Chronic diarrhoea

What you need to know about chronic diarrhoea

Every year, millions of people worldwide experience a period of diarrhoea. Diarrhoea is loose, unformed stool that may occur several times to as many as 20 times a day. With diarrhoea, it is often difficult to hold in the stool. There are two forms of diarrhoea: acute and chronic. With the first form, the symptoms resolve on their own within a few days; chronic diarrhoea lasts longer than three weeks. The stool may contain mucus or blood, may sometimes be watery, or may alternate with normally formed stools or constipation. With chronic diarrhoea, there is a risk of dehydration due to a lack of fluids or excessive loss of salt. This applies especially to young children and older people. It is therefore important to drink enough and, as a general rule, one glass of fluid for each bowel movement. If chronic diarrhoea is caused by a disease, treatment is started. Foods that cause symptoms are eliminated and in many cases a low-starch diet can be a useful addition.

Symptoms of chronic diarrhoea

• Watery or loose stools
• A changing bowel pattern
• Flatulence
• Bloated abdomen
• Fatigue
• Weight loss
• Insomnia
• Mucus and blood in the stool
• Hair loss
• Skin symptoms

Tests for chronic diarrhoea

In cases of chronic diarrhoea, stool testing via Darmklachten.nl may help. See our recommended test packages and individual modules below.

Causes of chronic diarrhoea

In most cases, chronic diarrhoea is caused by an underlying condition:

• Chronic bacterial infection or post-infectious syndrome
  The inflammation can become chronic if the bacterial infection does not disappear on its own. In some cases, intestinal symptoms persist after an acute attack of diarrhoea even though the bacteria have long since disappeared. This is called post-infectious syndrome. It is a syndrome that develops after inflammation and causes abdominal cramps, flatulence, bloating or diarrhoea, symptoms that may persist for years.
• Single-celled parasites in the large intestine
  Symptoms after infection with single-celled intestinal parasites do not appear until days later. In many cases, the consistency of the stool varies. With infection by Dientamoeba fragilis, the diarrhoea is less severe. Mushy stools, flatulence, bloating and increased urgency may persist for years. The same symptoms can occur with infection by Blastocystis hominis, but they are milder and nausea is common. These two species occur in the large intestine. A parasite that infects the small intestine and causes chronic intestinal symptoms in about 10% of people is Giardia lamblia ; this infection can cause anaemia. If there is anaemia, weight loss and growth retardation in children, testing for this parasite should always be carried out.
• Tropical diseases
  After visiting the tropics, tropical parasitic infections can occur, such as infection with roundworms (Strongyloides). Malaria can also cause abdominal symptoms, in which case testing may be carried out through tropical medicine. Worm infections such as tapeworm are uncommon.
• Chronic intestinal inflammation: ulcerative colitis and Crohn’s disease
  Crohn’s disease and ulcerative colitis may be accompanied by prolonged, severe chronic diarrhoea, watery stools as often as ten times a day or even more. There may be mucus and blood in the stool, fatigue and skin or weight-related symptoms.
• Gallbladder or pancreatic disorders
  Gallstones cause abdominal pain in the upper right side of the abdomen, while pancreatic disorders can cause pain on the left side of the abdomen. Fatty stools and diarrhoea may also occur.
• Gluten intolerance
  Diarrhoea occurs after eating grains that contain gluten when someone has gluten intolerance (coeliac disease). Diarrhoea, bloating and abdominal pain occur especially in children; their intestinal villi sustain more damage than those of adults.
• Lactose intolerance
  An intolerance to milk sugar causes flatulence, bloating and diarrhoea. In the Netherlands, 15% of people are unable to break down milk sugar. They develop diarrhoea when they drink a glass of milk, but also from hidden lactose added to food and medicines.
• Food allergy
  Milk, eggs, soy, wheat, peanuts and nuts are among the ten most common food allergies.
• Nickel or latex allergy
  A nickel allergy causes skin symptoms on contact with nickel, but nuts, seeds and grains also have a high nickel content and can therefore cause internal symptoms. This also occurs with a latex allergy.
• Chemical colourings or food additives
  Food additives such as aspartame, sorbitol and fructose can cause diarrhoea and bloating.
• Histamine intolerance
  Histamine is a substance released in the intestine during allergies, but also after eating certain foods, and high levels of histamine in the intestine can cause diarrhoea. An increase in histamine is caused by a deficiency of the enzyme diamine oxidase (DAO), which breaks down histamine in the intestine. With a DAO deficiency, histamine levels become particularly high after eating aged cheese or chocolate and drinking red wine. Symptoms can also occur after eating foods with a high histamine content, such as sauerkraut or certain types of fish.
• Bowel cancer
  Bowel cancer can present with a changing bowel pattern, with diarrhoea alternating with constipation.
• Antibiotics or medication
  Diarrhoea often occurs during or after a course of antibiotics because the numbers of beneficial bacteria in the intestine are reduced or because there is an increase in yeasts such as Candida albicans. Cholesterol-lowering drugs, acid-suppressing medication, heart medication and antidepressants can also cause diarrhoea. If the symptoms started after taking medication, it may be possible to try switching to another medication. Always read the information leaflets for the medicines you take carefully.

More information about the tests

• Digestive parameters: pH, fat, starch, colour and consistency of the stool – read more…
• Gut flora analysis – Examination of the composition of the gut microbiota – read more…
• Bacterial infection with Salmonella, Campylobacter, Shigella, Yersinia and Clostridioides diffile – read more…
• Intestinal parasites – Testing for infections with intestinal parasites – read more…
• Calprotectin – Inflammatory marker for Crohn’s disease and ulcerative colitis – read more…
• Beta-defensin-2 – Anti-inflammatory substance produced exclusively in the large intestine and which protects it – read more
• Bile acids – Fat digestion – read more…
• Pancreatic elastase – Breakdown of fat, starch and proteins – read more…
• Antigliadin and anti-ht-Transglutaminase – Markers for gluten intolerance – read more…
• Histamine intolerance – Testing for the absence of the enzyme diamine oxidase – read more

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