Diarrhea is a symptom sometimes experienced with alcohol withdrawal. During detox, alcohol’s effects on the digestive tract and stress responses in the body can cause diarrhea.
Key Facts
- In chronic, heavy alcohol users, alcohol withdrawal-related diarrhea can be severe and lead to life-threatening consequences.
- Infections, underlying disease and certain medications can prolong diarrhea symptoms.
- Diarrhea can lead to severe dehydration, which must be treated promptly to avoid serious complications.
- There are steps you can take at home to treat mild to moderate alcohol withdrawal-related diarrhea.
- Supervised detox treatment should be considered when co-occurring medical or mental health conditions are involved.
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What is Alcohol Withdrawal-Related Diarrhea?
Alcohol-related diarrhea is a symptom sometimes associated with alcohol withdrawal syndrome (AWS), which describes symptoms that occur following the reduction or cessation of regular, heavy alcohol use.
AWS symptoms are often mild, including gastrointestinal issues such as nausea, vomiting and diarrhea.
However, fluid loss from vomiting or diarrhea during AWS can lead to dehydration, which, in severe cases, may require hospitalization.
In addition, electrolyte imbalances experienced due to dehydration can increase stress hormones and worsen other AWS symptoms, including anxiety, sweating, and shakiness.
Is Diarrhea Normal During Alcohol Withdrawal?
Diarrhea is a common symptom during alcohol detox. However, it is not experienced by everyone who detoxes from alcohol.
How Does Alcohol-Related Diarrhea Differ from Other Forms of Diarrhea?
Diarrhea from a hangover or an illness is usually caused by irritation of the gastrointestinal lining.
Alcohol-related diarrheais mainly caused by alcohol’s effects on the digestive system, including irritation of the stomach and intestines, faster movement of food through the gut, and changes in fluid absorption.
Hangovers usually resolve within one day. They do not produce the progressive features of AWS, such as agitation or confusion.
Food-borne illnesses produce different symptoms than AWS, including fever and abdominal cramps. The presence of blood or mucus in diarrhea may indicate infection and the need for medical attention.
Why It Happens
Autonomic Rebound & GI Motility After Stopping Alcohol
“Autonomic rebound” refers to a compensatory adjustment of chemical neurotransmitters in the brain that occurs after the sudden withdrawal of alcohol.
Heavy alcohol use causes over-stimulation of the GABA neurotransmitter associated with inhibition, and under-stimulation of the glutamate neurotransmitter associated with excitation.
The body compensates for these changes by reducing the activity of GABA and increasing the activity of glutamate. This “rebound” effect leads to hyperactivity of the nervous system that can cause symptoms of anxiety, agitation, and tremors.
The autonomic rebound effect also leads to increased gut motility (muscle contractions that move stool through the intestines) and the production of secretions that contribute to loose stools and bowel urgency.
Stress hormones and poor nutrient absorption can also contribute to increased stool volume and bowel frequency.
Microbiome Changes and Intestinal Barrier Injury
Excessive alcohol use can disturb the body’s microbiome, the internal environment of bacteria and other microorganisms that affect digestion and intestinal function.
This disturbance leads to intestinal bacteria becoming imbalanced, causing diarrhea or other gastrointestinal issues.
Inflammation of mucus membranes in the gut can lead to intestinal permeability issues, called leaky gut, where bacteria and toxins are able to move into the bloodstream.
Chronic alcohol use can also lead to bile acids being incompletely absorbed, which along with irritation in the colon, may trigger watery stools and diarrhea during early recovery.
Timeline & Duration of Alcohol Withdrawal-related Diarrhea
When it Starts, When it Peaks and How Long it Usually Lasts
In alcohol-dependent individuals, withdrawal-related diarrhea often begins within the first day of the last drink. It then peaks around day 2-3.
How Long Does Withdrawal-Related Diarrhea Typically Last?
Alcoholwithdrawal-related diarrhea usually improves over several days. If diarrhea persists beyond 1-2 weeks, you should seek medical attention to evaluate whether there are other causes for the diarrhea.
Heavy or prolonged alcohol use, infections, irritable bowel syndrome, pancreatitis, liver disease, certain medications or a poor diet can prolong alcoholwithdrawal-related diarrhea symptoms.
Risks, Dehydration & Red Flags: When to Get Help
Dehydration occurs when the body expels more fluid than it takes in.
Signs of and dehydration and electrolyte imbalance include:
- Thirst
- Dry mouth or throat
- Dark urine
- Fatigue
- Reduced urination
- Dizziness or orthostasis (where a sudden drop in blood pressure upon standing causes lightheadedness
Muscle cramps or palpitations (rapid, irregular heartbeat) suggest low potassium or magnesium levels. If levels go too low and other symptoms like confusion, loss of consciousness, or seizures occur, seek medical care.
