Treating Chronic Diarrhoea

HEALTH

Chronic diarrhoea is defined as three or more loose stools daily for at least four weeks. There are many possible causes of chronic diarrhoea. Treatment is aimed at treating the underlying cause of diarrhoea (whenever possible), to treat any deficiencies, and dealing with any complications of diarrhoea. Chronic diarrhoea can have a substantial impact on your quality of life and overall health. At its mildest, diarrhoea is an inconvenience; at its worst, it may be disabling or even life threatening. Fortunately, effective treatments are available for most of the cases.

Chronic or severe diarrhoea can lead to potentially serious complications, including dehydration and malnutrition. While you are being evaluated, you should be sure to drink plenty of fluids. You need to drink enough fluids if your urine is a light-yellow color.

If you are not able to drink enough fluids and you become dehydrated, you may be given fluids into a vein (IV) to replace the fluids and electrolytes (salts) lost in diarrhoea. This will not cure your diarrhea, but it can prevent more serious complications.

Causes of Chronic Diarrhoea

A wide range of problems can cause chronic diarrhoea; some of the most common causes include irritable bowel syndrome (IBS), inflammatory bowel disease (Crohn's disease and ulcerative colitis), intestinal tuberculosis, malabsorption syndromes, like celiac disease, in which food cannot be digested and absorbed, and chronic infections.

Irritable bowel syndrome — irritable bowel syndrome is one of the most common causes of chronic diarrhoea. IBS can cause crampy abdominal pain and changes in bowel habits (diarrhoea, constipation, or both). IBS can develop after having an infection. It is never life-threatening but it can impair the quality of life.

Inflammatory bowel disease — The two major types of inflammatory bowel disease are Crohn's disease and ulcerative colitis. Both these conditions develop when the body's immune system attacks parts of the large or small intestine. A clue to the presence of inflammatory bowel disease is appearance of blood in the stool along with pain in the abdomen and weight loss.

Infections — Intestinal infections may cause chronic diarrhoea in people who travel or live in tropical or resource-limited countries like India. Intestinal infections can also develop after eating contaminated food or drinking contaminated water or unpasteurized milk.

Endocrine disorders — An overactive thyroid (hyperthyroidism) can cause chronic diarrhoea and weight loss. Diabetes can cause chronic diarrhoea if the nerves that supply the digestive tract are injured.

Food allergy or sensitivity — Food allergies and hypersensitivity can cause chronic diarrhoea. People with celiac disease have an autoimmune disease triggered by gluten, a major component of wheat flour, which can cause diarrhoea and weight loss. Patients with lactose intolerance develop diarrhoea and gas when they ingest milk.

Medicines — Medicines (prescription and nonprescription), herbs, and dietary supplements can cause diarrhoea as a side effect. To determine if a medicine could be the cause of your diarrhoea, review your list of medicines with your doctor, nurse, or pharmacist. This information may also be available on the medicine bottle or paperwork that comes with most prescriptions.

Chronic Diarrhoea Evaluation -

You should seek medical attention if you have loose or watery stools that last more than three or four weeks. You may need to be seen sooner than this if you have any of these "alarm symptoms": bloody diarrhoea, fever, dehydration, weight loss or abdominal pain that interferes with your activities or prevents eating.

During your visit, it is important to mention when your diarrhoea began, any recent changes in medicines or medical problems. Also, provide your doctor with any information about any medicines you are taking for your diarrhoea.

Tests — Few blood and stool tests can help to find the underlying cause of diarrhoea. Special breath tests are used to test for lactose intolerance, or bacterial overgrowth of the small bowel. If these tests do not find the cause, other approaches may be needed, including esophagogastroduodenoscopy or colonoscopy. Your primary care provider can order initial stool and blood tests and, if indicated, can refer you to a specialist (a gastroenterologist). In many patients with chronic diarrhoea, a specific, curable cause cannot be identified. These patients may have irritable bowel syndrome.

Chronic Diarrhoea Treatment -

Treatment of chronic diarrhea aims to eliminate the underlying cause (if the cause is known), firm up the bowel movements, and treat any diarrhoea-related complications.

Treating the cause — the underlying cause of chronic diarrhoea should be found and treated whenever possible. For example, infections may be treated with antibiotics. In people with Crohns disease or ulcerative colitis, long-term treatment and follow-up is needed.

In some cases, treatment may be as simple as eliminating a food or medicine.

●For people with lactose intolerance, this means avoidance of foods or drinks that contain lactose

●Other ingredients that are known to cause diarrhoea include sugar-free products made with sorbitol.

●Certain medicines can also cause diarrhoea (such as laxatives and antacids).

Treating diarrhoea — In some patients, the goal is simply to control the diarrhoea. This approach is often used before testing, when the results of tests are normal or not helpful, or if diarrhoea is caused by a chronic medical problem. Treatments that make the stools more firm and less watery, such as a high-fiber diet or fiber supplement.

Dr Bhaskar Jyoti Baruah MD DM (AIIMS)

Gastroenterologist and Hepatologist, The GastroLife

Email ID – info@thegastrolife.com

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