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Managing Diarrhea When You Have Crohn’s Disease

Medically Reviewed by Minesh Khatri, MD on June 30, 2022

Diarrhea is one of the most common and troubling symptoms for people with Crohn’s disease. How severe it is depends on the person. Your doctor may suggest over-the-counter or prescription medications to treat your condition. There are also steps you can take to manage diarrhea and improve your quality of life. Here’s what you need to know.

What Is Diarrhea?

Diarrhea is when you have loose, runny bowel movements or poop. You might go a little more often or poop so much that you lose important vitamins and minerals. You might also have:

  • A sudden and urgent need to go
  • Blood in your stool
  • Trouble controlling your bowels
  • Belly pain and cramps
  • Weight loss even though you’re not trying to

What Causes Diarrhea When You Have Crohn’s Disease?

Lots of factors can cause Crohn’s diarrhea, and many are linked. One problem leads to another and then another. The main trigger is inflammation. Here’s how it can harm your gut:

Fluid and electrolyte imbalances. As much as 42 cups of fluid enter your intestine every day. Normally, fluids flow freely back and forth through the gut wall, along with nutrients and electrolytes – important minerals like sodium and chloride. Electrolytes help move fluid in and out of your cells. When inflammation affects their function, too much water stays in your gut, and the result is diarrhea.

Damage to the gut lining. Inflammation can damage epithelial cells in the gut lining. This thin layer of tightly packed cells acts as a barrier to keep out toxins and germs while it lets in fluids and electrolytes. When it’s damaged, the proteins that glue the cells together can leak. This allows proteins and bacteria to escape into your body where they cause even more inflammation and worse diarrhea.

Altered microbiome (dysbiosis). The microbiome is the common name for the trillions of mostly friendly bacteria, viruses, and fungi that live on and in your body. Though they’re in every nook and cranny – including between your toes – most are in your gut. These microbes perform functions that are essential for life and health. They help digest your food, make vitamins, and boost your immune system. When antibiotics, a poor diet, smoking, or stress upset the delicate balance of the microbiome, lots can go wrong. Unfriendly bacteria can overwhelm friendly ones. You may also have fewer different types of bacteria (bacterial diversity). This is important because lower diversity is linked to diarrhea that doesn’t go away after your gut has healed. Also, because the microbiome can’t control your immune system the way it normally would, you may have lots more inflammation – and more diarrhea.

Bile acids. Bile is a substance made in your liver that helps digest fats. Your body usually releases the right amount of bile based on the food you eat. If your body produces too much bile or can’t use it correctly, you may develop what’s known as bile acid diarrhea (BAD). It can trigger an urgent need to poop. You might have trouble controlling your urine, too. BAD is common in people with Crohn’s.

How Can I Treat Diarrhea With Crohn’s Disease?

Ask your doctor what you can do at home. Here are some good places to start:

Look at what you eat. If you’ve had Crohn’s for a while, you’ve probably figured out that certain foods make your symptoms worse. Your “forbidden food” list may be different from someone else’s. But many people find it helps to stay away from these foods, especially when you’re in a flare:

  • Whole grains
  • Beans
  • Fruits and veggies high in fiber
  • Nuts and seeds
  • Alcohol and caffeine
  • Dairy
  • Spicy foods
  • Greasy or fatty foods

You may get better results if you try a whole new way of eating. These two eating plans seem to help diarrhea and other Crohn’s symptoms in some people, often in a short amount of time.

Mediterranean diet. This eating plan is all about fruits, veggies, seafood, and healthy fats like olive oil. Most experts think it’s the best way to help Crohn’s as well as many other conditions.

Low-FODMAP diet. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are certain sugars, starches, and fiber in food that can trigger diarrhea, bloating, and gas in people with Crohn’s and other bowel problems. FODMAPS include:

  • Fructose from some fruits and honey
  • Lactose from dairy
  • Fructans from wheat, onions, garlic
  • Galactans from beans, lentils, and soybeans
  • Polyols from sugar alcohols and fruits that have pits, such as cherries, peaches, and plums (berries, pineapples, grapes, and melons are OK)

There’s a steep learning curve with a low-FODMAP diet, and it can be tough to stick to. But a strict low-FODMAP approach might help heal your gut. If you want to try it, it’s best to talk to a dietitian who can make sure you’re getting the right nutrients.

Acupuncture. This 3,000-year-old healing art is mainly known in the West for pain relief, but it also treats a wide range of health problems. In studies of Crohn’s, it’s been shown to:

  • Lessen disease activity
  • Lower inflammation
  • Relieve belly pain and diarrhea
  • Stop weight loss
  • Balance fluids and electrolytes
  • Improve gut barrier function
  • Help balance the microbiome
  • Greatly improve quality of life

Look for a licensed acupuncturist (LAc, OMD, or both) who has experience with GI problems.

Stress relief. Stress takes a toll on every part of your body, especially your gut. If you already have Crohn’s symptoms, stress makes them worse. If your disease is under control, stress can cause it to flare. The worst part is that having bloody diarrhea and pain is stressful in itself. Yet research suggests that stress relief can help even severe Crohn’s symptoms. Many people benefit from mind-body techniques, such as breathing or meditation. But spending time in nature or at a dance club might be more your style. The best advice is to take note of when you’re stressed and find a healthy way to relax as soon as possible. The longer stress goes on, the more damage it does.

Probiotics. Like many people with Crohn’s, you may already have tried probiotics. These are live organisms like bacteria or yeast that are good for your gut. They’re available in supplements and some types of yogurt. They may help balance your microbiome by curbing the number of harmful bacteria. And they may rein in an out-of-control immune system.

Studies of probiotics for Crohn’s disease have been mixed. This is likely because different studies use different types of probiotics. If you want to try them, ask your doctor first. If they give the green light, you might have to sample a few to find one that helps. Go slow at first and give it time to work.

Show Sources

SOURCES:

Gastroenterology Clinics of North America: “Diarrhea in Chronic Inflammatory Bowel Diseases.”

Scandinavian Journal of Gastroenterology: “Evaluation of the efficacy of octreotide LAR in the treatment of Crohn’s disease associated refractory diarrhea.”

Drugs.com: “Loperamide.”

Clinical Gastroenterology and Hepatology: “Chronic Diarrhea: Diagnosis and Management.”

Tissue Barriers: “Pathophysiology of IBD associated diarrhea.”

Gut and Liver: “Bile Acid Diarrhea: Prevalence, Pathogenesis, and Therapy.”

Expert Review of Gastroenterology & Hepatology: “The intestinal barrier: A fundamental role in health and disease.”

Cleveland Clinic: “Leaky Gut Syndrome,” “What Not to Eat If You Have Crohn’s Disease.”

The Journal of Allergy and Clinical Immunology: “The microbiome and inflammatory bowel disease.”

Clinical Gastroenterology and Hepatology: “Persistent Diarrhea in Patients With Crohn’s Disease After Mucosal Healing is Associated With Lower Diversity of the Intestinal Microbiome and Increased Dysbiosis.”

Gut and Liver: “Prevalence, Pathogenesis, and Therapy.”

Nutrients: “Diet Advice for Crohn’s Disease: FODMAPs and Beyond.”

Crohn’s and Colitis Foundation: “Acupuncture in Inflammatory Bowel Disease.”

Inflammatory Bowel Diseases: “Acupuncture in Inflammatory Bowel Disease.”

Cureus: “Stress and Inflammatory Bowel Disease: “Clear Mind, Happy Colon.”

Mayo Clinic: “Diarrhea.”

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