Risks of Dehydration
Elderly individuals and those with cardiac or kidney disease are at higher risk for dehydration, as well as those experiencing vomiting or an inability to keep fluids down.
Red flags Indicating A Need for Urgent Care
Emergency treatment is indicated in the case of:
- Bloody or black, tarry stool
- Severe or localized abdominal pain
- Persistent vomiting
- High fever
- Jaundice (yellowish skin color)
Also seek emergency treatment for signs of delirium tremens (DTs):
- Confusion
- Hallucinations
- Seizures
- Irregular heartbeat
- Chest pain
Symptom Relief at Home (What Actually Helps)
There are things you can do at home to relieve diarrhea symptoms.
Hydration Game Plan
- Rehydrate: Oral hydration solutions (ORSs) such as Pedialyte or Rehydralyte, provide a balance of sodium and glucose that improve absorbency of water and electrolytes in the intestines.
- These products can be purchased at drug stores or major online retailers. Take frequent, small sips of an ORS and track your urine output.
- Avoid alcohol, caffeine and high-sugar drinks that can increase diarrhea.
- Avoid sports drinks like Gatorade, unless ORSs are unavailable, as these contain a lower concentration of sodium and other electrolytes.
- Over the counter antidiarrheal medications like Imodium may be helpful if there is no fever or bloody stool present.
Make sure to strictly follow dosing recommendations. Do not use antidiarrheal medications if you have liver disease or suspect you may have an infection.
Food and Early-Recovery Gut Care
When experiencing diarrhea:
- Start by eating bland, low residue foods like applesauce, white toast, white rice, and cooked vegetables without seeds or skin (ex: carrots, green beans). Bland foods are easy to digest and help firm stool, reducing bowel movements. Soluble fiber foods like oats or psyllium supplements can be added, along with protein, as tolerated.
- Avoid greasy or spicy foods, artificial sweeteners and high-lactose foods and drinks (ex: soft cheese, ice cream, yogurt, milk).
- Consider short-term use of probiotics (ex: lactobacillus or bifidobacterium). Use these cautiously, according to directions.Avoid probiotics in cases of severe illness or if you are immunocompromised.
Professional Treatment & Safe Detox
Who Needs Supervised Detox?
Supervised detox, via inpatient or outpatient treatment, should be considered in cases of:
- Prior withdrawal with DTs or seizures
- Severe withdrawal symptoms
- Polysubstance use
- Older age
- Pregnancy
- When limited support is available
- Comorbid illnesses, such as diabetes or liver, pancreas or heart disease, are present
Inpatient settings (hospitals, clinics) provide 24/7 supervision and monitoring in a controlled environment. Inpatient detox is advisable for people with histories of heavy alcohol use or co-occurring mental health disorders.
Outpatient detox provides more flexible scheduling and easier options for managing home and family life. Outpatient treatment is usually less expensive than inpatient care.
How Clinicians Manage AWS
Clinical treatment of alcohol withdrawal syndrome involves:
- Evidence-based assessments, using the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) appraisal tool
- CIWA-Ar-guided treatment plan and interventions, with regular evaluation
- Evaluation for gastrointestinal bleeding or pancreatitis, if indicated; also, stool testing if infection is suspected
- Replenishing of electrolytes using IV or oral administration of fluids
- Administering benzodiazepines for anxiety symptoms when needed
- Administering thiamine (vitamin B1) before administering glucose to help the patient’s body process glucose and avoid possible Wernicke’s encephalopathy, a neurological condition caused by B1 deficiency and sometimes found in chronic alcoholic patients with poor nutrition
- Once stabilized, transitioning the patient to naltrexone and acamprosate medications (to treat cravings and reduce alcohol consumption) in preparation for aftercare
FAQs
Reasonable, short-term use is safe if there is no fever, bloody stool, or severe liver disease present.
Be sure not to exceed dosing recommendations on the label and don’t combine loperamide with sedatives or opioids.Seek medical care if symptoms persist or worsen.
Some strains of probiotics may modestly shorten the duration of diarrhea. Choose reputable products and watch for gas or bloating. If these occur, stop probiotic use or try a different strain.
Avoid probiotics if illness is severe or if you are immunocompromised. If diarrhea symptoms worsen, stop probiotic use.
Naltrexone and acamprosate can cause stomach upset and diarrhea in some people. Symptoms usually improve with time or by adjusting dosing.
Do not stop prescribed meds without discussing alternatives or how to manage side effects with your healthcare provider.
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