Dr. Widjaja Luman
Consultant Gastroenterologist and General Physician
B Sc (St. Andrews), MB ChB (Man), MRCP (UK), M.D. (Edin),
CCST (UK), FRCP (Edin)
(Ahli penyakit pencernaan dan hepar)
Persistent or chronic diarrhoea is diarrhoea illness that has lasted longer than 4 weeks. Unlike acute diarrhoea that is due to infections (viral or bacteria infections), the causes of chronic diarrhoea are usually non infective in nature. It can be due to benign conditions such as lactose intolerance or more serious disorders. These are diseases that cause inflammation in the lining of the gastro-intestinal tract and malabsorption of food. It is important to diagnose the cause of chronic diarrhea and treat the underlying condition.
What are the symptoms?
The main symptom of chronic diarrhea is loose or watery stools that persist for weeks. These stools may or may not be accompanied by a sense of urgency and stool incontinence. Stool frequency can be more than three times per day with loose watery stool. There are other associated symptoms such as :
- abdominal cramps
- weight loss
Presence of abdominal cramp and nausea usually means there is inflammation in the bowel. Bloating and weight loss suggests the cause may be due to malabsorption.
What are the causes?
The most common causes of chronic diarrhoea could be due to irritable bowel syndrome (IBS). In IBS, the bowel frequency tends to happen after food and the diarrhoea does not happen during sleep. Sufferers do not lose weight or notice blood in stool. Other non-serious causes of chronic diarrhoea are lactose intolerance or medications. Medications that causes chronic diarrhoea are non steroidal anti inflammatory drugs (NSAIDs), some diabetic medication, antacids, antibiotics, chemotherapy drugs and some anti depressant. You should discuss with your doctor if you notice the onset of diarrhoea with initiation of these medications.
Your diet can also play a role in chronic diarrhea. Certain ingredients speed up the rate of digestion, causing food to pass rapidly through the colon. Common culprits include milk and artificial sweeteners (sorbitol and fructose).
Inflammatory conditions that can cause loose, watery stools include ulcerative colitis and Crohn’s disease. These conditions can also cause bloody stools and abdominal pain.
Parasitic infection with amoeba and giardia can cause chronic diarrhoea. These parasites are endemic in some countries and diarrhoea usually starts after you return from your travel.
Malabsorptive causes of chronic diarrhoea are coeliac disease and chronic pancreatitis. Coeliac disease is an immunological disorder due to gluten intolerance. It is not a common condition in East Asians. It is common among the Caucasians and Northern Indian. Chronic pancreatitis is a prolonged inflammatory disorder of the pancreas. It is usually due to long standing excessive alcohol consumption and rarely due to auto-immune disorder.
When should I consult my doctor?
You should consult your doctor if
- the diarrhoea does not respond to over the counter anti diarrhoea medicine
- the diarrhoea is accompanied by blood in stool or fat globules in stool
- there is associated weight loss
- you have recently travelled to countries endemic for amoeba or giardia
- you are on medication that suppresses your immunity.
- you notice thirst and dark concentrated urine. These symptoms suggest you are dehydrated (lack of water in your body) and you need intravenous fluids.
What tests would my doctor order?
Your doctor may order simple stool test to look for presence of white / red blood cells or amoeba. Gastroscopy with small bowel biopsies and colonoscopy may be required in some cases in order to elucidate the cause.
What are the treatment?
Anti-diarrheal medications can relieve diarrhea, but these medications aren’t recommended as a long-term therapy. Treatment of chronic diarrhea depends on the cause. For example, if you are diagnosed with a medical condition like ulcerative colitis or Crohn’s disease, your doctor will discuss treatment options with you and recommend the best course of action. Treatment might include prescription medications like an immunosuppressant or a corticosteroid.
Sometimes the cause may not be found despite having undergone extensive investigations. The doctor may label the cause as irritable bowel syndrome. In this situation, it may be useful for you to monitor your food consumption and occurrence of diarrhoea. You may be able to identify possible trigger foods. Simple measures like stopping lactose containing food, cutting down on caffeine and alcoholic or diet beverages may provide the relief.