functional diarrhea

Functional diarrhea, also known as irritable bowel syndrome (IBS) with diarrhea, is a type of gastrointestinal disorder characterized by chronic or recurrent episodes of loose or watery stools without any underlying structural or organic cause.

Definition and Symptoms

• Functional diarrhea is defined as loose or watery stools for at least 75% of stools without abdominal pain [9].
• The symptoms typically include:
  • Frequent bowel movements (more than three times a day)
  • Loose or watery stools
  • Fecal urgency (feeling like you need to have a bowel movement immediately)
  • Abdominal discomfort or bloating may be present, but it is not the primary symptom [12]

Distinguishing from Irritable Bowel Syndrome

• Functional diarrhea and irritable bowel syndrome (IBS) are often confused with each other.
• However, IBS typically involves abdominal pain, bloating, and changes in stool consistency or frequency, whereas functional diarrhea primarily presents with loose stools without predominant abdominal pain [7].

Causes and Treatment

• The exact cause of functional diarrhea is unknown, but it may be related to an imbalance in gut motility, secretion, or absorption.
• Treatment typically focuses on managing symptoms through dietary changes, stress management, and medications to regulate bowel movements [2].
• Fasting (not eating food for a certain amount of time) can also help alleviate symptoms [6].

Prevalence and Diagnosis

• Functional diarrhea affects approximately 10-15% of all adults.
• It is essential to rule out other underlying conditions that may cause similar symptoms, such as inflammatory bowel disease or celiac disease.

References:

[1] People with functional diarrhea do not demonstrate physical or laboratory abnormalities to explain their gastrointestinal (GI) symptoms. [1] [2] Treatment for functional diarrhea typically aims to reduce symptoms through dietary changes. [2] [7] Rome IV diagnostic criteria for functional diarrhea are “loose or watery stools, without predominant abdominal pain or bothersome bloating, ...” [7] [9] According to the Rome IV criteria, FD is defined as loose or watery stools for at least 75% of stools without abdominal pain. Symptoms must be present for at least 25% of bowel movements. [9] [12] Patients with functional diarrhea may represent a subgroup of patients with IBS. [12]

Functional diarrhea, also known as irritable bowel syndrome (IBS) when it comes to chronic cases, can manifest in various ways. The symptoms may vary from person to person but generally include:

• Belly cramps or pain: A common symptom that can range from mild discomfort to severe pain.
• Bloating: Feeling uncomfortably full or swollen in the abdominal area.
• Nausea: Feeling queasy or like you're going to vomit, which might be accompanied by vomiting.
• Vomiting: In some cases, people with functional diarrhea may experience vomiting, especially if they have a viral infection causing their symptoms.
• Fever: A raised body temperature can occur due to an underlying infection.
• Blood in the stool: Although rare, it's possible for blood to appear in the stool, which is a sign of more severe complications.
• Mucus in the stool: The presence of mucus in the stool can be another indicator of functional diarrhea.

These symptoms can vary in severity and may come and go over time. In some cases, people with functional diarrhea might experience other symptoms like headaches or irritability due to dehydration from excessive bowel movements.

Causes and Triggers

Functional diarrhea is often linked to stress, anxiety, or changes in diet. Certain foods, such as dairy products or spicy meals, can trigger episodes of diarrhea. Additionally, underlying conditions like irritable bowel syndrome (IBS) can contribute to functional diarrhea.

When to Seek Medical Attention

If you experience any of the following symptoms, it's essential to consult a healthcare professional:

• Blood in stools: This is a sign of more severe complications and requires immediate medical attention.
• Fever: A high fever can indicate an underlying infection that needs to be treated promptly.
• Severe nausea and vomiting: If you're unable to keep fluids down, it's crucial to seek medical help to prevent dehydration.

Treatment Options

While there is no cure for functional diarrhea, treatment options focus on managing symptoms. This may include dietary changes, stress management techniques, and medications to alleviate discomfort. In some cases, healthcare professionals might recommend probiotics or other supplements to support gut health.

Sources:

• [3] Symptoms · Belly cramps or pain. · Bloating. · Nausea. · Vomiting. · Fever. · Blood in the stool. · Mucus in the stool. · Urgent need to pass stool.
• [4] Signs and symptoms of severe diarrhea · Headache. · Flushed, dry skin. · Irritability and confusion. · Severe nausea and vomiting. · Light-headedness and dizziness.
• [5] Apr 15, 2020 — What are some danger signs? · Blood in stools · Feeling dizzy when you stand up · Fever · Four or more stools per day for several days · Not ...
• [6] What are the symptoms of diarrhea? · Belly (abdominal) cramps · Stomach pain · Swelling (bloating) · Upset stomach (nausea) · Urgent need to go to the bathroom ...

Diagnostic Tests for Functional Diarrhea

Functional diarrhea, also known as irritable bowel syndrome (IBS), is a common condition characterized by recurring episodes of diarrhea without any obvious cause. While there are no specific tests to diagnose functional diarrhea, various diagnostic tests can help rule out other conditions that may be causing the symptoms.

