Diarrhea, characterized by loose, watery, and frequent bowel movements, is a common ailment that most people experience at some point in their lives. While often a short-lived inconvenience, persistent diarrhea can sometimes lead to unintended weight loss and may signal an underlying health issue. It's important to understand the potential causes of diarrhea and its connection to weight loss to determine when medical attention is necessary.
Understanding Diarrhea
Diarrhea is generally defined as the frequent passage of loose, watery stools. It is usually a symptom of an underlying issue rather than a disease itself. In many cases, diarrhea resolves within a few days and is not a cause for significant concern. However, chronic or severe diarrhea can lead to dehydration and other complications, including weight loss.
The Link Between Diarrhea and Weight Loss
While an occasional bout of diarrhea is unlikely to cause significant weight loss, persistent diarrhea can interfere with the body's ability to absorb nutrients from food. This malabsorption of nutrients can lead to weight loss over time. Additionally, diarrhea can cause dehydration, which can also contribute to a temporary drop in weight.
Common Causes of Diarrhea
Diarrhea can be triggered by a variety of factors, including:
- Infections: Viruses, bacteria, and parasites can all cause diarrhea. Common culprits include norovirus, rotavirus (especially in children), Escherichia coli (E. coli), and Clostridioides difficile (C. diff). Exposure to these pathogens can occur through contaminated food or water, or through contact with infected individuals. Traveler's diarrhea is a common form of diarrhea caused by bacteria or parasites encountered while traveling in developing countries.
- Dietary Factors: Certain foods and beverages can trigger diarrhea in some individuals. Lactose intolerance, for example, can cause diarrhea after consuming dairy products. Fructose, a sugar found in fruits and honey, and artificial sweeteners can also have a similar effect.
- Medications: Many medications, particularly antibiotics, can cause diarrhea as a side effect. Antibiotics can disrupt the natural balance of bacteria in the intestines, leading to diarrhea or an infection like C. diff.
- Digestive Disorders: Various digestive disorders, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease, can cause chronic diarrhea.
- Surgery: In some cases, surgery, particularly involving the digestive system, can lead to diarrhea.
Inflammatory Bowel Disease (IBD) and Diarrhea
IBD, which includes conditions like ulcerative colitis and Crohn's disease, is characterized by chronic inflammation of the digestive tract. Symptoms of IBD can include persistent diarrhea, abdominal pain, rectal bleeding, weight loss, and fatigue.
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- Ulcerative colitis causes long-lasting inflammation and sores, or ulcers, in the innermost lining of your colon and rectum.
- Crohn’s disease causes inflammation of the digestive tract lining and this inflammation often spreads deep into affected tissues.The exact cause of IBD remains unknown, but it is believed to involve a combination of genetic and environmental factors, as well as an abnormal immune system response. Stress is also known to aggravate symptoms.
Malabsorption and Diarrhea
Malabsorption occurs when the body is unable to properly absorb nutrients from food. This can be caused by various factors, including:
- Enzyme deficiencies: The pancreas may not produce enough enzymes needed to digest food, leading to exocrine pancreatic insufficiency (EPI). Without these enzymes, the body cannot properly absorb vitamins and nutrients.
- Damage to the small intestine: Conditions like celiac disease or Crohn's disease can damage the lining of the small intestine, impairing its ability to absorb nutrients.
- Surgical resections: Removal of portions of the small intestine can reduce the absorptive surface area, leading to malabsorption.
Symptoms of malabsorption can include chronic diarrhea, steatorrhea (fatty stools), weight loss, abdominal cramps, bloating, and gas. Malabsorption can also lead to deficiencies in essential vitamins and minerals, such as vitamins A, D, E, K, B12, folate, calcium, and iron.
Exocrine Pancreatic Insufficiency (EPI)
When you have exocrine pancreatic insufficiency (EPI), your body will let you know. The condition happens when your pancreas doesn’t make the enzymes you need to digest food. Without them, you won’t get enough important vitamins and nutrients from your diet. That can lead to a few classic signals of the condition.
You might feel or notice:
- You’re losing weight without trying. It’s a common symptom of EPI.
- Greasy, foul-smelling stools that float or are tough to flush. It’s a sign your body isn’t absorbing fat from your diet as it should.
- Diarrhea.
- Stomach cramps. You may be bloated, too.
