Diarrhea is when you have loose, watery stools or a frequent need to have a bowel movement. It is one of the most common symptoms of IBD.
During an IBD flare, the lining of the intestine becomes inflamed and cannot absorb all fluid. This results in stools being loose and watery, or even entirely liquid. The looser stool can also move more rapidly through the colon, causing more frequent bowel movements.
In general, people who have extensive inflammation of the colon (large intestine) or small intestine are more likely to have persistent diarrhea and urgency, rectal bleeding (bleeding from anus), and abdominal cramping. In ulcerative colitis, blood in the stool is common with diarrhea.
Other causes of diarrhea can include side effects of medications, changes in diet, and infections (e.g., Clostridium difficile, which can arise after use of antibiotics).
It is important to identify the triggers of frequent and persistent diarrhea. Talk to your physician to help determine the cause of your diarrhea, and find out if you need testing for IBD inflammation.
Changing your diet
In terms of diet, it may be helpful if you eat frequent, small meals. Try to sit for at least 15 to 20 minutes after meals, as it can slow down peristalsis – the rate that food passes through the gut.
Some people experience diarrhea after eating foods containing gluten, dairy, spice, fat, or high amounts of fibre. Dairy and fibre can be important to your nutrition, so speak to your physician and dietitian if you need to reduce their intake.
Examples of foods that may produce loose stool include dried beans, corn, raw vegetables, cabbage or spinach, dried fruits or foods that contain high fructose, bacon, processed meats, chips, and fried foods.
Drinks containing fructose, caffeine, alcohol, or carbonation can also trigger diarrhea so try limiting those.
If you are experiencing diarrhea, try to include foods with sodium and potassium daily. Foods that may help control diarrhea include boiled or mashed potatoes (also contains potassium), bananas or banana flakes (contains potassium), rice, noodles or pasta, peanut butter, white bread, and lean meats. Broth can help maintain hydration (it also contains sodium).
Try tracking what you eat, to help identify foods or fluids that may be bothersome and triggering your diarrhea. Check out our MyGut app to help you track your diet and food intake.
It is important to remember that one diet does not fit all people with Crohn's or colitis, and general dietary advice may not work for you. Visit our Diet and Nutrition section for more information.
If tests show your diarrhea is related to inflammation from IBD, medications to control disease activity include aminosalicylates (also called mesalamine or 5-ASA), corticosteroids such as prednisone, immune modifiers, and biologics. Visit our Treatment section for more information.
Other medications may include the antidiarrheal agents, loperamide or diphenoxylate. These help slow motility – movement of contents through your intestines – and increase the absorption of fluids and nutrients. Do not take antidiarrheals during a flare-up without your doctor’s advice, as they may cause further complications.
Fibre supplements, such as psyllium (Metamucil), may be helpful as they mix with water to form a gel, and that reduces looseness as well as frequency.
Talk to your healthcare provider before starting any prescribed or over-the-counter medications for the treatment of diarrhea.
When you are having diarrhea, make sure to drink a lot of water and electrolytes to replace the lost fluid. You may also want to consider drinking an oral rehydration solution to help replenish any lost sugars and salts. These solutions include three main ingredients: water, electrolytes or ‘salts’ which are chemicals your body needs to function normally, and carbohydrates, usually in the form of sugar. Packets of oral rehydration salts are available in pharmacies in most countries.
Signs of dehydration include thirst, less frequent urination, dry skin, persistent fatigue, light headedness, and dark-coloured urine.
Many people with Crohn's or colitis experience an urgency to have a bowel movement that arises frequently during the day. People colitis may also an extremely urgent need to expel feces, and yet, when they try to this this, they discover that they only have a small amount to pass. This is also known as "false urges", and is due to inflammation of the rectum.
Bowel retraining can help to manage urgent or frequent bowel movements. Create a regular time to empty your bowels and find ways to stimulate your bowels to empty more fully.
Another way to manage urgency is practicing pelvic floor exercises to strengthen the muscles around your rectum and anus to improve bowel control.