Chronic diarrhea – causes, diagnosis, treatment

Proven content

Chronic diarrhea is a condition that lasts more than ten days where your child passes an increased number of stools or an abnormal consistency with mucus or blood. Prolonged diarrhea causes digestive and absorption disorders, which significantly contributes to the prolongation of diarrheal symptoms.

What is chronic diarrhea?

Chronic diarrhea is a condition where you pass more stools that are loose or watery. Sometimes they are accompanied by the presence of mucus or blood. The disease state is considered chronic when it persists for more than 10 days. Failure to control the intestinal infection in an infant (especially in the first quarter of life) in the initial stage of the disease may lead to a life-threatening cachexia. In older infants, long-term persistence of diarrheal symptoms after acute infections usually does not pose such a significant risk, however, it has a significant impact on the prolongation of the convalescence period. Above all, it is necessary to control the root cause of the disease as early as possible. The prolonged disease process causes digestive and absorption disorders, which significantly contributes to the prolongation of diarrheal symptoms.

It may also be important to keep outbreaks of infection from outside the gastrointestinal tract beyond the period of intestinal infection. The most common causes of this type are persistent otitis media with accompanying bone tissue destruction, and chronic inflammatory lesions located in the respiratory system or urinary tract. When analyzing the causes of recurrent, severe, persistent intestinal infections, one should also take into account congenital, persistent immune deficiencies (especially the absence or deficiency of IgA).

Types of chronic diarrhea

Depending on the causesthat caused diarrhea, we distinguish:

1. osmotic diarrhea – occurs as a result of improper digestion of food in the intestines. It mainly concerns carbohydrates which, after getting into the colon, create compounds that inhibit the absorption of water from it. The consequence of this diarrhea is that you pass watery or loose stools. The causes of osmotic diarrhea include secondary intestinal disorders caused by infectious diarrhea, short bowel syndrome, bacterial overgrowth syndrome and intolerance to carbohydrates, e.g. sorbitol, fructose, and lactose. It can also appear in people who abuse osmotically active laxatives, e.g. lactulose;

2. inflammatory diarrhea – appearing in the course of food allergy, ulcerative enteritis and immunity disorders;

3. secretory diarrhea – the reason for its formation is the increased secretion of water and electrolytes into the intestines. It can also appear in people with congenital defects or autoimmune disorders and hormonally active tumors;

4. diarrhea in people with accelerated intestinal motility – it occurs especially in people with hyperthyroidism and those taking prokinetic preparations.

The causes of chronic diarrhea in children

The causes of chronic diarrhea are divided into:

1. FREQUENT:

1. pancreatic insufficiency (the cause may be pancreatitis and cystic fibrosis; the excreted stools are foul-smelling and abundant);
2. use of laxatives (very often adolescents who want to lose weight overuse laxatives; as a consequence, watery diarrhea appears);
3. short bowel syndrome;
4. chronic inflammatory bowel disease (manifested by problems with normal growth, diarrhea, abdominal pain and stools mixed with mucus and blood);
5. post-infection diarrhea (the cause is a chronic infection of the gastrointestinal tract or hypersensitivity to a specific food, e.g. cow’s milk);
6. celiac disease;
7. irritable bowel syndrome;
8. carbohydrate intolerance.

2. RARE:

1. sodium diarrhea;
2. chloride diarrhea;
3. Immune enteropathy and Autoimmune enteropathy;
4. phenotypic diarrhea;
5. Epithelial dysplasia (watery diarrhea occurs from birth);
6. congenital atrophy of microvilli.

The appearance of the stool and possible ailments

It is worth examining the stool carefully and paying attention to its volume, color and the presence of any admixtures in the form of pus, mucus or blood. There may also be undigested food debris in the stool and elements of intestinal parasites that suggest the presence of pathological changes. The appearance of the stools may indicate possible causes of digestive disorders:

1. feces with blood and mucus – may indicate the presence of hemorrhoids, colitis, cancer or allergy;
2. black tarry faeces – may mean that the patient is bleeding from the upper gastrointestinal tract;
3. feces with the addition of pus – occurs in people with diseases of the large intestine of a bacterial or inflammatory nature;
4. a watery stool – may indicate problems with intestinal absorption;
5. large volume and fatty faeces – means digestive problems related to pancreatic insufficiency.

