Chronic diarrhea: types, symptoms and complications

General definition

We speak of "conical diarrhea" to indicate an alteration of intestinal motility characterized by

a number of daily evacuations greater than or equal to 3, with the emission of liquid or semi-solid faeces (diarrhea),

that persists

for at least three or four consecutive weeks

Types of chronic diarrhea

Based on the cause that causes it, chronic diarrhea can be divided into three main categories:

TYPE OF CHRONIC DIARRHEA	SUBTYPE	DISTINGUISHING FEATURES
Chronic watery diarrhea	Osmotic (eg induced by osmotic laxatives such as magnesium salts and sorbitol, or by celiac disease) Secretoria (eg induced by microscopic colitis, abuse of laxatives with stimulating action, tumors) Functional (eg favored by irritable bowel syndrome)	In chronic osmotic diarrhea there is a considerable retention of water in the colon, caused by a reduced absorption of some substances. In the secretory variant, diarrhea is the result of reduced water absorption. Furthermore, chronic secretory diarrhea is distinguished by the exaggerated volume of faecal material emitted (> 1 l / day) and by the urgent need to go to the bathroom even at night. Functional diarrhea is caused by hypermotility of intestinal transit.
Chronic fatty diarrhea (from malabsorption)	Infectious (eg caused by giardiasis) Non-infectious (eg induced by celiac disease, amyloidosis, administration of some drugs such as orlistat and acarbose)	This type of chronic diarrhea is distinguished by the excessive formation of intestinal gas, steatorrhea and a marked reduction in body weight.
Chronic inflammatory (or exudative) diarrhea	Infectious: caused for example by bacteria such as Clostridium difficile, cytomegalovirus, herpes simplex, tuberculosis Non-infectious: induced by ulcerative colitis, Crohn's disease, diverticulitis, lymphomas, tumors	Chronic inflammatory diarrhea is distinguished by the presence of blood and pus in the faeces and an increase in calprotectin levels (marker of neutrophilic activity: an increase in this protein is an indication of inflammatory disease of the digestive tract)

Symptoms

The various types of chronic diarrhea are joined by a crown of symptoms, which therefore tend to always recur (regardless of the cause):

Abdominal pains
Liquid or semi-solid stools
Urgent need to go to the bathroom
Bowel sounds
Abdominal swelling sensation

Clearly, based on the cause of origin, the clinical picture of the patient suffering from chronic diarrhea is enriched with more complex symptoms.

Based on the "satellite" symptoms that accompany the classic clinical picture of chronic diarrhea, it is possible to hypothesize about the triggering cause:

Satellite symptoms that suggest the presence of chronic diarrhea	Hypothesis on the causes and type of chronic diarrhea
Chronic diarrhea alternating with periods of constipation Abdominal pains Abdominal pain relieved after evacuation Obvious abdominal swelling Feeling of incomplete evacuation Diarrhea with mucus (a symptom that occurs in 25% of evacuations) Evacuations often recur after meals and almost always during daylight hours Accentuation of symptoms in the presence of anxiety, stress and tension	Chronic irritable bowel syndrome
Abdominal cramps Abdominal pain Flatulence Weight reduction Steatorrhea (excessive presence of fat in the stool) Dermatitis herpetiformis Skin eruption (with vesicles and itching)	Chronic celiac disease diarrhea
Iron deficiency anemia	Chronic diarrhea due to celiac disease
Weight loss Lymphadenopathy (enlarged lymph nodes)	Chronic diarrhea due to infections or tumors
Episcleritis: inflammation of the superficial layers of the ocular sclera (white part of the eye)	Chronic diarrhea due to inflammatory diseases of the colon
Exophthalmos (prominent eyes) Heat sensation, hyper-sweating	Chronic hyperthyroid diarrhea
Night diarrhea Watery secretory diarrhea	Chronic microscopic colitis diarrhea: the hypothesis is almost ascertained when the aforementioned symptoms occur in the elderly, especially if they take anti-inflammatory drugs
Palpation pain in the abdomen	Infectious / inflammatory chronic diarrhea
Anal fistulas Blood in the stool Weight loss, anemia and fever (possible symptoms)	Chronic diarrhea due to Crohn's disease / ulcerative colitis
Immediate defecation stimulus after meals	Chronic irritable bowel syndrome
Oily stools	Chronic diarrhea due to malabsorption syndrome
Vomiting, nausea Temperature Strong abdominal pain	Chronic infectious colitis diarrhea (almost certain hypothesis in case of recent trips / camping or contact with infected subjects)
Anxiety Tension, fear, stress	Chronic psychological diarrhea

Complications

The complications of chronic diarrhea depend on the cause that led to it, the age and health of the patient. When chronic diarrhea occurs in an aggressive form, the patient runs the risk of running into serious nutritional disorders, vitamin deficiencies, dehydration, malnutrition, hypotension, tachycardia.

We also recall that an extremely aggressive conical diarrhea can induce the death of the patient due to dehydration and metabolic acidosis.