What Is Chronic Diarrhea?

Chronic diarrhea is defined as having three or more loose bowel movements a day for at least four weeks. Diarrhea occurs when there is a problem with the digestive process.

In normal digestion, the food you eat is broken down into liquid nutrients that are absorbed by the small intestines. The waste moves to the large intestine (colon), where the excess fluid is absorbed to form solid waste. 

When this process is disrupted, the waste can move too quickly through the large intestine. As a result, the fluid is not absorbed, and the stool comes out watery instead of solid. 

Short-term (acute) diarrhea is usually the result of a gastrointestinal infection. Chronic diarrhea, on the other hand, is typically caused by medical conditions, allergies, medications, or chronic infections.

This article discusses chronic diarrhea. It explains the symptoms that may accompany chronic diarrhea and its potential causes. It also details how chronic diarrhea is treated and strategies for prevention.

What Are the Symptoms of Chronic Diarrhea? 

Diarrhea is most commonly thought of as loose or watery bowel movements.

The medical definition of diarrhea is three episodes of loose or watery stool in a 24-hour period. Its termed chronic diarrhea when it persists for four or more weeks.

In addition to loose stool, symptoms that may accompany chronic diarrhea include:

• Abdominal cramping 
• Abdominal pain, ranging from mild to severe
• Black, tarry, or bloody stools
• Bloating
• Fever and/or chills
• Mucus in the stool
• Nausea
• Signs of dehydration, including dry mouth, thirst, weakness, and fatigue 
• Urgent need to have a bowel movement (called tenesmus)
• Vomiting

These symptoms can provide clues to the cause of chronic diarrhea. However, some people with chronic diarrhea do not experience any symptoms other than loose or watery stools.

What Are the Different Types of Diarrhea?

Medical professionals break down diarrhea into three categories: watery, inflammatory, and fatty diarrhea. Some people have a combination of two or more types of diarrhea.

Watery Diarrhea

Watery diarrhea occurs when your colon is unable to absorb enough water or is secreting more fluid than it is absorbing. 

Watery diarrhea can be the result of too much bile, irritable bowel syndrome, hyperthyroidism, neuropathy, or other medical conditions. 

Inflammatory Diarrhea 

Inflammatory diarrhea is caused by inflammation in your colon. Also known as colitis, it occurs when the mucous lining of the colon (mucosa) swells. This inhibits the colon’s ability to absorb fluid.

Signs of inflammatory diarrhea include small but frequent bouts of diarrhea that may be accompanied by pain, fever, or bleeding.

Inflammatory diarrhea is associated with: 

• Cancer
• Crohn’s disease
• Diverticulitis
• Ischemic colitis
• Radiation colitis
• Parasites
• Persistent infection, such as C. diff
• Ulcerative colitis 

Fatty Diarrhea 

Fatty diarrhea occurs when the body has difficulty breaking down and absorbing fats or intestinal bacteria produce excess fatty acids. 

Fatty diarrhea tends to come out in large but less frequent volumes. It typically smells worse than other stools and may leave a visible oily residue in the toilet. It may also be accompanied by indigestion, nausea, and weight loss.  

Common in people who have had gastric bypass surgery, fatty diarrhea can also be a sign of:

• Celiac disease
• Pancreatic insufficiency
• Small intestinal bacterial overgrowth 

What Are the Causes of Chronic Diarrhea?

There are many potential causes of chronic diarrhea, and it's possible that more than one may be at play in your particular case.

Medical Conditions

An underlying medical condition could very well be at the root of your symptoms. Many conditions that can cause diarrhea can be adequately managed with proper treatment.

It's important to talk to your healthcare provider about your symptoms so you can get a proper diagnosis and treatment plan.

A few causes of your chronic diarrhea that may be considered include:

• Inflammatory bowel diseases (IBD): Crohn's disease and ulcerative colitis can cause intermittent, chronic diarrhea. Diarrhea, stomach pain, rectal bleeding, fever, and weight loss may occur for weeks or months, often resolving for a period of time before recurring. Diarrhea may alternate with constipation or pencil-thin stools.
• Food sensitivities: Several food sensitivities can cause chronic diarrhea, either due to allergic responses or intolerance.
• Infections: Sometimes gastrointestinal infections either don't resolve, have a tendency to recur, or are followed by other infections, resulting in lingering diarrhea. Some parasites, such as Giardia, are not as easily recognized, so they are more likely to be misdiagnosed, linger, and cause chronic diarrhea.
• Colon cancer: Early-stage colon cancer rarely causes any symptoms and is a rare cause of chronic diarrhea accompanied by bloody stools and weight loss.
• Irritable bowel syndrome: This condition can cause fluctuating gastrointestinal symptoms, and sometimes triggers can be identified, but not always.
• Microscopic colitis: This condition causes severe, watery diarrhea, and crampy pain. It is believed to be associated with inflammation.

