What Is Chronic Diarrhea?

Diarrhea—bouts of watery and loose stool—is more than common; nearly every person has experienced it at one point or another. On average, adults experience diarrhea at least once a year. Children typically get diarrhea twice a year. Diarrhea will usually go away on its own after a short time. If it lasts longer, this can indicate a more serious medical problem. Diarrhea that sticks around for four weeks or more is called chronic diarrhea.

Here's what may be causing chronic diarrhea and what you can do to treat it.

Diarrhea vs. Chronic Diarrhea

Often, the infrequent bouts of loose, watery stool are nothing to worry about. Doctors call this occasional diarrhea "acute diarrhea." This term is used when diarrhea starts and resolves after one or two days. Usually, people get acute diarrhea from a virus or bacteria or, in less common situations, a parasite.

Sometimes, diarrhea doesn't go away on its own. If it lasts for four weeks or more, it's called chronic diarrhea. Chronic diarrhea may be continual, or it may come and go regularly. When diarrhea lasts for longer than a few days, it can signal that something more serious is happening.

Symptoms

The main symptom of diarrhea, including chronic diarrhea, is loose, watery stool. Diarrhea is when these bowel movements happen three or more times a day.

"Diarrhea for some is loose, explosive, urgent, frequent bowel movements," Christine Lee, MD, a gastroenterologist at Cleveland Clinic, told Health. But, for others, diarrhea might not be frequent or urgent but simply characterized as loose bowel movements. Still, others have more solid stool but consider it diarrhea because they have to go five or 10 times a day, said Dr. Lee.

When assessing diarrhea, healthcare providers use a tool called the Bristol Stool Chart. This chart splits stool into seven different categories from hard lumps to entirely liquid. Categories 5 to 7 are considered diarrhea.

For the most part, diarrhea comes with a few other symptoms. The most common symptoms associated with any type of diarrhea, chronic or not, include:

• Cramps or pain in the abdomen
• An urgent need to use the bathroom
• Loss of bowel control

However, because chronic diarrhea has many causes (more on that later), there are a host of secondary symptoms you might experience. Rabia De Latour, MD, a gastroenterologist at NYU Langone, told Health these include:

• Eye problems—if you have Crohn's disease
• Certain skin conditions—if you have celiac disease

A healthcare provider can also test for internal issues, such as inflammatory markers in your GI tract—an indication of inflammatory bowel disease, or IBD.

Most often, however, it's diarrhea itself that brings people to the doctor's office, said Dr. De Latour. "Chronic diarrhea can be very bothersome for people, especially if it limits their ability to live life," said Dr. De Latour. "People say things like, 'I can't go out to a restaurant' or 'I need to be by a bathroom all the time.' It can be somewhat debilitating."

What Causes Chronic Diarrhea?

Just like acute diarrhea, chronic diarrhea can be caused by a handful of things. Dr. Lee broke down the causes into six different categories.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is one of the most common reasons people have chronic diarrhea, and it actually consists of more than just one disease. IBD is an umbrella term for any disease that causes chronic inflammation of the digestive tract, most commonly Crohn's disease and ulcerative colitis. IBD are forms of autoimmune disorders, meaning that your body's immune system attacks itself, said Dr. Lee. The resulting inflammation can cause various symptoms:

• Frequent diarrhea
• Abdominal pain
• Unexplained weight loss
• Fatigue
• Bloody stool

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is another major cause of chronic diarrhea. Unlike IBD, IBS doesn't have a clear marker that doctors can test for. "With IBS, your colon is mechanically normal and organically normal with no pathology. It's just very sensitive to certain triggers," said Dr. Lee. Because of this, IBS is diagnosed based on the symptoms:

• Frequent diarrhea
• Abdominal pain or bloating
• Mucus in your stool

Infections

Very rarely, an infection can cause chronic diarrhea, said Dr. De Latour. Most of the time, infectious diarrhea is acute and clears up on its own. But sometimes, most often in developing countries that don't have much access to health care, long-term infections can cause chronic diarrhea, said Dr. De Latour. Infectious diarrhea can be caused by a virus, bacteria, or parasite.

Ischemia

Small bowel ischemia is a group of conditions that reduce blood flow to the small intestine. When not enough blood is flowing to the bowel, it can cause urgent diarrhea because it impairs the function of the colon, said Dr. Lee. Severe ischemia can turn into ischemic colitis, which causes inflammation of the colon and can cause ulcers.

Iatrogenic Diarrhea

Iatrogenic diarrhea—also known as drug-induced diarrhea—happens because of side effects from medications. Diarrhea is a potential side effect of nearly all medications. Even drugs we take all the time, like ibuprofen, can cause diarrhea, as can statins, which are taken for cholesterol and antibiotics, said Dr. De Latour. If someone is sensitive to side effects and regularly takes a drug that can cause diarrhea, their diarrhea can become chronic.

Food Intolerances

Unsurprisingly, food intolerances and sensitivities can cause chronic diarrhea. People who are lactose intolerant, for example, tend to get bouts of diarrhea after eating dairy, while people who are fructose intolerant get diarrhea after eating fruits like watermelon or even raisins, said Dr. Lee.

Although celiac disease is an autoimmune disorder, the symptoms can appear like a food intolerance—people with celiac disease react badly to gluten, so when they eat foods that contain wheat, they can get symptoms like bloating, abdominal pain, and chronic diarrhea.

