Diagnosis,

Chronic  Diarrhea

Edited by: Joe Hing Kwok Chu

The functions of the digestive tract include secretion, digestion, absorption, and movements. If any of these functions are impaired, it can cause diarrhea. Since the functions are inter-related, it is very seldom that only one is impaired. Usually chronic diarrhea involves the impairment of more than one functions.

Successful treatment is dependent on the accuracy of the diagnosis.

Diagnosis should include history, symptoms, digital examination of the rectum, stool examination. If the problem can not be identified, endoscope with flexible fiberoptic sigmoidoscope examination, X ray examination, ultra-sound examination can be performed. If necessary, the absoption function of small intestine (like glucose tolerance test, pathophysiological analysis is effective in the diagnosis of diarrhea but in practice many patients and health professionals are reluctant to handle the large amount of stool samples. Frequently anti-diarrheal drugs like loperamide, diphenoxylate with atropine, are prescribed for symptomatic therapy. These will not solve the real problems.

General description

I. Definition of Diarrhea

Diarrhea  can be used as symptom of diarrhea

or sign of diarrhea.

When a patient describes he/she  has  chronic

diarrhea, it can means:

As symptoms:

(1) Decrease in stool consistency, increase in frequencies of defecation, increase in volume, or increase in both frequencies and volume; or any combinations of the above mentioned symptoms.

(2) Several small stool excretions, with urgency, frequency, and with painfully but ineffectual attempt to defecate,  without systemic symptoms, like inflammation of the anus or rectum, or

(3) three or four large bulky defecations accompanied with about 8 kg (20 lbs) of body weight loss and accompanied with a skin sensation, such as burning, prickling, itching, or tingling, with no apparent physical cause. This can be caused by celiac sprue, which is characterized by  defective digestion and utilization of fats (shown in fatty stools).

As sign:

Increase in stool weight or volume of 225 t0 250 grams or c.c. per 24 hours.

I. Acute and Chronic