For some people, just one bad meal can be enough to cause a bout of uncomfortable diarrhea. But what happens if you get diarrhea all the time, even when you haven't eaten any food?
If you've had diarrhea every day but you're not sick (from a virus or infection, for instance), there may be an underlying medical condition causing it. In fact, there are many possible reasons chronic diarrhea happens on an empty stomach, even for days or weeks at at time.
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Here, learn the causes of non-food-related diarrhea that won't stop, how to get relief and when to see a doctor.
If you haven't already been diagnosed with a GI condition and your diarrhea lasts for more than two days, it's worth calling your doctor to get checked out. If you have diarrhea with other symptoms like fever, chills and nausea, go to the doctor as soon as possible. You could have an infection or virus that requires medication.
The Causes of Chronic Diarrhea (When You Haven't Eaten)
If you keep getting diarrhea on and off, even without eating, you could have chronic diarrhea — loose stools that last for more than four weeks, per the Cleveland Clinic.
Here are some potential reasons this could be happening:
1. Irritable Bowel Syndrome
If you've basically been pooping water (even on an empty stomach) you could be dealing with irritable bowel syndrome (IBS).
IBS causes watery stools, diarrhea, abdominal pain, cramping and other uncomfortable symptoms. Sometimes, it can cause constipation, or a mix of constipation and diarrhea, per the Cleveland Clinic.
IBS is called a functional GI disorder (also called gut-brain disorder) because it has to do with our how brains sends signals to our gut. Your brain may tell your colon to contract more often if you have IBS, causing your chronic diarrhea, per the Cleveland Clinic.
Talk to your doctor if you think you might have IBS. Lifestyle changes, like diet changes, exercise and stress management are the first lines of treatment for IBS. But sometimes, you can be prescribed a medication like Bentyl, which relaxes your colon.
2. Bile Acid Malabsorption
When bile acids from your liver are not properly absorbed by your intestines, they build up and cause your colon to secrete more water, resulting in watery diarrhea, per the Cleveland Clinic.
With this type of malabsorption, it can feel like the diarrhea won't stop. You may even have diarrhea for up to a week or more with no other symptoms.
People with the following conditions are most at risk for bile acid malabsorption, per the Cleveland Clinic:
- Microscopic colitis, a type of inflammatory bowel disease
- Crohn's disease
- Post-infectious IBS
- Exocrine pancreatic insufficiency, when your pancreas doesn't make enough enzymes to properly digest food
- Surgical bypass of intestines
- Gallbladder removal
- Radiation or chemotherapy
- Those taking metformin for type 2 diabetes
The first line of treatment for bile acid malabsorption is a class of medications called bile acid binders, like Cholestyramine and colestipol, per the Cleveland Clinic.
3. Hormone Disorders
Sometimes watery diarrhea is a side effect of certain hormonal imbalance conditions like hyperthyroidism or adrenal disorders, per the Cleveland Clinic.
Diarrhea from these conditions does not depend on what you eat, so you could get watery stools on an empty stomach.
Other symptoms of hyperthyroidism (overactive thyroid) include rapid heartbeat, shakiness, weight loss, increased appetite and sleep issues, among others, per the Cleveland Clinic.
Adrenal disorders have to do with the adrenal glands and how they produce the hormones cortisol, adrenaline and aldosterone. Some more well-known conditions include Addison's disease and Cushing's syndrome, per the Cleveland Clinic.
Symptoms can include weakness, extreme fatigue, low blood pressure and patches of darker skin, per the National Institutes of Health (NIH).
Treatment for these disorders may include hormone therapy, certain medications to regulate hormones or surgery to remove the thyroid or adrenal glands, per the Cleveland Clinic.
4. Celiac Disease
If you have yellow diarrhea after not eating (or diarrhea after eating particular foods) you may have celiac disease — a condition where eating gluten leads to damage of the small intestine, per the Celiac Disease Foundation.
Eating gluten when you have celiac can cause so much damage to your gut that you get fatty diarrhea even on an empty stomach. Other symptoms of the disease include: bloating, gas, foul-smelling stool, abdominal pain and nausea or vomiting, per the NIH.
5. Small Intestinal Bacterial Overgrowth (SIBO)
Sometimes an imbalance of "bad" versus "good" bacteria in your gut can cause fatty diarrhea.
One particular condition, called SIBO, is an overgrowth of "bad" bacteria that can stem from a previous infection with the H. pylori bacteria, prolonged use of antacids or recent gastric bypass surgery, among other things, per the Cleveland Clinic.
