Chronic diarrhea: what to do, causes, and quick fixes

Chronic diarrhea is loose or watery stools lasting more than four weeks. If you’ve been dealing with this, you already know it ruins plans, sleep, and confidence. This guide gives crisp answers: common causes, what tests help, simple fixes you can try, and when to get urgent care.

Common causes include infections, irritable bowel syndrome with diarrhea (IBS-D), inflammatory bowel disease (IBD), bile acid malabsorption, pancreatic insufficiency, medication side effects, and chronic infections like Giardia or C. difficile.

Start simple: track what you eat, any recent travel, antibiotics, or new medicines. Note patterns — does dairy make it worse? Do greasy meals trigger it? Small clues narrow down testing and treatment fast.

When to see a doctor now: fever, bloody stools, severe belly pain, weight loss, dehydration, or if diarrhea wakes you at night. Also seek care if symptoms last over two weeks or you can’t keep fluids down.

Tests doctors use include stool cultures, stool PCR for pathogens, C. difficile toxin test, fecal calprotectin for inflammation, blood tests, and imaging or colonoscopy if needed. Don’t be surprised if they ask about recent antibiotics and travel.

Treatment depends on cause. For infections, targeted antibiotics or antiparasitics help. For IBS-D, low FODMAP diet, loperamide, bile acid binders, or rifaximin can work. IBD needs anti-inflammatory or immune drugs. Pancreatic enzyme replacement helps with insufficiency.

Simple at-home steps that help right away: sip oral rehydration solution or make one with water, salt, and sugar; avoid caffeine and alcohol; pause lactose if that’s a trigger; try low-fiber bland foods for a day or two; use loperamide for short-term relief unless you have fever or bloody diarrhea.

Probiotics can help after antibiotics and sometimes for chronic loose stools, but strains matter. Saccharomyces boulardii and certain Lactobacillus strains have evidence for specific problems. Ask your provider which strain matches your situation.

If tests point to bile acid malabsorption, doctors may use cholestyramine or colesevelam. For small intestinal bacterial overgrowth (SIBO), herbal or prescription antibiotics like rifaximin are options. Don’t self-treat complicated causes — wrong drugs can make things worse.

Travelers: get stool tests and think about parasites if diarrhea lasts weeks. Post-infectious IBS can follow food poisoning and often improves with diet and time. If weight drops or blood shows up, push for more testing.

Keep a log: stool frequency, stool form (use the Bristol chart), foods, meds, and symptoms. This cuts down guesswork and helps your clinician make quick choices. Small records often speed diagnosis.

Final practical tip: stay hydrated, ask for specific tests instead of vague panels, and get a second opinion if symptoms drag on. Chronic diarrhea is treatable — you just need the right cause identified and the right plan.

If you want, bring a list of past antibiotics, surgeries, and travel dates to your visit. That history often cracks the case fast and saves time and repeat tests.

For severe dehydration, fainting, or mental confusion, go to emergency care immediately. Don’t ignore changes — early action makes a big difference. Act now.