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Patient education: Chronic diarrhea in

adults (Beyond the Basics)
Patient education: Chronic diarrhea in adults (Beyond the Basics)
Author:
J Thomas Lamont, MD

Section Editor:
Lawrence S Friedman, MD
Deputy Editor:
Shilpa Grover, MD, MPH, AGAF

Literature review current through: Nov 2022. | This topic last updated: Sep 07, 2022.
Please read the Disclaimer at the end of this page.

INTRODUCTION — Chronic diarrhea is defined as three or more loose

stools daily for at least four weeks. There are many possible causes of chronic diarrhea.
Treatment is aimed at treating the underlying cause of diarrhea (whenever possible),
firming up loose stools, and dealing with any complications of diarrhea.

Chronic diarrhea can have a substantial impact on your quality of life and overall health. At
its mildest, diarrhea is an inconvenience; at its worst, it may be disabling or even life

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threatening. Fortunately, effective treatments are available in almost all cases.

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This article will focus on causes of chronic diarrhea in developed countries, such as the
United States. More detailed information about chronic diarrhea in developed countries is
available by subscription. (See "Approach to the adult with chronic diarrhea in resource-
abundant settings".)

CHRONIC DIARRHEA CAUSES — A wide range of problems

can cause chronic diarrhea; some of the most common causes include irritable bowel
syndrome (IBS), inflammatory bowel disease (Crohn disease and ulcerative colitis),
malabsorption syndromes, like celiac disease, in which food cannot be digested and
absorbed, and chronic infections as well as many other less common causes of chronic
diarrhea.

Irritable bowel syndrome — Irritable bowel syndrome is one of the most

common causes of chronic diarrhea. IBS can cause crampy abdominal pain and changes in
bowel habits (diarrhea, constipation, or both). IBS can develop after having an infection.
(See "Patient education: Irritable bowel syndrome (Beyond the Basics)".)

Inflammatory bowel disease — The two major types of inflammatory

bowel disease are Crohn disease and ulcerative colitis. These autoimmune 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. (See
"Patient education: Crohn disease (Beyond the Basics)" and "Patient education: Ulcerative
colitis (Beyond the Basics)".)

Infections — Intestinal infections may cause chronic diarrhea in people who travel or

live in tropical or resource-limited countries. Intestinal infections can also develop after
eating contaminated food or drinking contaminated water or unpasteurized ("raw") milk.
(See "Patient education: Foodborne illness (food poisoning) (Beyond the Basics)".)

Endocrine disorders — An overactive thyroid (hyperthyroidism) can cause

chronic diarrhea and weight loss. Diabetes can cause chronic diarrhea if the nerves that
supply the digestive tract are injured.

Food allergy or sensitivity — Food allergies and hypersensitivity can

cause chronic diarrhea. People with celiac disease have an autoimmune disease triggered
by 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. (See
"Patient education: Celiac disease in adults (Beyond the Basics)".)

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Medicines — Medicines (prescription and nonprescription), herbs, Your

and dietary
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supplements can cause diarrhea as a side effect. To determine if a medicine could be the
cause of your diarrhea, 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 DIARRHEA 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 diarrhea, 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 diarrhea began, any recent changes
in medicines or medical problems, and if you have had accidents (leaking or smearing of
stool in the underwear). Also, provide your doctor with any information about foreign travel
and if you are taking medicines for your diarrhea.

Tests — Blood, stool, and urine tests can help to find the underlying cause of diarrhea.
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 x-rays or procedures, such as colonoscopy or sigmoidoscopy. 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 diarrhea, a specific, curable cause
cannot be identified. These patients may have irritable bowel syndrome. (See "Patient
education: Colonoscopy (Beyond the Basics)" and "Patient education: Flexible
sigmoidoscopy (Beyond the Basics)".)

In some cases, your doctor or nurse will recommend a trial of treatment before more
invasive tests (see 'Treatment trial' below).

CHRONIC DIARRHEA TREATMENT — Treatment of

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

Treating the cause — The underlying cause of chronic diarrhea should be

found and treated whenever possible. For example, infections may be treated with
antibiotics. In people with Crohn 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.

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●For people with lactose intolerance, this means avoidance of foods or drinks that contain
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lactose (table 1).

●Other ingredients that are known to cause diarrhea include sugar-free products made with
sorbitol and foods made with fat replacements (eg, Olestra).

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

Treating diarrhea — In some patients, the goal is simply to control the

diarrhea. This approach is often used before testing, when the results of tests are normal or
not helpful, or if diarrhea is caused by a chronic medical problem.

Diarrhea treatments include:

●Bismuth (sold as Kaopectate, Pepto-Bismol)

●Treatments that make the stools more formed and less watery, such as a high-fiber diet or
fiber supplement (see "Patient education: High-fiber diet (Beyond the Basics)")

●Antidiarrhea medicines – Examples include loperamide (sold as Imodium, available

without a prescription) or prescription medicines, such as diphenoxylate-atropine (Lomotil).
If you take loperamide, be careful to never exceed the dose on the label unless specifically
instructed by your doctor. Taking more than the recommended dose has led to serious
heart problems in some people.

●Anti-inflammatory medicines for Crohn disease or ulcerative colitis 

Treatment trial — Your doctor or nurse might recommend trying a treatment

before further testing. This approach can help to narrow down the list of possible causes of
your diarrhea.

