Watery Diarrhea - Not Always Due to Food Poisoning
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Watery Diarrhea - Not Always Due to Food Poisoning

Published on Oct 20, 2015 and last reviewed on Aug 09, 2023   -  4 min read


Watery diarrhea can be due to a severe condition called exocrine pancreatic insufficiency. Read the article to know more about this condition.

Watery Diarrhea - Not Always Due to Food Poisoning


A person having watery diarrhea may think it is simply a tummy flu. But things can be even more serious than just a gastrointestinal tract infection. Exocrine Pancreatic Insufficiency (EPI) means indigestion of food caused by the lack of digestive enzymes that normally are produced by the pancreas. Exocrine Pancreatic Insufficiency causes indigestion leading to watery diarrhea and hence also known as pancreatic maldigestion.

What is Fat Malabsorption?

EPI may also present with fat maldigestion, a condition known as steatorrhea. In steatorrhea, there are very foul smelling, pale and bulky stools that float on water in the toilet pan and is due to excess gas and undigested fat seen as oil droplets in the stools. In EPI induced steatorrhea, there may be an oily material leakage from the anal opening and there may also be mild to moderate levels of fecal incontinence (loss of control on feces). A lot of patients present with this oily leakage and fecal incontinence problems and they do not even know that they may be having a problem of exocrine pancreatic insufficiency induced steatorrhea.

What Are the Side Effects of EPI?

  • EPI causes night blindness and seizures.

  • Also there may be manifestations of loss of fat soluble vitamins (A, D, E, K) that starts to appear along with other symptoms of malabsorption of nutrients.
  • Low levels of calcium and magnesium in the serum may also lead to tetany (intermittent muscular spasms).
  • Flatulence and abdominal cramps is another problem due to indigestion.
  • Swelling (edema) of the peripheral limbs may result from protein depletion that are lost with other nutrients in the intestinal lumen.
  • Mouth ulcers and change in color of the tongue, abdominal distention, hair fall, weakened muscle movements are also amongst the common symptoms.
  • Vitamin K malabsorption causes bleeding disorders in the patients. Blood in urine or in stools is a common manifestation.
  • Bone disorders (osteopenia and osteomalacia) due to lack of vitamin D and low calcium levels in the body are commonly diagnosed as Metabolic Bone Disease (MBD). Bone aches and easy fractures are very common.

For normal digestion to take place, we need normal secretions of the pancreas consisting of proteins (3 percent) and a lot of water and electrolytes (97 percent). If due to diseases like long history of the infection of pancreas, there is a damage to the parts of the pancreas, it causes loss of function of pancreas that is associated with the digestion of the lipids and other nutrients in food.

Fats, we know, make a lot of bulk of our food and the resulting energy from food is largely dependent on the digestion of this fat content properly. Pancreas does all this digestion of the fats in the small intestinal lumen through its well formed secretions. 1 gram of fats when metabolized yield 9 Calories of energy which is more than double produced by the metabolism of 1g of carbohydrates (which is 4 Calories for 1 gram).

So, it is obvious that patient will feel lack of energy and fatigue too, along with diarrhea if he has the EPI. People usually know only one condition associated with the pancreatic insufficiency and that is diabetes mellitus. It is our duty to inform and guide the patients regarding other diseases too. Because, a well informed patient will never go for self medication and will not become a prey of the quakes if he/she gets any indigestion issues.

Who Is at a Greater Risk of Developing EPI?

If considerable damage to the tissues of pancreas occurs due to any reason, it may lead to EPI. The concomitant disorders may be hepatitis A, diabetes mellitus, SLE or lupus, previous surgery of the gastrointestinal tract, cystic fibrosis, celiac disease of the gut, Crohn's disease, hyperacidity in stomach due to any underlying disease, heavy smokers, chronic alcoholics, etc. So, if anyone has one of these diseases, and he also gets frequent indigestion, weight loss, lack of energy and some issues with the brain functioning, please do visit your primary care physician to rule out the chances of EPI.

What Are the Clinical Manifestations of EPI?

Exocrine pancreatic insufficiency (EPI) symptoms might include bloating, abdominal discomfort or cramps, and diarrhoea. Pancreatitis, cystic fibrosis, pancreatic cancer, and surgeries on the pancreas or upper gastrointestinal tract are only a few of the illnesses and ailments that can result in EPI.

What Is the Treatment of EPI?

Doctors use pancreatic enzyme replacement therapy (PERT) and dietary adjustments, such as abstaining from alcohol and stopping smoking, to treat exocrine pancreatic insufficiency (EPI). For the illness or condition that led to EPI, the doctor could suggest further therapies.

The small intestine can't properly digest food if a person has exocrine pancreatic insufficiency (EPI), which can result in malabsorption and malnutrition. The patient could be advised to take pancreatic enzyme replacement therapy (PERT) as well as to eat and consume small, frequent meals by the physician or certified dietitian.


Exocrine pancreatic insufficiency patients typically have vague symptoms when they visit their primary practitioner. With a thorough medical history, clinical examination, and early action for borderline patients, a diagnosis must have a high degree of suspicion.

Frequently Asked Questions


What Is the Reason for Watery Diarrhea Without Any Other Symptoms?

