Chronic Diarrhea

GENERAL INFORMATION:

What is chronic diarrhea? Chronic diarrhea is an increase in the amount of stool you have each day without changing your diet. You may also have an increased number of bowel movements in a day. The word chronic is used to describe conditions that may slowly get worse, come and go, and last for a long time. Diarrhea that lasts longer than four weeks may be considered chronic. Diarrhea is a symptom of an illness, infection, or another condition.

What causes chronic diarrhea? Chronic diarrhea may be caused by any of the following:

• Diet: Some people may not be able to completely digest (break down) certain foods, which leads to diarrhea. These foods may include those with carbohydrates (breads, cereals, and grains), fats, or other nutrients. Drinking too much alcohol too often may also lead to diarrhea. Adult drinks such as beer, wine, whiskey, and vodka contain alcohol.
  
  
• Diseases: These may include diseases of the stomach and bowels, such as irritable bowel syndrome (IBS). Diarrhea may occur with some types of cancer or problems affecting the thyroid or pancreas. It may also occur with diseases that weaken your immune system. The immune system is the part of your body that fights infections.
  
  
• Infection: This may be caused by germs, such as bacteria or viruses, or parasites (small living creatures).
  
  
• Medicine: Chronic diarrhea may occur when you use laxatives to treat constipation (dry, hard stools). It may also occur with some antibiotics, especially if they are used for a long time. Certain heart medicines and mineral supplements, such as magnesium, may also cause chronic diarrhea.
  
  
• Surgery or procedures: Chronic diarrhea may happen after you have stomach or bowel surgery. It may also occur with procedures that hurt the muscle that controls passing of stool.
  
  
• Unknown: In some cases, the cause of chronic diarrhea is not known.

How can I tell caregivers about my diarrhea? Tell your caregiver how often you have bowel movements and how much stool you pass each time. He also needs to know the color and smell of your stool. He needs to know if any blood, mucus, or oil droplets are seen in your stool. Tell your caregiver when your diarrhea started. If it comes and goes, tell your caregiver what happened before it occurs. Tell your caregiver if it happens after eating or at night. Tell him if you have any food allergies, medical conditions, or are using any medicine. He may need to know if you have traveled out of the country around the time your diarrhea started. Telling your caregiver about your past infections, diseases, surgeries, or procedures is also important.

What signs and symptoms may be related to my chronic diarrhea? You may pass small, liquid, or very loose stools. Your stools may contain blood, mucus, pus, or oil. You may feel like you need to have a bowel movement right away and not be able to control it. You may have stomach pain or weight loss. You may feel hard lumps on the sides of your neck that may be painful or have a fever with chills (shaking). The skin around your anus may be irritated, swollen, or thickened. A mass (lump) in your rectum may be seen or felt. You may have palpitations (a fast, pounding heartbeat) and your skin may look more red than usual.

How may my chronic diarrhea be treated? Your treatment will depend on the condition causing your chronic diarrhea. Before using any treatments, see your caregiver. Some treatments may make your diarrhea worse. Treatment may include any of the following:

• Fasting: This is when you do not eat, eat very little, or stop eating some foods. If you have a problem with digesting certain foods, your diarrhea may stop if you fast. Ask your caregiver if fasting would help your diarrhea go away.
  
  
• Medicines:
  
  
  • Antidiarrheal: This medicine is given to decrease the amount of diarrhea you are having. Some of these medicines coat the intestine (bowel) and make the stool less watery. Other antidiarrheal medicine works by slowing down how fast food moves through the bowel. Ask your caregiver if you can take this type of medicine for your diarrhea.
    
    
  • Antibiotics: Antibiotics may be used if an infection is causing your chronic diarrhea. These medicines help kill the bacteria or parasite causing the infection. Antibiotics may be given if you pass six or more loose stools per day. These may also be given if your stools contain blood or pus, or you have a fever. If a certain antibiotic caused your chronic diarrhea, you may need a different kind.
  
  
• Oral rehydration therapy: You lose body fluid and minerals through your stool when you have diarrhea. These will need to be replaced. You will need to drink more liquid than usual to avoid getting dehydrated. You may also drink an oral rehydration solution (ORS). An ORS has the right amounts of water, salts, and sugar that you need to replace body fluids. Your caregiver may instruct you about ORS you can buy or make at home. Ask your caregiver for more information about dehydration.
  
