Chronic Diarrhea

What is chronic diarrhea?

Diarrhea is loose, runny poop. We’ve all probably had it at one time or another. It tends to come out fast, suddenly and urgently, and you may have cramping or spasms in your colon when you go.

If you have food poisoning or the flu, you might have diarrhea for a day or so. It goes away when the original infection does. Chronic diarrhea is persistent diarrhea that continues for more than four weeks.

How common is this condition?

An estimated 1% to 3% of the population has chronic diarrhea. But these estimates may be low, as many people don’t seek treatment unless they have other symptoms, such as pain or bleeding.

Is it normal to have diarrhea all day every day?

Chronic and frequent diarrhea is an everyday experience for some people, but under normal circumstances, it shouldn’t be. Your colon, where poop is formed, is reacting to something abnormal.

Some people have chronic bowel diseases that cause chronic diarrhea. These diseases may not be curable, but you can treat the symptoms. Other causes are often curable with the right treatment.

What does persistent diarrhea indicate?

Normally, your colon receives liquefied food waste from your small intestine and gradually condenses it into solid poop. But with diarrhea, something impairs this process, leaving you with liquefied poop.

Something is making it hard for your colon to absorb water as it normally would, or making it excrete extra water, or both. It may be a problem with your colon itself or something abnormal inside it.

What are some common causes of chronic diarrhea?

Many diseases can cause chronic diarrhea. But before looking for diseases, a healthcare provider will ask you about your diet and medications. These are some of the most common causes of self-induced chronic diarrhea, and also some of the easiest causes to fix. Possible causes include:

Diet

Certain foods and drinks can cause diarrhea. If you eat or drink excessive amounts of them on a regular basis, or if you’re particularly sensitive to any of them, they might cause chronic diarrhea. Isolating the offending food or drink and reducing it or eliminating it from your diet may solve the problem. Consider:

• Coffee/Tea. Coffee affects your motility, speeding up your colonic transit time. Too much can make the food waste in your colon hastily exit before it has time to solidify. It’s unclear whether this is due to the caffeine or other chemicals in coffee. Some people experience similar effects from caffeinated tea or decaffeinated coffee. Different people may be more or less sensitive to different chemicals in these products. (You may also be sensitive to the milk or sweeteners added to them.) If you drink them often enough, you might have chronic side effects.
• Alcohol. Alcohol also speeds up your gut motility and your colonic transit time, especially on an empty stomach. It might be more likely to occur with moderate amounts than with excessive amounts. Too much alcohol may slow your digestion and dehydrate you, causing constipation. But regular, heavy drinking can cause diarrhea for a different reason — inflammation. If your colon is irritated and inflamed by alcohol, it can’t absorb water and minerals as it normally would. If the mucous lining of your colon has been damaged, it might even leak fluids.
• Specific sugars. Some sugars are harder to digest, and too much may cause diarrhea. Your intestines may lack the necessary enzymes to break them down, or there may be no such enzyme. Artificial sweeteners, such as sorbitol, mannitol and lactulose, are among the sugars that can’t be digested by human intestines. That’s why they don’t add calories. When your intestines can’t break the molecules down, they draw in extra water to help usher the oversized molecules out of your body. Fructose can have this effect in certain quantities and proportions, which is why products made with high fructose corn syrup may cause diarrhea. Some people also have specific intolerances to specific sugars. Lactose intolerance is the most common.
• Food intolerances. You might have a food intolerance if you have difficulties digesting a particular type of food. This often means that you lack an enzyme necessary to break the food down in your digestive system. Gluten intolerance, histamine intolerance and certain sugar (carbohydrate) intolerances are common examples of this. Unabsorbed foods cause diarrhea.

Medications/Supplements

Many medications can cause chronic diarrhea as a side effect. They can cause it by several different means. Whether they have that effect on you may depend on a variety of other factors, including dosage, diet and other conditions. Your healthcare provider will look at your complete medical profile to determine whether medications are a factor. Some that can cause chronic diarrhea include:

• NSAIDs (nonsteroidal anti-inflammatory drugs), such as aspirin and ibuprofen.
• Proton pump inhibitors (PPIs).
• Antibiotics, such as amoxicillin and cephalexin.
• Certain herbal supplements and tea ingredients, such as senna.
• High doses of certain vitamin and mineral supplements, such as vitamin C and magnesium.
• Antacids containing magnesium.
• Antidepressants (selective serotonin reuptake inhibitors) such as fluoxetine (Prozac®) and sertraline (Zoloft®).
• Beta-blockers.
• Metformin.
• Chemotherapy.
• Laxatives, when overused, as in bulimia nervosa.

What are the different types of diarrhea and their causes?

Healthcare providers sometimes classify diarrhea into three or four types as a way of narrowing down the cause. These types produce diarrhea with distinct qualities that doctors can recognize in your poop. They represent broad categories of causes. The three main types are inflammatory, fatty and watery. Some divide watery diarrhea into two sub-types (secretory and osmotic) to make four main types.

