Chronic diarrhea

Q: My friend, who is nearly 80, has been complaining that she is losing weight because “everything goes straight through.” Is this normal in older people? She has not been to see her doctor, but I think this needs investigating. She has no other health problems except for arthritis.

A: Old age is not a disease but any unusual symptom or change in bodily functions needs to be fully medically investigated.

Chronic diarrhea is defined as loose, frequent or watery stools lasting for four weeks or more.

There are some long-term bowel diseases, which can cause these symptoms, although it is most likely that your friend would have been diagnosed with one of these at a much earlier age.

They include Crohn’s disease, ulcerative colitis, celiac disease or gluten sensitivity and irritable bowel syndrome.

Diarrhea can also occur after abdominal surgery or removal of the gallbladder. You may be surprised to hear that chronic diarrhea or watery stools, sometimes with incontinence, is often the result of constipation or fecal impaction. Because the stool is hard, the more liquid feces needs to escape and so it finds a way to leak around the obstruction.

This is quite common in the elderly population and is frequently seen in long-term care homes. A physical examination of the abdomen should determine if this is the case, and laxatives or an enema may be all that is needed to remedy the situation.

If constipation is not discovered, then the doctor needs to do blood tests, which should include a complete blood count, liver function tests and electrolyte levels.

When “everything goes straight through,” the bowels may not have time to absorb vitamin B12, folic acid, calcium and iron. This is known as malabsorption syndrome and supplements may be required.

Stools should be examined for intestinal parasites such as Giardia and bacteria such as C. Difficile. Some viruses may also be the culprits. However, microscopic examination and culture may not always show positive results. A stool test for fecal occult or hidden blood should also be performed.

Further investigations may be required if colorectal or other intestinal cancers are suspected.

They include a colonoscopy, sigmoidoscopy, endoscopy or an upper gastrointestinal tract examination or a barium X-ray.

Laxative abuse should also be investigated because it is common in older people who don’t always admit it.

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