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    Acute and Chronic Diarrhea

    Diarrhea is characterized by loose, watery stool that must be passed more than 3 times daily. Almost every patient will experience diarrhea at least 1 or 2 times every year, although many cases are not serious. Acute diarrhea is a common condition that can affect patients of any age or sex, although it is frequently reported among young children and infants. Older patients suffering from the condition may feel unusually thirsty, light-headed, dizzy and tired. Their skin will feel dry, and they will notice that their urine looks darker in color. In younger patients, an adult may notice that a child is crying without producing tears or that the child is experiencing a decrease in urination throughout the day. Mostly, infants will seem irritable and may show signs of other illnesses, such as a high fever.

    Some cases of diarrhea are chronic, meaning that the condition lasts on and off throughout a patient’s life and may need more diligent medical attention to screen for chronic conditions such as inflammatory bowel disease (IBD). Other cases of acute diarrhea only last a couple of days and usually symptoms go away on their own.  Overall, infection is the leading cause of diarrhea in the world.  Travellers who develop sudden diarrhea symptoms should seek medical attention for possible antibiotic treatment.

    If you experience diarrhea for more than a few days, it is important that you go see a medical doctor about your symptoms. Persistent diarrhea often leads to dehydration because a significant amount of water and important chemicals called electrolytes is lost when patients frequently pass loose stool. Leaving dehydration unattended can lead to more serious health issues such as damage to the organs, bodily shock or coma. While most patients who are experiencing diarrhea are able to keep up with their fluids losses by oral ingestion, occasionally intravenous fluids will be needed – especially if the diarrhea persists with vomiting.  Diarrhea patients who also have a high fever, blood in the stool or excessively dark-colored stool should contact a medical provider immediately.

    Causes of Diarrhea

    Chronic diarrhea is usually a sign of underlying chronic conditions such as Crohn’s disease or Ulcerative Colitis, which occur when there is severe inflammation in a patient’s colon tissue. Conversely, acute diarrhea, is triggered by more common conditions, such as a virus or bacterium. It usually does not have to be diagnosed if it only lasts a couple of days. While some rarer causes of diarrhea include traveling (“Traveler’s Diarrhea”) and increased rate of digestion as a result of stomach surgery, some common reasons why a patient may have diarrhea include:

    • Bacteria—bacteria (i.e. C.diff, Salmonella and E. coli) found in contaminated food and drink can infect the body and trigger bouts of diarrhea.
    • Viruses—viral infections with the rotavirus is a very common cause of acute diarrhea, especially in young children. While it usually lasts for less than a week, it can cause other digestive problems that are more persistent.
    • Irritable Bowel Syndrome (IBS)irritable bowel syndrome is a common gastrointestinal (GI) condition that affects thousands of Americans. Although not as serious as Inflammatory Bowel Disease (IBD), IBS is characterized by dysfunction of the bowels that causes symptoms such as bouts of diarrhea, abdominal pain, cramping, constipation and bloating during “flare-ups.”
    • Inflammatory Bowel Disease (IBD)—inflammatory bowel disease is a chronic condition that occurs when colon tissue is inflamed. The most common types of Inflammatory Bowel Disease are Crohn’s disease and Ulcerative Colitis.
    • Small Intestinal Bacterial Overgrowth (SIBO) – especially common in patients who have received courses of antibiotics for any reason, and in patients with poor gut motility (diabetes, neuromuscular disorders).  This is caused by overgrowth of bacteria within the small intestine and results in malabsorption of ingested foods leading to diarrhea, abdominal bloating, cramping and belching.
    • Microscopic colitis – This is a condition affecting mostly people over the age of 60, and more common in females.  This is a condition in which the colon cannot absorb water from ingested food as well, resulting in diarrhea. 
    • Reaction to Food—certain foods have been known to trigger diarrhea. If your stomach is particularly sensitive, you may want to be weary of consuming too many foods like milk or cheese that contain lactose and some sugar substitutes.
    • Reaction to Medication—many antibiotics and antacids cause diarrhea because they contain magnesium. These side effects are usually temporary and go away once use of the drug is discontinued.

    Diarrhea Treatment

    Your gastroenterologist (GI doctor) can perform routine tests to diagnose possible underlying causes of your diarrhea. Common procedures include stool tests, blood tests, colonoscopy and sigmoidoscopy. In most cases, however, over-the-counter pr prescription medication will usually ease the symptoms until the condition goes away naturally. Depending on your other symptoms, you may need to consult with a doctor about which drug is best (i.e. diarrhea patients who detect blood in their stool ay need to avoid certain over-the-counter medications). It is important to consult a doctor for diarrhea that is severe, associated with blood, or persistent.  During this recovery process, it’s important to drink plenty of clear liquids to compensate for fluids lost of the watery stool.

    Try to avoid greasy foods, fibrous foods and sweet foods while you are experiencing diarrhea, as these can sometimes make the diarrhea worse. Milk, cheese and other dairy products have also been known to cause problems—although sometimes yogurt with active bacterial cultures in it may work to help diarrhea go away sooner, and in some cases taking probiotic medications can help restore the bowel’s normal bacterial flora helping with some symptoms of gas/bloat. Most patients opt for meals containing generally bland foods, such as bananas and rice, which tend to solidify stool. Toast, crackers and baked chicken also have stool-hardening effects.

    Reviewed 12/12/2011 by David M. Nolan, M.D.
    Diplomate of the American Board of Internal Medicine, 2011
    Currently a Fellow of Gastroenterology, at UCI 2011-2014

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