What is persistent diarrhea?
Diarrhea means loose or watery stools, usually three or more times a day. It is called acute when it lasts less than two weeks, persistent when it lasts two to four weeks, and chronic when it lasts more than four weeks. Acute diarrhea is usually caused by infection. Persistent and chronic diarrhea are more often caused by ongoing infections, medicines, food intolerances, irritable bowel syndrome, inflammatory bowel disease, celiac disease or microscopic colitis.
Diarrhea by duration
- AcuteLess than 2 weeks; usually a virus, bacteria or food poisoning.
- Persistent2 to 4 weeks; lingering infection, parasites or medicine effects.
- ChronicMore than 4 weeks; IBS, IBD, celiac disease, microscopic colitis and more.
What causes persistent diarrhea?
Common causes of persistent or chronic diarrhea include irritable bowel syndrome with diarrhea, lactose and other food intolerances, medicines such as metformin, antibiotics, magnesium and some blood pressure medicines, C. difficile and parasitic infections, inflammatory bowel disease, celiac disease, microscopic colitis, bile acid diarrhea after gallbladder removal, small intestinal bacterial overgrowth, an overactive thyroid and pancreatic insufficiency.
| Cause | Clues |
|---|---|
| IBS with diarrhea | Pain linked to bowel movements, no blood or weight loss |
| Food intolerance | Worse after dairy, sugar alcohols or certain carbohydrates |
| Medicines | Started after a new drug, such as metformin or magnesium |
| Infection (C. diff, parasites) | Recent antibiotics, travel, untreated water |
| Inflammatory bowel disease | Blood, urgency, night-time diarrhea, weight loss |
| Celiac disease | Bloating, anemia, family history |
| Microscopic colitis | Watery diarrhea, often in older adults, normal-looking colon |
| Bile acid diarrhea | After gallbladder removal |
Have symptoms like these?
Dr. Muhammad Ali Khan, a board-certified gastroenterologist and hepatologist, sees adults at our Katy and Cypress offices, serving patients across Greater Houston.
When is persistent diarrhea a warning sign?
See a doctor promptly for diarrhea with blood or black stools, unexplained weight loss, fever, diarrhea that wakes you from sleep, signs of dehydration, iron-deficiency anemia, severe abdominal pain, or new diarrhea after age 45. These features make an inflammatory, infectious or other structural cause more likely and call for testing.
See a doctor promptly for
- Blood in the stool or black stools
- Unexplained weight loss or fever
- Diarrhea that wakes you at night
- Dizziness, very little urine or other signs of dehydration
- New diarrhea after age 45
How is the cause of persistent diarrhea found?
A gastroenterologist starts with a detailed history, including medicines, diet, travel and antibiotic use. Tests may include stool studies for infection, C. difficile and inflammation (fecal calprotectin), blood tests for anemia, inflammation, celiac disease and thyroid function, and a colonoscopy with biopsies, which can diagnose inflammatory bowel disease and microscopic colitis. An upper endoscopy and breath tests may be added depending on the clues.
Your evaluation, step by step
- HistoryMedicines, diet, travel, antibiotics and stool pattern.
- Stool and blood testsInfection, inflammation, anemia, celiac and thyroid.
- ColonoscopyWith biopsies for IBD and microscopic colitis.
- TreatmentMatched to the confirmed cause.
Learn about colonoscopy in Katy and Cypress.
How is persistent diarrhea treated?
Treatment depends on the cause: dietary changes for food intolerances, medicine adjustments when a drug is responsible, specific antibiotics for C. difficile or antiparasitic medicine for parasites, anti-inflammatory and immune-modifying therapy for inflammatory bowel disease, a gluten-free diet for celiac disease, targeted medicines for microscopic colitis or bile acid diarrhea, and IBS-focused treatments. Staying hydrated is important throughout.
Tip: Keep a stool diary
Note how many bowel movements you have, whether they wake you, any blood, and what you ate. This record helps your doctor narrow the cause quickly.
Get answers instead of guessing
Request a visit with Dr. Muhammad Ali Khan at our Katy and Cypress offices. Call the office to check your insurance coverage; self-pay options are available.
Key takeaways
- Persistent diarrhea lasts two to four weeks; chronic diarrhea lasts more than four weeks.
- Common causes include IBS, food intolerances, medicines, infections, IBD, celiac disease and microscopic colitis.
- Blood, weight loss, fever, night-time diarrhea or dehydration need prompt care.
- Stool tests, blood tests and colonoscopy with biopsies usually find the cause.
- Treatment is matched to the specific cause.
Frequently asked questions
When should I worry about diarrhea that will not go away?
See a doctor if diarrhea lasts more than three days with warning signs, or more than two weeks even without them.
Can stress cause chronic diarrhea?
Stress can trigger diarrhea, especially in IBS, but chronic diarrhea should be evaluated for other causes.
What is microscopic colitis?
It is inflammation of the colon that is only visible under a microscope, causing chronic watery diarrhea, often in older adults. It is diagnosed with colonoscopy biopsies.
Can gallbladder removal cause diarrhea?
Yes. Some people develop bile acid diarrhea after gallbladder removal, which can be treated with specific medicines.
Do I need a referral to see a gastroenterologist in Katy or Cypress?
It depends on your insurance plan. Many PPO plans let you book a specialist directly, while some HMO plans require a referral from your primary care doctor. Call (346) 340-4414 and the team can help you check.
Sources
- NIDDK — Diarrhea
- MedlinePlus — Diarrhea
- MedlinePlus — C. diff infections
- NIDDK — Celiac disease
- NIDDK — Irritable bowel syndrome
- NIDDK — Ulcerative colitis
Where to be seen in Katy and Cypress
United Gastroenterology Associates has two offices: Katy, at 23920 Katy Freeway, Suite 555, next to Memorial Hermann Katy Hospital, and Cypress, at 21216 Northwest Freeway, Suite 640, on US-290. Both are open Monday through Friday, 8:30 AM to 5:00 PM, closed for lunch from 12:00 to 1:30 PM, and serve patients from Fulshear, Richmond and across Greater Houston. Call (346) 340-4414 for either office.
Katy office
23920 Katy Freeway, Suite 555
Katy, TX 77494
Memorial Hermann Medical Plaza 1
Next steps
If you are dealing with persistent diarrhea or any ongoing digestive concern, a focused evaluation can find the cause and start the right treatment. Dr. Muhammad Ali Khan and the team at United Gastroenterology Associates see adults from Katy, Cypress, Fulshear, Richmond, Greater Houston and across Texas. Call (346) 340-4414 or request an appointment today.
If you have severe pain, vomit blood, pass black stools or have chest pain, call 911 or go to the nearest emergency room.
