What are the causes of prolonged diarrhea?

From the Guidelines

Prolonged diarrhea lasting more than 2-3 days requires immediate medical attention, especially if accompanied by fever, blood in stool, or dehydration, as it can lead to dangerous dehydration and electrolyte imbalances if untreated. The management of prolonged diarrhea should focus on hydration with oral rehydration solutions like Pedialyte or a homemade solution (1 liter of water with 6 teaspoons of sugar and 1/2 teaspoon of salt) 1. For mild cases, over-the-counter medications like loperamide (Imodium) 4mg initially followed by 2mg after each loose stool (maximum 16mg daily) can provide temporary relief, but should not be used if you have fever or bloody stools. It is essential to follow the BRAT diet (bananas, rice, applesauce, toast) temporarily while avoiding dairy, caffeine, alcohol, and fatty foods. Probiotics such as Lactobacillus or Saccharomyces boulardii may help restore gut flora.

Causes of Prolonged Diarrhea

Prolonged diarrhea can have various causes, including:

• Infections, such as those caused by norovirus, Salmonella enterica subspecies, and Campylobacter 1
• Medication side effects, such as those caused by magnesium supplements, antihypertensives, and non-steroidal anti-inflammatory drugs 1
• Inflammatory bowel disease, such as Crohn's disease and ulcerative colitis
• Irritable bowel syndrome

Risk Factors

Certain risk factors can increase the likelihood of developing prolonged diarrhea, including:

• Family history of neoplastic, inflammatory bowel, or coeliac disease 1
• Previous surgery, such as extensive resections of the ileum and right colon 1
• Previous pancreatic disease 1
• Systemic disease, such as thyrotoxicosis, hypoparathyroid disease, diabetes mellitus, adrenal disease, or systemic sclerosis 1
• Alcohol abuse 1
• Excessive intake of caffeine, milk in patients with lactase deficiency, food additives, fructose, and other FODMAPs 1

Prevention

Prevention of prolonged diarrhea can be achieved through general measures, including:

• Use of hand hygiene
• Proper food preparation and storage
• Avoidance of high-risk foods, such as undercooked meat and seafood, unpasteurized milk, and soft cheese made with unpasteurized milk
• Avoidance of unsafe water
• Use of infection prevention and control measures in hospitals, childcare, and nursing home settings
• Appropriate use of antimicrobial agents
• Appropriate pet selection and supervision of contact with animals, specifically in public settings 1

From the FDA Drug Label

that diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic Pseudomembranous Colitis: Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Ciprofloxacin Tablets USP, 250 mg, 500 mg and 750 mg, and may range in severity from mild diarrhea to fatal colitis.

Prolonged Diarrhea is a possible side effect of ciprofloxacin, and it may be caused by Clostridium difficile associated diarrhea (CDAD). Patients should contact their physician as soon as possible if they experience watery and bloody stools or other symptoms of diarrhea. 2 2

From the Research

Prolonged Diarrhea Treatment

• Oral rehydration solutions (ORS) are a mainstay of treatment for patients with short bowel syndrome (SBS) and can be used to manage fluid balance in the presence of SBS 3.
• The use of ORS has revolutionized the management of acute diarrhea, resulting in decreased mortality associated with acute diarrheal illnesses in children, although stool volume and diarrhea durations are not reduced 4.
• Various modifications to the standard ORS have been derived, including hypo-osmolar or hyperosmolar solutions, use of rice-based ORS, zinc supplementation, and the use of amino acids 4.

Oral Rehydration Solutions

• A historical turning point occurred in the treatment of diarrhea when it was discovered that glucose could enhance intestinal sodium and water absorption, leading to the development of ORS 5.
• However, some studies suggest that glucose-based ORS may not appreciably reduce diarrheal stool volume and may even exacerbate a net secretory state, particularly for pathogens that affect glucose transport 5.
• The use of a single solution for oral rehydration and maintenance therapy of infants with diarrhea and mild to moderate dehydration has been shown to be effective 6.

Management of Acute Diarrhea

• Acute diarrheal disease accounts for 179 million outpatient visits annually in the United States, and most episodes are uncomplicated and self-limited, requiring only an initial evaluation and supportive treatment 7.
• Management begins with replacing water, electrolytes, and nutrients, with oral rehydration preferred, and intravenous rehydration warranted in cases of severe dehydration or sepsis 7.
• Antidiarrheal agents can be used as symptomatic therapy for acute watery diarrhea, and empiric antibiotics are rarely warranted, except in sepsis and some cases of travelers' or inflammatory diarrhea 7.