# Why is IBS-D more active in the morning.



## Kenny (Jan 28, 2020)

Hello ,

I'v been noticing my IBS morning runs/diarrhea is becoming worse over the years. The urge to use the bathroom first thing after one gets up , followed my multiple bowel movements until one feels a "complete evacuation". This settles down mid afternoon to evening . Mornings are the worst for my IBS .

Does anyone have any idea what makes it worse in the mornings ?


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## Boyardee (Feb 7, 2019)

Sorry as I can't answer why exactly but because I deal with this also-have been for over twenty years actually, I have asked the same question and whether it helps or not I can tell you that it is common for IBS-D.


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## Ilyria (Jun 2, 2020)

Well for some people who don't know their triggers I would say it's the food/drink they take first thing in the morning. I think it is the most obvious reason and the first one that comes to mind. For me personally it was anxiety induced-I would open my eyes in bed and at the moment I would place my feet on the floor to get out of bed a wave of nausea would start followed by several urgent BM. It is irony that the fear of eating food for having diarrhea can in fact cause a panic attack strong enough to induce such a reaction. But my GP says it is very common with IBS-D.
I don't have that problem anymore and I have a relaxing morning routine that enables me to actually enjoy my morning (still have several BM but not urgent nor painful). 
Third..I read a few articles about the role of melatonin-sleep hormone that is produced in our gut and brain but if the connection is broken melatonin could cause this reaction. I don't know enough about it and I could not get more info from my doctor.


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## AZGuy (Nov 15, 2017)

I'd say 99% of us have this morning issue. I think something happens during the night with our digestive systems, as well as our hormones or whatever our body does during the night to recharge. I've heard theories like the brain-gut connection and the addition of seratonin in the stomach or something. No one knows 100% but clearly something happens in the night to amp up the motility or its just not absorbing the water in our systems causing the diarrhea in the mornings. I've been trying to figure it out for decades.


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## bushja1 (Apr 23, 2003)

Yeah, I'm the same way. I don't always have diarrhea but always have multiple BMs in the morning. If I'm going to get full blown diarrhea it is usually shortly after lunch. My biggest problem lately is later in the afternoon and into the evening I feel like some is stuck in my rectum. I might squeeze out a hard small turd and then a few minutes later have to go again. Just a tiny bit comes out. It seems like my intestines are constantly moving. Drives me nuts. Motofen or Lomotil help but I hate to take them when I'm really not having diarrhea.


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## AZGuy (Nov 15, 2017)

I'm the same way. If I'm not having diarrhea then I constantly just go a little bit all day long. I always have that sense of urgency if even a little bit comes out. But its rarely hard poops. Lately I've just been taking Lomotil every day. At least it helps a little with that urgency feeling and slows it down somewhat. But even taking it...I feel the stool builds up in me until one day it just all comes out anyways and its a miserable day.


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## Kenny (Jan 28, 2020)

Thanks for your responses. Our symptoms are so similar yet doctors have no clue how to treat this condition . If and when I find something/anything to ease the urgency in the mornings , I'll post it on this thread.

There are so many theories - anxiety , serotonin ,gut microbiome and some of you have shared your insights. I was just wondering if a low level inflammation could be the problem, a low level inflammation caused by anxiety ?

I am trying out some anti inflammatory herbs like cumin,fennel and thyme . If it helps in any way , will keep you folks posted.


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## Ilyria (Jun 2, 2020)

Sadly, today I was in the emergency room for non-ibs reasons BUT while I was there I found out that people with ibs have a much higher concentration of cortisol-stress hormone in their system then "normal" people. The value of this hormone peaks between 7-9 and if you have an inflammation like we do in higher concentration this hormone just makes things worse. Some doctors think this could be the reason for multiple BM and morning diarrhea.


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## Kenny (Jan 28, 2020)

That does make sense I wonder whether cortisol is the culprit here and how we can try to "block" cortisol to see if the theory is right.


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## Ilyria (Jun 2, 2020)

Well the concentration is lowest in the afternoon from 4-6 so maybe that can explain why there are no BM in the afternoon/evening for most ibs people. 
I don't know how to "block" it without medication..but it would be interesting indeed.


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## AZGuy (Nov 15, 2017)

A lot of the cortisol thing makes sense. Years ago I went to an acupuncturist and I did a 24 hour saliva cortisol test. We found that I did have higher than normal cortisol levels. But we never really pursued it more. I've only read about that natural things to control it like stress reduction, sleeping well, etc. Well my IBS-D is chronic and extreme. None of those things helped. I wonder if there are cortisol-blocking drugs. I do see online supplements but not sure how effective they are. I've never thought to try it. I have taken anti-anxiety pills for nearly 20 years to little or no effect on my bowels. It certainly hasn't cured me. I might ask my primary care and my gastro doctor about it at my next appts.


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## mellosphere (Sep 22, 2015)

Interesting. My ibs is also worst in the early morning. Lots of cramps and the majority of my stools are in the first 5 hours or so in the day. I would be interested to know what your doctors say about cortisol.


