Diarrhea

Diarrhea simply means having loose or watery stools—often more frequently than usual. Common causes include:

Infections (Viruses, Bacteria, Parasites):

Strikes fast, hits hard. Think sudden diarrhea with nausea, fever, cramps — and maybe a family member or roommate racing you to the bathroom. Classic “something’s going around” vibes.

Food Intolerance:

That dairy/gluten/other trigger food isn’t just being dramatic — your gut just doesn’t vibe with it. If the symptoms show up like clockwork after certain meals, your food may be the culprit.

Medications or Antibiotics:

New prescription? Cue the chaos. Diarrhea is a common side effect, especially with antibiotics, which can throw your gut bacteria into disarray.

Chronic Conditions:

When the runs don’t run their course — and stick around for weeks or come with red flags like weight loss, blood, or fatigue — we think bigger picture. Possible causes include IBS, IBD, celiac disease, or (less often) something more serious.

Bonus tip: Keep a symptom diary. It helps connect the dots — and helps us figure out what’s really behind all the movement.

Most short bouts of diarrhea are mild and self-limited, but you should see a doctor if you have:

• Signs of dehydration (very thirsty, dry mouth, low urine output, dizziness)

• High fever or blood/pus in stool

• Diarrhea lasting more than 3–5 days

• Severe abdominal pain or vomiting that won’t stop

• Recent travel (especially to developing countries), or immune system condition

• Diarrhea in a newborn or young child that doesn’t improve quickly

Persistent or recurrent diarrhea can occasionally signal a more serious underlying condition, such as inflammatory bowel disease (like Crohn’s disease or ulcerative colitis), celiac disease, or, in rare cases, colon cancer.

As physicians, we're especially concerned if diarrhea is accompanied by "alarm" features: blood in the stool, unexplained weight loss, ongoing fevers, significant night sweats, or new abdominal pain that doesn’t resolve. A family history of inflammatory bowel disease or colon cancer also raises the level of concern, and warrants timely investigation.

If your diarrhea lasts longer than four weeks, becomes progressively worse, or is associated with the warning signs above, it’s important to book a thorough evaluation. Early assessment can help identify and treat serious problems before they become more advanced.

Remember: while most diarrhea is self-limited and benign, we don’t want to miss something significant hiding beneath the surface.

When evaluating chronic diarrhea, we always begin with a careful history and physical examination to understand your symptoms, potential triggers, travel history, and any associated health concerns. Initial tests often include basic bloodwork (to screen for anemia, inflammation, thyroid disorders, and possibly celiac disease) and stool studies—these may look for infections (stool culture, ova and parasites), evidence of blood or inflammation, and occasionally fat in the stool if malabsorption is suspected.

If your symptoms have “alarm features” (such as blood in the stool, unintended weight loss, ongoing fevers, or a family history of inflammatory bowel disease or colon cancer), or if initial tests do not yield a diagnosis, we may recommend you pursue more advanced investigations. These can include a colonoscopy (to look directly at the colon and take biopsies), cross-sectional imaging like an abdominal CT or MRI, or specialized absorption and stool tests (such as fecal calprotectin, or pancreatic function tests) depending on what’s most likely in your case.

All testing is always personalized to your unique symptoms and medical background—we strive to be thorough, but also to avoid unnecessary procedures whenever possible.

Hydration is non-negotiable:

Keep sipping—think water, diluted juice, broth, or oral rehydration solutions. Skip the coffee, cocktails, and sugary drinks that can make things worse.

Keep food simple (your gut will thank you):

If you’re hungry, stick to bland basics like bananas, white rice, applesauce, and toast. The old-school “BRAT” diet isn’t gospel, but it’s a solid starting point. Avoid anything greasy, spicy, dairy-heavy, or packed with fiber until your system settles.

Rest, don’t test:

Now’s not the time to experiment with mystery leftovers or hit the gym. Give your body a break, and avoid anything that makes symptoms worse.

Consider probiotics:

Certain strains—like Saccharomyces boulardii or Lactobacillus rhamnosus GG—may help get things back on track, especially after antibiotics or with mild gut infections.

Meds, with a side of caution:

Over-the-counter options like loperamide (Imodium) can help slow things down—but skip them if you’ve got a fever, blood in your stool, or suspect an infection. When in doubt, check with your healthcare provider.

Because chronic diarrhea has many possible causes, effective treatment always starts by identifying the underlying reason. Here are the most common approaches based on cause:

• Irritable Bowel Syndrome (IBS-D or functional diarrhea):

  • Dietary changes such as a low FODMAP diet

  • Soluble fiber supplements (psyllium)

  • Stress management, including regular physical activity and relaxation techniques

  • Medications like loperamide (Imodium), or prescription gut-targeted agents (like eluxadoline or rifaximin)

  • In some cases, bile acid binders (cholestyramine) if bile acid malabsorption is suspected

• Inflammatory Bowel Disease (Crohn’s, ulcerative colitis):

  • Prescription medications to reduce gut inflammation such as aminosalicylates (mesalamine), corticosteroids, immunosuppressants (azathioprine, methotrexate), biologics (infliximab, adalimumab), or JAK inhibitors

  • Close monitoring by a gastroenterologist

• Food intolerances:

  • Identification and strict avoidance of trigger foods (e.g., lactose-free diet for lactose intolerance, gluten-free for celiac disease)

  • Lactase enzyme supplements for lactose intolerance

  • Dietitian support for nutritional balance

• Chronic infections and small intestinal bacterial overgrowth (SIBO):

  • Targeted antibiotics (such as rifaximin or metronidazole) or antiparasitic agents as needed based on stool test results

• Probiotics:

  • Evidence supports specific strains such as Saccharomyces boulardii and Lactobacillus rhamnosus GG for certain causes of chronic diarrhea, especially after infections or antibiotic use

• Bile acid diarrhea:

  • Bile acid sequestrants (e.g., cholestyramine, colesevelam)

  • Adjustment of fat intake depending on underlying digestive issues

• Pancreatic insufficiency or malabsorption:

  • Pancreatic enzyme replacement therapy (like pancrelipase)

  • Vitamin supplementation as needed

Bottom line: Chronic diarrhea is not “one size fits all.” The key is a personalized treatment plan—often combining lifestyle changes, dietary adjustments, targeted medications, and sometimes specialist care. With proper treatment, most people see a dramatic improvement in symptoms and quality of life. If you’re struggling with long-term diarrhea, don’t hesitate to reach out for a thorough evaluation and a tailored plan.