SIBO is typically treated with antibiotics and then an elimination diet targeting carbohydrates and sugars (i.e., foods that can "feed" the bad bacteria) until your symptoms go away, per the Cleveland Clinic. Your doctor can work with you on an elimination diet plan.
6. Mesenteric Ischemia
This is a rare condition where blood flow is blocked from your intestines, causing abdominal pain and on and off diarrhea.
Mesenteric ischemia can be chronic (where plaques build up in your arteries over time) or acute (where the blockage is constant and there's a severe decrease in blood flow), per Johns Hopkins Medicine.
People most at risk for mesenteric ischemia are those with underlying heart issues like heart disease, high cholesterol, high blood pressure and recent heart attack. Other things like pancreatitis and kidney failure can cause it, too, per Johns Hopkins Medicine.
You'll need to get a few blood tests and scans to diagnose this issue, and treatment is usually surgeries like angioplasty (where arteries are inflated to restore blood flow) or bypass surgery, per Johns Hopkins Medicine.
7. Inflammatory Bowel Diseases (IBD)
Any time your colon is inflamed, you can be at risk for inflammatory diarrhea. This type of diarrhea tends to come out more frequently and in small amounts, whether you've eaten or not, per the Cleveland Clinic. It can even cause you to wake up to poop in the middle of the night.
Some inflammatory conditions that cause chronic diarrhea include the following, per the Cleveland Clinic:
- Crohn's disease: a condition that inflames the intestines, causing cramping, pain, fever and rectal bleeding
- Ulcerative colitis: a condition that causes irritation and ulcers (large sores) in your large intestine that usually start out in your rectum
Treatment for these conditions typically includes certain medications that relax and heal the lining of the intestines (like anti-inflammatories), antibiotics to treat lingering infection and in some severe cases, surgery.
8. Persistent Infections
If you've had chronic diarrhea (with or without other symptoms), it's a possibility you have an infection that just won't go away.
Untreated parasites can cause long-term diarrhea, as well as C. diff infection (or, Clostridioides difficile), a highly-contagious bacteria that often infects people who've recently taken antibiotics, per the Cleveland Clinic.
If your diarrhea has been happening for weeks, ask your doctor to run some tests to see if you have a parasite or lingering infection. They will likely treat you with antibiotics or antiparasitic medications.
9. Certain Medications
Sometimes a medication you're taking for another condition can cause diarrhea as a side effect. Some of these include the following, per the National Library of Medicine:
- Antacids (especially ones with magnesium in them)
- Cough drops with artificial sweeteners, per the Missouri Poison Center
- Drugs to treat heartburn and stomach ulcers (like Prilosec, Nexium, Prevacid and Zantac)
- Immunosuppressants (like methotrexate)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
If your chronic diarrhea doesn't subside while on a certain medication, talk to your doctor about maybe switching kinds or dosage, if possible.
Sugar-free gum and candies can also lead to chronic diarrhea for some people, according to the Canadian Society for Intestinal Research.
What About Malnutrition?
While some people think that malnutrition could cause chronic diarrhea, there is little evidence to support this claim.
More research needs to be done on the subject of malnutrition and its effects on the digestive system to know whether it causes chronic diarrhea.
How Long Does Chronic Diarrhea Take to Heal?
The amount of time it takes diarrhea to heal will depend on the cause.
Acute cases of diarrhea — caused by things like the rotovirus or norovirus — usually take one to three days to resolve, per the Mayo Clinic. But diarrhea from bacteria like E. coli may start one to 14 days after infection and last up to two weeks, per NHS.
If your diarrhea is chronic, caused by parasites, food allergies, IBS, IBD or medications, it may be intermittent and ongoing, meaning recovery time varies greatly. Talk to your doctor about how long it could take to heal, and treatments to help you heal faster.
Can Avoiding Food Fix Diarrhea Quickly?
You may think that avoiding food will help you recover from diarrhea quickly, but this is not completely true.
While it may be helpful to avoid food during bouts of extreme diarrhea, or while you're feeling queasy, fasting over longer periods with chronic diarrhea could actually do more harm than good. You could lose too much weight, or not get enough nutrients needed for your body to function properly, per NHS.
If you're in the middle of a chronic diarrhea flare-up, try eating soft, bland foods to soothe your stomach, like bananas, broths, plain baked potatoes or rice.
Ultimately, if you have an underlying health condition that's causing chronic diarrhea, fasting is not going to cure it long-term. Your doctor needs to figure out your root issue and then recommend you either avoid certain foods or take certain medications.
