Why have I had diarrhea for 6 weeks nonstop?
January 28, 2014 5:57 PM   Subscribe

YANMD. I've had watery diarrhea (6 or more times/day) since mid-Dec, starting around the time norovirus was going around the schools. No other symptoms - no fever, chills, pain, etc. Nothing scary like blood or mucous in the diarrhea, and I am drinking enough fluid that I am peeing. I went to the doctor after 4 weeks of this, and he did blood work (to make sure my electrolytes weren't out of whack). My doctor -- who is excellent -- isn't worried about me but, oh my, is this ever an inconvenience.

I did a stool sample which showed no shigella or campylobacter, no c.diff, and no parasites. It was positive for yeast and since I was still having symptoms, the doctor decided to treat it. I just finished a 7 day course of fluconazole 100 mg daily but the symptoms are the same.

Now I'm just stumped. Surely a virus would have run its course by now? I work in a hospital so of course I thought of c.diff but that was negative. How accurate is a stool sample? Could something have been missed? Could I have temporary lactose intolerance? My GI tract seems equally unhappy whether I eat is dairy or not, though I haven't done a rigorous elimination diet or anything. Should I? I've heard of IBS of course, but it seems like this started when everyone around me had a virus.

In an ideal world I would like to know exactly what is causing this and to cure it -- or at the very least to manage it. Brainstorm me, mefi - what could this be?
posted by selfmedicating to Health & Fitness (32 answers total) 1 user marked this as a favorite
what are you eating?
posted by cristinacristinacristina at 6:00 PM on January 28, 2014 [1 favorite]

Try some probiotics or at least some yogurt that has probiotics? That has worked wonders in this house.
posted by dpx.mfx at 6:03 PM on January 28, 2014 [1 favorite]

I lived in SE Asia for a while, and so I am familiar with this kind of thing. Not fun.

Are you taking probiotics? If not, start taking them now - really good ones.

And is there any way you can convince your doc to just give you a strong short course of antibiotics? I feel like you should at least try some cipro and mega courses of probiotics.
posted by jardinier at 6:04 PM on January 28, 2014

Sorry -- I forgot to say what I've been eating -- mostly bread and pasta and bananas lately. Eggs and bacon are surprisingly successful. "Unsuccessful" foods have been anything like chickpeas or cornbread. Easy-to-digest stuff like white bread has been fine. Sugary stuff has been bad.
posted by selfmedicating at 6:05 PM on January 28, 2014

You're not drinking too much booze?
posted by Sebmojo at 6:07 PM on January 28, 2014

Also have been taking tons of probiotics, but not any special kind (the acidophilus they sell at CVS -- usuallly I take 2 with each meal). It helps some. It is entirely possible I'm not taking the right kind but I've been hesitant to drop $40 on fancy Whole Foods type probiotics. Recommendations are welcome. And I will stop thread-sitting now and get my kid to bed.
posted by selfmedicating at 6:07 PM on January 28, 2014

Have you tried a mild opiate? In your shoes, I would throw a couple of Tylenol #1s in myself for at least symptomatic relief.
posted by kmennie at 6:09 PM on January 28, 2014

In terms of dietary medicine approaches: Is bread and pasta what you usually eat or the only thing you can tolerate now? If the former, I would consider eating as many whole, unprocessed foods as you can - leafy greens, seeds, nuts, whole grains, veggies, fruits. That will get some real fiber in your diet.

And try the Bio K probiotic - drink one a day. If you don't have any soy allergies, use the non-dairy one.
posted by jardinier at 6:14 PM on January 28, 2014

I gotta say...having diarrhea for 6 weeks, non-stop, is anything but normal and I am very surprised that you doctor isn't more curious about your condition. Taking probiotics is great, but I think it might be time to see a GI specialist to see if there is something else going on that a probiotic isn't going to fix.
posted by Seymour Zamboni at 6:17 PM on January 28, 2014 [16 favorites]

Why not just take a mild amount of imodium for a while to force the flow to slow down? Maybe a week or so of like the minimum half-tab dose, then quit again and see if it comes back?
posted by emptythought at 6:18 PM on January 28, 2014

I would absolutely get another appointment with a GP or a GI specialist-- six weeks does not mean you should be self-medicating at Whole Foods for heaven's sake.
posted by jetlagaddict at 6:20 PM on January 28, 2014

I had a similar issue and was eating the brat diet in hopes of curing it--turns out I'm allergic to grains, so I was just making things worse. An elimination diet is worth trying.

