There are two typesof diarrhea, acute and chronic. Acute diarrhea lasts for 1 to 2 weeks. Chronic diarrhea is an ongoing problem, lasting for longer than 2 or 3 weeks. Unlike the acute type, chronic diarrhea may be a nuisance for a healthy person, but for someone who has a weak immune system, it may even become a life-threatening illness.
Mechanism of the condition
The mechanism of diarrhea is well studied and experts say that the real cause of diarrhea are the osmotic substances. These substances with osmotic properties are capable of drawing water to the intestine. They are present in the stool, forcing water from the intestines to be excreted, resulting in looser stools. Bloating and flatulence often occur too.
Possible causes of chronic diarrhea
Several studies done in the past have shown that there are many causes of diarrhea. In most cases, changes in bowel habits characteristic to diarrhea are short lived and clear up on their own. Whenever diarrhea lasts more than two or three weeks, getting medical help is generally recommended.
Some of the most common causes of diarrhea are:
Food
It is a well known fact that most people experience diarrhea after eating a certain type of food. Different types of food cause different diarrhea patterns. For example, many people are intolerant of milk and milk products so even small amounts of the milk sugar (lactose) can cause diarrhea. Others have low tolerance for hot pepper. It is also proven that large amounts of fatty foods cause diarrhea in some people. Some types of sugar may also cause diarrhea. The artificial sugar sorbitol, which is normally used as a sweetener and particularly in diet gums and candies is proven to have properties that can cause diarrhea. Mannitol is another sweet substance frequently found with sorbitol which may cause diarrhea.
Chemical Laxatives
Although sometimes laxatives cannot be avoided or they are even recommended, many people become dependent on them early in life and use them on a daily basis.
The most commonly used are:
- magnesium (Epsom salt),
- cascara (Nature's Remedy),
- phenolphthalein (Exlax, Correctol, Feen-A-Mint)
Prescription Drugs
If a change in bowel habit occurred after taking a new drug, that could be the possible cause of diarrhea and the physician should be contacted. It is well known that antibiotics may cause diarrhea. Diarrhea can develop up to one month after taking antibiotics.
Infection
There are many different bacteria and many viruses and other infectious agents that find their way into our bodies and cause diarrhea. One of the most serious bacterial infections that can cause diarrhea is salmonella infection. It is rather serious and requires medical evaluation. Salmonella usually comes from contaminated poultry. Other bacteria that can cause diarrhea are: Campylobacter, Clostridium difficile, Escherichia coli, Listeria onocytogenes, Shigella etc.
There are also some parasites, such as amoeba and giardia, Cryptosporidium parvum, Cyclospora cayetanensis, Entamoeba histolytica that attack the intestines and cause diarrhea. Virus infection is probably the most common cause of the short term diarrhea and, fortunately, it usually clears up on its own. The most common viral infections related to diarrhea are HIV, rotavirus, Norwalk agent etc.
Traveler's Diarrhea
This is a very common and very specific condition that has long been observed as a separate condition. It is now proven that the cause of traveler's diarrhea is a toxic bacterium called Escherichia Coli. the good thing is that this infection can often be prevented by avoiding fresh, uncooked products and fruits. It can also come from the non-bottled beverages.
Certain Diseases
Several researches have proven that there are certain intestinal disorders that can cause chronic diarrhea. These include ulcerative and microscopic colitis, Crohn's disease, diverticulosis, and even colon cancer. Diabetes, thyroid and other endocrine diseases also cause diarrhea in most of the cases. There is no need to point out that these are all serious diseases that require careful medical attention and treatment.
Stress and Irritable Bowel Syndrome
Irritable bowel syndrome is a problem that occurs when the intestines, especially the colon, do not contract in a smooth, rhythmic manner. It is characterized with abdominal pain, distention, and stool with mucous. Sometimes there is alternating constipation and diarrhea. It is proven that emotional stress often aggravates these symptoms.
