Chronic diarrhea is defined as diarrhea that persists for more than 4 weeks. Infections are generally not a cause for chronic diarrhea, so one must consider other medical conditions that may lead to a chronic diarrhea state. Causes for chronic diarrhea are numerous but we may see this condition after certain surgeries are performed; in particular, a vagotomy or gastrectomy, cholecystectomy (gallbladder removal) or bowel resection. In addition, abdominal pelvic radiation therapy could lead to chronic diarrhea. Drug-induced diarrhea may be from various medications and sometimes the patient is not aware that a medication may be leading to diarrhea symptoms. An example may be as simple as an antacid, which if a patient is taking on a regular basis could lead to diarrhea, as most of these contain magnesium.
Various endocrine diseases could cause chronic diarrhea, such as hyperthyroidism, diabetes mellitus, hypoparathyroidism or Addison's disease. Circulatory problems like congestive heart failure, vasculitis or poor bowel circulation can also lead to diarrhea and immune deficiency syndromes like AIDS or various neurologic diseases might also lead to chronic diarrhea. Chronic bacterial infections also can be a cause and the most common of these would be parasites like Giardia, Strongyloides, Yersinia, or tuberculosis.
A common cause of chronic diarrhea may be inflammatory bowel disease, usually called Crohn's disease, ileitis, or ulcerative colitis, these conditions lead to chronic inflammation of the lining of the bowel wall, resulting in seepage of secretions, mucous, blood and hypermotility all resulting in chronic diarrhea. Occasionally diverticulitis of the colon or a collagenous colitis might also be a factor. In addition, tumors of the colon, especially if they are in the lower part of the colon could cause diarrhea. These could be either colon cancers or colon polyps as well as abdominal lymphomas or carcinoid tumors. Certain glandular tumors like pancreatic carcinoma, gastrinoma, thyroid carcinoma or carcinoid tumors can also lead to diarrhea.
Maldigestion or malabsorption is another not uncommon cause of diarrhea. This could be secondary to a decrease in production of digestive enzymes from either the pancreas or the bile resulting in poor absorption and thus diarrhea. Additionally, there are various conditions of the lining of the small intestine which prevent absorption of food and nutrients and therefore result in a diarrhea state, and these can be reviewed under the section of malabsorption.
In order to diagnose the cause of chronic diarrhea, often times a rather extensive work-up is necessary. First of all it includes a careful history and physical examination. Various other tests are employed including blood counts, serum chemistries, liver function and thyroid tests, urine evaluation, stool examination for bacteria as well as parasites and blood and a possible stool collection for fat or electrolytes. Colonoscopy and/or upper endoscopy are frequently employed to evaluate the inside of the GI tract and take specimens if necessary. Occasionally upper or lower GI x-rays are also employed as well as abdominal and pelvic sonography or computerized CAT scans of the abdomen. There is no one treatment for chronic diarrhea as the approach is dependent upon the actual cause, so once a work-up is completed, therapy can be directed at the specific cause for the chronic diarrhea. In rare cases, no cause is determined and this is called a chronic idiopathic diarrhea, in which case dietary manipulation and various anti-diarrheal medications are employed.
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Other Gastrointestinal Diseases:
- Celiac Sprue |
Crohn's Disease |
Colon Cancer |
Colon Polyps |
Colorectal Cancer Screening Guidelines for 2001 |
Constipation |
Diarrhea |
Diverticulosis |
Esophageal Strictures |
Fecal Incontenence |
Gastrointestinal Bleeding |
GERD Treatment Guidelines Summary |
Helicobacter Pylori |
Hemorrhoids |
Irritable Bowel Syndrome |
Lactose Intolerance |
Malabsorption Syndromes |
Pancreatic Cancer |
Pancreatitis |
Pilonidal Cysts |
Puritis Ani |
Rectal Abscess |
Rectal Prolapse |
Treatment of Anal Fissures |
Ulcerative Colitis |
Whipple's Disease
Related Links
- Definitions
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