Chronic diarrhea: Diagnosis, Treatment, Diet 🆙

Diagnosis

Like any pathology or disorder, the diagnosis of chronic diarrhea begins with the anamnesis, that is, with the collection of the symptoms reported by the patient. Here, the doctor must first understand what the patient means when he claims to be suffering from "chronic diarrhea", given that each of us has a subjective conception of his own intestinal activity.
Once the disorder has been ascertained, the doctor will have to investigate the triggering cause, asking specific questions about the frequency of daily bowel movements, the consistency of the fecal mass, the volume of the stool, the duration of the disorder and, of course, the presence of any accompanying symptoms.
Certainly, a stay in tropical countries broadens the spectrum of the likelihood that chronic diarrhea is closely linked to a gastrointestinal infection. However, this does not exclude the possibility that the excessive frequency of diarrheal discharges depends on extrainfectious causes. Just to give an example, a chronic diarrhea with traces of blood that occurs immediately after a trip to African countries may be due more to ulcerative colitis than to an intestinal infection by amoeba (as it might initially be assumed).
Tracing the triggering cause is the first and most important step in establishing adequate treatment. To this end, physical examination is essential to provide further clues to the nature of chronic diarrhea.
The most performed assessment tests are:

Anoscopy: diagnostic test useful for detecting any fistulas, ulcerations or fecaloma
Abdominal physical examination to look for inflammation, tumors, any internal scars
Rectal examination
Search for occult blood in the stool
Additional laboratory tests: complete blood count, albumin, liver function test, plasma electrolyte levels, thyroid stimulating hormone levels, search for eggs or parasites in the stool
Colonoscopy and sigmoidoscopy
Colon biopsy (indicated when microscopic colitis is suspected)

Cure

Treatment of chronic diarrhea aims at:

Eliminate the triggering cause
Balance bowel movements
Prevent any complications
Avoid relapses

The ideal cure for chronic diarrhea is clearly the elimination of the cause that induced it. However, as we have seen, the possible triggers are extremely numerous and heterogeneous; therefore, taking a specific treatment right away turns out to be rather difficult precisely because the cause is not always clearly identifiable. For this reason, before undertaking any treatment for chronic diarrhea, the physician should first determine the type (chronic watery, oily or inflammatory diarrhea). The next step involves the execution of specific laboratory tests for the differential diagnosis, therefore the implementation of adequate treatment.

When chronic diarrhea manifests itself with aggressive symptoms, such as to suggest a potentially serious pathology for the patient's health and life (eg serious infections), prophylactic antibiotic therapy could be a valid and preliminary treatment option.

When the cause of chronic diarrhea is known, the treatment is more immediate and simple:

ANTIBIOTICS

If chronic diarrhea is caused by a bacterial infection, antibiotics are the cure of choice. The duration of antibiotic therapy depends on the type of infection and the patient's state of health: in subjects also suffering from Crohn's disease or ulcerative colitis, the therapy must instead be followed for a longer period.

CHANGES IN EATING HABITS

When chronic diarrhea is due to food intolerance, the most effective therapy is simply removing that food from the diet.

STOP TO LAXATIVES

If the cause of chronic diarrhea lies in the abuse of drugs or laxatives, it is evident how the suspension of these drugs can heal the disorder.

SYMPTOM TREATMENT (no action is taken on the cause)

The administration of some antidiarrheal drugs can be useful to give temporary relief to the patient suffering from chronic diarrhea: we have spoken of "temporary" relief because these drugs do not act in any way on the triggering cause, but can postpone the urge to defecate. Medicines for the treatment of diarrhea include: Scopolamine, Atropine sulfate and intestinal motility inhibitors (eg Bismuth salicylate, Lactobacillus Acidophilus, Loperamide and Diphenoxilate). Even soluble fiber supplements can help in the context of chronic diarrhea to regulate intestinal functions and favor the establishment of a symbiotic microbial flora.

CURE FOR IRRITABLE COLON SYNDROME

When chronic diarrhea is closely linked to irritable bowel syndrome, the doctor prescribes drugs capable of reducing gastric secretion and intestinal motility (eg Atropine sulfate, Scopolamine). Even prokinetic substances (e.g. psyllium) are sometimes recommended to balance the frequency of bowel movements, especially when episodes of chronic diarrhea and constipation alternate: in this specific case, psyllium exerts its action by absorbing excess fluids and increasing the consistency. of the kilo (fecal bolus).

AGAINST ANXIETY AND STRESS

As we have seen, chronic diarrhea can result from a marked alteration in mood. In these cases, and subject to medical prescription, the patient can take serotonergic drugs, such as Venlafaxine and Alosetron. Natural remedies for anxiety and stress can also benefit the patient suffering from chronic diarrhea.

TREATMENT FOR CROHN'S DISEASE

Chronic Crohn's disease-dependent diarrhea is not that simple to treat, even considering the severity of the underlying condition. In any case, to relieve the symptoms of chronic diarrhea in the context of Crohn's disease, the patient will have to pay extreme attention to the diet and take specific drugs (for further information, read drugs against Crohn's disease).

Chronic Diarrhea: What to do

In addition to the possible administration of specific drugs, chronic diarrhea must also be treated with the correction of some behavioral and dietary habits.
For example, avoiding dehydration by administering fluids is a very important rule in the context of chronic diarrhea. We remember, in fact, that a state of severe dehydration can seriously compromise the functions of the subject in your country.
Strictly avoiding alcohol and limiting caffeinated beverages (tea and coffee) are two important rules for accelerating chronic post-diarrhea healing: in addition to promoting dehydration of the body, in fact, these substances tend to irritate the mucous membranes of the digestive system.
Special attention should also be paid to sweeteners: substances such as sorbitol, mannitol and xylitol (sugar alcohols) can in fact aggravate the condition due to their markedly laxative effect.
To relieve the feeling of abdominal bloating that accompanies chronic diarrhea, it is advisable to avoid or limit as much as possible the intake of foods capable of increasing intestinal gas (eg beans, onions, peas and legumes in general).
A categorical "NO" instead belongs to milk: diarrhea in general, even worse the chronic variant, drastically reduces the enzyme level that populates the intestine, including lactase (enzyme used for the digestion of milk). By preventing lactase from carrying out its activity, the digestion and absorption of lactose in various foods are compromised; therefore, a water recall is favored (by osmotic effect) and diarrhea is worsened by symptoms such as meteorism, nausea and flatulence.
On the other hand, all foods capable of counteracting chronic diarrhea should be preferred, therefore rice (with known astringent properties), apple and carrot (able to solidify the stool), blueberry (antidiarrheal properties) and potatoes.
A note of merit therefore belongs to a healthy, balanced and regular diet, which is important for promoting recovery after a few weeks of chronic diarrhea.