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What is Diarrhea and What Causes It?

Updated: Oct 14, 2023

Diarrhea is a condition in which stool (faeces) are discharged from the bowels frequently and in a very soft, loose or watery form.

It can be associated with a sense of urgency, or a sudden unexpected evacuation of the bowels.

With diarrhea, the bowels can’t absorb water as easily. This causes liquid to pass through the bowels unused resulting in poorly formed, liquid stools.

The Bristol stool chart can be used to help identify the different appearance and shape of stools, with type 6 being considered mild diarrhea and type 7 severe diarrhea.

Bristol stool chart

Acute bouts of diarrhea usually last no more than a few days, but can be up to a week.

Cases are considered chronic if it lasts for more than 4 weeks.

What can cause diarrhea?

Diarrhea can be a beneficial process to get rid of unwanted microbes from the body.

Typically diarrhea is short term but can become chronic in cases where the microbe is not removed from the body and continues to reside in the intestines, or if it causes damage to the gut leading to a small intestinal bacterial overgrowth (SIBO) or post-infectious irritable bowel syndrome (IBS).

Fructose is a sugar found naturally in fruits, juices and honey, but is also in many processed foods and drinks.

  • Artificial sweeteners.

Such as sorbitol, erythritol and mannitol. Artificial sweeteners are nonabsorbable sugars found in chewing gum and other sugar-free products and can cause diarrhea in some otherwise healthy people.

  • Lactose intolerance.

Lactose is a sugar found in milk and other dairy products. People who have difficulty digesting lactose have diarrhea after eating dairy products. Lactose intolerance can increase with age because levels of the enzyme that helps digest lactose drop as you get older.

  • Surgery of the intestines, gallbladder or pancreas

  • Bile acid malabsorption or diarrhea (BAM or BAD)

Bile acid diarrhea (BAD) is caused by excess bile acids in the colon, due to impaired absorption of bile acids in the terminal ileum of the gut.

BAD can occur concurrently with irritable bowel syndrome (IBS) and Inflammatory bowel disease (IBD).

25% to 50% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) also have evidence of BAD.

Empty roll of toilet paper

When can diarrhea be serious?

Those with diarrhea can get dehydrated quickly so it is important to hydrate frequently with a natural electrolyte drink. Nutrient deficiencies and weight loss can also occur due to malabsorption, leading to a host of poor health conditions.

Medical investigation is required if the diarrhea:

  • lasts more than four weeks

  • is bloody

  • occurs mostly at night

  • is associated with moderate to severe pain

  • involves vomiting, nausea and/or a fever

  • causes weight loss

Most cases of diarrhea pass within a day or two. But if persistent it is essential the underlying cause is identified and addressed.

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