Chronic Diarrhea Treatment in Katy, TX
Diarrhea that lasts for weeks usually has a cause. We look for it with focused testing and treat what we find.
Understanding Chronic Diarrhea
Diarrhea means loose, watery stools, usually three or more times a day. Most diarrhea is short-lived and goes away on its own. Doctors group it by how long it lasts:
- Acute diarrhea lasts less than 2 weeks and is usually caused by a stomach bug, food poisoning or a medicine.
- Persistent diarrhea lasts 2 to 4 weeks.
- Chronic diarrhea lasts 4 weeks or longer. It can be constant, or it can come and go.
Chronic diarrhea affects about 1 in 20 people at any given time. It is not a diagnosis on its own but a sign that something else needs to be found and treated.
Symptoms that often come with diarrhea
- An urgent need to use the bathroom, sometimes with accidents
- Cramping or pain in the abdomen
- Bloating and gas
- Nausea
- Greasy, pale or foul-smelling stools that are hard to flush, which can be a sign of poor fat absorption
Common causes of chronic diarrhea
- Irritable bowel syndrome with diarrhea (IBS-D), one of the most common causes, especially when diarrhea comes with belly pain
- Food intolerances, such as lactose or fructose intolerance, and sugar alcohols such as sorbitol and xylitol found in sugar-free gum and candy
- Bile acid diarrhea, when too much bile reaches the colon. It can happen after gallbladder removal or bowel surgery, is found in many people told they have IBS-D, and is often missed.
- Microscopic colitis, inflammation that can only be seen on biopsies, most common in women over 50
- Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
- Celiac disease
- Small intestinal bacterial overgrowth (SIBO)
- Infections that do not clear on their own, such as Giardia or C. difficile, especially after antibiotics
- Medicines, including metformin, magnesium supplements and antacids, antibiotics, NSAID pain relievers such as ibuprofen, some antidepressants, acid-reducing medicines, some blood pressure medicines, cancer treatments, and some weight-loss and diabetes medicines
- Pancreas problems, when the pancreas does not make enough digestive enzymes
- Other conditions, such as an overactive thyroid, poorly controlled diabetes, or previous surgery on the stomach or bowel
When to see a gastroenterologist
See a specialist if diarrhea lasts more than four weeks, keeps coming back, or wakes you at night. See a doctor promptly if diarrhea comes with:
- Blood in the stool or black, tarry stools
- Weight loss you cannot explain
- Fever, or anemia on a blood test
- A new change in bowel habits that starts at age 45 or older
- A family history of colon cancer, inflammatory bowel disease or celiac disease
Go to the emergency room or call 911 for signs of severe dehydration, such as dizziness or fainting, very little urine, confusion or a fast heartbeat, or for diarrhea with heavy bleeding or severe belly pain.
Our approach to Chronic Diarrhea
Chronic diarrhea has many possible causes, so a careful history is the most useful first step. We ask how long it has lasted, what your stools look like, whether it happens at night, how it relates to meals, and about every medicine and supplement you take. Then we use a stepwise approach so you only have the tests you need.
Finding the cause
- Blood tests for celiac disease, anemia and thyroid function
- Stool tests for infections such as Giardia and C. difficile, for inflammation (fecal calprotectin), and for pancreas function
- Breath tests for lactose or fructose intolerance, or for SIBO
- Testing for bile acid diarrhea, or a trial of a bile acid binder medicine
- A colonoscopy with biopsies, which can find inflammatory bowel disease and is the only way to diagnose microscopic colitis
- An upper endoscopy with biopsies to confirm celiac disease or look for other small intestine problems
Colonoscopies and upper endoscopies are performed by our own physicians at Zazen Surgery Center, in the same building as our clinic.
Treatment matched to the cause
- Treating the condition behind it, such as antibiotic or antiparasitic medicine for infection, antibiotics for SIBO, budesonide for microscopic colitis, medicines for inflammatory bowel disease, or a gluten-free diet for celiac disease.
- Bile acid binders, such as cholestyramine or colesevelam, for bile acid diarrhea.
- Medicines for IBS with diarrhea, including loperamide, rifaximin and other prescription options.
- Pancreatic enzyme replacement when the pancreas does not make enough digestive enzymes.
- Diet therapy with a registered dietitian, such as a low FODMAP plan for IBS or limiting lactose or fructose, while keeping your diet as varied as possible.
- Reviewing your medicines with you and your prescribing doctors when a medicine may be the cause. Do not stop a prescribed medicine on your own.
During any bout of diarrhea, replacing fluids and salts matters. Water alone is not enough when diarrhea is heavy. Oral rehydration drinks are best, especially for older adults and people with other health problems.
Many people live with diarrhea for years because they think it is just how their body works. Often there is a specific, treatable cause, such as bile acid diarrhea or microscopic colitis, that has never been looked for.
