Chronic Diarrhea

What Is Chronic Diarrhea?

The American College of Gastroenterology classifies chronic diarrhea as diarrhea that lasts for over four weeks. Acute diarrhea, which is one of the most common illnesses in the US, is diarrhea that lasts less than two weeks, and persistent diarrhea lasts between two or four weeks. Chronic diarrhea can be a symptom of a gastrointestinal condition, such as inflammatory bowel disease (IBD), or it can be the result of an infection (less common).

What Are the Symptoms of Chronic Diarrhea?

The most prominent symptom of chronic diarrhea is loose or watery stools that persist for four weeks or longer. However, other symptoms that can present with chronic diarrhea are:

• Bloating
• Nausea
• Abdominal cramping 
• Fecal urgency

Acute diarrhea is often caused by a viral infection (viral gastroenteritis), and symptoms should subside in several days to a week. Chronic diarrhea is categorized by its length.

What Are the Causes of Chronic Diarrhea?

Chronic fatty or malabsorptive diarrhea is most commonly caused by either low pancreatic enzyme levels or by a small bowel disease, which causes malabsorption of fats, carbohydrates and protein. Low pancreatic enzyme levels are typically due to chronic pancreatitis. Causes of chronic pancreatitis in the United States include overconsumption of alcohol over an extended period of time, cystic fibrosis, and pancreatic cancer. 

The small bowel disease most common in the United States is celiac disease, which is a inflammatory disease of the small intestine caused by gluten ingestion. Crohn’s disease and ulcerative colitis, which are inflammatory bowel diseases, can also cause chronic diarrhea. Other diseases that may cause chronic diarrhea include tropical sprue, Whipple’s disease, and eosinophilic gastroenteritis; however, these are rare causes. Diarrhea is also associated with irritable bowel syndrome (IBS). IBS may alternate between chronic constipation and chronic diarrhea. Other signs of IBS include abdominal pain that relieves after defecation, bloating, and a feeling of incomplete evacuation of the bowel. 

Chronic diarrhea can also be caused by parasitic infections (less common) and diet. Milk and artificial sweeteners, such as fructose) can cause food to pass too quickly through the intestines, causing chronic diarrhea. 

Chronic diarrhea may also be caused by:

• Overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
• Alcohol abuse
• Diabetes
• Polyps from colon cancer

How Is Chronic Diarrhea Diagnosed?

If you present to your physician with chronic diarrhea, they will ask you about your personal and family gastrointestinal history and your symptoms. Most likely, they will order a complete blood count (CBC), metabolic panel, or stool sample.Chronic diarrhea always has an underlying cause, ranging from severe, such as colon cancer, to much less severe, such as IBS. Your physician’s main goal will be to find the underlying cause. 

A stool sample could reveal elevated white blood cells or calprotectin, which are signs of intestinal inflammation. If an overabundance of fat is present in the stool, this could be caused by chronic pancreatitis or celiac disease. 

If neither a blood test nor a stool sample was satisfactory, your gastroenterologist may order further testing, such as a CT scan of the abdomen and pelvis or a colonoscopy to examine your colon.

What Is the Treatment for Chronic Diarrhea?

Over-the-counter anti-diarrheal medications often work well for treatment if you have acute diarrhea. However, these medications aren’t recommended to treat chronic diarrhea, because you have to treat the underlying condition. If the underlying condition is Crohn’s disease, ulcerative colitis, pancreatitis, or celiac disease, corticosteroids or immunosuppressive medications could be potential options. Parasitic infections are treated with antibiotics. The course of treatment will depend on each individual case. 

Diet and lifestyle changes can also relieve chronic diarrhea. You may have a trigger food that is contributing to your chronic diarrhea, such as milk. Eliminating certain foods and bringing new foods into the diet (such as those low in fiber) may help control symptoms. Also, in general, those who have chronic diarrhea should:

• Avoid caffeinated beverages and sugary drinks 
• Avoid alcoholic beverages
• Eat low-fiber foods
• Drink clear liquids to stay hydrated

While diet and lifestyle changes will likely not cure chronic diarrhea completely, small changes can help improve symptoms. 

Can You Prevent Chronic Diarrhea?

Because chronic diarrhea is most often caused by an underlying medical condition, it can be difficult to prevent. However, you can help lower your risk of developing chronic diarrhea from parasitic infection by safe food handling and handwashing, such as:

• Drinking filtered water
• Cooking meat thoroughly
• Cleaning meat before cooking it
• Washing hands after food handling
• Washing fruits and vegetables before consumption
• Washing your hands thoroughly after using the bathroom or changing a diaper
• Cleaning all kitchen surfaces thoroughly

Practicing safe food handling in the kitchen helps reduce the risk of bacterial or parasitic infection. 

Are There Complications from Chronic Diarrhea?

In cases of acute diarrhea, there are very few complications. However, those with chronic diarrhea run the risk of dehydration because of how much water the body is losing through the stool. They can develop malnutrition as they are less capable to absorb needed calories, vitamins and minerals. If you have chronic diarrhea, remember to drink plenty of fluids, including water, unsweetened and decaffeinated tea, and broth.