the mind – mental depression or frustration is said to be one of the symptoms of Vataja Grahani which has often been compared to irritable bowel syndrome. Diarrhoea is one of the symptoms of Grahani disease and is associated with a mind component i.e. stress or anxiety / frustration.
Jealousy, fear, anger, greed, grief, humility and hatred are couonted among the mental factors which can cause ajirna i.e. indigestion of food. This can further cause diarrhoea.
In all these conditions, apart from medicines and diet, psychiatric counselling / psychotherapy (sattvavajaya chikitsa) and mind-healing should be included in the treatment of diarrhoea.
Agantuja Atisara – Master Charaka has included bhayaja and shokaja atisara under Agantuja Atisara i.e. exogenous diarrhoeas. He says that the symptoms of these two types of diarrhoea are similar to Vatika or Vataja Atisara – diarrhoea caused by predominant involvement of aggravated vata.
Shoka and Bhaya would cause aggravation of vata instantaneously. Vata alleviating medicines and diet should be administered to treat bhayaja and shokaja atisara effectively. The patient of bhayaja atisara is exhilarated and those suffering from shokaja atisara should be consoled – psychotherapy.
Related Reading – ‘Shokaja Atisara & Bhayaja Atisara’
