How to Deal If You’re Trapped in an Agonizing Constipation-Diarrhea Cycle

Erica Sloan
·7 min read

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If you haven’t pooped in days, you might find yourself praying for any sort of bowel movement—well, except diarrhea. And if you’re dealing with a seemingly unending flow of shitty lava, you’re probably wishing you could just stop pooping. So it’s easy to see why getting stuck in a cycle of constipation and diarrhea is a special kind of hell.

Experiencing such a worst-of-both-worlds poop scenario is a classic marker of irritable bowel syndrome (IBS), a commonly diagnosed GI condition that can be pretty unpredictable, says Mark Pimentel, MD, a gastroenterologist at Cedars-Sinai in Los Angeles and the director of the Medically Associated Science and Technology (MAST) program, which focuses on IBS. There’s a constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), and mixed version (IBS-M) of the condition, and all of these types can come with some degree of both bowel extremes, which can be tough to manage, Dr. Pimentel tells SELF.

In fact, yo-yoing between constipation and diarrhea can actually be the result of treating either symptom, whether or not you’ve been formally diagnosed with IBS. Read on to learn how the vicious constipation-diarrhea cycle typically starts and how to get yourself off the GI seesaw.

What’s causing me to swing between constipation and diarrhea?

Technically speaking, you’re constipated if you’re pooping fewer than three times a week, whereas diarrhea means you’re letting out loose or watery poops three or more times a day. Simply dealing with a combination of the above on a regular basis and experiencing discomfort with either may be enough for a doctor to diagnose you with IBS. (After all, the condition is technically defined by a set of GI-related symptoms, like abdominal pain and changes in poop frequency and consistency, that have gone on consistently for at least three months.)

The problem is, experts don’t fully understand what leads to these symptoms in the first place. One of the primary theories is that there’s a breakdown in communication between your gut and your brain, leading the former to become hypersensitive to nerve signals from the latter—but again, we don’t know why that might happen to certain people (factors like genetics, a mental health issue, or a bacterial imbalance are all potential culprits). As a result, the drugs we have for IBS just treat individual symptoms, Dr. Pimentel says, which, in itself, can cause a flip-flopping effect between bowel problems.

Take constipation: A doctor will typically recommend trying a stool softener or a laxative, which either makes your poop wetter or bulkier, or stimulates the nerves in your gut to push things along—and all of this can inadvertently cause loose poops. And for diarrhea, you’d likely take loperamide (a.k.a. Imodium), which slows the movement of your intestines, potentially triggering constipation. So in either case, you might knock out one symptom only to end up with the opposite one—cue the GI whack-a-mole!

But you could certainly get milder versions of constipation and diarrhea—say, struggling to poop for a couple days or getting the runs every so often—or some occasional switching between the two for a few one-off reasons as well.

For instance, traveling can lead to constipation because of changes in your eating and sleeping patterns, or diarrhea if you wind up with food poisoning, Haleh Pazwash, MD, FACG, a gastroenterologist at Gastroenterology Associates of New Jersey, tells SELF. Eating a lot more fiber than usual; going hard on alcohol, sugar, or sugar substitutes (sorry, Diet Coke lovers!); or ramping up your exercise routine could also prompt diarrhea, just as drinking less water could make you a bit constipated, she adds. And let’s not forget about those notoriously bad period poops: Right before you start bleeding, a rise in the hormone progesterone might back you up, while intestinal contractions that kick in peak flow can cause you to push poop out in a hurry.

A few types of drugs can also throw your gut into a tizzy. For instance, some antidepressants, certain blood pressure meds, iron supplements, and even antacids can lead to constipation, while antibiotics, metformin (for diabetes), and magnesium supplements can trigger diarrhea, Dr. Pazwash adds.

Constipation and diarrhea can also show up together in more serious gut conditions, like inflammatory bowel disease (including Crohn’s or ulcerative colitis), colorectal cancer, or pancreatic cancer. But these are much rarer than IBS, and almost always involve other red flags, like blood in your poop, heavy fatigue or weakness, and unintentional weight loss, Dr. Pimentel says.

What can I do to stop the constipation-diarrhea cycle?

If you’re stuck in this frustrating loop for more than a few days, or if it happens to you often enough to mess with your ability to go about your daily life, try to make an appointment with a gastroenterologist—they can do blood and stool tests to rule out the more serious stuff. (You can also start with your primary care doc, who can assess your symptoms and make a referral if you need one.) Thanks to recent research, largely from Dr. Pimentel’s lab, we now know that certain gut bacteria may play a role in IBS; a GI doc can also give you a hydrogen or methane breath test to check for an overgrowth of those microbes, and potentially prescribe an antibiotic if diarrhea is the primary symptom giving you trouble.

In the meantime, check in on your water and fiber intake, Dr. Pazwash says, because both are key factors in smooth digestion. Staying well-hydrated can keep your poop looking more like putty than pebbles, and you also need to replenish your fluids if you’re losing a ton via watery stools. And “the irony of fiber,” Dr. Pazwash says, “is it can be the treatment for both constipation and diarrhea.” Soluble fiber binds to water in your colon, which can slow things down, while insoluble fiber bulks up your poop, prompting your intestines to squeeze it out more quickly. Most fruits and vegetables have both types, so you can’t go wrong with slowly adding more plants to your meals.

You’ll also want to go easy on the alcohol and caffeine when you’re in the throes of a constipation-diarrhea cycle, Dr. Pazwash says, as both can rile up your gut; alcohol speeds through it, and caffeine stimulates its movement, resulting in liquidy poops.

Beyond what you’re taking in, Dr. Pimentel recommends considering when—and spacing things out a bit. When you eat three full meals (instead of noshing all day), your stomach has enough time to fully empty, which is when “special cleaning contractions” occur, he explains. (These help clear undigested particles and tamp down the growth of certain bacteria.)

And if you’re planning to pop an OTC medication to help with either constipation or diarrhea in real time, start with the gentlest option. “The stronger the drug you use, the more wildly you’re going to swing yourself [in the opposite direction],” Dr. Pimentel says. It’s the reason why he suggests a mild stool softener like docusate (a.k.a. Colace) for brief bouts of constipation, versus a stimulant laxative like senna, which will have a more intense effect. In the case of sporadic diarrhea, Imodium can help, but perhaps you take half of a typical adult dose (one capsule) to start if you’re concerned about triggering constipation, he says.

When you’re determining how much or how often to take any of these OTC meds, it’s important to remember that “it’s more of an art than a science,” Dr. Pazwash says. Everyone responds differently, so err on the side of less, because “you can always add,” she says. As with most things, when it comes to resolving both constipation and diarrhea, moderation is key—smaller course corrections can keep you from flying off track in another direction.

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Originally Appeared on SELF

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