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A sizeable percentage of patients presenting to a specialist general surgeon will complain of diarrhoea usually meaning that they are passing looser and or more frequent stools. Three or more loose or liquid stools in 24hours is the definition of diarrhoea. There are a variety of reasons for this although in the majority of cases no immediately identifiable cause will be found and the patient will be diagnosed with one of the variants of Irritable Bowel Syndrome (IBS).
A number of important conditions (infections, inflammatory diseases and cancers) must be excluded by a taking careful note of all symptoms history, an examination and where appropriate specialist investigations. Associated symptoms that may give rise to concern where diarrhoea is persistent are rectal bleeding, abdominal pains and weight loss particularly in those patients over the age of 65 years.
It is important to differentiate between diarrhoea, when stools are looser and/or more frequent and incontinence where the passage of a normal of soft stool occurs involuntarily. The treatments suggested may be markedly different.
Causes of Diarrhoea
- Irritable Bowel Syndrome
- Diverticular Disease
- Infections (Campylobacter, Salmonella, Shigella, Clostridium Difficile, Parasites)
- Inflammatory Bowel Disease (Ulcerative Colitis, Crohn’s disease)
- Colorectal Cancer
- Medication (PPI’s, Diabetic medicine, Statins, NSAIDS)
- Other Diseases (Thyroid, Diabetes)
- Coeliac Disease
- Microscopic Colitis
Clearly the underlying causes of the symptoms need to be addressed usually by a specialist surgeon or gastroenterologist after appropriate investigation. Where no particular cause can be found the following treatments may be useful.
- High Fibre Diet
- Anti-motility drugs