Occasional morning diarrhea is normal, and can follow a transient infection of the gut or pregnancy.

But if you find yourself running to the bathroom every morning for extended periods of time, you may have a chronic gut condition, unhealthy lifestyle, or food allergy/sensitivity.

Read on to find more about what could be the cause behind your morning diarrhea and what you can do about it.

Symptoms of morning diarrhea

If your morning diarrhea is due to a chronic gut condition, it may be accompanied by unpleasant symptoms like:

• Bloody stools
• Weight loss
• Fever
• Nausea
• Vomiting
• Abdominal pain

These symptoms can be due a transient bacterial infection of the gut, but they may also be a part of a more insidious underlying gut condition like Inflammatory Bowel Disease (IBD).

If you experience any of these symptoms every morning, it’s time to visit a doctor.

Causes of morning diarrhea

Lifestyle factors

Morning diarrhea can be a result of several lifestyle factors. These include:

• Alcohol. Drinking too much alcohol before bed can irritate the gastrointestinal tract and lead to morning diarrhea.
• Cigarette smoking. Cigarette smoke contains nicotine, which can cause loose stools. If you smoke too much right before sleeping, you can experience morning diarrhea. Smoking is also a major risk factor for Crohn’s disease, which is another (more serious) cause of morning diarrhea.
• Coffee. Too much coffee means a large intake of caffeine, which can stimulate the gastrointestinal tract and cause morning diarrhea. A large breakfast can also send you running to the washroom every morning!
• Snacks. If you tend to snack in the middle of the night, you may experience morning diarrhea.
• Dehydration. Diarrhea can cause dehydration but the reverse is also possible. That’s because dehydration alters electrolyte balance in the body, which is responsible for maintaining the integrity and appropriate permeability of cell membranes. When this balance is upset, too much water may leak out from the gut, leading to diarrhea. Make sure you’re properly hydrated.
• Food poisoning. Food poisoning is a common cause of morning diarrhea. Both bacterial and viral infections can lead to diarrhea, so it’s important to eat food that has been prepared under hygienic conditions. Avoid food that has passed its expiration date.
• Pregnancy. Pregnancy results in massive hormonal changes in the body, which can trigger morning diarrhea.
• Medications. Many drugs (including some antibiotics) cause some type of GI side-effect. This can include loss of appetite, nausea, and diarrhea. If you take your medication before bed, it can lead to morning diarrhea.
• Stress. Your mind has great control over your gut. Emotional stress and anxiety can both trigger morning diarrhea.

Long-term gut conditions

Long-term gut conditions that can lead to morning diarrhea include IBS, IBD, and food allergies. These conditions require medical treatment.

Irritable Bowel Syndrome (IBS)

IBS is a functional gut disorder characterized by recurrent abdominal pain. There are three main subtypes — IBS-D, IBS-C, and IBS-M. Patients with IBS-D and IBS-M can experience regular morning diarrhea, especially during a flare. IBS is often accompanied by other symptoms, including:

• Gas
• Constipation
• Bloating
• Abdominal cramps

Many IBS patients are also lactose intolerant, which means they can’t digest the milk sugar lactose. Lactose is found in many dairy products, and if lactose-intolerant patients consume these at night (or during breakfast), this could lead to morning diarrhea.

Inflammatory Bowel Disease (IBD)

IBD is a long-term, inflammatory condition of the gut. It’s an umbrella term for two diseases — Crohn’s disease and ulcerative colitis.

Crohn’s disease can affect any part of the GI tract, from the mouth to the anus, while ulcerative colitis involves the large intestine only.

In addition to morning diarrhea, IBD can lead to fever, weight loss, fatigue, abdominal pain, and a variety of extraintestinal manifestations like joint pain and eye inflammation.

Just like IBS, IBD also comes and goes and you may experience morning diarrhea during a flare.

Food allergy/sensitivity

Many people are allergic or intolerant to foods like dairy, egg, fruits, and peanuts. If such foods are a regular part of their diet, patients may experience morning diarrhea. The best way to deal with food allergies/intolerance is to eliminate trigger foods from the diet altogether.

How to treat morning diarrhea?

To treat morning diarrhea, you must determine and treat its cause.

Dietary changes are a non-specific treatment and may help with various causes. The goal is to eliminate foods that irritate gut lining. These include fizzy drinks, raw fruits, gluten-containing foods like cereals and pastas, and FODMAPs, which are sugars like lactose.

Eliminating FODMAPs may be especially helpful in patients with IBS because they’ve been shown to trigger IBS symptoms. 

Other IBS treatments include antidepressants (like imipramine and desipramine), anticholinergic drugs (like dicyclomine), and antidiarrheals (like loperamide). Anticholinergic drugs inhibit the nerve supply to the gut and may be especially helpful in reducing bowel spasms.

Managing stress is also an important part of IBS treatment. Yoga, counselling, mindfulness training, meditation, and running are effective ways to deal with stress and may help with morning diarrhea even if you don’t have IBS.

IBD treatment is a bit more complex and involves keeping gut inflammation down. Glucocorticoids are the first-line agents for dealing with inflammation, but your doctor may prescribe additional anti-inflammatory drugs.

These can include mesalamine, cyclosporine, methotrexate, and mercaptopurine. 

If you’re using antiviral or antibacterial medications to treat food poisoning, be aware that some of these may actually worsen your diarrhea. It’s important to talk to a doctor about antibiotics — self-medication with antibiotics is never a good idea.

Finally, if smoking, alcohol, snacking, or eating large breakfasts is causing your morning diarrhea, cutting them down is the best way to go.

Takeaway

Occasional morning diarrhea is normal but long-term diarrhea requires medical work-up.

Morning diarrhea can be due to benign causes like drinking too much coffee and smoking too many cigarettes, but can also be due to more worrisome conditions like IBD.

The treatment for your morning diarrhea will depend upon its cause, so it’s important to obtain a diagnosis for long-term morning diarrhea.

Medically Reviewed by Onikepe Adegbola, MD PhD