Treating Chronic Diarrhea

Treatment for chronic diarrhea really depends on the underlying cause. After determining the cause of your issues, your healthcare provider will advise you on the best methods to treat the problem.

Food Intolerance

Some treatments are relatively simple to figure out—if you have chronic diarrhea because of food intolerance or celiac disease, you can treat the symptoms by avoiding the foods that trigger you, said Dr. De Latour.

Treatment for IBS also involves changing your diet. "It's really getting to know the patient and figuring out what their triggers are and avoiding those," said Dr. Lee.

If you're diagnosed, your healthcare provider will suggest an elimination diet—typically the FODMAP diet—to determine what triggers your symptoms. This means avoiding high FODMAP foods, a group of highly fermentable carbs that tend to irritate the gut, including the following examples:

• Yogurt, milk, and other dairy products
• Wheat
• Beans and lentils
• Vegetables like asparagus and onions
• Fruits like cherries and pears

Once you figure out what triggers you, avoiding those foods can help treat your symptoms. A healthcare provider might also suggest taking medication like antimotility drugs to slow diarrhea, said Dr. De Latour.

Infection

If an infection is causing your chronic diarrhea, treatment usually involves treating whatever is infecting you, whether it means taking antibiotics to clear up a bacterial infection or medications that target parasites. Viral infections tend to clear up on their own, according to Dr. De Latour.

Inflammatory Bowel Disease

When the source of your diarrhea is IBD, your doctor will suggest "a barrage of different medicines and then evaluate your response," said Dr. De Latour. Those medicines can include anti-inflammatories as well as biologics that try to decrease the immune response to the disease.

If IBD goes untreated for a long time (or doesn't respond to medication), surgery might also be part of your treatment plan. Surgery can repair damage to your digestive system.

Drug-induced Diarrhea

With iatrogenic diarrhea (diarrhea caused by medications), you can work with a healthcare provider to find a new medication that doesn't affect you. If antibiotics are causing your diarrhea, taking a probiotic to replace some of the bacteria might help.

Ischemia Diarrhea

To treat ischemia (a lack of blood flow), the American College of Gastroenterology says a healthcare provider will likely suggest medications to manage the condition, especially if the loss of blood flow hasn't damaged your GI tract. Medications can include blood thinners to prevent clots and antibiotics to treat or prevent infections.

If ischemia is more severe, a healthcare provider might suggest an angioplasty or stent to open narrowed blood vessels or surgery to restore blood flow, remove blockages, or repair damaged intestinal tissue.

Over-the-Counter Medications for Diarrhea

If you have acute diarrhea, you might reach for Pepto Bismol or Imodium—both can make short-term diarrhea more bearable. Note that, according to Dr. Lee, Pepto Bismol (bismuth subsalicylate) shouldn't be taken by those who are pregnant or allergic to aspirin.

However, these over-the-counter (OTC) medications shouldn't be your go-to for a lengthy period when dealing with chronic diarrhea. It's important to instead treat the underlying cause of chronic diarrhea.

These OTC medications won't cure your chronic diarrhea—they'll mask the issue. That's especially true for Imodium (aka loperamide), which merely slows diarrhea down. While it's great for bouts of acute diarrhea, Imodium is potentially dangerous for chronic diarrhea since it can back up your colon. "That may actually worsen whatever the problem is," said Dr. Lee.

Overall, if your diarrhea is chronic, the best way to treat it is first to figure out the root cause and treat that rather than just treating the symptoms.

Effects of Untreated Chronic Diarrhea

Again, the long-term effects of chronic diarrhea depend on the underlying cause. But, with all causes of diarrhea, dehydration is a big concern. When you have frequent diarrhea, you're losing water and electrolytes faster than usual, and replacing them is important.

If dehydration goes untreated in the long term, it affect your kidneys, heart rate, or blood. As Dr. Lee explained, dehydration "can increase your risk of acute renal failure, electrolyte imbalance, and put you at risk for arrhythmias and possibly even blood clots."

Hemorrhoids are another long-term complication of untreated chronic diarrhea, regardless of cause, said Dr. Lee.

Certain causes of chronic diarrhea, like ischemia and inflammatory diseases, can cause permanent damage to your bowel if untreated. "If it's severe enough and IBD, specifically ulcerative colitis, goes unchecked, the person can become extremely sick and might have to have their entire colon removed," said Dr. De Latour.

When To Contact a Healthcare Provider

Overall, anyone with chronic diarrhea should check in with a healthcare provider rather than ignoring it or trying to treat the symptoms alone. That's especially important if your chronic diarrhea is accompanied by "alarm symptoms," said Dr. De Latour. "If you notice unexplained weight loss or lightheadedness, you should really seek medical attention ASAP."

Other alarming symptoms that accompany diarrhea include:

• Severe pain in your abdomen or rectum
• A high fever (over 102 degrees)
• Stools containing blood or pus
• Stools that are black and tarry

Treating the underlying cause of your chronic diarrhea should resolve your symptoms.

A Quick Review

Diarrhea is a common problem and usually goes away on its own within two days or so. It can be caused by a number of different things, including infections and bowel disorders.

When diarrhea lasts four weeks or more, it is considered chronic, regardless of whether it is continual or comes and goes. Diarrhea that lasts longer than a few days warrants a visit with a healthcare provider. Healthcare providers can run tests to determine why you're having symptoms and treat the root cause of the problem.