Chronic diarrhea and its symptoms

In addition to the greater amount of liquid or semi-liquid stools passed and their increased frequency, there are accompanying symptoms in the form of:

1. vomiting
2. high temperature,
3. weight reduction,
4. stomach aches
5. lack of appetite
6. exhaustion of the body.

Diagnostics of chronic diarrhea

In the diagnosis of chronic diarrhea, a medical interview with the patient is useful, in order to establish the basis of the diarrhea and its relationship with the previously consumed food. The doctor may ask about the course of the diarrhea, e.g. if it is severe, it may be infectious. It is also useful to get information about the appearance of your stools. The diagnostic tests used in the diagnosis of chronic diarrhea are:

1. Faecal test: its purpose is to test the electrolyte concentration in the stool and its osmorality in order to distinguish between secretory and osmotic diarrhea. In addition, the stool test allows for the assessment of fat excretion in the stool and the content of elastase (evaluation of the pancreas). If the bacteriological origin of diarrhea is suspected, a bacteriological examination of the feces is performed.

2. Endoscopic examination of the colon – is performed to find the cause of diarrhea, such as Crohn’s disease.

3. Blood test – blood count is important together with the leukocyte image, the assessment of electrolytes and urea in the serum, and a blood test for celiac disease.

4. Physical examination – the doctor assesses the patient’s lymph nodes (determines whether they are enlarged), and also checks whether the spleen and liver are enlarged. In addition, possible changes around the anus are assessed, such as abrasive epidermis, fistulas and fissures. The doctor also looks at the patient’s fingers – if they are rod-shaped, we are dealing with malabsorption and celiac disease. The patient’s skin should be carefully assessed as its condition may indicate a cause of chronic diarrhea.

5. Specialized examinations – colonoscopy is performed (examination of the lower gastrointestinal tract) or gastroscopy (examination of the upper gastrointestinal tract). In the course of these tests, specimens for histopathological examination or bacteriological culture may be taken. In some cases, there is a need for imaging tests in the form of magnetic resonance imaging, X-ray or ultrasound examinations.

Chronic diarrhea – treatment

Choosing the type of treatment for chronic diarrhea depends on its cause. In patients with fructose and lactose intolerance, it is most important to eliminate milk, fruit and juices from the diet. In patients who have problems with digesting and absorbing fats, it is necessary to replace them with fats containing interchain fatty acids. In turn, patients with celiac disease should implement a gluten-free diet.

Pharmacological treatment is aimed at treating the underlying disease, such as Crohn’s disease, post-antibiotic diarrhea or ulcerative colitis. In children with sodium or chlorine diarrhea, electrolyte mixtures are administered to replenish their deficiencies in the child’s body.

Sometimes it is necessary to undergo surgery, especially in children with functional tumors, e.g. in the course of carcinoid tumors. Such situations, however, occur relatively rarely.

Practical advice useful in the course of chronic diarrhea

1. Eat mild foods that do not irritate the digestive tract, such as boiled potatoes, boiled carrots, rice, or skinless boiled chicken.

2. Remember to rehydrate your body with oral rehydration fluids (they are used not only in the course of diarrhea, but also prophylactically).

3. After the diarrhea has resolved, avoid consuming dairy foods for one week (there may be a risk of lactose intolerance).

4. Avoid using artificial sweeteners. Don’t eat burbot.

5. It is recommended to avoid consuming products that aggravate the symptoms of diarrhea. These include spicy and fatty foods, dairy products, caffeine and high-fiber products. Apples and pears also exacerbate unpleasant symptoms.

Is it possible to recover completely?

It all depends on the cause of chronic diarrhea. Complete recovery is possible in diarrhea after antibiotic treatment or in food allergy that disappears between the ages of 2 and 5. In other cases, it all depends on the underlying disease.