Diarrhoea that persists beyond a few weeks can be functionally debilitating and an indication of a significant underlying medical problem. A systematic approach to diagnosis involving a thorough history, examination and carefully targeted investigations allows for identification of cause in most cases. Appropriate treatment of the underlying problem is associated with improved outcomes for patients compared with symptomatic management alone.
- Chronic diarrhoea is defined as the passage of at least three loose to watery stools per day for more than four weeks.
- Diarrhoea predominant IBS and functional diarrhoea are common, but organic causes need exclusion, particularly in the presence of red flag symptoms.
- Questioning patients on stool consistency, onset and pattern of diarrhoea and associated symptoms can help in diagnosis.
- Taking a thorough patient history, including family and medication history can help identify an underlying cause.
- Referral to a specialist is necessary if a common cause and treatment are not established on initial presentation, if further evaluation is required or if a patient presents with red flag symptoms.
- Treatment should be directed at the underlying cause.
- When an underlying cause of chronic diarrhoea cannot be established, empirical treatment guided by the patient's history may help improve symptoms.