Malabsorption
Certain foods that cannot be absorbed properly are passed into the stool, resulting in diarrhea in an attempt to excrete them. Besides diarrhea, symptoms include weight loss, and nutritional deficiencies. The cause of this condition may be bacterial overgrowth, chronic pancreatitis, previous intestinal resections, and lymphatic obstruction.
Motility disorders
It occurs as a result of too rapid a transit of intestinal materials, allowing insufficient time for food and water to be absorbed.
Food allergies
The fact is that true food allergies are rare as a cause of chronic diarrhea and persons allergic to some foods such as strawberries or shellfish experience only a short-lived intestinal upset.
Symptoms of chronic diarrhea
The main symptom of diarrhea is frequent, loose, watery bowel movements, or stools. Other possible symptoms are:
Dehydration
When diarrhea continues without the replacement of the lost fluids, the patient is at high risk of becoming dehydrated, which can cause serious health problems, especially in children and the elderly. Symptoms of dehydration include dry mouth, dry eyes, infrequent urination, and urine with a dark color and strong odor and in more serious cases fever, nausea, vomiting, and stomach pain, malnutrition and weight loss.
Who is at risk for chronic diarrhea?
It is clear that people with severely weakened immune systems, such as those with AIDS, those who are taking certain types of chemotherapy or who have recently received an organ transplant, are at greater risk of developing problems with chronic diarrhea.
Diagnosis of chronic diarrhea
The bad thing about diarrhea is that diagnosis may be difficult and requires a doctor to take detailed patient’s history and perform a physical exam. There are several test that can be done in order to confirm the diagnosis and the most common are:
- blood or stool tests (Complete blood count, thyroid function tests, Electrolytes, Calcium, Phosphorus, albumin, and liver function tests are commonly used. Beta-carotene and Prothrombin time may also be helpful)
- stool cultures may be used to test for bacteria
- special stains - they may be required to look for some parasites
- radiographs (x-rays)
- endoscopy - procedure in which a tube is inserted into the mouth or rectum so that the doctor can look directly at the intestine
- abdominal CT scans – they may show chronic pancreatitis, colon cancer, and signs of Crohn's Diseases (ileitis) or pancreatic endocrine tumors
Treatment of chronic diarrhea
The fact is that the treatment of diarrhea depends upon the cause.
- Diarrhea caused by an infection should be treated with appropriate antibiotics.
- Diarrhea not caused by an infection is more difficult to diagnose and treat. Long-term medication or surgery may be required.
- If the cause, such as sorbitol or a certain drug is removed, the diarrhea usually stops and the body can heal.
- Beans and spicy food should be avoided during the treatment
- A banana, rice, applesauce, and toast (BRAT) diet has been recommended for years
- The lost fluid shoud be recompensated and that’s why water or electrolyte drinks that contain a balance of water, sugar, and salt should be used.
- Beverages containing caffeine, such as tea, coffee, and soft drinks shouldn’t be used.
- Foods containing starch, such as cereals, crackers, rice, and mashed potatoes, are very easily digested.
- Hygiene and isolation are important in limiting the spreading of the disease.
Medications:
- Loperamide
- Diphenoxylate with atropine
- Codeine, tincture of opium, and Paregoric
- Cholestyramine
- Octreotide
- Clonidine patch
How is chronic diarrhea spread?
Every patient and all the persons that come in the contact with them should know that chronic diarrhea caused by an infection can be spread by drinking water or eating food contaminated with stool. This means that every close contact with a person who has diarrhea may also spread infection. However, chronic diarrhea not caused by an infection cannot be spread to other people.
How can chronic diarrhea be prevented?
There are some tips which can reduce the chance of getting an infection which may cause diarrhea and they are:
- Drink clean or purified water
- Use proper food-handling techniques
- Maintain proper hand-washing habits
- Avoid dairy products, fatty foods, high-fiber foods or seasoned foods
- www.healthlink.mcw.edu
- www.ibscrohns.about.com
- www.hmc.psu.edu
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