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Functional Diarrhea

WHAT IS FUNCTIONAL DIARRHEA?

Diarrhea is a bowel condition causing frequent episodes of loose or watery bowel movements (poop). There are different types of diarrhea. When diarrhea happens for a short period of time it may be caused by an infection or food sensitivity. Diarrhea over a long period of time can be caused by several possible conditions.

 

In functional diarrhea, there is no cause found. It is not related to irritable bowel syndrome, celiac disease or inflammatory bowel disease. Abdominal pain and bloating may be present, but they are not the main symptoms.

 

The Bristol Stool Form Scale is used to check stool (poop) forms. Types 6 to 7 are the forms seen with diarrhea.

Bristol Stool Scale

Stool form may change depending on what you eat or medications you take. Keeping a Stool Diary for 14 days to track your bowel movement patterns is helpful and will give your healthcare provider an idea of your stool patterns.

DIAGNOSIS

Your healthcare provider will take a detailed history of your symptoms, do a physical examination, review your medications and diet patterns. It is important to let your healthcare provider know if you have had previous/recent infections, any recent travel or recent changes in your medications.

 

Your healthcare provider may order some blood and stool tests to check for infection and celiac disease depending on your symptoms. A colonoscopy may be requested to find out why you have diarrhea. Not all patients with diarrhea symptoms will need a colonoscopy.

 

A colonoscopy is a test that looks into your colon (large intestine) using a long flexible camera that is inserted into the anus (the opening where stool comes out). During the procedure, the doctor may collect biopsies of your colon to check for the cause of your diarrhea.

 

Functional diarrhea is diagnosed if your test results do not show a cause for your symptoms and if you have:

  • Loose or watery stools, without predominant abdominal pain or bothersome bloating, occurring in more than 25% of stools

  • Ongoing diarrhea for the last 3 months and started at least 6 months before diagnosis

  • Do not meet criteria for irritable bowel syndrome (IBS)*

* see section on irritable bowel syndrome

ALARM OR CONCERNING FEATURES

There are features NOT normal of functional diarrhea and may signal other serious health problems. See your healthcare provider or seek immediate medical attention if you experience any of the following symptoms:

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  • Blood in your stools or black, tarry stools

  • Excessive and unintentional weight loss

  • Fever

  • Constant pain in your stomach area that does not get better after a bowel movement and wakes you up throughout the night

  • High volume diarrhea

  • More than 6 to 10 bowel movements a day

TREATMENT

Before starting any treatment, see your healthcare provider to check you do not have an infection or other causes for diarrhea. These treatments should not be attempted if you have any alarming or concerning features. Discuss potential side effects with your healthcare provider.

 

It is important to talk to your healthcare provider about the management of your functional diarrhea. You should also have follow-up care with your healthcare provider to see how you responded to the treatment. Not all treatments work for everyone and treatment is guided by your response.

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Soluble Fiber

These types of fibers easily dissolve in water. They bulk loose stools by absorbing some of the water content in the colon. These supplements can be found over-the-counter. Soluble fibres can also be found in certain types of foods.

Examples: psyllium fibre supplements (Metamucil®), psyllium husk, inulin (Benefibre), guar gum (Fibre4), oats, beans, peas, barley, citrus fruits, carrots

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Anti-diarrheal Medications

This medication can be purchased over-the-counter and can decrease the frequency and stool volume.  

Example: loperamide (Imodium®)

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Neuromodulators

These medications are traditionally used in higher doses for depression. But at lower doses it can help slow down the movement of stools and alleviate the pain in your stomach area. These medications will require a prescription from your healthcare provider.

Examples: amitriptyline, desipramine 
 

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