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## Kenny (Jan 28, 2020)

Makes sense. I have an appointment with my shrink later this month , I will bring it up as well.I have noticed that psychiatrists are way more helpful and accommodating than gastroenterologists in the case of IBS so I have stopped seeing my gastro. One of the reasons i was exploring "Ashwagandha" is because it has been known to control cortisols, I dont know how far it will work though.I have never tried it .


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## marqueemoon2 (Mar 2, 2020)

Definitely for me mornings are the worst. The inflammation and cortisol theories are very interesting, just wish more gastro doctors would be willing to explore these theories with their patients instead of just tossing the standard rounds of meds at them.

Doesn't it seem like people who have bad IBS-D in the morning, just simply have rapid transit times? Why would that be so hard for doctors to figure out and fix correctly?

How is everyone's sleep? I'm curious if the quality of sleep has something to do with terrible mornings.


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## AZGuy (Nov 15, 2017)

The cortisol thing intrigues me too. But I fear its just another avenue that won't lead to anything. Mainly cause there really aren't drugs to stop cortisol production. There are a zillion herbs out there but sometimes I'm scared to take those things.

I'm curious about everyone's sleep habits. Like what is a normal bedtime for you? When do you wake up? And how many hours does it take you to empty out in the mornings? For me, when I was on a normal sleep schedule...I found myself waking up at 7 or 8am. But I would constantly go all morning till about noon. Then it would calm down. So I started playing with my sleep schedule. I now am a night owl. I stay up to 2 or 3am. Then I will sleep till 11am or noon. I find doing this I somehow sleep through those previous horrible morning hours. Then I find I will go a few times from about noon till 2pm and then I'm usually done at that point. Just altering my wake time just shortens the misery. Now this isn't always the case. There have been times my diarrhea wakes me up at 5-7am and I still go. But on average....sleeping till noon has reduced my symptoms.


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## bushja1 (Apr 23, 2003)

I get up early...6 a.m. Go to bed around 10 pm. More out of boredom than tiredness. Miss having Baseball to watch in the evenings. I wake up like clockwork around 3 am to pee. Sometimes have trouble getting back to sleep. I have multiple BMs every half hour or so for a couple hours in the morning. If I have to go out I try to go as much as I can before taking Motofen or Lomotil. I've mentioned before that I also have small bms later in the afternoon and evening .


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## mellosphere (Sep 22, 2015)

Surprised you guys can sleep so long. Its always been a bad symptom of my ibs-d to have cramps that wake me up. I go to bed at 10 and awake with cramps every morning between 3-4am unless i eat something outside my limited diet, then it could be 1-2am. Then i go about 3-6 times between 6am to 11am. Then usually fine til evening. Sometimes i will go in the evening, sometimes not. But the cramps return for a bit. I would go to bed earlier but the evening cramps usually subside around 9:30 so i get ready for bed after that.


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## Kenny (Jan 28, 2020)

My sleep pattern is okay , not terrible.

I have noticed that the days I do not sleep well , IBS is 30-40% worse.

@Marqueen2 : I do believe there is a connection between sleep and IBS for sure .


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## Ilyria (Jun 2, 2020)

I agree and firmly believe there is a connection and if I don't sleep well then I pay for it in the morning.
Lately I had a pattern where I go to sleep around 22 and wake up around 6-6:30. It was ok I guess and I could live with it. But for the last month and a half I've been in bed most of the time, too weak to get up, and some of my nights are not good anymore so..there is a difference.


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## bushja1 (Apr 23, 2003)

Knock wood I very seldom have problems overnight. Once in a while I might get really gassy and before long I have to go. Usually it happens pretty close to time to get up anyway. I agree that if I don't sleep well my IBS is worse the next day. For some reason it also makes me very hungry if I lack sleep.


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## mellosphere (Sep 22, 2015)

I find it interesting you all are saying that if you dont sleep well, your ibs is worse. I mean i definitely see the correlation but the cause is the ibs being worse some days or others, not the sleep itself. The sleep is what is affected by ibs, not the other way around, at least for me. Not that it really matters.


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## bushja1 (Apr 23, 2003)

Now for me IBS doesn't bother my sleep, but lack of sleep bothers my IBS. Knock wood, I rarely have trouble with my IBS during the overnight hours. Sometime worry or excitement might keep me from a good nights sleep. Invariably the next day my IBS is worse. Every time I'm going to fly I end up sleeping poorly because of worry and excitement. Of course the next day I have D worse than ever which makes the travel even more stressful.


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## AZGuy (Nov 15, 2017)

I honestly don't think sleeping well or not really makes much of a difference for me. Its not like I can get a great nights sleep and then have no issues the next day. There are always issues. But I think a rough night certainly makes the next day even more challenging. I find the best thing to do is eliminate stress. Meaning I dont travel anymore or go out. I try to stay home as much as possible. I know its not the ideal way to live...but I find it better for me. The less I have to think about my bathroom or going out and having to prepare myself...the better my body is. So I've learned to accept my live at home.


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## Ilyria (Jun 2, 2020)

I also tried to stay at home as much as I could. We have a portable toilet in the car if we go on longer trips. Rest of my family lives 300 km away so it's a nightmare every time we must go. Now I don't know anymore..I feel like my stomach is calmer but everything else is not so I would like to go out and stuff but can barely walk soo..not not good!


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