A person having watery diarrhea may think it is simply tummy flu. But things can be even more serious than just a gastrointestinal tract infection. Watery diarrhea is usually caused due to stomach infection, but it may also be symptomatic of other conditions. Watery diarrhea may also occur from lactose intolerance, caffeine, laxative foods, and alcohol use which other symptoms may not accompany.


Is Watery Diarrhea Always Related to Food Poisoning?

Watery diarrhea usually occurs through food poisoning and may also be frequently caused by several underlying diseases that may or may not have been diagnosed. Certain side effects of drugs may additionally lead to an episode of diarrhea. Mentioned below are a few of them.
- Lactose intolerance.
- Celiac disease.
- Crohn's disease.
- Irritable bowel syndrome.
- Antibiotics.
- Antidepressants.
- Proton pump inhibitors.
- chemotherapeutic drugs.


What Is the Reason for the Occasional Occurrence of Watery Diarrhea?

Watery diarrhea is a short-term sickness that arises commonly from a gastrointestinal infection. Sometimes the gut biome may be sufficiently strong to neutralize the infectious cause, while the etiology may overpower the gut immunity in other cases. This imbalance in the reaction is responsible for the occasional occurrence of watery diarrhea.


When Does Watery Diarrhea Become Worrisome?

Watery diarrhea lasting more than two days without any improvement can be worrisome. The condition may be accompanied by other clinical manifestations, such as those mentioned below.
- Polydipsia.
- Polyuria.
- Anuria.
- Skin rash.
- Weakness.
- Abdominal pain.
- Fever.
- Rectal pain.
- Bloody stools.


Can Diarrhea Be Let to Run Its Course?

A person having watery diarrhea may think it is simply stomach flu. But things can be even more serious than just a gastrointestinal tract infection. Letting diarrhea run its course makes the individual lose excess fluids and salts, resulting in weakness and tiredness. Hence, it is better to treat the condition if it does not improve within 2 to 4 days.


What Can Be Done to Stop Watery Diarrhea?

The following steps can be taken to treat diarrhea:
- Sufficient hydration.
- Semi-solid and low-fiber food.
- Avoid high-fiber, dairy, and highly seasoned foods.
- OTC antidiarrheal drugs (Loperamide, Bismuth subsalicylate, etc.).
- Prebiotics.
- Antibiotics.


Is It Possible to Have Watery Diarrhea Without Being Sick?

Diarrhea is one of the most common conditions of the digestive system and can occur due to an array of causative agents which can be either harmful or merely an adverse reaction in the body. It is possible to have watery diarrhea without being sick from ingesting laxative foods or certain medications. Stress has also been associated with diarrhea.


What Other Condition Mimics Gastroenteritis?

The following conditions can mimic gastroenteritis:
- Amebiasis.
- Appendicitis.
- Campylobacter Infections.
- Clostridioides (Clostridium) Difficile Colitis.
- Escherichia coli (E coli) Infections.
- Food Poisoning.
- Giardiasis.
- Peritonitis and Abdominal Sepsis.
- Salmonella Infection (Salmonellosis).
- Shigellosis.


What Is the Cause of Yellow Watery Diarrhea?

Yellow watery diarrhea can be an indication of several underlying diseases. Yellow watery diarrhea most commonly indicates the malfunctioning of the individual’s liver or gallbladder. On the other hand, bright yellow watery stool may be due to giardiasis. Yellow watery diarrhea almost always has mucus present.


After How Long, Watery Diarrhea Be Considered Serious?

Diarrhea may be resolved within 2 to 4 days. If the condition does not improve by then, it requires medical attention. Persistent diarrhea beyond four weeks is a sign of chronic diarrhea. The presence of symptoms mentioned below is another signal of a serious case of diarrhea.
- Excessive thirst.
- Weakness.
- Dizziness.
- Decreased urinary output.
- Dark-colored urine.
- Rectal pain.
- Dry mouth.
- Scaly skin.
- Severe dehydration.


What Is the Time Gap Between Eating Something and Getting Diarrhea?

Diarrhea can occur between 30 minutes to 8 hours of consuming infected food. This time varies from person to person. Other factors that influence the time difference between ingestion of food and the beginning of an episode of diarrhea include the patient’s age, an underlying gastrointestinal condition, the onset of abdominal pain, the temperature of the environment, mental stress, and the amount of water intake.


What Can Be Done to Reset the Stomach After Diarrhea?

Diarrhea refers to increased frequency of the bowels. To reset the gut to its normal condition, one can follow certain steps:
- Removing offending food from the diet.
- Take prebiotics.
- Sufficient diet and exercise.
- Follow a Mediterranean diet.
- Stress management.
- Diagnosis of the underlying cause and apt therapies.


Are the Good Gut Bacteria Removed by Diarrhea?

The gut bacterial biome is seriously affected by infectious diarrhea. The population of good bacteria is depleted, along with a heavy loss of fluids, salts, and minerals. Dehydration is the immediate aftermath of diarrhea that requires correction as soon as possible. There must be a quick recovery of the gut biome as well.


What Is the Cause of Paradoxical Diarrhea?

Paradoxical diarrhea is caused due to hard impaction of stool in the colon around which leakage of watery diarrhea occurs. The hard impacted stool is an aftermath of long-standing and untreated constipation. There are several medications that can aid in dislodging the impacted stool and at times physical maneuvers may be required.

Last reviewed at:
09 Aug 2023  -  4 min read




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