Chronic diarrhea is a poorly known disease because people think that changes in their bowel movements are normal, and they are so wrong. It can be a source of multiple complications in the long run. Therefore, getting to know the symptoms, possible causes, and treatments available is mandatory for avoiding preventable complications.
By reading this article, you would obtain key insights from a doctor about everything you need to know concerning chronic diarrhea.
What is diarrhea?
Diarrhea or diarrhoea is what occurs due to the impairment of the intestine when processing the stool. The factors that bump the stool formation will cause a diarrheal illness and are several, like the diet, allergies, inflammatory and infectious diseases, and more.
Continuous activity of the intestines forms the stool. They absorb and discharge various substances and water throughout the way, and the bowel movement shapes the stool appearance. After many hours of this process, what once was food would go out of the body as stool.
The scientific community has thoroughly analyzed the stool over time. To the point that there is a tool, the “Bristol Stool Chart” (see the image below), that helps them to interpret the stool aspect, and determine what is probably affecting the body if it is not looking normal. It is a scale in which the more dehydrated stool has a round shape, and it is in association with constipation. On the contrary, in diarrhea, it loses its firmness due to the intestines inflammation that affects the reabsorption of water.
If there is any factor causing the intestine to fail at its job of reabsorbing water, then the water would continue through the intestinal passage with the stool, causing diarrhea. However, this is not that simple; several mechanisms exist for increasing the water in the intestinal path by harmful means. Some of them even cause the intestines to uncontrollably discharge water, which has the term “secretory diarrhea.” Others, by limiting the absorption of food and electrolytes, prompt the drag of water to the intestinal passage, this mechanism is known as “osmotic diarrhea.”
When is diarrhea considered chronic?
The definition of chronic diarrhea is diarrhea lasting longer than four weeks; however, most of the time is even longer than six weeks, and the cause rarely is an infection. It is different from persistent diarrhea, which is longer than two weeks, albeit lower than four, and other reasons could produce it too. On the contrary, to chronic diarrhea, acute diarrhea lasts less than two weeks, and infections are usually the problem.
A doctor will use precise and objective definitions of diarrhea as three or more defecations per day, with a decrease in its consistency, or by measuring the weight of the stools, that it would give more than 200 grams. Still, please remember that in this case, diarrhea could be any change in the stool habit, including loose stool, watery stool, increase or decrease in the daily bowel movements or increased stool volume. Importantly, if the difference in the routine is a higher frequency of defecation, but with no changes in the stool shape, the name for that is pseudodiarrhea. So pretty much all the time your doctor will use to define diarrhea the stool consistency, instead of the frequency.
Nearly all of the diarrheas are self-limited, transient, and due to infectious diseases. The expectation is that most of the diarrheas resolve within one week, and all of them in less than four. Yet, the estimation is that one to five percent of the adults has chronic diarrhea. The problem with this condition is the many hazards that could prompt it. In developed countries, it is usual to find noninfectious causes, while in the developing ones, the infections are more prevalent. If a person starts experiencing constant changes in what otherwise had to be a consistent way of evacuating, should go and check-up.
What is the classification of chronic diarrhea?
Dozens of causes could explain chronic diarrhea, however many of them share the mechanisms on how they do it. Therefore, it exists four major classifications of how chronic diarrhea develops, which explains nearly all of them. There are for watery diarrhea, two leading causes, osmotic and secretory diarrhea. Then, there is inflammatory diarrhea, which includes most of the severe conditions as inflammatory bowel disease or cancer. And finally, a particular subtype that is chronic diarrhea with steatorrhea. Let me briefly introduce them to you.
Watery diarrhea, as I said before, has two ways of developing either a secretory or osmotic. Osmotic diarrhea can be due to carbonated beverages (soda), fruits, nonsugar gum, and malabsorption diseases, which by staying in the intestinal passage, drag water with them, causing diarrhea. Secretory diarrhea includes irritable bowel disease, hormonal diseases, medications, food allergy, or cancer, and more, they stimulate the intestines to somehow discharge water from them, also ending in diarrhea.
Inflammatory diarrhea is more severe, either in symptoms and complications in comparison to watery diarrhea, this type could cause bloody stool. Mostly cancer, inflammatory diseases, and infections are in this section causing direct harm to the intestine.
Chronic diarrhea with steatorrhea is particular because they mean diarrhea without a complete absorption of fatty food, for which is responsible the liver and the pancreas discharges. Here are diseases as exocrine pancreas insufficiency or overall lousy absorption of food syndromes, giardiasis (beaver fever), as the more common among others.
What are the causes of chronic diarrhea?