Nthing that your doctor should be more concerned. I was sick like you are for a week before calling my doctor, and they were concerned and got me in right away. If they can't figure out what's wrong they may give up on you (that's what happened to me--"oh you probably have IBS") but you can and should figure out what's wrong. Be persistent. This is not normal.
posted by chaiminda at 6:21 PM on January 28, 2014

Totally agree that you need to get your doctor to pay more attention - but if this is a gut bacteria issue, 6 weeks of diarrhea isn't unusual. You can get mild dysentery in which case the diarrhea will continue until the cause is wiped out. And dysentery can come in forms without the most extreme symptoms.
posted by jardinier at 6:35 PM on January 28, 2014

Go back to your PCP. If you don't need a referral to see a specialist, go directly to a gastroenterologist.

There was nothing "scary" in my constant diarrhea for two months, until there was mucus, and a few weeks later there was blood, and then I was diagnosed with ulcerative colitis.

Do not ignore this.
posted by telegraph at 6:37 PM on January 28, 2014 [2 favorites]

To be fair to the doctor -- I got blood work done and a stool sample taken and he treated what was found (yeast). I just took the last tablet of fluconazole from my 1 wk treatment before writing the question. I more want to have ideas of what to ask when I follow up.
posted by selfmedicating at 6:40 PM on January 28, 2014

Does your doctor know you're still having these symptoms?
posted by OsoMeaty at 6:47 PM on January 28, 2014

Just an anecdote: A couple years ago I had a lot of stomach issues, and I started having a lot of diarrhea (not quite as often as you, but I couldn't get it to go away even with the usual BRAT diet) along with a lot of general stomach/GI tract pain. Turned out that I was actually mega-constipated, and the liquid was all that could get out around the blocked stool. I did a saline enema (not as awful as it sounds) which immediately relieved some of the GI pressure, then a few days later I had a big bowel movement, then I felt a whole lot better.
posted by radioamy at 6:51 PM on January 28, 2014 [2 favorites]

How is your stress level? I had a similar ongoing diarrhea of mystery origin that was never solved but eventually went away on its own, and looking back, I was under an incredible amount of stress at the time. Maybe you have something similar going on?
posted by rabbitrabbit at 7:19 PM on January 28, 2014

OK, I'll follow up, my UC had to be diagnosed via a flexible sigmoidoscopy (basically a less invasive colonoscopy). My stool samples and blood work at the time were normal.
posted by telegraph at 7:22 PM on January 28, 2014

Chronic diarrhea could be s symptom of celiac disease (gluten allergy). You do seem to eat a lot of gluten, so maybe check other symptoms of gluten allergy/intolerance to see if you have any?
posted by TheGoodBlood at 7:23 PM on January 28, 2014 [1 favorite]

My grandfather had the same thing - months of diarrhea that the doctors didn't seem to concerned about. They kept telling him to come back in a month if what they tried didn't work. Eventually, my uncle dragged him up to the local urgent care, they didn't know what it was but gave him some ciprofloaxin, and he was better in 3 days. It might be worth a shot to just go somewhere they will giv e you some antibiotics.
posted by procrastination at 7:24 PM on January 28, 2014

I went through a bout of this myself (thankfully mine only lasted a bit over 2 weeks because I was adamant that somebody fix me) and what I discovered is that doctors are absurdly hesitant to prescribe antibiotics for the shits. Why they dole out endless tetracycline to zitty teenagers and won't give something to a person crapping their brains out is beyond me.

Anyway, after 2 weeks of it and a stool sample and bloodwork and just being told to wait it out, it got to the point where I got on the phone and actually yelled at several nurses, followed by going into the doctors' office to yell a them in person, I walked out with a script for Cipro.

I was completely symptom free 36 hours later.

It's been six weeks. This is absurd. One antibiotic for this extreme case is not going to drug-resistanceitize the world, and could very well make you better. If your doctor doesn't pony up the goods, office hop until you find one who will.
posted by phunniemee at 8:05 PM on January 28, 2014 [2 favorites]

Am episode of food poisoning never "went away" for me; a biopsy revealed colitis, an auto immune disease like crohns. My diagnosis was not typical (treatment has been good), but there are many more steps you can take.
posted by smoke at 8:36 PM on January 28, 2014 [1 favorite]

As others have said--gastroenterologist. You are local to me; feel free to Memail me for the name of mine. I also have ulcerative colitis and this doctor has gotten it into remission.
posted by apartment dweller at 8:59 PM on January 28, 2014 [1 favorite]

I had mystery diarrhea for an entire YEAR before someone suggested that i try cutting out dairy. Turned out that I had become lactose intolerant and didn't realize it.

