What is diarrhea?

Diarrhea is defined as having frequent, loose or watery stools.  Associated symptoms may include urgency, fever, nausea, vomiting, cramping, and bloating.  Most cases of diarrhea are acute, lasting less than 2 weeks, but some cases are persistent lasting up to a month.  Chronic diarrhea is defined as lasting longer than 4 weeks.

What causes acute diarrhea?

The most common cause of acute diarrhea is a viral infection.  Rotavirus is a common cause of acute diarrhea in children and norovirus is a common cause of acute diarrhea in adults.  Traveler’s diarrhea is often caused by a bacterial infection such as E. coli.

Acute diarrhea can also be caused by certain foods like prunes and dried fruits.  Mints and chewing gum containing artificial sweeteners like sorbitol can cause diarrhea when consumed in large amounts.

Certain medications can cause diarrhea.  Antacids and antibiotics frequently cause watery stools.  Diarrhea is a side effect of many other medications.

When should I see a doctor about acute diarrhea?

Most cases of acute diarrhea resolve spontaneously in a few days.  You should see a doctor if you:

  • Feel weak and lightheaded
  • See blood in your stool
  • Have severe abdominal pain
  • Can’t keep fluids down
  • Have diarrhea lasting more than 4 days

How is acute diarrhea treated?

You should stay hydrated by drinking plenty of fluids containing salt and sugar.  Commercially available products such as Pedialyte or Gatorade can be quite helpful.   Avoid milk containing liquids.  Anti-diarrheal medications like loperamide (Imodium AD) improve symptoms, but should not be used if you have bloody diarrhea with fever since they can worsen colon infections.  Bismuth subsalicylate (Pepto-Bismol) is effective for many patients with traveler’s diarrhea.  Antibiotics are sometimes prescribed for acute diarrhea.

What causes chronic diarrhea?

Some common causes of diarrhea lasting longer than 4 weeks include:

  • Celiac Disease
  • Irritable bowel syndrome
  • Ulcerative Colitis
  • Crohn’s Disease
  • Microscopic Colitis
  • Colon Cancer or colon polyps
  • Lactose intolerance
  • Artificial sweeteners
  • Pancreatic insufficiency
  • Parasitic infections
  • Bacterial infections
  • Medications
  • Diabetes
  • Hyperthyroidism
  • Radiation therapy
  • Surgical resections

How is chronic diarrhea evaluated?

The patient history is very important in diagnosing chronic diarrhea.  Red flag symptoms include weight loss, rectal bleeding, and diarrhea that wakes you up from sleep.  Your past medical history, travel history, current medications, and recent exposure to patients with diarrhea can be helpful in sorting out the cause of chronic diarrhea.  Abnormalities on physical exam such as abdominal tenderness, and increased bowel sounds can also help with the diagnosis.

Test may include blood work and stool studies (culture, toxin assay, parasite tests) and colonoscopy.  Upper endoscopy (EGD) is sometimes used to help diagnose chronic diarrhea caused by malabsorption.  Small intestinal X-rays are occasionally ordered to help with the diagnosis.  CT scans are useful in some cases.  More invasive studies like small bowel enteroscopy or capsule endoscopy provide additional information in difficult to diagnose cases.

What treatments are available for chronic diarrhea?

The treatment of chronic diarrhea depends on the cause.  Celiac disease for instance is treated with a specific diet that eliminates gluten (wheat protein).   Pancreatic insufficiency is treated with pancreatic enzyme replacements.  Infections are treated with antibiotics.  You should consult with a gastroenterologist for all cases of chronic diarrhea.  These specialists are experts at diagnosis and treating chronic diarrhea.

Disclaimer: The information presented on this website is not intended to take the place of your personal physician’s advice and is not intended to diagnose, treat, cure or prevent any disease.  Discuss this information with your healthcare provider to determine what is right for you.  All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical condition.

This website is owned and managed by Brian Cooley, MD. Any information, offers or instruction as written, inferred or implied is the sole responsibility of Brian Cooley, MD and does not warrant claim or representation, inherent, or implied of DHAT, its subsidiaries or employees.