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Persistent Diarrhoea

What Is Persistent Diarrhoea

Persistent diarrhoea means having loose or watery stools more often than usual, and for longer than you would expect from a simple stomach bug. Doctors typically classify it by how long it lasts. Persistent diarrhoea lasts for more than 14 days, while chronic diarrhoea lasts for more than 4 weeks.

If you have what seems to be constant diarrhoea or frequent diarrhoea, it may sometimes be linked to an underlying bowel condition. It may be worth seeing a doctor for an assessment to find the cause and possible treatment.

Causes of Persistent Diarrhoea

There are several possible causes of persistent diarrhoea, ranging from lingering infections to inflammatory conditions. In rare cases, it may also be due to colorectal cancer.

Lingering or Recurrent Gut Infections

Some bacterial, viral or parasitic infections (such as Giardia infection) can last longer than expected or temporarily affect your gut’s ability to absorb or digest certain nutrients, leading to diarrhoea even after the original infection has cleared.

Irritable Bowel Syndrome (IBS)

IBS is a common condition affecting how the gut and brain communicate with each other. It can cause repeated, frequent diarrhoea. This may also present with abdominal pain, bloating, and a sudden urge to use the bathroom.

Inflammatory Bowel Disease (IBD)

Persistent diarrhoea may occur when the bowel becomes inflamed due to conditions such as ulcerative colitis or Crohnʼs disease. This inflammation can lead to ongoing, sometimes severe diarrhoea. This may be paired with abdominal pain, blood or mucus in the stool, fatigue, and weight loss.

Food Intolerance or Malabsorption

Lactose intolerance can trigger diarrhoea, bloating, gas, and abdominal discomfort after having dairy. Coeliac disease affects how the small intestine absorbs nutrients, which can also lead to diarrhoea, bloating, fatigue, and weight loss.

Microscopic Colitis

This condition of the colon commonly causes ongoing, watery diarrhoea, sometimes with a sudden urge to go. It can be tricky to catch early, since the colon often looks completely normal on endoscopy unless tissue samples (biopsies) are examined under a microscope.

Bile Acid Diarrhoea

An under-recognised cause of chronic diarrhoea, bile acid diarrhoea happens when too much bile acid reaches the colon. It can lead to watery diarrhoea with urgency, and sometimes difficulty controlling bowel movements.

Colorectal Cancer or Other Structural Bowel Diseases

A persistent change in your bowel habits can be a warning sign of colorectal cancer or other structural bowel conditions, and needs prompt medical review. This is more likely to be the case if it is accompanied by symptoms such as blood in the stool, abdominal discomfort, and unexplained weight loss.

Medication Side Effects

Certain medicines can trigger or prolong diarrhoea. Examples include antibiotics, magnesium-containing antacids, sugar alcohols such as sorbitol, and medicines such as metformin.

Note that persistent diarrhoea is not always “just food poisoningˮ. If it continues for more than a few days or lasts for weeks, you should consult a doctor for an assessment.

How to Tell if You Have Persistent Diarrhoea (Signs and Symptoms of Persistent Diarrhoea)

Rather than trying to self-diagnose, it helps to track a few details about your symptoms.

Keeping track of the duration, frequency, stool appearance, and any symptoms that occur alongside your diarrhoea can help your doctor narrow down the cause.

  • How long your symptoms have lasted, and when they first started
  • How often they happen, such as the number of times per hour, day, or week
  • What your stools look like, e.g. loose, watery, unusually coloured, or bloody
  • If other symptoms are appearing alongside the diarrhoea, such as:
    • Abdominal cramps, bloating, nausea, or trouble controlling bowel movements
    • Blood, mucus, fever, or chills, which could be signs of an infection
    • Greasy, foul-smelling stools and weight loss, suggesting malabsorption
  • If your diarrhoea has a pattern, such as:
    • A tendency to happen after dairy, which may suggest lactose intolerance
    • Abdominal pain that improves after a bowel movement and is associated with changes in stool frequency or form, which may suggest IBS

See a Specialist about Chronic Constipation

If you have been experiencing persistent diarrhoea, book an appointment with our colorectal specialist for a proper assessment of your symptoms and a suitable treatment plan.