Watery diarrhea

Watery diarrhea happens when your colon is unable to absorb enough water and electrolytes from your poop and/or when it’s secreting more than it’s absorbing. The osmotic type is caused by poorly absorbed nutrients that draw extra water into your colon. (This is how osmotic laxatives work.) Meanwhile, secretory diarrhea represents a wide variety of diseases that can cause watery diarrhea.

Some of these causes include:

• Bile acid diarrhea. (This happens when there’s too much bile in the gut; also known as bile acid malabsorption, or BAM.)
• Microscopic colitis.
• Diabetes-related neuropathy.
• Vagotomy.
• Hyperthyroidism.
• Adrenal disorders.
• Neuroendocrine tumors.
• Irritable bowel syndrome (IBS).

Fatty diarrhea

Sometimes, excess fat in your poop changes the consistency to diarrhea. This can happen when your body has trouble breaking down and absorbing fats, or when bacteria in your gut produce excessive fatty acids. Fatty diarrhea may be less frequent but with greater volume. It may be smellier than normal and may leave a visible oil residue in the toilet. It may come with nausea, indigestion and weight loss.

Causes include:

• Malabsorption disorders such as pancreatic insufficiency and celiac disease.
• Small intestinal bacterial overgrowth (SIBO).
• Mesenteric ischemia.
• Gastric bypass surgery.

Inflammatory diarrhea

Inflammatory diarrhea is caused by inflammation in your colon (colitis). Inflammation affects the mucous lining of your colon (mucosa). It causes swelling and impairs the colon’s ability to absorb. Inflammatory diarrhea tends to come out more frequently and in smaller amounts. It may be accompanied by stomach pain, fever or bleeding. Inflammatory conditions that can cause chronic diarrhea include:

• Persistent infections, such as parasites or C. diff (pseudomembranous colitis).
• Inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease.)
• Ischemic colitis.
• Diverticulitis.
• Radiation colitis.
• Cancer.

What are the long-term side effects of chronic diarrhea?

Diarrhea that comes on suddenly and urgently or that’s difficult to hold in can have a dominating effect on your day-to-day life. It requires you to always have your eye on the nearest bathroom.

This habit can be difficult to hide on a regular, long-term basis. It can affect your confidence, as well as your overall quality of life. It may affect your ability to hold a job, especially a public-facing one.

Physically, chronic diarrhea puts you at risk of dehydration and its side effects. You lose a lot of water and electrolytes — minerals found in your body fluids — with chronic diarrhea.

Electrolyte losses can have serious consequences. They can affect your heart, lungs, brain and nervous system. Dehydration also stresses your kidneys and can lead to kidney disease.

What can I do at home to treat chronic diarrhea?

You might need a medical diagnosis and medical treatment to stop it. However, there are some things you can try first:

• Examine your diet and whether something you regularly eat or drink may be causing your diarrhea. If you consume coffee, tea, alcohol or something made with artificial sweeteners, like diet soda, try eliminating that first. If you have fatty diarrhea, try eliminating fats from your diet and see if it stops. Lactose intolerance is very common, especially in people of African or Asian descent. You might want to try eliminating dairy products. You may also want to try a more formal elimination diet, such as the low-FODMAP diet, to isolate your food intolerances.
• If you use medications regularly, ask your doctor whether any of them might be causing your diarrhea. If so, ask if you can try an alternative or try going off of it temporarily.
• Make sure you stay hydrated while you have diarrhea. Try a hydration solution, such as a sports drink or electrolyte mix that you add to water. Water alone doesn’t contain electrolytes.

How do you get rid of chronic diarrhea?

If it doesn’t go away with simple diet and medication changes, you need to see a healthcare provider. The provider will thoroughly examine the possible causes of your chronic diarrhea in order to identify the right treatment. Treating the underlying condition may solve your chronic diarrhea, or the condition may not be directly treatable. You may need treatment that targets your chronic diarrhea separately.

Treatment may include:

• Opiate antidiarrheals. These slow down your colonic transit time and increase absorption in your colon. Loperamide, often the first choice, isn’t habit-forming and is available over the counter (OTC).
• Bile acid binders for bile acid diarrhea.
• Clonidine for diabetes-related diarrhea.
• Eluxadoline for IBS-related diarrhea.
• Antibiotics or antiparasitics for infections.
• Fiber supplements, such as psyllium, to add bulk to your poop and slow down its transit.

When should I see a doctor about my chronic diarrhea?

It’s never a bad idea to see a doctor about chronic diarrhea. Unless you think you can solve it by quitting something in your diet, you’ll probably need treatment. If it’s been going on for a long time, you might be more at risk of additional complications that may also need treatment. You should seek care right away if you have other symptoms of illness, such as:

• Fever.
• Pain.
• Bleeding.
• Unintended weight loss.
• Paleness.
• Weakness or fatigue.

A note from Cleveland Clinic

Diarrhea is common, but usually, it goes away quickly and without treatment. Diarrhea that persists for a month or longer needs to be addressed by a healthcare professional. Sometimes, the cause turns out to be simple and relatively easy to fix. In other cases, you might discover an underlying condition needing complex treatment. In either case, don’t ignore this symptom. Your healthcare provider can help.