Diarrhea
In order to effectively improve diarrhea symptoms with the goal of resolution, obtaining a thorough history to identify all possible causes of diarrhea is imperative. From there, a targeted, personalized treatment plan can be created to sequentially improve symptoms.
Diarrhea
Regular diarrhea with or without abdominal pain can be inconvenient and bothersome. Diarrhea can affect the quality of your life in a way that prevents or limits your interest or willingness to do extracurricular activities, and if you find yourself living in this limited way, you may ultimately feel that you are not living your life! If this is something you are struggling with, well we are here to help!
Diarrhea that regularly affects more than 25% of your bowel movements over a 3 month time period may meet criteria for functional diarrhea. If you experience abdominal pain in relation to the diarrhea, you may meet criteria for Irritable Bowel Syndrome (IBS) with diarrhea. If you are experiencing diarrhea, there is no need to feel alone; an estimated 5% of people (about 1 in 20 people) meet Rome IV criteria for functional diarrhea or IBS with diarrhea.
Common Diarrhea Symptoms
In addition to loose bowel movements ranging on the Bristol Stool Scale from 6 to 7, many patients with diarrhea also experience fecal urgency. Fecal urgency can be hard to describe and have variable definitions. Overall, fecal urgency can be thought of as a sudden sensation of needing to urgently have a bowel movement. This immediate sense of urgency can result in patients feeling unable to make it to the toilet in time, ultimately creating a reduced sensation of bowel control that can negatively impact mental and emotional well being. Because of this, fecal urgency is routinely reported as one of the top symptoms patients want to improve / prioritize when creating a chronic diarrhea management plan. If this is you, we are here and ready to work with you to create a personalized plan that focuses on improving fecal urgency as well as other diarrhea symptoms.
Understanding Diarrhea
There are many causes of diarrhea, and obtaining a careful understanding of your medical, surgical, dietary, and behavioral history can be very important in identifying diarrhea triggers and creating a personalized plan to get you feeling better. Ultimately, successfully treating diarrhea often involves approaching the problem from a brain-gut-microbiome disorder perspective, and when the brain-gut-microbiome disorder is improved, so is the diarrhea.
From a simple perspective, diarrhea results because something ingested or created by the bowel is not being absorbed.
From A Traditional Medical Perspective, Underlying Causes For Diarrhea Can Be Categorized As:
Inflammatory
An inflammatory process disrupts absorption of nutrients and irritates the colon causing malabsorption and diarrhea. Examples include Crohn’s Disease, Ulcerative Colitis, Microscopic colitis.
Malabsorption
Non-absorbed bile acids or enzyme(s) missing in the bowel fail to break down and or absorb certain sugars, fats or proteins, resulting in diarrhea.
Infectious
An infection interferes with absorption of water or nutrients in the bowel or even at times increases secretion of water into the bowel through various mechanisms causing diarrhea.
Medication related
An ingested medicine causes diarrhea.
Motility disorder
An underlying dysmotility moves nutrients through the colon too fast, preventing absorption, resulting in diarrhea.
Endocrinopathy
An underlying endocrine disorder results in malabsorption and diarrhea.
However, this traditional medical perspective is being challenged as more published data suggests that other processes affecting the brain-gut-microbiome can create an environment of malabsorption, faster intestinal motility and or abdominal pain. The exact pathway through which the central nervous system and the gut microbiome communicate with and affect each other is not completely understood. People with depression are more likely to report constipation and or diarrhea and mouse models suggest that mice with depression are more likely to have faster intestinal motility and increased abdominal pain without changes in the underlying pathology of their abdominal organs. Therefore, focusing efforts on understanding underlying mental processes, stressors and microbiome changes in addition to traditional medical approaches to diarrhea could be the key to helping people with chronic diarrhea improve their symptoms and feel better.
Treating Diarrhea
In order to effectively improve diarrhea symptoms with the goal of resolution, obtaining a thorough history to identify all possible causes of diarrhea is imperative. From there, a targeted, personalized treatment plan can be created to sequentially improve symptoms. This approach maximizes symptom relief while minimizing medications, costs and dietary restrictions. With this in mind, let’s give you a brief overview of the different approaches, and if you would like a more personalized plan, please sign up for a counseling session.
Recognizing and Treating Mood Imbalances
If you are experiencing any mood imbalances such as anxiety, depression, or stress, then recognizing and addressing these feelings is just as important as trying nutritional and or over-the-counter remedies. Taking the time to be fully present in your mind body experience by using tools such as exercise, journaling, meditation, and yoga to identify and release triggers of anxiety, depression, and stress can help improve gastrointestinal imbalances that occur in these unhealthy states and that can affect bowel movements. As Easy Belly continues to grow, we will add more resources to help you address these mood imbalances.
Dietary Modifications
Low FODMAP Diet
When it comes to diet, research supports trying a low FODMAP diet to improve symptoms in patients with IBS and diarrhea.
What does FODMAP mean?