Treatments that might be offered include:

●A trial of antibiotics, for an infection

●Stopping a medicine

●Changing your diet, for a possible food allergy or problem absorbing nutrients (such as
lactose intolerance)

Treating complications — Chronic or severe diarrhea 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 are drinking enough fluids if
your urine is a light yellow color.
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If you are not able to drink enough fluids and you become dehydrated, you may be given
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fluids into a vein (IV) to replace the fluids and electrolytes (salts) lost in diarrhea. This will not
cure your diarrhea, but it can prevent more serious complications.

WHERE TO GET MORE INFORMATION — Your

healthcare provider is the best source of information for questions and concerns related to
your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals,
are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient

education materials.

The Basics — The Basics patient education pieces answer the four or five key
questions a patient might have about a given condition. These articles are best for patients
who want a general overview and who prefer short, easy-to-read materials.

Patient education: Diarrhea in adolescents and adults (The Basics)

Patient education: Diarrhea in children (The Basics)
Patient education: Food poisoning (The Basics)
Patient education: High-fiber diet (The Basics)
Patient education: Microscopic colitis (The Basics)
Patient education: Campylobacter infection (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer,
more sophisticated, and more detailed. These articles are best for patients who want in-
depth information and are comfortable with some medical jargon.

Patient education: Irritable bowel syndrome (Beyond the Basics)

Patient education: Crohn disease (Beyond the Basics)
Patient education: Ulcerative colitis (Beyond the Basics)
Patient education: Foodborne illness (food poisoning) (Beyond the Basics)
Patient education: Celiac disease in adults (Beyond the Basics)
Patient education: Colonoscopy (Beyond the Basics)
Patient education: Flexible sigmoidoscopy (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)

Professional level information — Professional level articles are

designed to keep doctors and other health professionals up-to-date on the latest medical
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findings. These articles are thorough, long, and complex, and they contain multiple
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references to the research on which they are based. Professional level articles are best for
people who are comfortable with a lot of medical terminology and who want to read the
same materials their doctors are reading.

Approach to the adult with chronic diarrhea in resource-abundant settings

Approach to the adult patient with suspected malabsorption
Small intestinal bacterial overgrowth: Clinical manifestations and diagnosis
Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults
Cryptosporidiosis: Epidemiology, clinical manifestations, and diagnosis
Cyclospora infection
Definitions, epidemiology, and risk factors for inflammatory bowel disease
Eosinophilic gastrointestinal diseases
Giardiasis: Epidemiology, clinical manifestations, and diagnosis
Small intestinal bacterial overgrowth: Etiology and pathogenesis
Evaluation of the patient with HIV and diarrhea
Epidemiology, clinical manifestations, and diagnosis of Cystoisospora (Isospora) infections
Lactose intolerance and malabsorption: Clinical manifestations, diagnosis, and
management
Microscopic (lymphocytic and collagenous) colitis: Clinical manifestations, diagnosis, and
management
Overview of the medical management of mild (low risk) Crohn disease in adults
Management of the hospitalized adult patient with severe ulcerative colitis
Overview of the management of Crohn disease in children and adolescents
Treatment of irritable bowel syndrome in adults
Giardiasis: Treatment and prevention

The following organizations also provide reliable health information.

●National Library of Medicine

     (www.nlm.nih.gov/medlineplus/diarrhea.html)

●National Institute of Diabetes and Digestive and Kidney Diseases

     (https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea)

[1-5]
1. Juckett G, Trivedi R. Evaluation of chronic diarrhea. Am Fam Physician 2011; 84:1119.
2. Fine KD, Schiller LR. AGA technical review on the evaluation and management of chronic
diarrhea. Gastroenterology 1999; 116:1464.

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3/19/23, 10:21 AM Patient education: Chronic diarrhea in adults (Beyond the Basics) - Uptodate Free

3. Habba SF. Chronic diarrhea: identifying a new syndrome. Am J Gastroenterol 2000;

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95:2140.
4. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders.
Gastroenterology 2006; 130:1480.
5. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt
LJ, Chey WD, et al. An evidence-based position statement on the management of
irritable bowel syndrome. Am J Gastroenterol 2009; 104 Suppl 1:S1.
This generalized information is a limited summary of diagnosis, treatment, and/or
medication information. It is not meant to be comprehensive and should be used as a tool
to help the user understand and/or assess potential diagnostic and treatment options. It
does NOT include all information about conditions, treatments, medications, side effects, or
risks that may apply to a specific patient. It is not intended to be medical advice or a
substitute for the medical advice, diagnosis, or treatment of a health care provider based on
the health care provider's examination and assessment of a patient's specific and unique
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and its affiliates disclaim any warranty or liability relating to this information or the use
thereof. The use of this information is governed by the Terms of Use, available at
https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc.
and its affiliates and/or licensors. All rights reserved.
Topic 2000 Version 21.0

References

1 : Evaluation of chronic diarrhea.

2 : AGA technical review on the evaluation and management of chronic diarrhea.

3 : Chronic diarrhea: identifying a new syndrome.

4 : Functional bowel disorders.

5 : An evidence-based position statement on the management of irritable bowel syndrome.

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