- Bad-smelling gas. When you don’t absorb food well, bacteria can grow in your intestine and release smelly gasses.
- Swelling in your lower legs.
- Skin that’s pale, bruises easily, or gets rashes.
Besides its outward symptoms, EPI also affects your body in ways you can’t always see or feel. When you don’t absorb fat and other nutrients from food well, your body can be low on vitamins A, D, E, and K. Without them, you could become less able to see at night or in low light, a condition called night blindness. You could also get bone diseases like osteopenia. EPI can also lead to anemia, in which your blood doesn’t have enough healthy red blood cells.
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In severe cases, your bones could break easily, and you might get muscle spasms or cramps, or have seizures. When you don’t get enough vitamins and nutrients from your food you could also have problems with walking and balance. You could also notice weakness or numbness in your hands and feet.
When to Seek Medical Attention
While occasional diarrhea is usually not a cause for concern, it's important to seek medical attention if:
- Diarrhea persists for more than a few days
- Diarrhea is accompanied by severe abdominal pain, fever, or bloody stools
- You experience signs of dehydration, such as decreased urination, excessive thirst, or dizziness
- You are losing weight without trying
- You have a history of digestive disorders, such as IBD or celiac disease
Children, particularly those under the age of two, are at a higher risk of dehydration from diarrhea and should be seen by a doctor if their symptoms don't improve within a day.
Diagnosis and Treatment of Diarrhea and Weight Loss
The cause of diarrhea is often determined using a blood test or a stool test. A healthcare provider may order specific medical tests based on your symptoms, family history, and other factors. For example, if you have symptoms of a peptic ulcer, your provider may recommend an upper endoscopy. Other tests may include:
- Blood tests: Your blood can show signs of certain health conditions like diabetes, celiac disease, and infections. It can also give your provider information about how your metabolism, thyroid, and adrenal glands are working.
- Cancer screening tests: If your provider wants to rule out cancer, you may need screening or imaging tests. For example, a colonoscopy can detect colorectal cancer.
- Imaging tests: Tests like an MRI (magnetic resonance imaging) or CT scan (computed tomography scan) can provide detailed images of your organs, like your brain, heart, lungs, and abdominal organs. You may need one of these tests if your provider wants to rule out tumors or diseases that may be visible on these scans.
- Urine test: A urinalysis can provide information about your kidneys and bladder, including certain health conditions and infections.
Your treatment for unexplained weight loss depends on what’s causing it. For example, if you have a toothache, you may need to see a dentist. If the cause is a peptic ulcer, your provider may treat it with antibiotics. People with celiac disease must avoid all gluten.
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If you have EPI, your doctor will suggest treatments that can help. They can also recommend other ways to improve your digestion.In patients who cannot be completely restored to normal (for example after extensive surgical removal of the intestine), special dietary measures need to be adopted. Dietary treatment will also depend on the site of malabsorption. If fat is being malabsorbed, a low fat diet should be consumed. For carbohydrate malabsorption, disaccharides, specifically lactose, often must be restricted. This involves limiting milk products or choosing many of the low lactose products now available. Lactase enzyme tablets may also be taken with milk products to digest the lactose.
Prevention of Diarrhea
Preventing infectious diarrhea
Wash your hands to prevent the spread of infectious diarrhea. Wash frequently. Wash your hands before and after preparing food. Lather with soap for at least 20 seconds. After putting soap on your hands, rub your hands together for at least 20 seconds. Use hand sanitizer when washing isn't possible. Use an alcohol-based hand sanitizer when you can't get to a sink. Apply the hand sanitizer as you would hand lotion, making sure to cover the front and back of both hands.
Vaccination
You can help protect your infant from rotavirus, the most common cause of viral diarrhea in children, with one of two approved vaccines.
Preventing traveler's diarrhea
Diarrhea commonly affects people who travel to countries with poor sanitation and contaminated food.
- Watch what you eat. Eat hot, well-cooked foods. Don't eat raw fruits and vegetables unless you can peel them yourself.
- Watch what you drink. Drink bottled water, soda, beer, or wine served in its original container. Don't drink tap water or use ice cubes. Use bottled water even for brushing your teeth. Beverages made with boiled water, such as coffee and tea, are probably safe.
- Ask your health care team about antibiotics.
- Check for travel warnings.