Chronic Diarrhoea
Chronic diarrhea is defined as the presence of loose or watery stools that persist for more than four weeks. It can be caused by a variety of underlying conditions, ranging from infections to chronic diseases and functional disorders. Here’s a detailed overview:
Causes:
Infections:
- Parasitic Infections: Such as Giardia lamblia, Entamoeba histolytica.
- Bacterial Infections: Chronic infections like Clostridium difficile.
- Viral Infections: Less common for chronic diarrhea but possible.
Inflammatory Bowel Disease (IBD):
- Crohn’s Disease: Inflammation that can affect any part of the gastrointestinal tract.
- Ulcerative Colitis: Inflammation and ulcers in the lining of the colon and rectum.
Irritable Bowel Syndrome (IBS):
- A functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits.
Malabsorption Syndromes:
- Celiac Disease: An autoimmune disorder triggered by gluten.
- Lactose Intolerance: Inability to digest lactose, leading to diarrhea when consuming dairy products.
- Pancreatic Insufficiency: Conditions like chronic pancreatitis affecting enzyme production.
Endocrine Disorders:
- Hyperthyroidism: Overactive thyroid can speed up digestion.
- Diabetes: Can lead to diabetic enteropathy affecting bowel movements.
Medications:
- Long-term use of antibiotics, laxatives, and certain other medications can cause chronic diarrhea.
Chronic Infections:
- HIV/AIDS: Opportunistic infections can cause persistent diarrhea.
Small Intestinal Bacterial Overgrowth (SIBO):
- Overgrowth of bacteria in the small intestine disrupting normal digestion and absorption.
Chronic Parasitic Infections:
- Persistent parasitic infections can lead to chronic diarrhea.
Microscopic Colitis:
- Inflammation of the colon that is visible only under a microscope.
Symptoms:
- Frequent loose or watery stools.
- Abdominal pain or cramping.
- Bloating and gas.
- Urgency to have a bowel movement.
- Fatigue due to dehydration and nutrient loss.
- Weight loss if associated with malabsorption.
- Blood or mucus in the stool (more common in IBD or infections).
Diagnosis:
Medical History and Physical Examination:
- To identify patterns, dietary habits, and potential risk factors.
Stool Tests:
- To check for infections, blood, fat, and other abnormalities.
Blood Tests:
- To check for signs of infection, inflammation, anemia, and other abnormalities.
Endoscopy:
- Colonoscopy: To examine the colon and rectum.
- Upper Endoscopy: To examine the upper gastrointestinal tract.
Imaging Studies:
- CT scans or MRIs to visualize the abdominal organs.
Breath Tests:
- To diagnose lactose intolerance or SIBO.
Biopsy:
- Tissue samples taken during endoscopy to check for conditions like celiac disease or microscopic colitis.
Treatment:
Addressing the Underlying Cause:
- Infections: Appropriate antibiotics or antiparasitic medications.
- IBD: Anti-inflammatory drugs, immunosuppressants, and biologics.
- IBS: Dietary changes, antispasmodics, and other medications.
- Malabsorption Syndromes: Gluten-free diet for celiac disease, lactase supplements for lactose intolerance, pancreatic enzyme replacement therapy for pancreatic insufficiency.
Dietary Modifications:
- Avoiding trigger foods.
- Following a low-FODMAP diet for IBS.
- Ensuring adequate hydration and electrolyte balance.
Medications:
- Anti-diarrheal Agents: Such as loperamide to reduce diarrhea.
- Probiotics: To restore healthy gut bacteria.
- Bile Acid Sequestrants: For bile acid malabsorption.
Lifestyle Changes:
- Managing stress and anxiety, which can worsen symptoms.
- Regular exercise to promote overall digestive health.
When to Seek Medical Attention:
- Severe or persistent diarrhea lasting more than a few days.
- Significant weight loss.
- Blood or pus in the stool.
- Severe abdominal or rectal pain.
- Signs of dehydration (dry mouth, decreased urination, dizziness).
- Fever with diarrhea.
Chronic diarrhea can significantly impact quality of life and may indicate a more serious underlying condition. It’s important to seek medical evaluation for appropriate diagnosis and treatment.