What should I do if I wake up in the middle of the night with stomach pain and diarrhea?

Acute Nocturnal Stomach Pain and Diarrhea

For acute onset of stomach pain and diarrhea waking you at night, start loperamide 2-4 mg immediately to control the diarrhea, maintain fluid intake with glucose-containing drinks or soups, and seek medical attention if symptoms persist beyond 48 hours, you develop fever above 38.5°C, see blood in your stool, or experience severe vomiting. 1

Immediate Self-Management

Antidiarrheal medication:

• Take loperamide 2 mg immediately, then 2 mg after each loose stool, up to maximum 16 mg per day 1, 2
• Loperamide is the drug of choice for acute diarrhea and can be used safely without delay in previously healthy adults 1
• Do NOT exceed recommended dosages due to risk of serious cardiac arrhythmias including sudden death 2

Fluid replacement:

• Drink glucose-containing beverages (lemonades, sweet sodas, fruit juices) or electrolyte-rich soups 1
• Let thirst guide your fluid intake 1
• Oral rehydration solutions are not necessary for otherwise healthy adults 1

Food intake:

• Eat small, light meals guided by appetite 1
• Avoid fatty, heavy, spicy foods and caffeine (including cola drinks) 1
• Consider avoiding milk and dairy products temporarily 1

Warning Signs Requiring Immediate Medical Attention

Seek medical care urgently if you develop:

• High fever (above 38.5°C/101.3°F) 1
• Frank blood in stools (dysentery) 1
• Severe vomiting that prevents fluid intake 1
• Signs of dehydration (extreme thirst, decreased urination, dizziness, confusion) 1
• Severe abdominal distention 1

When to See a Doctor (Non-Urgent)

Contact your healthcare provider if:

• No improvement within 48 hours 1, 3
• Symptoms worsen or your overall condition deteriorates 1
• You develop persistent fever, abdominal distention, or any blood in stools 1
• You are over 75 years old, have significant chronic illnesses, or are immunosuppressed 1

What This Likely Represents

Most probable cause:

• Viral gastroenteritis (self-limited, typically resolves in 24-72 hours) 3
• Foodborne illness if symptoms began within hours of eating 3

Less likely but possible:

• Bacterial gastroenteritis (more likely if fever or bloody stools develop) 3
• Acute flare of underlying irritable bowel syndrome if you have chronic bowel symptoms 1

Important Caveats

Medication safety:

• Loperamide at recommended doses is safe and effective, but higher doses can cause life-threatening cardiac arrhythmias 2
• Avoid loperamide if you develop high fever or bloody diarrhea, as this suggests bacterial dysentery requiring different treatment 1
• Do not combine loperamide with medications that prolong QT interval (certain antibiotics, antiarrhythmics, antipsychotics) 2

Probiotics:

• Not recommended for early treatment of acute diarrhea 1
• May be considered if symptoms become prolonged, but evidence is limited 1

Antibiotics:

• Not appropriate for self-treatment of acute diarrhea in your home country 1
• Reserved for specific diagnosed bacterial infections or traveler's diarrhea 1