  
• Intravenous therapy: You may get fluid through an intravenous (IV) tube that is placed in your vein. You may need this if you are having more than 10 to 15 bowel movements each day. You may also need IV fluid if your diarrhea has not stopped after 48 hours (two days). IV fluids have water, sugar, protein and mineral salts to replace the body fluid lost with diarrhea.

What can I do to prevent or treat my chronic diarrhea? For loose bowel movements that occur three or fewer times a day without other problems, do the following:

• Avoid eating oily foods that may be causing your diarrhea. If your diarrhea occurs after eating oily or greasy foods, avoid fried foods. You should also avoid foods with high oil contents. Such foods include fatty meats, rich sauces, and adding butter, margarine, or sour cream to your food.
  
  
• Avoid dairy products if you are lactose intolerant. If you get diarrhea after drinking milk or eating dairy products, you may not be able to digest lactose. Dairy products are milk and foods made from milk, such as cheese or ice cream. Lactose is a type of sugar found in dairy products. You may need to only eat or drink dairy products that are lactose-free. Read the food label to check for lactose or ingredients that may contain lactose. Ask your caregiver for more information on lactose-controlled diet.
  
  
• Drink plenty of liquids. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). With diarrhea, you may need to drink more than this. The best liquids to drink contain water, sugar, and salt. These liquids help your body hold in fluid and help prevent dehydration. Ask your caregiver what liquids are best to drink, and how much you should drink.
  
  
• Avoid drinks and food that contain caffeine. Caffeine may make dehydration worse. It may be found in coffee, tea, soda, chocolate, and some sports foods and drinks.
  
  
• Do not drink alcohol. Alcohol may make dehydration worse. Drinking too much alcohol too often may cause problems that can lead to having chronic diarrhea. Alcohol is found in beer, wine, liquor, such as vodka and whiskey, and other adult drinks.
  
  
• Use antibiotics correctly. Always take your antibiotics exactly as ordered by your caregiver. Keep taking this medicine until it is gone, even if you feel better. Do not use antibiotics that are not yours, or that are left over from another illness.
  
  
• Wash your hands often with soap and warm water. Always wash them after using the toilet, and before preparing or serving food. Germ-killing hand lotion or gel may be used to clean your hands when you have no water.

Will I need appointments with other caregivers?

• If you have certain signs and symptoms, such as blood in your diarrhea, you may need to see a gastroenterologist. If caregivers do not know what is causing your chronic diarrhea, you may need other tests. A procedure called a colonoscopy may be done to look for problems in your colon. During the colonoscopy, caregivers may take a sample of your tissue to be tested. Your caregiver may tell your city or state health department about your diarrhea. Letting them know may keep an infection causing diarrhea from infecting more people.
  
  
• If an infection caused your chronic diarrhea, you may need to see your caregiver after being treated. This is important if people around you have weak immune systems because they are more likely to get infected. It is important if you prepare or handle food because germs can be passed to others through foods that you serve. Since infections may come back, make an appointment if you get diarrhea again. If you cannot eat certain foods or have bowel disease, more appointments with your caregiver may be needed.

What should I expect with time or treatment? The chances of getting well from your chronic diarrhea depend on what is causing it. Diarrhea caused by certain foods will stop when you stop eating them. Diarrhea due to a medical condition may go away. However, the diarrhea usually comes back if the condition is not treated or controlled. Chronic diarrhea caused by an infection may come back or may lead to bowel disease. You may need to stay in the hospital if your diarrhea is severe. IV fluids and antibiotics may be needed.

Call your caregiver if you have any of the following:

• Signs and symptoms that are new, do not improve, or are getting worse.
  
  
• Questions or concerns about your symptoms, condition, treatment, or care.

Seek immediate help by calling 911 if you have any of the following:

• A fast heartbeat or breathing, or feeling very tired.
  
  
• Dry skin, mouth, and tongue, and feeling very thirsty.
  
  
• Feeling lightheaded, faint, or very weak or tired.
  
  
• Fever.
  
  
• Four or more loose bowel movements a day, or your stool has blood or pus in it.
  
  
• Trouble eating, drinking, and keeping food down.
  
  
• You are confused or cannot think clearly.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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