Additionally, diarrhea can be caused by malabsorption and/or motility issues, which can occur on their own or as part of illnesses that affect the gastrointestinal system.

Malabsorption

Malabsorption is caused by any condition that hampers the processes your body uses to absorb nutrients. Crohn's disease and Giardia are two examples.

Malabsorption of fats causes a distinct kind of diarrhea called steatorrhea. Diseases linked to fat malabsorption include:

• Alcoholic liver disease
• Chronic pancreatitis
• Cystic fibrosis
• Gallbladder disease
• Tropical sprue

Other forms of malabsorption that cause diarrhea include:

• Celiac disease is an autoimmune condition that's triggered by antibodies that react to gluten which causes stomach pain, diarrhea, fatigue, and weight loss that improves once gluten-containing foods are discontinued.
• Lactose intolerance (lactase deficiency) causes diarrhea because the lactose in dairy products isn't broken down into a form that can be absorbed—leading to watery diarrhea as fluid enters the intestines.
• Sugar alcohol and other non-absorbable sugars found in some candies and food additives can cause malabsorptive diarrhea in some people.
  

Motility Issues

Conditions and disorders that affect gastric motility, the rhythmic movement of food and waste through the digestive tract, can cause chronic diarrhea for varying reasons. These include:

• Hyperthyroidism: Excessive thyroid hormones stimulate intestinal movements and impair nutrient absorption.
• Diabetes: High blood sugar can cause malabsorption that results in diarrhea or leads to autonomic neuropathy, which impairs the function of some of the body's internal organs.
• Diarrhea-predominant irritable bowel syndrome (IBS-D) is another motility disorder.

Medications

Some medications can cause diarrhea either as an allergic reaction or as a normal medication side effect. You can develop chronic medication-induced diarrhea even if you have already been taking a particular medicine without problems for years.

Drug-induced diarrhea can be caused by: 

• Antacids
• Antibiotics
• Antidepressants
• Chemotherapy
• Heartburn medications 
• Immunosuppressants
• Laxatives
• Metformin
• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Ulcer medications
  

Complications of Chronic Diarrhea

If you have chronic diarrhea, you can experience serious health problems, even if your diarrhea is caused by a situation that isn't dangerous, such as a food allergy.

Dehydration

When you lose fluid in the stool, you can become dehydrated. Chronic diarrhea causes mild dehydration, which makes you thirsty. Severe dehydration results in decreased urine volume, dark urine, fatigue, lightheadedness, and low blood pressure.

Interestingly, dehydration is more dangerous if you have acute diarrhea, as your body tends to compensate better for dehydration if you have chronic, recurrent diarrhea.

Nutrition

You can also miss out on vitamins, minerals, proteins, and fats when your diarrhea is associated with a lack of absorption of these vital nutrients. Chronic diarrhea can also result in weight loss if you aren't absorbing enough carbohydrates and calories from the food you eat.

Bleeding and Irritation

Chronic diarrhea can cause irritation of the colon or the rectum, potentially resulting in fragile tissue and bleeding.

How to Treat Chronic Diarrhea

Chronic diarrhea is treated in a variety of ways depending on the cause:

• Antidiarrheal medications, such as Imodium (loperamide), Peptobismol (bismuth subsalicylate), and Lomotil (diphenoxylate and atropine), are used as short-term solutions for diarrhea.
• Antispasmodic medications, such as Bentyl (dicyclomine), Buscopan (hyoscine butylbromide), or Levsin (hyoscyamine), are used to treat IBS-D.
• Biologics, such as Cimzia, Entyvio, Humira, Remicade, Simponi, and Stelara, are used to treat inflammatory diarrhea from Crohn’s disease or ulcerative colitis. 
• Corticosteroids like budesonide and prednisone are sometimes used to treat inflammatory diarrhea. 
• Dietary changes, such as a gluten-free diet for celiac disease or a low-fat diet for gallbladder disease.
• Digestive enzymes, such as amylase, lipase, and protease, are used to treat diarrhea caused by some forms of malabsorption.
• Immunosuppressives like Methotrexate are used to treat inflammatory diarrhea. 
• Lactase supplements, like Lactaid, can help people with lactose intolerance digest the sugar in dairy to prevent diarrhea.
• Probiotics, strains of "friendly" bacteria that naturally occur in the body, are often recommended to treat chronic diarrhea.
• Sulfa drugs like sulfasalazine can be prescribed for ulcerative colitis. 

