How To Treat Chronic Diarrhea: Case Study

#GutHealth #DiarrheaTreatment #IBSRelief #DigestiveHealth #ProbioticsWork #Loperamide #HomeRemedies #BRATdiet #OralRehydration #StomachIssues

Mr. Nandan Shrivastava, a 42-year-old marketing executive from Lucknow, had always enjoyed his food. Be it street-side chaats or lavish buffet dinners, he relished every bite. However, over the past six months, his joy of eating turned into a nightmare. Nearly every time he ate—even a seemingly safe meal—he found himself rushing to the toilet within an hour.

Nandan’s story is not uncommon. Diarrhea affects millions of individuals globally, and in many cases, like his, it becomes chronic or recurrent. Through his case, we explore the causes, symptoms, medications, home remedies, and prevention strategies for diarrhea, especially when it is linked to eating episodes.

What is Chronic Diarrhea:

Diarrhea is medically defined as the passage of loose, watery stools more than three times in a day. While it may seem like a minor inconvenience, persistent or severe diarrhea can result in dehydration, electrolyte imbalance, and even hospitalization if not managed promptly.

Types of Diarrhea:

1. Acute Diarrhea – Lasts 1–2 days; usually due to infection or food poisoning.

2. Chronic Diarrhea – Persists for more than four weeks; often due to digestive disorders or food intolerances.

3. Traveler’s Diarrhea – Linked to contaminated food/water in unfamiliar regions.

Nandan’s symptoms, being post-meal and frequent, pointed toward chronic diarrhea.

Chronic Diarrhea Symptoms:

• Watery stools after meals

• Abdominal cramping and gurgling sounds

• Occasional bloating and gas

• Weight loss over 2 months (~4 kg)

• Mild fatigue

• No fever, no vomiting

After consulting Dr. Anirban Biswas and undergoing some tests, it became evident that Nandan’s diarrhea was postprandial (post-meal) and not due to an acute infection. The next step was to dig deeper into the causes.

Common Causes of Recurrent Diarrhea After Eating:

1. Food Intolerance or Sensitivity

• Lactose intolerance (inability to digest milk sugar)

• Gluten sensitivity or celiac disease

• Fructose malabsorption

  
  

2. Irritable Bowel Syndrome—Diarrhea Predominant (IBS-D)

A functional gut disorder characterized by disturbed bowel movements and abdominal discomfort, often triggered by food or stress.

3. Post-Infectious Gut Changes

After a bout of food poisoning or gastroenteritis, some people develop temporary lactose intolerance or altered gut flora.

4. Microbial Overgrowth

Small intestinal bacterial overgrowth (SIBO) or gut dysbiosis can lead to fermentation, bloating, and loose stools.

5. Medication Side Effects

Antibiotics, magnesium supplements, and some heart medications can disturb bowel function.

In Nandan’s case, tests revealed mild lactose intolerance and IBS-D. He had developed this after a stomach infection last year, likely altering his gut microbiome.

Medical Management: What Medicines Help Stop Diarrhea?

Let’s explore the best medicine options for diarrhea, as advised to Mr. Shrivastava:

1. Loperamide (Imodium)

• Mechanism: Slows gut movement, allowing better water absorption.

• Use: Best for acute non-infectious diarrhea or IBS-D.

• Caution: Avoid in bloody or fever-associated diarrhea; not recommended long-term.

  
  

2. Bismuth Subsalicylate (Pepto-Bismol)

• Action: Antibacterial and anti-inflammatory; coats the stomach.

• Use: Useful in traveler’s diarrhea and mild IBS.

• Warning: Avoid in people allergic to aspirin or on blood thinners.

  
  

3. Probiotics

• Example: Saccharomyces boulardii, Lactobacillus rhamnosus GG

• Benefit: Restore gut flora, reduce antibiotic-associated diarrhea.

• Use: Great for both infectious and chronic diarrhea management.

  
  

Nandan was prescribed Loperamide for SOS use (during travel or meetings), a daily probiotic, and Bismuth subsalicylate for short-term flare-ups.

Antibiotics: When Are They Needed?

Antibiotics are not usually prescribed unless the diarrhea is:

• Severe and bloody

• Associated with high fever

• Proven to be due to bacterial infection (e.g., Salmonella, Shigella)

  
  

Common choices include:

• Ciprofloxacin

• Azithromycin

• Rifaximin (particularly for IBS-D)

Since Nandan’s stool tests were negative for pathogens, he did not require antibiotics.

Oral Rehydration Therapy (ORS): A Lifesaver

Even with mild diarrhea, dehydration is a risk. Mr. Shrivastava was advised to:

• Use ORS packets dissolved in clean water after each motion.

• Sip coconut water, clear soups, or buttermilk during the day.

ORS contains the right mix of glucose and electrolytes to help the gut absorb water effectively.

Long-Term Management:

For IBS-D:

• Medications:

  • Antispasmodics (e.g., Dicyclomine) for cramps

  • Tricyclic antidepressants (low dose) for gut-brain regulation

• Diet Changes (Low FODMAP Diet):

  • Avoid fermentable carbs like onions, garlic, apples, lentils

  • Introduce foods like oats, carrots, rice

  
  

For Lactose Intolerance:

• Limit milk, ice cream, and cheese

• Use lactase enzyme supplements with dairy

• Choose lactose-free alternatives

Home Remedies for Diarrhea:

While medicines helped, Nandan also adopted some natural remedies and dietary habits:

1. Rice Water

• Mild starch helps bulk up stools

• Easy to digest

2. Ginger Tea

• Reduces cramping

• Aids digestion

3. BRAT Diet

• Bananas, Rice, Applesauce, Toast

• Best during flare-ups

4. Yogurt & Fermented Foods

• Replenish good gut bacteria

• Include curd, kefir, kimchi, and sauerkraut

5. Apple Cider Vinegar

• Diluted with water, helps balance gut pH

He also stopped eating raw salads and spicy food temporarily and drank boiled water only.

Preventive Strategies:

To prevent further episodes, Dr. Biswas asked Nandan to make the following changes:

Lifestyle Modifications	Details
Hand hygiene	Washing before meals, after toilet use
Mindful eating	Chewing food slowly, avoiding overeating
Managing stress	Practiced yoga and deep breathing
Avoiding unsafe food	No more roadside chaat or untreated water
Food diary	Tracked triggers like milk and onions

Red Flags: When to Seek Medical Help Immediately

Nandan was advised to report to the hospital if he ever experienced

• Blood in stools

• High fever

• Severe abdominal pain

• Dehydration signs (dizziness, dry mouth)

• Diarrhea lasting >3 days without improvement

  
  

Conclusion: A Balanced Gut, A Balanced Life

Mr. Nandan Shrivastava’s battle with recurrent diarrhea after meals was frustrating and embarrassing. But with proper medical advice, medicines, dietary changes, and home remedies, he regained control over his health.

Today, he enjoys simple, balanced meals and never skips his probiotic yogurt bowl. His message for others: “Don’t ignore repeated motions. They might be your gut crying out for help.”