A subject that is uncomfortable to talk about, but more common than one would think. Fortunately, it is usually only temporary, lasting only a few days. Diarrhea comes in two forms: acute and chronic. The conditions have similar symptoms, but much different implications for patients. Unpleasant acute symptoms include an urgent need to use the bathroom, inability to control bowel movements, nausea, and stomach pain. However, when symptoms last longer than a few weeks, we call this as chronic diarrhea.
Types and causes
Fatty/malabsorptive diarrhea happens when your body digests and absorbs fats in your diet incorrectly, which can be due to a low amount of pancreatic enzymes or small intestine disease. Abnormal digestive pancreatic enzyme levels can be due to chronic pancreatitis, cystic fibrosis, trauma, and malignancy. Small bowel disease may also impair the absorption of fats that can lead to diarrhea including celiac disease, Crohn’s disease, Whipple’s disease, tropical sprue, and eosinophilic gastroenteritis.
Watery diarrhea is a result of our body’s inability to absorb carbohydrates. Conditions included in this include intolerance to lactose, sorbitol, or fructose, antibiotic-induced diarrhea, and certain medications.
Diarrhea can be caused by a variety of factors, such as:
- Infections and inflammation
- Viral or bacterial gastroenteritis typically is considered acute diarrhea and resolves with supportive care.
- Parasitic infections such as giardia can lead to chronic diarrhea.
- Irritable bowel syndrome (IBS)
- Environmental exposures
- Other digestive disorders such as, certain types of thyroid disorders, uncontrolled diabetes mellitus, and a family history of gastrointestinal illness such as inflammatory bowel disease or celiac disease.
When to see a doctor
A patient should seek further evaluation if diarrhea is persistent, accompanied by severe abdominal pain, or stool has blood. Another reason to seek immediate medical attention is if a patient becomes dehydrated, or notices symptoms of weight loss, fevers, or night sweats.
Seeking treatment for diarrhea
Treatment of chronic diarrhea depends on the proper identification and treatment of the underlying cause. Symptom relief may include a prescription of antimotility drugs and antibiotics if necessary. Our providers may order a stool test to evaluate for bacterial and parasitic infections and fecal fat content. Depending on the person's history and physical exam, blood work and CT or MRI scans may be ordered. 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.