Chronic diarrhea history and symptoms

The hallmark of chronic diarrhea is loose stools lasting for 4 weeks or more. A positive history of foul smelling stools that are difficult to flush, bloody loose bowel movements, and cramping abdominal pain are suggestive of chronic diarrhea. The most common symptoms of chronic diarrhea include cramping abdominal pain, elevation in body temperature, and increased frequency of bowel movements.

Obtaining the history is the most important aspect of making a diagnosis of chronic diarrhea. It provides insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and the prognosis. Specific histories about symptoms (duration, onset, progression), associated symptoms, and drug usage have to be obtained. Specific areas of focus when obtaining the history are outlined below:^[1][2]

• Age and gender
• Onset, duration, progression, pattern, and timing of symptoms
• Associated symptoms (lethargy, fever, confusion)
• Current medications
• Association with food and fasting states
• Symptoms of other organ failure (renal failure, liver failure, adrenal failure)
• Ingestion of poisons or chemicals
• Co-morbid conditions like diabetes, immunodeficiency
• Severe infections
• Any alterations in sensorium as a result of dehydration
• Family history

The hallmark of chronic diarrhea is loose stools lasting for 4 weeks or more. Other most common symptoms of chronic diarrhea include:

• Abdominal cramps
• Abdominal pain
• Fever
• Occult blood in stool
• Bloating
• Nausea

Less common symptoms of chronic diarrhea include:

• Confusion or agitation
• Altered mental status
• Disorientation
• Abdominal guarding
• Difficulty speaking
• Stupor or coma

The following algorithm gives diagnostic workflow for chronic non-infectious diarrhea. ^[3]

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