Two options are possible, infectious and non-infectious causes. Infectious chronic diarrhea could be by an infection that becomes chronic as some parasites or an insidious infection by microorganisms that are hard to eliminate as C. difficile. Nonetheless, non-infectious causes the vast majority of the cases, and comprise several possibilities. For example, from an infection, it could develop a permanent functional impairment that ends in chronic diarrhea. And it would no longer have the illness that caused it in the first place.
Throughout the world, parasites have been identified as the most common infectious agents causing persistent diarrhea. Two main types of parasites infect people, protozoa and helminths. The former has most of the cases with Giardia, Cryptosporidium, Entamoeba histolytica, Cystoisospora belli, Dientamoeba fragilis, and Strongyloides stercoralis. Several other causes in susceptible patients that have a weakened immune system could also exist.
Non-infectious chronic diarrhea includes several possibilities, either inflammatory or not. From the noninflammatory malabsorptive diarrhea, lactose intolerance is significant. Then, with inflammation, there are conditions as people allergic to gluten (celiac disease), cystic fibrosis, microscopic colitis, irritable bowel disease, ischemic colitis, inflammatory bowel disease, or even cancer.
How are infections that can cause chronic diarrhea spread?
Most of the infections transmit by foodborne; therefore, it is pretty common that it starts as a food poisoning disease, similar to gastroenteritis. However, others can transmit through water, or by manipulation of contaminated surfaces. It is usual to acquire them by traveling abroad, so it would start as a traveler’s diarrhea, which is acute, and with time, it becomes a chronic infection.
Who is at risk for chronic diarrhea?
The population that gets hit the hardest are the elderly, while the children and the people with debilitating conditions are keeners to have chronic diarrhea. Let’s talk about them.
From 5% of the general population that suffers from chronic diarrhea, approximately 40% is over 60 years. These number tells about this condition being predominantly in this group.
The people with a weak immune system are vulnerable to acquire an infection that a healthy person would not affect. The conditions that weaken the immune system include diabetes, cancer, people taking steroids or immune-suppressive drugs, and more.
The children are also keener to develop many types of diarrhea, including the chronic one. Even there is a child’s diarrhea or toddler’s diarrhea, which is watery diarrhea of no known cause that stays for long periods. It is in a relationship with diet, and it is the most common cause of this disease in children from six to ten years old.
What are the symptoms of chronic diarrhea?
The evaluation of the symptoms on every diarrhea should as start as timely as 14 days from symptoms onset. None of the chronic diarrheas have a unique feature that allows your doctor to find the cause immediately. All the elements for characterizing the disease would depend on the patient-specific factors such as age, recent travels, underlying condition, family history, or even stress levels. And the symptoms of the specific regions affected by the underlying condition.
The symptoms would vary, suggesting a mild or more severe condition triggering chronic diarrhea. Colitis is the term the doctors use to describe the inflammation of the large bowel, which mostly correlates with diarrhea. It is a histologic term, and nonspecific, what do I mean with this? This inflammation could only be seen through a microscope with a direct sample of your large bowel, besides it only implies inflammation that can be by many disorders.
The typical symptoms are watery diarrhea or loose stools, and abdominal pain. However, some signs and symptoms suggest an inflammatory or more severe disease underneath as bloody stool, fever, losing weight (11 lb minimum), symptoms appearance on advanced age (over fifty years), family history of colon cancer, diarrhea mostly in the night, persistent diarrhea even without eating for long periods. All of them are alarming signs that should make you assist to your doctor.
What other symptoms might you have with diarrhea?
There are plenty and would ultimately depend on disease-causing diarrhea. For example, chronic diarrhea could be by hyperthyroidism, which also expresses heat intolerance, anxiety, palpitations, hand tremor, and more.
Furthermore, a patient with inflammatory bowel disease, which is a very prevalent condition causing chronic diarrhea could have malaise, fatigue, joint pain, nausea, vomiting, and weight loss. Patients with cancer or whatever inflammatory cause could also have these problematic symptoms.
What is exocrine pancreatic insufficiency?
The pancreas fulfills a vital function concerning food digestion by discharging useful enzymes that degrade them. If that role is not functioning, then food would remain complete and impair the bowel movements causing diarrhea. Exocrine pancreatic insufficiency is the name for that lack of pancreas function. It could be either by pancreas disease or nonrelated to it and are many, but the most common is chronic pancreatitis.
Chronic pancreatitis is the chronic inflammation of the pancreas, and it ends in exocrine pancreatic insufficiency, among other complications. This condition is the classical representation of chronic diarrhea with steatorrhea.
What is the difference between inflammatory bowel disease and irritable bowel syndrome?
Irritable bowel syndrome is functional diarrhea, and it has abdominal pain and changes in defecation habit without and identifiable cause. This gastrointestinal disorder is diagnosed by the Rome IV criteria, which is a list of signs and symptoms that patients with this condition fulfill. On the contrary, inflammatory bowel disease is an abnormal inflammatory response in all the intestinal tract, which expresses as two types, ulcerative colitis and Crohn disease. Patients with this condition are keener to acquire cancer in the long run.
