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Chronic Diarrhea in Irritable Bowel Syndrome

If you suffer from chronic diarrhea associated with your IBS, you will know the symptoms already - loose stools, urgency, abdominal pain, wind and bloating to name but a few.

Does this sound familiar to you?

The worst thing about all this is that they can occur at any time, but sudden runs after eating or in the mornings are the most common.

If you find your symptoms are occurring at night, the diagnosis should be reconsidered as this is really very unusual and other conditions such as colitis should be considered.

In this section, I will discuss diarrhea, the diet that may help your and other IBS-D treatment that can improve your symptoms.

When you look at the various chronic diarrhea causes you have to consider whether this is true liquid stool or not.

It can be confirmed by measuring the weight of your stools, but this is rarely done due to the inconvenience and unpleasant nature of doing it.

What Investigations Are Required
For Chronic Diarrhea Symptoms in IBS-D?

Your IBS-D is diagnosed by the symptoms you experience and length of your illness. To clarify this, it is classified by the Rome Criteria.

This is a combination of abdominal pain or colon pain associated with chronic diarrhea for 3 months or at least recurring over this time. Sudden onset after eating or in the mornings is common, but at night these features are rare.

Investigations are not always necessary, although the amount of investigation really depends on your age, your history and the diarrhea that you have.

If you are over 50 years of age with new onset of symptoms or have a young family history of bowel cancer, it would be wise to have further investigations.

These may include blood tests, a stool sample and referral to a gastroenterologist for investigations such as a colonoscopy, Flexible Sigmoidoscopy procedure, CT or barium enema X-ray.

If you have symptoms that are related to your period, you may need to be investigated for endometriosis.

If your stools are black these will also need investigating as black diarrhea normally indicates bleeding from the upper gut.

Green and yellow diarrhea may be due to infection, although it can indicate a disease process in the small bowel.

Symptoms can also sometimes occur in an adrenal problem known as Addison's disease where low steroid or cortisol levels can be a problem. Blood tests should highlight this if an issue.

Defining Diarrhea

Chronic diarrhea is defined in various ways, but most of my patients define their symptoms as going to the toilet to open their bowels too frequently and/or producing loose to watery stools.

Now for the technical stuff! As mentioned earlier, if you ask a doctor what it is they will define the condition by the stool weight of all things!

The diagnosis is made if the stool weight is greater than 250g a day, although as mentioned earlier, in practice this is rarely confirmed as most people really don’t want to go weighing stools.

Chronic diarrhea in IBS is usually less than this as, whilst going to the toilet is frequent, the amount passed is often small in comparison to the urgency symptoms that most sufferers experience.

I’m sure you recognize the need to get to the toilet urgently, but only to pass small amounts from the effort. That’s not to say that its all over very quickly, oh no it usually means sitting there sometimes for hours because the urge remains.

No one knows the cause of your symptoms, but it is likely to be multifactorial including influences such as foods, infections, environment, stress, lifestyle and maybe genetics too as sometimes you do see an increase in some families.

Chronic Diarrhea Treatment in IBS-D

Your treatment needs to be both effective and simple. Whilst drugs or “antidiarrheals” such as loperamide (Imodium), Codeine, Kaolin and Morphine, or more unusual treatments such as cholestyramine (Questran) and methylcellulose can be effective, most sufferers understandably don’t want to be taking drugs in the long term. However, they can be particularly effective in an acute attack.

So, what you need to know is ways of stopping symptoms in the longer term. By far the best way of dealing with this is through special diets.

The saying “you are what you eat” really does have some bearing in Irritable Bowel Syndrome. We all know that diet has an effect on Irritable Bowel Syndrome don’t we?

You probably know some foods that upset your chronic diarrhea already. Sudden symptoms after eating are well recognized by some sufferers.

Taking a good fluid intake to maintain hydration, avoiding complex carbohydrates, fats and dairy products can all be helpful in reducing symptoms.

A nutritionist or dietician can be very helpful when reviewing this, but you can also learn more about the right diet by going to the diet page.

Some people with IBS-D benefit from using colonic irrigation to cleanse their bowel. This is something that you have to try to see if it's useful for you, although there are anecdotal reports of benefit in Irritable Bowel Syndrome.

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