An Approach to Chronic Diarrhoea

Diarrhoea is a universal human experience. It is both a symptom and a sign. On symptoms it is defined as abnormal passage of three or more loose or liquid stools per day. As a sign, diarrhoea is an increase in stool weight (or volume) of more than 200 grams (or mL) per 24 hours on a Western diet. Previous studies have suggested that stool weight is higher in Indians, and the upper limit of normal daily stool weight for Indians is thus kept at 400 g. Diarrhoea should not be defined solely in terms of fecal weight because fecal consistency and weight correlate best with the ratio of water-holding capacity of insoluble solids to the total water present. Diarrhoea is generally considered acute when it lasts less than two or three weeks. Chronic diarrhoea is defined if symptoms persist for more than four weeks. Chronic diarrhoea is a common clinical problem. Prevalence of chronic diarrhoea in the general population ranges between 3-5%. WHO has stated it could be between 5-20%. Unlike acute diarrhoea which is mostly self-limited, chronic diarrhoea often persists, unless some therapy is instituted. This makes an accurate diagnosis central to effective management. Effect of chronic diarrhoea on quality of life and health care expenses are considerable.