(Your symptoms sound more severe than mine, but getting out dairy for a few days is an easy & free way to eliminate lactose intolerance as the problem.)
posted by Kololo at 9:54 PM on January 28, 2014 [1 favorite]

Really - gastroenterologist now. It takes weeks or months to schedule the diagnostic procedures (sigmoidoscopy or colonoscopy) that will give you definitive answers. Start the process now. The GI can also do the contrast barium enema to see what's what. You don't want to start this process six weeks from now after you've lost a bunch of weight and feel like crap (no pun intended).
posted by crazycanuck at 12:09 AM on January 29, 2014 [4 favorites]

I'm surprised by all the vitriol here towards your doctor, who as far as I can tell has done the right things. The majority of infectious diarrheas are viral, self limited, and only require symptomatic treatment, and that's why doctors are hesitant to prescribe antibiotics for suspected infectious diarrhea - not to mention the fact that most antibiotics cause diarrhea themselves and can cause C diff which is nothing to scoff at. It's not all about antibiotic resistance. Acne isn't viral, so that's a different story entirely. Anyway, before I get derailed -

Your doctor has done an initial workup and tried a course of treatment, but unfortunately it hasn't worked (there's something called "the retrospectoscope" that sometimes doctors joke about, in reference to the fact that things seem different as you look back on a case with knowledge of what ended up happening, whereas doctors often have to make decisions based on limited data, which I suspect is the reason many folks are like "why isn't your doctor more worried? Look what's happened!" - ok, but the doctor doesn't know what's happened. The doctor knows about what happened weeks ago when the appointment was. It may seem to have made sense, looking through the retrospectoscope, to go straight to a GI doctor when it turns out to be inflammatory bowel disease in the end, but if it turns out to be something simpler, then it wouldn't have made much sense and would have cost you/the healthcare system more. There's a reason why a workup progresses in a stepwise fashion, and communication with your doctor is key).

Given the circumstances at the time, it was reasonable to assume that you had infectious diarrhea which is more common, which you had had exposure to, and certainly isn't anything to worry about in most cases. Now the infectious workup hasn't turned up much and a course of treatment has been ineffective. Time to go back for a recheck. Please let your doctor, who knows you and your case best, decide whether you need a GI referral or order further workup at this point. You're welcome to ask about the ideas brought up in this thread. One thing to keep in mind - the C diff toxin assay is not a 100% sensitive test.

Final note: have you tried Imodium for symptomatic relief?
posted by treehorn+bunny at 12:32 AM on January 29, 2014 [5 favorites]

Go to the health food store and buy acidophilus capsules that are refrigerated. They're not particularly expensive and they work 1000 times better than the others. Take 3 a day.

When I had that problem after surgery and post-op infection and then antibiotics that killed most of me but left my heart beating, acidophilus (again, refrigerated) and rice straightened me up.

Continuous diarrhea is not normal, as you know, and you should definitely pursue this with a gastroenterologist.
posted by aryma at 12:53 AM on January 29, 2014

Ask your doctor if your pancreas is functioning normal, my mother-in-law had bouts of diarrhea and nausea and was finally diagnosed with pancreatitis.
posted by just asking at 2:45 AM on January 29, 2014

I had six months of this. It could be something scary like C-diff. You only know for sure whether or not it's C-diff with a stool sample. In my case, it turned out an antibiotic had rearranged my flora and fauna so I was intolerant to caffeine.

Really, your doctor should have referred you.
posted by angrycat at 3:36 AM on January 29, 2014

Cut out wheat and see if you don't improve dramatically within about 36 hours. In general, you should try for fewer carbs and more protein and a little fiber - pan-saute some chicken, without onion or garlic, and have that with some mild soft non-legume (they're just hard on you when you're delicate) vegetables and a small proportion of rice. (Potato is your other non-wheat carb option, but white rice does seem to be particularly digestively beneficial.)

If egg is still working okay, make omelettes or fritattas with mild additives (and throw a little rice in there too, it's really good and will help provide enough carbs that you're not accidentally starting a ketogenic diet in the middle of all this). If you're using dairy fat to cook with (butter, etc), maybe switch to olive or coconut oil.

And yes, step up to the refrigerated probiotics. It doesn't have to be the $50 ones, but something that's not extra-processed to be shelf-stable.

You really should let your doctor know this is still going on, if you haven't spoken to him in the past couple of weeks.
posted by Lyn Never at 9:00 AM on January 29, 2014

Diarrhea is a possible side effect of fluconazole. IANAD, just curious if it will ease up at all now that you are through taking that. Perhaps the infection is cleared up and you are dealing with a side effect.
posted by veerat at 2:00 PM on January 29, 2014

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