Treatment for Chronic Diarrhea
The treatment options for your chronic diarrhea will largely depend on what's causing it.
However, there are a few things you can do at home to help ease the discomfort that comes with flare-ups, especially while you're waiting to be properly diagnosed.
Some home and over-the-counter remedies to try include the following:
1. Drink Plenty of Fluids
Because diarrhea can lead to dehydration and electrolyte imbalance, it's important to stay hydrated (with water or drinks like Pedialyte) and restore your salt levels with foods like pretzels or soup, per Beyond Celiac.
Try taking small sips of water throughout the day. Or, try watering down juice to make hydration more appealing.
Ultimately, aim to get anywhere between 11.5 and 15.5 cups of water per day, through drinking and water-rich foods, per the Mayo Clinic.
2. Take an Antidiarrheal
If your doctor gives the OK, taking an over-the-counter antidiarrheal medication like Imodium could help stop your flare and give you some short-term relief, per the Cleveland Clinic.
Just make sure you're not taking Imodium every day for long periods of time, as this could keep you from solving the root cause of your diarrhea.
3. Try Zinc Supplements
Zinc supplementation has been shown to reduce the duration and severity of diarrhea and prevent future diarrhea episodes, according to the World Health Organization.
While it's not exactly known how zinc stops diarrhea, it could be worth trying a daily zinc supplement to see if it clears your symptoms, with your doctor's approval, of course.
4. Avoid Trigger Foods
If you find that your diarrhea is particularly caused by certain foods (especially if you have IBS or lactose intolerance), try avoiding those foods to see if your symptoms go away.
5. Practice Stress-Relieving Techniques
If your IBS is triggered by stress, try different stress-relieving techniques to help calm down your nervous system. This could include deep breathing, meditation, yoga, gentle exercise or talk therapy, per NYU Langone Health.
6. Try Probiotics
Your doctor may recommend taking probiotics to help balance your gut's microbiome, and help keep diarrhea at bay. This is especially helpful while you're on antibiotics, which tend to kill off good and bad bacteria.
7. Take Medication as Prescribed
If you've been prescribed a medication for your underlying GI condition (like Crohn's, ulcerative colitis, etc.) make sure you are taking it consistently and at the proper dosage. This will help keep your symptoms at a manageable level, and hopefully keep diarrhea flares from happening.
When to See a Doctor
Getting diarrhea even without food (i.e., on an empty stomach) is typically caused by an underlying medical condition.
If you've already been diagnosed with a condition that's known to cause diarrhea (and you're being properly treated for it), the best thing you can do is manage flares as much as possible to avoid pain and discomfort.
(Note: If you're being properly treated for your condition, your chronic diarrhea should subside.)
If, however, your diarrhea suddenly worsens and comes with other symptoms like bloody or tarry stool, fever, chills, dizziness, weight loss or symptoms of dehydration, call your doctor, or visit your nearest emergency room. They can run tests to figure out what's going on.
- Cleveland Clinic: "Irritable Bowel Syndrome"
- Cleveland Clinic: "Chronic Diarrhea"
- Cleveland Clinic: "Bild Acid Malabsorption"
- Celiac Disease Foundation: "What Is Celiac Disease?"
- Cleveland Clinic: "Celiac Disease"
- SIBO: "Small Intestinal Bacterial Overgrowth"
- Johns Hopkins Medicine: "Mesenteric Ischemia"
- Beyond Celiac: "Rehydrating After Diarrhea"
- Mayo Clinic: "Norovirus Infection"
- NHS: "Escherichia coli (E. coli)"
- Cleveland Clinic: "C. diff (Clostridioides difficile) Infection"
- National Library of Medicine: "Drug-Induced Diarrhea"
- Merck Manual: "Overview of Malabsorption"
- NHS: "Malnutrition"
- Mayo Clinic Health System: "Tips for drinking more water"
- Johns Hopkins Medicine: "5 Foods to Avoid With IBS"
- NYU Langone Health: "Stress Reduction for Irritable Bowel Syndrome"
- Cleveland Clinic: "Loperamide Capsules or Tablets"
- Harvard Health Publishing: "How to Get More Probiotics"
- World Health Organization: "Zinc supplementation in the management of diarrhoea"
- Mount Sinai: "Psyllium Information"
- National Institutes of Health: "What Are the Symptoms of Adrenal Gland Disorders?'
- NIH: "Symptoms & Causes of Celiac Disease"
- Missouri Poison Center: "Cough Drops"
- Canadian Society for Intestinal Research: "Sugar-Free Gum and Candies"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.