Definition of Chronic Diarrhea

Diarrhea is considered as chronic, when it lasts for more than 3 weeks.

Main Causes of Chronic Diarrhea

Unlike acute diarrhea, chronic diarrhea is mostly of non-infectious origin.

• Irritable Bowel Syndrome (IBS) ;
• Inflammatory Bowel Disease (IBD);
• Lactose Intolerance;
• Celiac Disease;
• Toddler’s Diarrhea (Dietary Fructose Intolerance - DFI);
• Liver, Gallbladder, Pancreatic Disease;
• Diverticulitis;
• Food Allergies;
• Small Intestinal Bacterial Overgrowth (SIBO);
• Short Bowel Syndrome;
• Diabetes;
• Alcoholism;
• Malnutrition;
• Medications.

Less common causes of chronic diarrhea  are diabetes, ischemic and collagenous colitis, systemic sclerosis, hyperthyroidism, Addison’s disease, uremia, chronic infection/poisoning, AIDS, bowel surgery, inborn diseases, and Brainerd diarrhea.

Irritable Bowel Syndrome (IBS, Spastic Colon)

Chronic diarrhea or constipation or both, appearing in people under 40 years of age with no underlying bowel disease, no bleeding or weight loss, are the main characteristics of irritable bowel syndrome. Symptoms (diarrhea, constipation, bloating, gas, painful abdominal cramps, or urgency) typically appear after the meal or stress event, and are relieved with a bowel movement. ‘Functional diarrhea‘, also called painless or nervous diarrhea, is like IBS, but without abdominal pain.

Ischemic Colitis

Ischemic colitis, also known as colonic ischemia, mostly occurs in people after 50 years of age. Acute ischemic colitis is usually caused by a blood clot (formed during a stroke, heart failure or operation of abdominal aorta), and chronic ischemic colitis is mostly a result of atherosclerosis of the large intestinal arteries.

Symptoms of Ischemic Colitis

• lower left abdominal pain;
• bloody diarrhea.

Diagnosis of Ischemic Colitis

A colonoscopy may show mucosal ulcers and biopsy may reveal submucosal bleeding. Abdominal arteriogram or MRI may show blocked arteries (1).

Treatment of Ischemic Colitis

Any underlying disease should be treated, and appropriate blood pressure and cholesterol level should be maintained. Patient should quit smoking and be active to stimulate circulation. Healing depends on the extent of arterial damage and patient’s overall health condition.

If death of an affected part of the colon (gangrene), colon perforation, or peritonitis occur, urgent surgical treatment is needed; in these cases prognosis is bad.

Dehydration

Dehydration - the lack of water in the body - is a result of water loss greater than intake. In healthy adult, about 7 liters of water from digestive juices is secreted into the intestine and about 2 liters of dietary water is ingested every day, but only 100-200 ml of water is lost with the stool, since most of it is re-absorbed in intestine. In acute diarrhea, as much as 20 liters of water (and electrolytes) may be lost in one day.

Symptoms of MILD Dehydration

Some extent of dehydration may occurs in a couple of hours. 

• thirst*, dry mouth, few tears when crying;
• reduced amount (less than usual) of morning urine (in infants, no wet diaper for 3 hours, is a sign of dehydration);
• fatigue, dizziness.

*Note: Thirst isn’t a reliable sign of dehydration - it may be absent, especially in children, old, and in severely dehydrated persons.

Diarrhea Due to Bad Sanitation

Inappropriate sewage disposal leads to contamination of drinking water with human or animal stools; this is the main cause of diarrhea in poor countries. Besides which, inadequate food storing and bad hygiene during food preparation result in food poisoning.

Prevention Of Diarhea in Poor Countries:

Latrines

Using latrines can help to keep the sources of drinking water clean.

Image 1. Latrine

Vaccination against Rotavirus

All children under 5 years of age should be vaccinated with oral vaccine. In poor countries, vaccination has greatly reduced mortality from diarrhea in last years.

A) Treatment of ACUTE Diarrhea

Treatment of Acute Diarrhea in ADULTS

Acute diarrhea in most cases stops on its own in few days. If there’s no fever or other debilitating symptom, the person can continue with regular activities but should avoid any strain.

Fluid Replacement

An adult with a mild diarrhea can drink plain water or tea, a cup (250 ml) at the time, and repeatedly through the day to maintain more than 200 ml of translucent or bright yelow morning urine and more than 500 ml of daily urine. In severe diarrhea, drinks with sugar and salt, like Gatorade or Rehydralyte, are recommended since they provide faster rehydration. Combination of diluted fruit juice (1:1) with salt crackers or salt broth is also appropriate. Drinks to avoid: alcohol, caffeinated and carbonated drinks, and in prolonged diarrhea also milk; they may all aggravate diarrhea. Treatment of dehydration.

Diarrhea Diet

There’s no reason to change the diet during the acute diarrhea. It’s good to avoid very fatty, sugary or spicy food, though.