What is chronic diarrhea?
Doctors conventionally divide long-term diarrhea according to mechanism - this helps to narrow down the range of causes. The nature of the stool (watery, oily, bloody), its frequency, association with food, and nighttime urges provide important clues.
- Watery - IBS, microscopic colitis, carbohydrate intolerance, medications, hormonal disorders
- Fatty (steatorrhea) - celiac disease, pancreatic insufficiency, giardiasis
- Inflammatory (with blood and mucus) - ulcerative colitis, Crohn's disease, infections, tumors
Main reasons
The most common cause in young people without warning signs is irritable bowel syndrome with a predominance of diarrhea. However, it can only be diagnosed after organic diseases have been excluded. It is also important to remember what medications were taken before the complaints appeared: diarrhea is often caused by metformin, magnesium preparations, some antibiotics, antacids and sweeteners.
- Irritable bowel syndrome
- Lactose and fructose intolerance
- Giardiasis and other parasitoses
- Celiac disease
- Inflammatory bowel diseases
- Hyperthyroidism, diabetes mellitus
- Chronic pancreatitis, a condition after removal of the gallbladder
- Colorectal cancer and polyps
Symptoms
In addition to frequent loose stools, a person may experience pain, bloating and weakness. Prolonged diarrhea is dangerous due to loss of fluid, salts and nutrients - hence fatigue, cramps, dry skin, weight loss and vitamin deficiency.
- Loose or pasty stools more than 3 times a day
- Urgency, sometimes incontinence
- Pain and rumbling in the stomach
- Bloating
- Weakness, weight loss due to organic causes
Diagnostics
The examination begins with blood and stool tests. Normal results in the absence of alarming signs in a young person speak in favor of a functional disorder. Increased calprotectin, anemia, blood in the stool and age over 45–50 years are indications for colonoscopy with a biopsy, including from unchanged mucosa, to exclude microscopic colitis. In case of fatty stool, pancreatic function is assessed and celiac disease is excluded.
- Complete blood count, CRP, iron, albumin, electrolytes
- TSH, glucose
- Antibodies to tissue transglutaminase
- Calprotectin, coprogram, stool tests for Giardia, helminths, infections
- Colonoscopy with biopsy, gastroscopy, abdominal ultrasound
Treatment and what to do before visiting a doctor
Treatment depends on the cause: antiparasitic drugs for giardiasis, a gluten-free diet for celiac disease, enzymes for pancreatic insufficiency, anti-inflammatory therapy for inflammatory bowel diseases, adjustment of medications if diarrhea is caused by them. For IBS, a low-FODMAP diet, antispasmodics, and antimotility medications are used. It is important to replenish fluid losses. Fixatives can be used for a short time, but not if there is blood in the stool or fever.
- Drink enough fluids; if you have frequent bowel movements, use rehydration solutions
- Keep a food and bowel diary
- Temporarily limit milk, fatty foods, coffee, alcohol, sweeteners
- Do not take antibiotics without a doctor's prescription
- Bring to your appointment a list of all medications you are taking.