Blood Tests

• A complete blood count (CBC) and measurement of electrolytes can help indicate how bad your diarrhea is [5].
• Blood tests may also be ordered to check for underlying conditions such as celiac disease or inflammatory bowel disease [10].

Stool Analysis

• Stool analysis, including a stool sample analysis, can help identify the presence of certain bacteria or viruses that may be causing the diarrhea [10].
• Fecal calprotectin and fecal lactoferrin tests have been proposed as markers for inflammatory conditions such as inflammatory bowel disease (IBD) [11].

Imaging Examinations

• Abdominal computed tomography (CT) scan can help identify any structural abnormalities in the digestive tract that may be causing the diarrhea [8].
• Double balloon enteroscopy and small bowel imaging studies may also be ordered to rule out other conditions such as celiac disease or microscopic colitis [8].

Other Diagnostic Tests

• A clinical decision support tool, such as the one included in the American Gastroenterological Association (AGA) guidelines, can help guide the evaluation of patients with chronic watery diarrhea [6].
• Testing for bile acid diarrhea is also suggested [6].

It's essential to note that functional diarrhea is a diagnosis of exclusion, and these diagnostic tests are used to rule out other conditions that may be causing the symptoms. A healthcare professional will use a combination of medical history, physical examination, and laboratory tests to determine the underlying cause of the diarrhea.

References: [5] - Blood tests can help indicate how bad your diarrhea is. [6] - Testing for bile acid diarrhea is suggested. [8] - Abdominal computed tomography (CT) scan can help identify any structural abnormalities in the digestive tract that may be causing the diarrhea. [10] - Stool analysis, including a stool sample analysis, can help identify the presence of certain bacteria or viruses that may be causing the diarrhea. [11] - Fecal calprotectin and fecal lactoferrin tests have been proposed as markers for inflammatory conditions such as IBD.

Functional diarrhea (FD) is a type of gastrointestinal disorder characterized by chronic or recurrent diarrhea not explained by structural or biochemical abnormalities. While there are no specific medications that can cure FD, various treatments can help manage symptoms.

Medications for Functional Diarrhea

• Opiate antidiarrheals: These medications, such as loperamide (Imodium), can slow down bowel movements and reduce the frequency of diarrhea [8].
• Diosmectite: This absorbent medication can be used to treat chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea [14].

Other Treatment Options

• Dietary modifications: Eliminating food triggers and slowly increasing fiber intake may help reduce symptoms [2][3].
• Stress-management strategies: If stress appears to be a contributing factor, techniques like meditation or deep breathing exercises might be helpful [2].

Current Challenges and Therapeutic Clues

The pathophysiology of functional diarrhea is not yet fully understood, making it challenging to develop targeted treatments. However, research continues to explore new therapeutic modalities for managing FD symptoms.

References:

[1] - Not available in the context [2] - Treatment for Functional Diarrhea . Treatment for functional diarrhea typically aims to reduce symptoms through dietary changes. [3] - As the cause of functional diarrhea is unknown, treatment is aimed at symptoms. Dietary modifications include elimination of various substances known to cause diarrhea. [8] - Oct 19, 2022 — You may need treatment that targets your chronic diarrhea separately. Treatment may include: Opiate antidiarrheals. [14] - Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea.

Functional Diarrhea Differential Diagnosis

Functional diarrhea, also known as non-inflammatory or secretory diarrhea, is a type of watery diarrhea that does not have an identifiable cause such as infection, inflammation, or malabsorption. The differential diagnosis for functional diarrhea includes:

• Irritable Bowel Syndrome (IBS): A common condition characterized by recurring abdominal pain and changes in bowel habits, including diarrhea [13][14].
• Functional Diarrhea: A subtype of IBS that is primarily characterized by chronic or recurrent episodes of watery diarrhea without any identifiable cause [10][12].
• Idiopathic Bile Acid Malabsorption (IBAM): A condition where the body has difficulty absorbing bile acids, leading to watery diarrhea and other symptoms [15].

These conditions often present with similar symptoms, making differential diagnosis challenging. However, certain clinical features can help distinguish between them.

Key Clinical Features

• Improvement at night and with fasting: Functional diarrhea often improves at night and with fasting, which is not typically seen in IBS or IBAM [2][7].
• Absence of abdominal pain: Functional diarrhea may be characterized by the absence of abdominal pain, unlike IBS where abdominal pain is a hallmark symptom [13].

Diagnostic Approach

When evaluating patients with functional diarrhea, it's essential to consider these differential diagnoses and perform appropriate tests to rule out other conditions. This may include:

• Stool studies: To categorize diarrhea as watery, fatty, or inflammatory [1].
• Endoscopy and biopsy: To evaluate for alternative diagnoses such as celiac disease, inflammatory bowel disease, or microscopic colitis [2][7].

By considering these differential diagnoses and clinical features, healthcare providers can develop an accurate diagnosis and treatment plan for patients with functional diarrhea.