Diarrhea is one of the most common complaints in the United States and causes distress and a poor quality of life for many people around the world. There are a few criteria to diagnose diarrhea.

  • Loose bowel movement
  • Frequent bowel movements (one bowel movement versus over 20 bowel movements per day)
  • Urgency and stool incontinence

Diagnosis can be complicated. Often times I see patients in my clinic for a 2nd or 3rd opinion in regards to their problem with diarrhea, with chronic problems over a decade. Although I consider myself very thorough, even I fail to diagnose a few cases, which we call Idiopathic diarrhea, which really means nobody knows the cause. When I used to practice in Poplar Bluff Missouri, I had patients tell me “Dr. I know where every bathroom is located from Poplar Bluff to St. Louis.” That is over a 150 miles distance!!! In California, I have been told similar stories, where the patients are aware of multiple bathroom in every city as they travel. Even worse, people start avoiding social situations and church due to fear of having “accidents.” The worse problem most people experience is stool urgency and incontinence, which causes embarrassment.

Please remember that YOU ARE NOT THE ONLY ONE and that I CAN HELP!!!

Not to bore you, but here are a few causes of diarrhea which require evaluation in a step wise approach. I wrote a list to give you an idea of how complicated it can be. For your own good, please do not try to memorize this list!!!

Osmotic Diarrhea:

  • Non-absorbed solutes like sorbitol (sugar substitute), fructose found in fruits.
  • Lactose intolerance
  • Intestinal diseases such as Celiac Disease
  • Pancreatic diseases and lack of adequate digestive enzymes
  • Small intestine reduction such as after weight loss surgery
  • Bile salt malabsorption in Crohn’s disease
  • Medications

Secretory Diarrhea:

  • Irritable bowel Syndrome
  • Endocrine problems such as thyroid disease
  • Laxatives
  • Medications
  • Bacteria
  • Hormones
  • Nerves system defects such as in advanced diabetes
  • Bacterial overgrowth in the gut
  • Microscopic colitis

Mucosal Injury diarrhea

  • Inflammatory bowel disease
  • Acute infections such as E.Coli, parasites, and viruses
  • Chronic infections
  • Ischemia – Lack of adequate blood supply to the bowel


Evaluation and Treatment

Your doctor will most likely obtain a thorough history and conduct a full evaluation. You may need blood and stool testing. You may need an endoscopy and or imaging testing.

Of course there is always medication therapy to slow down or stop diarrhea, but in most cases, it is wise to first evaluate and treat the underlying cause prior to medication therapy.