Dr. Vivian Asamoah, MD
Board-Certified Gastroenterologist, Integrative Medicine
Key Facts
What you need to know
Everything you need to know before your appointment.
Who should consider this
Anyone with loose stools or diarrhea that has lasted more than four weeks or keeps coming back.
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What to expect
A detailed first visit and a step-by-step plan that starts with the simplest tests.
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Recovery and results
Many people improve within weeks once the cause is treated, though some causes take longer.
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Why our team
Gastroenterologists and registered dietitians who look for the specific cause of chronic diarrhea.
Learn moreWhat Our Patients Say
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Dr. Asamoah is a wonderful doctor with an excellent bedside manner who cares about what you're going through and leaves no stone unturned I highly recommend.
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From the moment of entering the Surgical Center, I felt like I was an individual and my needs were of concern. The actual procedure experience was great. Dr. Asamoah has a way of making you feel at ease. She's gathered a staff of people who do the same thing. Highly recommend.
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I was very impressed with both doctors' expression of authentic interest in and concern with my health concerns. A rare experience.
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Highly recommend. The office staff and Dr. Asamoah were helpful, friendly and very accommodating! We left feeling like we have answers and are hopeful.
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First time visit. Impressed by the clean and nice environment. Friendly staff. Doctor takes her time to hear you and answer any questions you have. Great experience.
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Wow!!! Absolutely amazed by the facility and doctor! Dr. Vivian Asamoah is extremely educational, professional, and so sweet! I went in feeling extremely anxious because of my health issues, and she put me at ease by explaining every detail! Xiomara, her MA, was so helpful and thorough. Honestly, she is by far one of the best doctors I've seen. God bless this office and everyone in it! I most definitely recommend her!
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I went in to check on issues I was having with my colon. I was in a panic and was not feeling my best. Dr. Asamoah was kind and very understanding, with great patient-relationship skills. She is genuine and truly professional. Her staff is great and wonderful. I will recommend my family and friends.
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Had a great experience. The doctors are very understanding and comforting. They listen to all of your needs. Loved their music. Very relaxing.
Individual results vary.
Ready to talk with a specialist about your diarrhea?
Schedule a consultation with our team. We are here to help you find lasting relief.
Expert GI. Whole-person care. All under one roof.Common questions about Chronic Diarrhea
Diarrhea is considered chronic when loose or watery stools last for four weeks or longer. It can be constant or come and go. Diarrhea that lasts 2 to 4 weeks is called persistent.
Common causes include IBS, food intolerances such as lactose intolerance, bile acid diarrhea, microscopic colitis, inflammatory bowel disease, celiac disease, infections and medicines. Many people have a cause that can be found with simple tests.
See a doctor right away if diarrhea comes with blood or black stools, a fever of 102°F or higher, or severe belly pain. Also see a doctor if diarrhea lasts more than 2 days without getting better, or keeps coming back. Get help right away for signs of dehydration, such as dizziness, very little urine or confusion. If diarrhea lasts four weeks or longer, see a gastroenterologist.
Testing usually starts with blood tests and stool tests for infection and inflammation. Depending on the results, breath tests, a colonoscopy with biopsies or an upper endoscopy may be recommended.
After gallbladder removal, bile flows more steadily into the intestine, and extra bile acids can reach the colon and cause diarrhea. This is called bile acid diarrhea, and it usually responds well to medicines that bind bile acids.
Microscopic colitis is inflammation of the colon that looks normal during a colonoscopy and can only be seen on biopsies. It causes watery diarrhea, is most common in women over 50, and is often linked to certain medicines. Budesonide works well for most people.
Yes. Common examples include metformin, magnesium supplements, some antidepressants, acid-reducing medicines, some blood pressure medicines and antibiotics. Talk to your doctor before stopping any prescribed medicine.
Drink plenty of fluids that contain salts and sugar, such as oral rehydration drinks. Broth and diluted juice can help when diarrhea is mild. Most people can keep eating normally. Limiting alcohol, caffeine, fatty foods, sugar-free sweeteners and, if you are sensitive to it, dairy can help.
For most adults, loperamide is safe when taken as the label directs. Taking more than the label says can cause serious, even deadly, heart rhythm problems. Do not use it if you have bloody or black stools, and ask a doctor first if you have a fever. The label says to stop and see a doctor if diarrhea lasts more than 2 days. If you need it often, talk to your doctor about the cause and the right dose for you.
Yes. A gastroenterologist can find the cause with focused testing and treat it, whether it is IBS, bile acid diarrhea, microscopic colitis, celiac disease, an infection or inflammatory bowel disease.
Houston Gastro Institute diagnoses and treats chronic diarrhea at our clinic on Kingsland Boulevard in Katy, TX. Patients come to us from across west Houston, including Cinco Ranch, Fulshear, Richmond, Brookshire, Sugar Land and Cypress. Colonoscopies and upper endoscopies are performed at Zazen Surgery Center in the same building.