How to Prevent Chronic Diarrhea

If you have a history of chronic diarrhea, following your treatment plan can help to prevent further episodes. This may include medication, following a specific diet, or avoiding certain foods. 

Keep a Food Journal

If you haven’t already identified foods that aggravate your symptoms, your healthcare provider may recommend keeping a food diary and symptoms log. This can help pinpoint specific foods that trigger your chronic diarrhea.

Common problematic foods for people with chronic diarrhea include:

• Alcohol
• Artificial sweeteners, including NutraSweet, Splenda, or Equal
• Caffeine 
• Concentrated sweets like dried fruits or prune juice
• Cow’s milk and other dairy produce 
• Cruciferous vegetables like cabbage, cauliflower, broccoli, and Brussels sprouts
• Fatty meats like bacon 
• Fruit and juice
• High-fat foods
• Legumes
• Sugar alcohols like sorbitol, mannitol, or xylitol commonly found in sugar-free mints, gum, and candy

Other Dietary Strategies

Additional tips for preventing a recurrence of chronic diarrhea include:

• Avoid drinking with meals, which can speed up stomach emptying and may worsen diarrhea.
• Boost your intake of electrolytes like sodium and potassium, which help balance the amount of water in your body. Broth, sports drinks, bananas, nectars, and potatoes are good sources of electrolytes. 
• Drink beverages that are room temperature and not too cold or hot—both can speed digestion and lead to diarrhea.
• Eat smaller, more frequent meals throughout the day.
• Get more probiotics through foods like yogurt, pickles, sauerkraut, and kimchi or supplements
• Increase your fluid intake between meals to prevent dehydration.
• Take pectin 20 to 30 minutes before meals. It’s a soluble fiber found in plants that can prevent diarrhea by slowing the transit of stool in your intestines.
• Wait 20 to 30 minutes after eating to engage in activity or exercise.

Hygiene and Food Safety

You can prevent infectious chronic diarrhea by following food-safety guidelines, washing your hands frequently, and taking precautions when traveling. Keep the following tips in mind:

• Clean kitchen surfaces frequently to prevent contamination.
• Cook meat thoroughly.
• Wash fruits and vegetables thoroughly before eating or cooking.
• Wash your hands before and after handling food and after using the bathroom, changing a diaper, or attending to a sick person.
• Watch what you drink, especially when traveling to countries with inadequate sanitation. Drink only from a clean water source, boil water to eliminate pathogens, or use a quality water filter.
  
• When traveling, eat foods that are cooked and served hot.

When to See a Healthcare Provider

If you have long-term diarrhea, don't put off seeing your healthcare provider. Signs that you should see your healthcare provider include:

• Your diarrhea has lasted for more than two weeks (either intermittently or the entire time).
• You see blood in or on your stool.
• You have persistent abdominal cramps or severe pain.
• You're vomiting a lot.
• Your diarrhea wakes you from your sleep.
• You experience alternating constipation and diarrhea.
• You notice you're losing weight even though you haven't been trying to.

Your healthcare provider may order blood tests or a stool sample to check for blood in the stool or an infection due to bacteria, a virus, or a parasite.

You may need a colonoscopy or flexible sigmoidoscopy, which may identify IBD or early signs of colon cancer. Even if it turns out that you have colon cancer, it is usually curable, particularly if detected early.

Summary

Chronic diarrhea is defined as three or more loose bowel movements a day for four weeks or longer. Diarrhea may occur on its own or alongside other symptoms, like abdominal cramping, bloating, nausea, or vomiting. 

Different types of chronic diarrhea include watery diarrhea, inflammatory diarrhea, and fatty diarrhea. Chronic diarrhea can be caused by medical conditions, malabsorption, motility issues, or medications. It can also be caused by a combination of factors.

Complications of chronic diarrhea include dehydration, nutritional deficiencies, and irritation of the colon or rectum. If you experience chronic diarrhea, see your healthcare provider. Treatment for chronic diarrhea depends on the cause.