The International Medical Group is a multi-disciplinary medical practice that offers professional and personalized care. Dr Bella Beraha, born in Venezuela, joined us this month from Miami. She is an M.D. in Internal Medicine and runs a successful medically supervised weight loss program from the clinic.  The International Medical Group performs a wide range of services from general family medicine and specialist services to Botox, dermal fillers and natural hormone replacement therapy. We always welcome new patients and will assist you in any way that we can to ensure that you get the treatment and care that you need. Stop by our offices or call us with any questions. We look forward to meeting you.

By: Dr. Bella Beraha

Chronic diarrhoea is defined as loose stools that last for at least four weeks. This usually means three or more loose stools per day. There are many possible causes of chronic diarrhoea.

Chronic diarrhoea can have a substantial impact on your quality of life and overall health. At its mildest, diarrhoea is an inconvenience; at its worst, it may be disabling and even life threatening.

CAUSES — A wide range of problems can cause chronic diarrhoea; some of the most common causes include:

1-Irritable bowel syndrome — is one of the most common causes of chronic diarrhoea. IBS can cause “crampy” abdominal pain and changes in bowel habits (diarrhoea, constipation, or both). The pain and discomfort may occur in different parts of the abdomen. Pain usually comes and goes. The length of each bout of pain can vary greatly. The pain often eases when you pass stools or gas. Many people with IBS describe the pain as a spasm or colic. The severity of the pain can vary from mild to severe, both from person to person, and from time to time in the same person. Bloating and swelling of your abdomen may develop from time to time. You may pass more gas than usual.

2-Inflammatory bowel disease — There are several types of inflammatory bowel disease, two of the most common of which are Crohn’s disease and ulcerative colitis. These conditions may develop when the body’s immune system attacks parts of the digestive tract.

Both ulcerative colitis and Crohn’s disease usually run a waxing and waning course in the intensity and severity of illness. When there is severe inflammation, the disease is considered to be in an active stage, and the person experiences a flare-up of the condition. When the degree of inflammation is less (or absent), the person usually is without symptoms, and the disease is considered to be in remission.

Symptoms may range from mild to severe and generally depend upon the part of the intestinal tract involved. They include the following:

• Abdominal cramps and pain
• Bloody diarrhoea
• Severe urgency to have a bowel movement
• Fever
• Loss of appetite
• Weight loss
• Anemia (due to blood loss)
• Persons with IBD may have arthritis, skin conditions, inflammation of the eye, liver and kidney disorders, and bone loss.

3-Infections — Intestinal infections are a cause of chronic diarrhoea. Infections that cause chronic diarrhoea can be seen in people who travel or live in tropical or developing countries. Intestinal infections can also develop after eating contaminated food or drinking contaminated water or unpasteurized (“raw”) milk.

There are a few infectious diseases that can cause chronic diarrhoea.

4-Endocrine disorders — An overactive thyroid (hyperthyroidism) can cause chronic diarrhoea and weight loss. Diabetes can cause chronic diarrhoea if the nerves that supply the digestive tract are injured as well as an under-active pituitary or adrenal gland (Addison’s disease).

5-Food allergy or sensitivity — Food allergies and hypersensitivity can cause chronic diarrhoea. . Carbohydrate or sugar malabsorption is an inability to digest and absorb sugars. The most well-recognized malabsorption of sugar occurs with lactase deficiency (also known as lactose or milk intolerance) in which milk products containing the milk sugar, lactose, lead to diarrhoea. The lactose is not broken up in the intestine because of the absence of an intestinal enzyme, lactase that normally breaks up lactose. Without being broken up, lactose cannot be absorbed into the body. The undigested lactose reaches the colon and pulls water into the colon. This leads to diarrhoea. Although lactose is the most common form of sugar malabsorption, other sugars in the diet also may cause diarrhoea, including fructose and sorbitol.

People with celiac disease (gluten allergy) often have diarrhoea and weight loss.

6-Fat malabsorption. Malabsorption of fat is the inability to digest or absorb fat. Fat malabsorption may occur because of reduced pancreatic secretions that are necessary for normal digestion of fat (for example, due to pancreatitis ) or by diseases of the lining of the small intestine that prevent the absorption of digested fat (for example, celiac disease). Undigested fat enters the last part of the small intestine and colon where bacteria turn it into substances (chemicals) that cause water to be secreted by the small intestine and colon. Passage through the small intestine and colon also may be more rapid when there is malabsorption of fat.

7-Medicines — Medicines (prescription and nonprescription), herbs, and dietary supplements can cause diarrhoea as a side effect. To determine if a medicine could be the cause of your diarrhoea, review your list of medicines with your doctor, nurse, or pharmacist. This information may also be available on the medicine bottle or paperwork that comes with most prescriptions. On occasion, laxative abuse in an attempt to lose weight is the cause of chronic diarrhoea.

8-Bacterial overgrowth of the small intestine. Because of small intestinal problems, normal colonic bacteria may spread from the colon and into the small intestine. When they do, they are in a position to digest food that the small intestine has not had time to absorb.

9-Post-infection. Following acute viral, bacterial or parasitic infections, some individuals develop chronic diarrhoea. The cause of this type of diarrhoea is not clear, but some of the individuals have bacterial overgrowth of the small intestine. This condition also is referred to as post-infectious IBS.

10-Colon cancer. Colon cancer can cause either diarrhoea or constipation. If the cancer blocks the passage of stool, it usually causes constipation. Sometimes, however, there is secretion of water behind the blockage, and liquid stool from behind the blockage leaks around the cancer and results in diarrhoea. Cancer, particularly in the distal part of the colon, can lead to thin stools. Cancer in the rectum can lead to a sense of incomplete evacuation.

11-Severe constipation. By blocking the colon, hardened stool can lead to the same problems as colon cancer, as discussed previously.

EVALUATION — You should seek medical attention if you have loose or watery stools that last more than three weeks. You may need to be seen sooner than this if you have complications of diarrhoea (eg, bloody diarrhoea, fever, dehydration, or weight loss).

During your visit, it is important to mention when your diarrhoea began, any recent changes in medicines or medical problems, and if you have had accidents (leaking or smearing of stool in the underwear).

Tests — Blood, stool, and urine tests can help to find the underlying cause of diarrhoea. If these tests do not find the cause, other approaches may be needed, including X-rays or procedures, such as colonoscopy or sigmoidoscopy.

In some cases, your doctor or nurse will recommend a trial of treatment before more invasive tests

In conclusion, if any of the symptoms/clinical scenarios stated above sound familiar; please visit your doctor because you may be dealing with a chronic disease and the diarrhoea is just the manifestation.