woman on toilet

Chronic Diarrhea: Symptoms and Causes

Someone experiencing chronic diarrhea has loose, watery stool for more than four weeks. Chronic diarrhea affects 1%-5% of the adult population. Many others experience acute, short-term diarrhea that lasts a day or two.

In this article, we’ll review the symptoms associated with chronic diarrhea and its underlying causes.

chronic diarrhea - woman with abdominal pain

Symptoms of Chronic Diarrhea

Rather than diseases causing chronic diarrhea, it’s often from an underlying condition. Unlike cases of acute diarrhea, which are self-limited, chronic diarrhea requires investigation. Along with watery stool, individuals experience abdominal cramps and discomfort, bloating, and nausea.

The condition also leads to dehydration and electrolyte deficiencies. This can manifest with excessive thirst, dark urine, fatigue, and dizziness.

In addition to these symptoms, there may be additional signs of the underlying condition. For example, if irritable bowel syndrome (IBS) is the cause, abdominal discomfort relates to defecation. The pain can either worsen or ameliorate with bowel movements. There may also be changes in stool consistency and/or frequency.

In the case of Crohn’s disease or ulcerative colitis, the stool may contain blood.

With celiac disease, the stool contains more fat. The individual may also experience extreme fatigue, weight loss, nausea, vomiting, and bloating. If left untreated, celiac disease can lead to anemia, osteoporosis, cognitive impairment, joint pain, and more.

chronic diarrhea - doctor holding model of intestines

Causes of Chronic Diarrhea

Chronic diarrhea may be a symptom of a larger issue. There are a few different subtypes of diarrhea. These are:

  • Functional
  • Secretory
  • Osmotic
  • Inflammatory
  • Fatty

Different conditions cause each subtype.

For example, functional diarrhea is very common and caused by IBS. This condition impairs gut motility and causes chronic diarrhea.

Secretory diarrhea occurs as a result of derangements in the small bowel secretion, colon secretion, or gastrointestinal water and electrolyte absorption. Malabsorption of bile acids, various endocrine conditions, surgeries of the digestive tract, or chronic alcohol abuse may cause this subtype.

Osmotic diarrhea develops when the body absorbs carbohydrates and other substances poorly. This then draws water into the stool. Oftentimes, this happens in cases of lactose intolerance or reactions to artificial sweeteners. Laxative overuse may also cause this form of diarrhea.

Fatty diarrhea is often the result of conditions that cause fat malabsorption. These conditions include celiac disease, infections with giardia, and diseases of the pancreas. As the name implies, the stool contains excess fat. Oily droplets may float in the toilet and the stool may be lighter than normal. Small intestine bacterial overgrowth (SIBO-D) can also cause fatty diarrhea.

Inflammatory diarrhea usually needs more investigation than other subtypes. Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis can cause this type of diarrhea. C. difficile and colon cancer can also cause inflammatory diarrhea.

Many prescription medications and cause chronic diarrhea too. Usually, the subtypes experienced are osmosis, secretory, fatty, or functional diarrhea. Common drugs associated with chronic diarrhea include:

  • Laxatives with magnesium
  • Antacids with magnesium
  • Antibiotics
  • Certain diabetes drugs
  • Heart disease medication
  • Non-steroid anti-inflammatory drugs (NSAIDs)
  • Thyroid medication
  • Immunosuppressants
  • Cancer treatment drugs

Be sure to talk to your doctor about the side effects of any medication you’re taking.

chronic diarrhea - patient and doctor talking

When Should You See a Doctor for Chronic Diarrhea?

If your diarrhea persists for several days despite using home remedies or your symptoms become severe, see your doctor. These severe symptoms include:

  • Dehydration
  • Blood or mucus in the stool
  • High fever

If you recently traveled to a foreign country, you should call your doctor as well.

Many conditions can lead to chronic diarrhea, so treating the underlying condition is essential. Your doctor will base their diagnosis on your medical history, physical examination, and blood and stool tests. Other tests such as a colonoscopy, abdominal ultrasound, and intestinal tissue biopsy can also help.

Overall, some of the most common causes of chronic diarrhea include:

  • Irritable bowel syndrome (IBS)
  • Crohn’s disease
  • Ulcerative colitis
  • Celiac disease
  • C. diff infections

Keep a journal to identify food triggers. If food is the cause, simple dietary changes can help. There are specific tests to identify the cause as well.

If medications trigger your chronic diarrhea, your doctor may prescribe an alternative drug.

For symptomatic relief, short-term over-the-counter antidiarrheal drugs like bismuth and loperamide can help.

Do not ignore chronic diarrhea as it suggests an underlying problem that needs treatment. A gastroenterologist can usually identify these conditions. The goal is not only to treat diarrhea, but also the root cause of it.

In the meantime, it’s important to learn how to manage diarrhea. There are supplements and medications that can help relieve symptoms.