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These types of carbohydrates can increase bowel water content and microbiome gas production, which can cause GI distress and diarrhea in people with IBS with diarrhea. By restricting the diet – reducing as much as possible the consumption of FODMAPs – this water content and gas production can be reduced, improving IBS with diarrhea symptoms. Once the symptoms are improved, certain FODMAPs can slowly be reintroduced, and based on how a person feels as the FODMAPs are reintroduced, a personalized FODMAP consumption plan can be created to reduce symptoms.
Low Starch & Sucrose Diet
A newer study suggests that reducing starch and sucrose can improve symptoms in patients with IBS with diarrhea. Participants experienced improvement when they reduced their average grams of starch per day from 64 (+44) grams per day to 7 (+9) grams per day. Participants experienced improvement when they reduced their average grams of sucrose per day from 17 (+13) grams per day to 4 (+4) grams per day. Participants achieved this by increasing fish, fruit, nut and water consumption while reducing consumption of cereals, pastries, and pulses (the seed from a legume such as lentils, beans and peas).
Low Fat Diet
If you have had your gallbladder removed or have noticed a relationship of eating fatty foods with diarrhea, then a Low Fat Diet that involves restricting the fat content of your meals may improve your diarrhea symptoms. A Low Fat Diet involves limiting your fat intake as much as possible so that fat consumption involves less than 3 grams of fat per food serving. There are also medications that can be prescribed in this setting to improve your diarrhea. This can be identified and addressed when creating a personalized diarrhea treatment plan for you.
Trial Of Increased Fiber Intake
Fiber is something that is consumed and is not absorbed (remains in the bowel lumen). Fiber is believed to improve diarrhea by remaining in the bowel and helping bulk the loose bowel movement. Consuming an adequate amount of fiber-rich foods like fruits and vegetables may improve bowel movements. The daily recommended fiber intake for children and adults ranges from 25 to 35 grams per day, and over 90% of adults and children fail to consume the daily recommended intake of fiber. The average person is estimated to consume less than half of this daily recommendation.
Sequential Elimination of Common Diarrhea Triggers
Some patients I have worked with have expressed significant improvement in their symptoms when they have sequentially eliminated common dietary triggers. This often first involves eliminating dairy products, which include milk, cheese, yogurt, cream, and butter. If the patient is still experiencing diarrhea, they next work to eliminate caffeine. If still experiencing diarrhea, the patient will next eliminate processed sugars.
Try Using a Food Diary to Identify and Eliminate Diarrhea Triggers
If this all seems too complex, a simpler, more personalized way to identify dietary triggers can involve the use of a Food Diary. There are many ways to approach keeping a food diary. One way can involve the use of an Excel Sheet. In an Excel Sheet, record foods you eat in column A. Label column B “Day 1,” column C “Day 2,” column D “Day 3.” Document GI symptoms for up to 3 days after eating the food. Review your list and try to eliminate dietary triggers.
Over-the-Counter (OTC) Therapies
Imodium (Loperamide)
An over the counter medication that can be considered involves use of Imodium. Taking this medication can worsen acute infectious diarrhea, so please do not use Imodium if there are any concerns that an infection could be causing your diarrhea. Additionally, taking too much of the medication can result in constipation, so please increase the dose slowly and cautiously. The initial recommended dose of Imodium is 4 mg. You can take an additional 2 mg with each loose stool for a maximum dose of 16 mg per day.
Fiber Supplements
Adding a fiber supplement to your diet, such as Metamucil, can help you achieve your daily fiber intake requirement and add bulk to your stools, which hopefully will reduce your diarrhea. Increasing fiber consumption slowly is important; if you increase fiber supplementation too quickly, you may experience common fiber side effects such as bloating and or abdominal distention, cramping abdominal pain, and/or flatulence. If you do experience this, you are recommended to reduce your fiber dose to the highest amount tolerated. Try taking a quarter teaspoon of Metamucil daily. Increase by a quarter teaspoon every 3 days. You can increase to a maximum dose of 2 teaspoons twice a day.
Prescription Medications
When mood improvements, dietary modifications and over-the-counter options prove insufficient, prescription medications are often necessary. Prescription treatments can be used either alone or in combination with other relief options. Pending the patient’s preference, prescription medications can be considered earlier versus later in the treatment plan. By maintaining strong, open communication with our patients, and by providing our patients education, we work with our patients using shared-decision making platforms to create patient centered plans that over time help patients achieve successful improvement of their diarrhea.
Remember, this approach is for people with Diarrhea without alarm symptoms and is intended to help you as you await seeing your GI provider. If you have any of the following alarm symptoms, please let your doctor know so that they can expedite having you seen. Alarm symptoms most often include but are not limited to blood in stool, abdominal pain or diarrhea that awakens you out of sleep, or unintentional weight loss. This also includes if you have a family history of inflammatory bowel disease (IBD) or colon cancer in first-degree relatives (Mom, Dad, Siblings) age 60 or younger, or irritable bowel syndrome diagnosed after age 40.
Telemedicine Consultation
At Easy Belly, we place a strong emphasis on long-term patient-centered care.
Our goal is to help you understand your condition, explore your options, and decide on a treatment plan that best suits your needs and lifestyle.
