Chronic diarrhea: clear answers and practical steps

Dealing with loose stools day after day wears you down. Chronic diarrhea means having watery or loose bowel movements for more than four weeks. It’s not a single disease — it’s a symptom that can come from several different problems. Knowing which one you have changes what helps.

Common causes and what to watch for

Start with a quick checklist: any blood in the stool, weight loss, fever, or severe belly pain? Those are red flags and need a doctor now. If symptoms are milder but persistent, common causes include:

- Irritable bowel syndrome with diarrhea (IBS-D). Often linked to stress, food triggers, and cramping. Symptoms can come and go.

- Inflammatory bowel disease (Crohn’s or ulcerative colitis). Look for blood, urgency, and weight loss.

- Microscopic colitis. Mostly in older adults, causes watery diarrhea even though the colon looks normal on scope.

- Infections and parasites. Some infections linger, and Clostridioides difficile (C. diff) can follow antibiotics.

- Bile acid malabsorption. Bile acids not absorbed properly can speed stool transit and make it watery.

- Small intestinal bacterial overgrowth (SIBO) and pancreatic insufficiency. Both change digestion and stool consistency.

- Medications and foods. Metformin, laxatives, sugar alcohols (xylitol, sorbitol), and too much caffeine or alcohol can cause long‑term loose stools.

Tests, simple fixes, and treatments that actually help

Start with a doctor visit. They’ll likely do blood tests (CBC, thyroid, celiac antibodies), stool tests (culture, C. difficile toxin, ova and parasites), and may order fecal calprotectin to check for inflammation. If needed, a colonoscopy with biopsies or breath testing for SIBO will follow.

While you wait for tests, try these practical steps: cut out obvious triggers — lactose, lots of raw fruit, sugary drinks, and artificial sweeteners. Try a low‑FODMAP approach for a few weeks if IBS‑D is suspected. Add soluble fiber like psyllium to bulk stools and help slow things down.

Over‑the‑counter loperamide often gives quick symptom relief. For bile acid issues, bile acid binders such as cholestyramine can work well but need a prescription and follow‑up. Rifaximin is commonly used when SIBO is detected. Microscopic colitis often responds to budesonide, and inflammatory bowel disease needs targeted therapy from a gastroenterologist.

Don’t forget hydration — use oral rehydration solutions if stools are frequent. Probiotics like Saccharomyces boulardii or certain Lactobacillus strains can help some people, but they’re not a cure‑all.

If symptoms are stopping you from working, causing weight loss, or you see blood or fever, get urgent care. Chronic diarrhea is manageable once the cause is clear. With the right tests and a simple plan, you can get control back and feel better fast.