Persistent Diarrhea: When to Seek Further Medical Evaluation?

Persistent diarrhea?

Hello doctor, I started experiencing diarrhea on June 25th, which occurs about 2 to 3 hours after eating, and it has been watery.
I visited the clinic on June 28th for treatment and received medication.
For my meals, I only consumed white toast or congee.
However, after three days, my diarrhea symptoms did not improve.
On July 2nd, I underwent surgery to remove a lipoma, and the doctor prescribed antibiotics and pain medication.
In the afternoon, I switched to another clinic for my diarrhea issue.
I took the antibiotics for a week, and the medication from the second clinic for another week.
My diarrhea symptoms began to improve on July 6th, and by July 7th, my bowel movements returned to normal.
I gradually resumed a normal diet starting July 8th, but on July 9th, after eating out for lunch at work, I experienced abdominal discomfort in the afternoon and started having diarrhea again, which was also watery.
That evening, I returned to the clinic for more medication.
On July 10th, I had a light diet during the day, and my bowel movements were normal in the evening.
However, I ate a bit more for dinner (takeout), and as a result, I had two episodes of diarrhea that night and woke up to have another episode.
Today (July 11th), I had another bout of diarrhea after getting up.
The clinic doctor mentioned that it is likely gastroenteritis and that the antibiotics may have wiped out the good bacteria in my gut.
I would like to ask if it is necessary to go to the hospital for further examination in this situation.
Is there a possibility of ulcers or other conditions? Or should I just continue taking the medication from the clinic and manage my diet for now? I am hesitant about undergoing gastroscopy or colonoscopy.
Thank you!

Andy, 30~39 year old female. Ask Date: 2007/07/11

Dr. Lin Minghui reply Gastroenterology and Hepatology

When experiencing gastroenteritis, it is important to maintain a light diet and ensure adequate hydration and electrolyte replenishment.
Gastroenteritis can have many causes, including poor dietary practices, viruses, bacteria, or medications.
Endocrine disorders and psychological states can also have an impact.
Diarrhea caused by antibiotics can lead to more severe watery diarrhea (pseudomembranous colitis).
If gastroenteritis is accompanied by fever, severe diarrhea, dehydration, or bloody stools, it is essential to seek medical evaluation.
Additionally, chronic diarrhea should also be investigated for its underlying causes.
Wishing you good health!

Reply Date: 2007/07/11

More Info

Persistent diarrhea can be a distressing condition, and it’s understandable to seek clarity on when further medical evaluation is necessary. Based on your description, it appears that you have been experiencing diarrhea since June 25, with some improvement after taking antibiotics and other medications. However, the recurrence of symptoms after consuming certain foods raises some concerns.

Firstly, it’s important to recognize that diarrhea can be caused by a variety of factors, including infections (viral, bacterial, or parasitic), food intolerances, medications (like antibiotics, which can disrupt the balance of gut bacteria), and underlying gastrointestinal conditions such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). Given that your symptoms improved initially but then recurred, it suggests that there may still be an underlying issue that needs to be addressed.

Here are some key points to consider regarding your situation:
1. Duration and Severity of Symptoms: Diarrhea that persists for more than a few days, especially if it is accompanied by other symptoms such as abdominal pain, fever, or blood in the stool, warrants further evaluation. Since you have experienced diarrhea for several weeks, it is advisable to consult a healthcare professional for a thorough assessment.

2. Dietary Factors: You mentioned that your symptoms worsened after eating out. This could indicate a food intolerance or sensitivity, or even a reaction to something specific in the food you consumed. Keeping a food diary may help identify any patterns or triggers that exacerbate your symptoms.

3. Antibiotic Use: Antibiotics can disrupt the normal flora of the gut, leading to conditions such as antibiotic-associated diarrhea or even Clostridium difficile infection, which can be serious. If you suspect that your diarrhea is related to antibiotic use, it’s crucial to discuss this with your doctor, who may consider testing for C. difficile or other infections.

4. Need for Further Testing: If your symptoms do not improve with conservative management (dietary changes and medications), or if you develop new symptoms (such as significant weight loss, persistent abdominal pain, or blood in the stool), further evaluation may be necessary. This could include laboratory tests, imaging studies, or endoscopic procedures like a colonoscopy or upper endoscopy, depending on your symptoms and medical history.

5. Concerns About Endoscopy: It’s understandable to have apprehensions about procedures like endoscopy. However, these tests can provide valuable information about the health of your gastrointestinal tract and help rule out serious conditions. Discuss your concerns with your healthcare provider, who can explain the benefits and risks, and help you make an informed decision.

6. Managing Anxiety: If anxiety about your symptoms or potential procedures is affecting your quality of life, consider discussing this with your doctor. They may recommend strategies to help manage anxiety, which can also impact gastrointestinal symptoms.

In summary, while it may be tempting to wait and see if your symptoms resolve on their own, given the duration and recurrence of your diarrhea, it would be prudent to seek further medical evaluation. A healthcare provider can help determine the underlying cause of your symptoms and recommend appropriate treatment. Remember, early intervention can often lead to better outcomes and relief from discomfort.

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