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What causes diarrhea in the middle of the night?

Nocturnal diarrhea refers to diarrhea that happens at night. Chronic nocturnal diarrhea can be a sign of a more serious health condition, such as diabetes, a bowel disorder, or an infection.

Persistent diarrhea can also interrupt sleep and affect the quality of life. Treatment depends on the severity of the symptom and its underlying cause.

Diarrhea is defined as loose, watery stools. It may be acute and last for a few days, or it can be chronic and continue for 4 or more weeks. In this article, we discuss the possible causes of nocturnal diarrhea and how to treat them.

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What are the symptoms?

Anxious woman in bed at night due to nocturnal diarrhea
Symptoms of nocturnal diarrhea may include fever and stomach pain.

Nocturnal diarrhea symptoms commonly includes the following:

  • bloating
  • fever
  • interrupted sleep
  • nausea
  • stomach pain
  • the urge to pass stool

Symptoms range from mild to severe, and they will also typically be present during the day. People with mild diarrhea often experience symptoms for just a few days, and these can usually be managed with home remedies.

Serious cases of diarrhea can cause additional symptoms, such as:

  • blood in the stool
  • severe pain
  • otherwise unexplained weight loss

Diarrhea that occurs several times a day for a month or longer is classed as chronic.

Long-term nocturnal diarrhea may also lead to sleep problems, which can affect mood and energy levels.


Diarrhea may be caused by:

  • allergies
  • foods
  • infections
  • medications
  • stress

If any of these factors are responsible, nocturnal diarrhea typically clears up once the infection is treated or the trigger is eliminated.

However, chronic nocturnal diarrhea is likely to have a more serious underlying cause, such as:

Secretory diarrhea

toilet roll hanging in a toilet
Causes of diarrhea may include foods, infections, and stress.

Secretory diarrhea occurs when the intestine cannot properly absorb electrolytes. This is a common cause of both acute and chronic diarrhea.

Secretory diarrhea can result from:

  • alcoholism
  • bacterial toxins
  • medications
  • intestinal surgery
  • other medical problems that interfere with intestinal function

Irritable bowel syndrome (IBS)

IBS is a functional disorder, which means that the digestive tract seems to be regular but does not function correctly.

Symptoms include:

  • bloating and gas
  • diarrhea
  • constipation
  • mucus in the stool
  • stomach pain and cramping

Most people with IBS do not experience nocturnal diarrhea or severe symptoms. Typically, watery stools occur during the daytime, often after eating.

Nocturnal diarrhea is considered an “alarm symptom” in people with IBS. This means that it requires prompt medical attention.

Other alarm symptoms include:

  • blood in the stool
  • progressive pain
  • unexplained weight loss

Inflammatory bowel disease (IBD)

IBD refers to several chronic conditions that cause inflammation of the gastrointestinal tract. Up to 1.6 million people in the United States experience IBD.

IBD causes inflammation, unlike IBS. It also leads to changes in the gut that can increase the risk of bowel cancer.

Some people with IBD experience nocturnal and daytime diarrhea. Other symptoms include:

  • blood or mucus in the stool
  • fatigue
  • fever
  • loss of appetite
  • nausea
  • pain during bowel movements
  • stomach pain and cramps
  • vomiting
  • weight loss

The exact cause of IBD is unknown, though risk factors include having a family history of bowel conditions, being a smoker, and taking certain medications.

Most people with IBD are diagnosed before the age of 30.

Microscopic colitis

Microscopic colitis causes inflammation of the large intestine and leads to persistent diarrhea. The inflammation associated with this condition can only be observed using a microscope.

Older adults are more commonly affected by microscopic colitis, but anyone who continues to experience nocturnal diarrhea, even when fasting, should be tested for this condition.

Other symptoms include:

  • fecal incontinence
  • nausea
  • stomach pain and cramping
  • weight loss

The cause of microscopic colitis is unknown, but taking nonsteroidal anti-inflammatory drugs for 6 months or longer may increase the risk of developing it.


Diabetes affects the way the body uses glucose, which is sugar in the blood. Unless treated, it causes high levels to build up in the blood, which can lead to several complications.

Individuals with poorly controlled diabetes and insulin-dependency are at risk for nocturnal diarrhea. It may also affect those with nerve damage caused by diabetes, which is known as diabetic neuropathy.

Diabetes symptoms include:

  • blurred vision
  • fatigue and irritability
  • frequent infections
  • increased hunger
  • increased thirst
  • unexplained weight loss
  • slow-healing wounds
  • urinary frequency

The cause of diabetes varies and depends on the type. Type 1 diabetes is linked to an overactive immune system, while type 2 occurs when the cells become resistant to insulin, a hormone.

Gestational diabetes affects some people during pregnancy.

What are the treatment options?

Mild diarrhea can clear up on its own within a few days. During this time, the focus of treatment is to alleviate symptoms and keep a person hydrated.

Severe or chronic diarrhea should be reported to a doctor, who will investigate the underlying cause and formulate a treatment plan.

Some treatment options may include:

  • taking medications, such as antidiarrheal drugs and antibiotics
  • avoiding problematic foods, medications, or allergens
  • changing the diet, for example by eating more bland foods and avoiding high-fiber and fatty foods
  • managing stress through relaxation techniques and a healthful lifestyle
  • staying hydrated, with water, juices, and clear broths
  • reducing the intake of caffeine and avoiding alcohol

Underlying conditions that contribute to nocturnal diarrhea will also require treatment.

What if it is IBD?

IBD cannot be cured, so treatment aims to reduce symptoms and achieve and maintain periods of remission.

Medications for IBD include anti-inflammatory drugs, immune suppressors, and therapies that target inflammation.

In some cases, surgery is needed to widen a narrow bowel or remove damaged parts of the digestive tract.

How is microscopic colitis treated?

Discontinuing medications that cause problems and making dietary adjustments can treat persistent or severe cases of microscopic colitis.

If these approaches do not work, anti-inflammatory drugs and medicines that block bile acids can be used.

In rare cases, a surgeon will need to remove part or all of the colon.

Methods of prevention?

Eating in bed late at night
To prevent mild diarrhea., it is recommended not to eat for 2 to 3 hours before bed.

Mild diarrhea is a common experience. It may be possible to reduce the frequency and severity of diarrhea episodes by trying the following:

  • making dietary adjustments and eliminating problematic foods
  • avoiding IBS or IBD triggers
  • not eating for 2 to 3 hours before bed
  • quitting smoking
  • establishing a healthful sleep routine
  • managing stress with meditation, exercise, and deep breathing techniques
  • maintaining a healthy weight
  • following the treatment plan prescribed for chronic conditions, such as diabetes

Type 1 diabetes is treated with insulin injections or an insulin pump. A person must also check blood sugar levels frequently and monitor their intake of carbohydrates.

Type 2 diabetes can be managed with lifestyle changes, blood sugar monitoring, and medications.


Untreated diarrhea can lead to complications, including dehydration.

Dehydration can cause:

  • loss of electrolytes
  • muscle weakness
  • abnormal heart rhythm
  • lightheadedness
  • nausea
  • kidney failure
  • shock
  • coma

When an underlying disorder is responsible for nocturnal diarrhea, additional complications can arise. For example, untreated diabetes may lead to vision loss or nerve damage.


Nocturnal diarrhea may clear up in a few days or become chronic. The outlook typically depends on the underlying cause.

A person should see a doctor right away if they also have any of the following:

  • symptoms of dehydration
  • blood or mucus in the stool
  • a high or persistent fever
  • other symptoms that suggest a more serious condition

If symptoms persist for more than a few days, it is important to see a doctor for a diagnosis.

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