Chronic Diarrhea: Symptoms & Treatments

Definition & symptoms

Chronic diarrhea is watery or liquid stool that has persisted beyond four weeks. Passage of watery or liquid stool may or may not be bloody.

There are two different types of chronic diarrhea. The first is fatty/malabsorptive diarrhea. This occurs when your body is improperly digesting and absorbing fats in your diet. This can be due to a low amount of pancreatic enzymes or small intestine disease. Abnormal digestive pancreatic enzymes levels can be due to chronic pancreatitis, cystic fibrosis, trauma, and malignancy. Small bowel disease may also impair absorption of fats. Small bowel diseases that can lead to diarrhea include celiac disease, Crohn’s disease, Whipple’s disease, tropical sprue, and eosinophilic gastroenteritis.

The second type is watery diarrhea. Carbohydrate malabsorption can lead to watery diarrhea. Conditions included in this include intolerance to lactose, sorbitol, or fructose, antibiotic induced diarrhea, and certain medications.

Infections and inflammation can also lead to diarrhea. Viral or bacterial gastroenteritis typically is considered an acute diarrhea and resolves with supportive care. Parasitic infections such as giardia can lead to chronic diarrhea. Irritable bowel syndrome, thyroid disorders, and uncontrolled diabetes mellitus may also result in alterations in bowel habits.

Risk factors

There may be many causes, but some risk factors for developing chronic diarrhea include travel, a family history of a diarrhea related gastrointestinal illness such as inflammatory bowel disease or celiac disease, or environmental exposures.

Diagnostics

Many episodes resolve within several days with supportive care alone. Further evaluation needs to be done if diarrhea is persistent, accompanied by severe abdominal pain, or stool has blood. Testing may include stool studies to evaluate for bacterial and parasitic infections and fecal fat content. Blood work and CT or MRI scans may be ordered depending on the person’s history and physical exam. Endoscopy may be warranted with both an upper endoscopy and a colonoscopy. The endoscopist may take tissue samples to evaluate for any small or large intestine pathology. More advanced studies with a balloon enteroscopy or capsule endoscopy may also be warranted to evaluate areas of the small intestine that cannot be reached with a conventional upper endoscope or colonoscope.

Treatment

Treatment of chronic diarrhea depends on the proper identification and treatment of the underlying cause. Symptom relief may include prescription of antimotility drugs and antibiotics if necessary.