Diarrhea is a common bowel symptom and most of us will experience a bout or two during the course of a year. For some people it occurs more often than for others. We all expect diarrhea to ease within a few days and usually it is done because of common viral infections. However, there are instances where diarrhea tends to occur over and over again due to certain conditions, triggers or for unknown reasons.
What is recurrent diarrhea?
Recurrent diarrhea is watery, loose and/or frequent stool that occurs over and over. It should not be confused with persistent diarrhea where the diarrhea continues non-stop. In recurrent diarrhea, the diarrhea comes and goes only to return again within a few days or weeks. It may also recur after months although it is difficult to ascertain whether furture episodes are related to previous ones given the length of time in between. Recurrent diarrhea can be difficult to diagnose at times without a careful analysis of dietary and lifestyle factors.
It is important to understand the different between normal and diarrheal stools. Normal stools are soft but firm in consistency whereas diarrheal stools are typically watery. However, diarrhea is not only based on the consistency of the stool. The frequency of bowel movement is another factor. In diarrhea stool is typically passed more than three times in a 24 hour period whereas normal bowel habit is passing stool anywhere between three times a day to three times a week.
Recurrent diarrhea is simply a pattern of diarrhea. Diarrheal stool lasting for hours, days or even weeks then ceases and the stool consistency and frequency returns to normal. The diarrhea then starts again only to cease after a period of time. This stop and start pattern of diarrhea can go on for weeks, months or even years.
Causes of Recurrent Diarrhea
Infections are the most common cause of diarrhea but tend to present with persistent diarrhea until the infection resolves. The diarrhea may start again if the infection recurs. However, with recurrent diarrhea the causes are usually dietary or lifestyle related or may occur with certain chronic diseases.
Foods and Drinks
Individual sensitivity to foods can trigger diarrhea every time the problem food is consumed. This can occur even without any underlying digestive or absorption disorders of the gut. Lactose intolerance is one of the common food intolerances. In this condition the body is unable to digest lactose (milk sugar) due to a lack of the enzyme lactase. This ia problem with digestion. Sometimes the problem lies with absorption where the gut cannot absorb certain nutrients as is the case in fructose malabsorption.
Alcohol and caffeine can both be irritants and trigger bowel symptoms like diarrhea. The quantity consumed may be a factor. Other substaces may be toxic and therefore lead to a host of symptoms including diarrhea. These substances may be consumed intentionally as is the case with ingested illicit substances. At other times these toxins may be consumed accidentally as is seen with poisoning. However, poisoning can be intentional as is the case with suicide. Often there is vomiting with diarrhea being a later symptom.
A number of different bowel diseases can result in recurrent diarrhea. The main condition is inflammatory bowel disease (IBD) which is an autoimmune condition of the gut. In IBD the immune system attacks the gut thereby causing inflammation and ulceration. Ulcerative colitis is one type of inflammatory bowel disease that may cause recurrent diarrhea every time the condition flares up. The othe rtype of IBD, Crohn’s disease, can also present with diarrhea if the bowel is affected.
Certain bowel disorders like irritable bowel syndrome may also present with diarrhea. This occurs in IBS-D (irritable bowel syndrome with diarrhea) as well as with mixed IBS. Although there are a host of symptoms that arise in irritable bowel syndrome, it is not a disease in the typical sense of the word. There is no clearly identifiable disease mechanism. Instead it appears to be a disorder with bowel motility. Therefore it is known as a functional bowel disorder.
Although uncommon, recurrent diarrhea may at times be due to psychogenic factors. Anxiety and nervousness are the two common psychological states where diarrhea may occur. This diarrhea is momentary and resolves once the anxiety subsides. Sometimes diarrhea can arise with strong emotion like anger or grief but this is often just a single episode rather than recurrent diarrhea.
Remedies for Recurrent Diarrhea
Recurrent diarrhea should always be medically investigated and treated appropriately where possible. However, it can be difficult to find the exact cause of recurrent diarrhea at times whereas at other times it may be due to every day dietary and lifestyle factors. The following non-drug measures can therefore be helpful:
- Identify the trigger foods and drinks by keeping a food diary. Every food and drink consumed should be recorded to try to find a pattern between possible problem consumales and the onset of the diarrhea.
- Try an elimination diet. With an elimination diet, most foods and beverages are stopped and then gradually introduced back into the diet. The onset of diarrhea indicates a possible problem food or drink.
- Increase fiber intake. Low fiber diets may lead to watery stools as fiber plays an important role in absorbing water and binding the stool. Fresh fruits and vegetables as well as high fiber grains are the best options but fiber supplements can be used if necessary.
- Limit stimulants like caffeine. Any stimulant can increase movement through the bowels and some people may be more sensitive than others where even a small amount of stimulants can trigger diarrhea.
- Avoid high salt, preservatives and other additives. These substances can draw out water from the body into the bowels thereby causing watery stools. Some preservatives like MSG are known to irritate the bowels of sensitive individuals.
- Do not consume any food or drink in excess. Even foods and beverages that do trigger diarrhea normally can become a problem when consumed in very large quantities.