Reviewed by: HU Medical Review Board | Last reviewed: August 2023

In inflammatory bowel disease (IBD), there is chronic inflammation in the digestive tract. In Crohn's disease (CD) the inflammation can occur anywhere from the mouth to the anus. In ulcerative colitis (UC), the inflammation occurs in the colon (large intestine) and rectum. An important part of dealing with any form of IBD is the long-term management of symptoms that it causes.

Diarrhea is one of the most common symptoms caused by IBD. Acute diarrhea is loose, watery stool that happens more than 3 times a day. Chronic diarrhea is diarrhea that lasts for 4 or more weeks.

Chronic diarrhea with Crohn's and colitis

Healthcare providers will assess a patient's symptoms to determine whether or not they are exhibiting acute or chronic diarrhea. Acute diarrhea is defined as watery stool lasting 2 weeks, whereas chronic diarrhea is watery stool lasting longer than 4 weeks. Acute diarrhea is often caused by a virus, but sometimes it is caused by bacteria, in which case it will be treated with antibiotics. Chronic diarrhea, on the other hand, may be due to Crohn's or ulcerative colitis.1,2

Chronic diarrhea often directly impacts a patient's nutritional status. Patients experiencing chronic diarrhea are at risk of becoming malnourished, because not enough nutrients can be absorbed by the digestive tract. While it is possible that certain food types can agitate the digestive tract causing chronic diarrhea, it is important for patients to contact their healthcare provider before self-imposing any dietary restrictions.

Patients experiencing chronic diarrhea due to IBD should work with their healthcare providers to develop a treatment plan. One form of management is the use of medications called anti-diarrheals.

Treating symptoms vs. treating the disease

Chronic diarrhea is a common symptom reported by patients with Crohn's and colitis.3

This can be extremely uncomfortable and negatively impact a patient's health and quality of life. Anti-diarrheal medications can be helpful in long-term management of IBD. However, it is important to note that anti-diarrheals will not treat the underlying cause of the diarrhea, which is inflammation in the digestive tract due to IBD. This inflammation can only be treated with medications that specifically target the disease itself, such as aminosalicylates,immunomodulators, corticosteroids, antibiotics, and/orbiologic therapies.

Over-the-counter symptom management medications such as anti-diarrheals should never be used to replace those IBD medications, only to supplement them. Although anti-diarrheals will not treat the underlying cause of the diarrhea, they may help to mask the symptom and improve a person's quality of life on a day-to-day basis.

An anti-diarrheal is a medication that provides symptomatic relief of diarrhea. The most common anti-diarrheal is loperamide, also known as Imodium. Loperamide is an over-the-counter medication that can be useful in decreasing bowel movement frequency by effectively slowing down the digestive process. This allows for the better absorption of nutrients through the digestive tract. Loperamide also increases the anal sphincter tone at rest. Some other forms of anti-diarrheals, such as diphenoxylate/atropine (Lomotil), are only available with a prescription.1,3

Patients who have a fever along with diarrhea are generally advised to avoid anti-diarrheals such as loperamide. A fever is often an indication of an infection that could worsen upon taking loperamide. Instead, your healthcare provider may prescribe an antibiotic regimen to treat the infection.1

More in-depth testing with Crohn’s and colitis

It is always recommended that patients experiencing either acute or chronic diarrhea should have more in-depth testing, such as blood or stool tests, to accurately diagnose the cause. Also, it is important to replace water loss by drinking fluids with sugar and salt. Doctors may also recommend replacing any vitamin or mineral deficiencies with vitamins or supplements.1

Identifying the cause of chronic diarrhea

Chronic diarrhea is a sign that nutrients are not being well enough absorbed during the digestive process. Patients who have chronic diarrhea will often undergo blood tests to guide replacement of fluids, electrolytes, and minerals. A blood test can also identify whether the diarrhea is being caused by anemia or a bacterial infection.1

Patients with chronic diarrhea may also undergo fecal testing in order to accurately diagnose the cause. The presence of white blood cells indicates inflammation in the body, potentially due to IBD. If parasites or bacterial cultures are present in the stool sample, this could be the cause of diarrhea.

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