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Q. I get persistent diarrhea for 3-4 times a week. Please help.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 29, 2020 and last reviewed on: Aug 20, 2020

Hello doctor,

I have diarrhea three to four times a week, 30-60 minutes after eating dinner. The stool is mushy and has a normal shade of brown color and comes in multiple pieces but the toilet water becomes very cloudy with a dark green sometimes yellowish color. This started after I had mild constant pain in my abdomen for about a month when the pain stopped the diarrhea started.

I underwent some blood tests and there are no signs of inflammation and the doctor said everything is fine except for mild dehydration.

Dr. Ajeet Kumar Lohana

Medical Gastroenterology
#

Hello,

Welcome to icliniq.com.

I can understand that you must be very upset about your symptoms that have been running for almost over two months.

There are few possibilities like peptic ulcer disease (ulcers within the stomach and duodenum a part of the small bowel), and the pain due to pancreatic inflammation called pancreatitis. Since you mentioned the pain has been there for a month and was more like a steady mild pain, and pain worse after meals favor more to the former diagnosis than later.

But I want you to give me more information about this before I can really make a clear cut difference in between the above possibilities. Could you tell me the total number of stool you pass in a week's time? How much is the approximate amount of the stools in each episode of diarrhea, such as 50 ml, 100 ml, 200 ml, or even larger than this? Do stools contain fat particles? Are they excessively smelly? Does this diarrhea ever awaken you from sleep at midnight? I understand you mention that diarrhea usually follows 30-60 minutes after meals. Did you notice any blood in the stools?

The pain you had radiate to back? Did you have a fever in the last one month? You mentioned that you had blood tests done. Do you have blood tests like serum amylase, serum lipase for pancreatic inflammation? Did they test for H.pylori infection? This is a bug that is commonly responsible for ulcers within the stomach and duodenum.

Any history of passing worms in the stools? History of foreign travel? Exposure to dogs or other pets? Any family history (parents, or siblings) having pain or diarrhea in their young age? Lastly, would you mind telling me the duration of alcohol intake? And are you a regular drinker? How much alcohol on that single episode? Plus also let me know do you smoke?

Kindly if possible, then upload all blood tests that you have done recently, as I can interpret those in light of symptoms you mentioned. I will wait for further information.


The Probable causes:

Peptic ulcer disease. Acute pancreatitis with pancreatic diarrhea. Worm infestation of the bowel? Celiac disease.


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Thank you doctor,

The total number of the stool I pass is on average 1-3 each day, so in one week probably around 10-15, at most on a single day around 4. The amount is a bit hard to say, but I figure between 100-200. It does not contain any fat particles, sometimes it floats for a little while but nearly most of the time it sinks. No excessively smelly, most times the gas I pass does not smell at all. It has awakened me from sleep only once in this past two months, sometimes I wake up with my stomach just making sounds but no diarrhea, but I fall immediately back to sleep, so it does not really concern me. There is no blood in the stool, only greenish cloudy toilet water as I mentioned before.

The pain did not radiate to the back and never had a fever in the last two months. I will attach the blood test done as an image. No worms, no foreign travel. Both my mother and brother have a bit of a sensitive stomach, for example, when eating a large portion of high fat food, but have never experienced anything like what I am experiencing now. I drank alcohol once before, sometimes twice a week, but quite a large amount. I do not smoke. Also, maybe worth to mention I think I am extra sensitive right now for lactose and high-fiber food as I always get diarrhea after eating that.

Dr. Ajeet Kumar Lohana

Medical Gastroenterology
#

Hello,

Welcome back to icliniq.com.

Well the blood report and urine analysis you uploaded are within normal limits (attachment removed to protect patient identity).

But I would suggest you some more investigations that will help us further to exclude other possibilities as a potential reason for your symptoms. The particular set of investigations are stool related, I will write down below that you can do in a week time (not urgent) and share with me the reports once available. As for as I understand the overall scenario there are still a few possibilities.

1. Peptic ulcer disease: The characteristic pain you had seem secondary to peptic ulcer disease which are ulcers, erosion formations within the stomach and small intestine. I would investigate this with a stool testings for H.pylori infection, if found positive, would give you some antibiotic course to treat it.

2. Functional dyspepsia or hypersensitive stomach. Given your family history of this condition, plus given a mild (not significant pain at moment) pain and now change in the bowel habits make me this a possibility. I will given you acid suppressant medications which would correct this problem.

3. The pain and diarrhea are just secondary to bacterial overgrowth or abnormal accumulation of the bacteria within the small bowel. The condition is called as small intestinal bacterial overgrowth SIBO and dysbiosis. This basically produces excessive gases, particularly after foods like milk, salads, beans, certain cereals, grains collectively called as FODMAPs diet. Alcohol is one of them to produce excessive gases after fermentation in the small bowel when combine with these abnormal bacteria.

So I must say, it is completely possible that your symptoms are a result of all these conditions which are in to play. Diagnosing individual condition would cost time, money and labor rather I usually give medications, and usually see person improving and making diagnosis retrospectively without that much exhaustive testing. So the treatment plan is some preliminary testing only, and I would suggest you some treatment and some precautions related to foods. You can find it below. I would like to hear from you in a week time, preferably after testing.


The Probable causes:

Peptic ulcer disease H.pylori (Helicobacter pylori) induced. Functional dyspepsia (FD) with Irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO). I will rule out some other potential causes of your symptoms by lab test only.

Investigations to be done:

Liver function test. HBA1c (glycated hemoglobin) you have some test for blood sugar that were normal. This is an additional testing for confirmation or exclusion of diabetes.
Serum amylase. Serum vitamin B12 and RBC folate level. Anti TTg, IgA and IgG. Stool for detail report. Stool for ova and parasites. Stool for fecal calprotectin. Stool for C.difficle antigen, spot Na and spot K, fat globules and reducing substances. Stool for sudan stain.

Probable diagnosis:

Small intestinal bacterial overgrowth. Functional dyspepsia with Irritable bowel syndrome.

Treatment plan:

Capsule Esomeprazole 40 mg half an hour before meals for two weeks, tablet Ondansetron 16 mg half an hour before meals twice daily for two weeks, tablet Lactaid everytime just before taking any diary foods like milk, icecream, coffee, tea, etc. It is lactase enzyme which help digest lactose and lactose based diets. Tablet Lomotil two tablets after a loose bowel, not more than 6 tablets in a day. This is for diarrhea.

Preventive measures:

Avoid FODMAPs. They should be reduced in your diet and/or completely eliminated from you diet.

Regarding follow up:

Follow up with above test results.


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