Schedule an appointment

What to Be Concerned About with Persistent Diarrhoea

You should seek medical assessment or urgent care if you experience any of the following with your diarrhoea:
  • Blood in the stool or black, tarry stools
  • Significant abdominal or rectal pain
  • Fever, dehydration, or symptoms that persist or worsen
  • Unexplained weight loss, fatigue, or paleness that may suggest anaemia
  • A hard abdominal mass

These symptoms can be associated with condition such as IBD, microscopic colitis, severe infection, or colorectal cancer, and warrant early investigation.

How Persistent Diarrhoea Is Diagnosed

During the consultation, your doctor will usually take a detailed medical history and ask about your symptoms, with questions like these:
  • How long youʼve had diarrhoea and how it started
  • How often it happens and what your stools look like
  • If anything seems to trigger it, such as certain foods
  • If youʼve noticed blood, mucus, fever, or other symptoms alongside it
  • Your recent travel history and any new medicines you may have started

 

During the physical exam, your doctor may also perform the following:

  • Check for signs of dehydration, fever, or unexplained weight change
  • Gently press on your abdomen to check for tenderness or a mass
  • Listen to your bowel sounds with a stethoscope
  • Perform a digital rectal exam if concerns exist about bleeding, blockage, or a problem lower in the bowel

Further Tests

Depending on your case, the doctor may also order further tests to help identify the cause:

  • Blood tests to check for dehydration, infection, inflammation, anaemia, or screen for conditions such as coeliac disease
  • Stool tests for blood, bacteria, parasites, or other disease markers
  • Special tests for specific conditions such as these:
    • Faecal calprotectin or lactoferrin, to check for IBD
    • Upper GI endoscopy with small-bowel biopsies, to check for coeliac disease
    • A hydrogen breath test, to check for lactose or fructose malabsorption, or small intestinal bacterial overgrowth
  • Imaging such as CT or MRI if your doctor suspects an underlying structural abnormality or complication
  • An endoscopy (colonoscopy) if your doctor suspects microscopic colitis, polyps, or colorectal cancer

Possible Treatments for Persistent Diarrhoea

Treatment for persistent diarrhoea depends on how severe it is and what is causing it.

Self-Care While Awaiting Medical Review

  • Focus on replacing fluids and electrolytes, such as by drinking oral rehydration solutions
  • Avoid caffeine, alcohol, fatty or oily foods, and dairy if these worsen your symptoms. Some people may also benefit from temporarily limiting high-fibre foods during active diarrhoea.
 

Medical Treatment for Common Non-Surgical Causes

  • Bacterial or parasitic infections are often managed with antibiotics or anti-parasitic medication
  • Lactose intolerance and coeliac disease are managed with targeted dietary changes, such as a lactose-free and gluten-free diet
  • IBS is often managed with dietary and lifestyle changes
  • Microscopic colitis may be managed with dietary changes, antidiarrhoeal medication, or budesonide
 

Surgical Options for More Serious Cases

IBD is often managed with medication and lifestyle adjustment, though surgery may be needed for more serious or complicated cases.

Where a structural lesion, colorectal cancer, bowel obstruction, or another serious condition is suspected, urgent assessment may be required. Treatment becomes specific to the condition, sometimes involving endoscopic or surgical management.

Symptoms

Anal Discharge or Swelling
Groin Pain or Swelling
Pimple/Cyst/Abscess Near Anus
Tailbone Infection
Rectal Bleeding (Blood in Stool)
Abdominal Pain (Lower Abdomen)
Chronic Constipation
Persistent Diarrhoea

Discuss Your Treatment Options with a Specialist

Persistent diarrhoea can take a toll on your day-to-day life, and seeking medical attention early may help identify the possible cause. Speak to our colorectal specialist to discuss your symptoms and possible treatment options.

Book an Appointment