Question: I read your column on constipation, but my problem is just the opposite. I have diarrhea ALL THE TIME. No matter what I eat or drink. I have been to doctors several times, and had several colonoscopies, but they never find anything and do not know what to do. Any suggestions? — Mike
You seem to have chronic diarrhea. This usually means three or more loose stools per day. There are many possible causes of chronic diarrhea. You have been to several doctors but still you need to be evaluated in detail by a gastroenterologist to arrive at the proper solution to your problem. Treatment must be aimed at correcting the cause of diarrhea and firming up loose stools. Uncontrolled diarrhea may lead to complications. Effective treatments are available for most people.
The common causes of diarrhea are different in different countries.
In USA, many causes can cause chronic diarrhea. Some of the most common causes include irritable bowel syndrome, inflammation in the bowels or malabsorption of food when food cannot be digested properly. Many times, chronic infections of the gut may cause diarrhea.
One common cause is irritable bowel syndrome. Irritable bowel syndrome is one of the most common causes of chronic diarrhea. It can cause crampy abdominal pain, diarrhea or constipation. It is diagnosed when a specific, curable cause cannot be identified.
Intestinal infections are a cause of chronic diarrhea can be seen in people who travel or live in tropical or developing countries. Intestinal infections can also develop after eating contaminated food or drinking contaminated water or unpasteurized raw milk.
Some hormonal conditions may cause loose bowels. Common hormonal conditions like overactive thyroid may cause chronic diarrhea and weight loss. Long-term uncontrolled diabetes can cause chronic diarrhea. Poor control of diabetes damages the nerves that control working of bowels and may cause diarrhea.
Food allergies and hypersensitivity can cause chronic diarrhea. People with celiac disease are sensitive to gluten, a major component of wheat flour, which can cause diarrhea and weight loss. Patients with lactose intolerance develop diarrhea and gas when they ingest milk.
Some prescription medicines, herbs and dietary supplements can cause diarrhea as a side effect. Review the information that comes with most prescriptions.
Try to seek medical attention if you have loose or watery stools that lasts more than several weeks, have blood in the stool, have fever, weight loss or abdominal pain.
Testing of blood, stool and urine can help find the underlying cause of diarrhea. Breath tests are used to test for lactose intolerance or bacterial overgrowth of the small bowel. X-rays may be needed. Your lower bowel may need checking by an instrument.
The underlying cause of chronic diarrhea should be found and treated whenever possible. For example, infections may be treated with antibiotics. There are some new treatments now available for Crohn’s disease or ulcerative colitis.
In some cases, treatment may be as simple as eliminating a food or medicine.
Lactose intolerance may mean elimination for foods or drinks that contain lactose or taking lactose tablets when you eat foods that have lactose.
Sugar-free products made with sorbitol and foods made with fat replacements like Olestra may cause diarrhea.
Long term use of laxatives and antacids may also cause diarrhea.
Some over the counter products may treat diarrhea by trying to improve consistency of stool. For example, bismuth-containing products may help. Sometimes, a high-fiber diet or fiber supplement may help.
Some antidiarrhea medicines like loperamide are available without a prescription. There are prescription medicines, such as diphenoxylate-atropine Lomotil that may help.
Octreotide is another prescription medicine that might be given to people with severe diarrhea.
I hope your doctor finds a cause and helps you.
Suman Kumar Mishr MD, Fellow of American College of Endocrinology. Cridersville, Ohio