Skip to content
Cartoon endoscope logoDoctor Kichian'sGastroenterology
Call
Lower GI

Chronic Diarrhea

Diarrhea lasting more than four weeks warrants evaluation. Causes range from dietary and functional to autoimmune and infectious — targeted testing usually finds the answer.

Ask your family doctor to referSee related services

Symptoms

  • Loose or watery stools lasting more than 4 weeks
  • Urgency, cramping, or incontinence
  • Weight loss or nutritional deficiencies
  • Nocturnal diarrhea (a red flag)

Possible causes

  • IBS-D, microscopic colitis, IBD, or celiac disease
  • Bile-acid diarrhea and small-intestinal bacterial overgrowth (SIBO)
  • Medications (metformin, PPIs, magnesium, antibiotics)
  • Lactose or fructose intolerance; artificial sweeteners

How we diagnose

  • Focused history including medications, travel, diet
  • Stool studies: infection, calprotectin, fecal fat
  • Bloodwork: celiac serology, thyroid, CBC, CMP
  • Colonoscopy with biopsies for microscopic colitis when indicated

Treatment options

  • Treat underlying cause (celiac diet, IBD therapy, etc.)
  • Bile-acid binders (cholestyramine) for bile-acid diarrhea
  • Targeted antibiotics for SIBO
  • Symptom-based agents (loperamide) when appropriate

Lifestyle & prevention

  • Trial-based elimination diets under guidance
  • Hydration and electrolyte awareness
  • Symptom diary to identify patterns