The irritable bowel symptoms are in a relationship with stress and include alteration in the defecation habit, abdominal pain, abdominal bloating, watery diarrhea in interchange with constipation. Also, specific food may trigger these symptoms. Patients below fifty years and without alarm signs would possibly not be tested for this condition, albeit bothering it is not as severe as an inflammatory condition.
In contrast, the symptoms of inflammatory bowel disease are much more severe than the ones of the irritable bowel. It could have stools with blood or mucus, severe abdominal cramping, fever, joint pain, nausea, and vomiting. Furthermore, this condition develops complications either in the intestine or outside of them, that could carry death.
What are the potential complications of diarrhea?
Chronic diarrhea could have either complication of diarrhea or the underlying disease. Diarrhea alone could cause dehydration if the patient is having a high frequency of watery diarrhea. Anemia could be another because of a chronic loss of blood through the stool, or by a decreased absorption of essential proteins for red blood cell production. The children could experience a failure to thrive because of the lousy process and absorption of food.
The other diseases as infectious, inflammatory, or cancer, could cause death in multiple ways. It is less likely if the symptoms are mild; however, if the person starts having any of the alarm signs, the probabilities of complications raise considerably.
How the doctor diagnose chronic diarrhea?
The doctor, firstly, for diagnosing chronic diarrhea, will ask about your symptoms, stool characteristics, and if their duration has more than 14 days. What the doctor really wants to know is the underlying cause of it.
As you just read, there are many infectious or non-infectious causes, depending on your background. Typically, your doctor will do a complete interrogation. After that, a thorough physical examination to find the signs that could indicate an underlying disease.
At the body exam, your doctor would not want to find any of these alarming signs as pallor in the skin and mucous membranes as the eyelids, liver and spleen enlargement, swollen lymph nodes, or the presence of an abnormal mass in the abdomen. To rule out all the possible worse conditions is core for continuing the assessment of the patient.
The medical exams comprise from blood tests to stool analysis of a stool sample, and it would be as much as necessary. For example, this could mean one stool sample analysis every 2 or 3 days, for maximizing the chances of finding parasites in the stool. Every particular microorganism could have an exam, such as commercial enzyme immunoassay testing or polymerase chain reaction (PCR). When no infectious cause raises, the non-infectious reason is methodically studied. If celiac disease is a suspicion, your doctor will run special blood exams.
Then there are specific exams for differentiating between inflammatory and noninflammatory conditions. This exam is the fecal calprotectin with a stool sample of the patient. If positive, it highly suggests an inflammatory disease, and if negative, it does not discard it. The final exam would be an endoscopic procedure that depending on the suspicion, could be either of the small, large, or both intestines for tissue samples that require further study.
What is the treatment for chronic diarrhea?
The main complication of chronic diarrhea is dehydration. Therefore, the foundation of therapy is rehydration containing electrolytes and glucose, not just regular water. Children and the elderly are especially prone to dehydration and its complications. Severe dehydration may require hospitalization with intravenous therapy. When the rehydration therapy of the patient is guaranteed, a systematic search for the cause of chronic diarrhea begins.
With the identification of a cause, then specific therapy starts, such as antimicrobial agents for infectious diseases. Or, drugs for functional non-infectious conditions. Other novel medications besides antibiotics, are useful to treat difficult situations such as infection by C. difficile. Fecal microbial transplantation effectively resolves this infection when standards antibiotics can not.
Sometimes doctors utilize medication as an empiric treatment, as in chronic diarrhea happens with nitazoxanide, which means that they use it without having a specific diagnosis, purely by patient background and symptoms. The parasites are frequently elusive to the diagnostic tools doctor use, and this medication has a wide range of parasite elimination capabilities. Therefore, it is often a recommendation to see if the patient gets better.
Inflammatory disease treatment could vary widely because of the different sources. They could require lifestyle changes, steroids, immune system modulators, anti-cancer treatment, repository therapy, surgery, and others. Assisting early with your doctor is essential.
Can probiotics aid digestive health?
For now, there is only modest prove that probiotics do help and in specific situations. They are under study in several scenarios as diarrhea posterior to an antibiotic course or acquired in hospital settings. The two with most effectivity, for now, are Lactobacillus GG and S. boulardii. Other probiotics exist and also are under exhaustive analysis. However, for now, the studies keep flowing, and this situation changes from time to time.
What can I do if I am presenting symptoms of it?
Well, for that, I got you covered. This tool is a chronic diarrhea symptoms checker. For helping you determine, how likely is that your symptoms are by this condition. It is free, and would only take a few minutes.