Overview of Functional Diarrhea
Functional diarrhea refers to non-organic factors caused by persistent diarrhea, not accompanied by abdominal pain as the manifestation of the disease manifested in the persistent discharge of loose feces (pasty feces) or watery feces, not accompanied by abdominal pain or abdominal discomfort may be the result of gastrointestinal dynamics and visceral sensory abnormality, psychological factors, intestinal bacterial flora imbalance and so on mainly to take the general treatment, medication and Chinese medicine, and so on.
Definition
Functional diarrhea is a syndrome of gastrointestinal dysfunction characterized by persistent or recurrent evacuation of loose feces (pasty feces) or watery feces without abdominal pain or discomfort.
Incidence
The incidence of functional diarrhea is increasing year by year, and the prevalence rate among adolescents in Shanghai is reported to be 5.43%.
Causes
Causes
Abnormalities in gastrointestinal motility and visceral sensation
The main cause of functional diarrhea.
The patient’s gastrointestinal reaction is hyperactive, and the intestinal peristalsis increases, causing food to be discharged without complete digestion in the gastrointestinal tract, resulting in unformed stools and an increase in the number of bowel movements.
Psychological factors
Nervousness, anxiety and other adverse emotions can make the brain – intestinal axis dysfunction, visceral dysfunction, resulting in gastrointestinal dysfunction appear diarrhea.
Imbalance of intestinal flora
With ageing or other diseases, the intestinal flora undergoes structural changes and the beneficial bacteria decrease, causing functional diarrhea.
Irrational dietary structure
Unreasonable dietary structure and lack of dietary fiber in the diet to promote gastrointestinal motility can also cause functional diarrhea.
Others
Body immunity, genetics, autonomic nervous system dysfunction, etc. may also lead to this disease.
Symptoms
Main Symptoms
Abnormal bowel movements
Abnormal shape: Stools may be loose or mushy or watery.
Abnormal frequency: some patients may show increased frequency of defecation.
Complications
Dehydration
Repeated diarrhea without timely rehydration may lead to dehydration, which is characterized by thirst, sunken eye sockets, dry skin, and in severe cases, coma.
Malnutrition
Prolonged diarrhea can lead to malnutrition, which may include weight loss, fatigue and depression.
Consultation
Department of Medicine
Gastroenterology
Prolonged diarrhea may lead to malnutrition.
Preparation
Consultation: Registration, Preparation of Documents, Frequently Asked Questions
Tips for the doctor
Before going to the doctor, try to keep a record of the symptoms you have experienced and their duration for the doctor’s reference.
Preparation List
Symptom list
Pay particular attention to the time of onset of symptoms, special symptoms, etc.
How many times a day do you have bowel movements and what is the shape of the stool?
Any abdominal pain?
Any fever?
What foods have you eaten recently?
Have you recently taken any medications such as salicylates, glucocorticoids, antibiotics, etc.?
Have you had any relevant tests such as gastroscopy, colonoscopy, etc.?
List of medical history
Any previous intestinal diseases?
Any recent surgical treatment?
Have family members experienced similar symptoms?
Checklist
Test results for the last 6 months to bring to the doctor’s office
Colonoscopy
Routine blood test, routine stool test
Liver function, blood glucose, thyroid function tests
Bacterial culture of stool
Abdominal ultrasonography, abdominal CT examination
Medication List
Medications used in the last 3 months, if available, bring the box or package with you to the doctor’s office.
Antibacterial drugs: metronidazole (or tinidazole), clarithromycin, amoxicillin, levofloxacin
NSAIDs: aspirin, clopidogrel, ibuprofen, indomethacin
Glucocorticoids: prednisone, methylprednisone, hydrocortisone, dexamethasone
Diagnosis
The diagnosis of this disease is primarily based on the exclusion of other etiologies.
Diagnosis is based on
medical history
No other gastrointestinal disorders.
May have been in a bad mood and mentally stressed recently.
Clinical manifestations
Diarrhea only, not accompanied by abdominal pain.
No abdominal mass was seen on examination.
Laboratory Tests
Stool routine examination
The patient’s feces can be examined for red blood cells, white blood cells, parasites, etc., to rule out other diseases of the intestinal tract.
Stool culture
Stool culture can determine the presence of pathogenic bacteria infection.
Other tests
Depending on the patient’s condition, thyroid function tests, blood tests, liver function tests, blood sugar tests, etc. may be performed to exclude diarrhea caused by other organ diseases and endocrine diseases.
Endoscopy
Gastroscopy and colonoscopy can except whether there are intestinal tumors, polyps, ulcers, erosion, bleeding and other lesions to help diagnosis.
Precautions
Fasting for 8 hours, no water for 5 hours, and no smoking before the gastroscopy, because food in the stomach memory will affect the examination. If you wear movable dentures, you should take them out in advance.
Fasting is required on the day of colonoscopy. Before the examination, take intestinal cleanser as required by the doctor.
Imaging Tests
Barium X-ray
It can observe whether there are masses and ulcers in the gastrointestinal tract and exclude other causes of diarrhea due to other diseases.
Fasting is prohibited for 12 hours before the examination, and drinking is prohibited for 4 hours before the examination. Do not take medicines containing metal elements, such as calcium tablets, before doing barium contrast.
Ultrasound
Abdominal ultrasound can check whether there are lesions in the liver, gallbladder, pancreas and other organs in the abdominal cavity, and exclude diarrhea caused by related etiology.
Precautions: No food or water after 10:00 p.m. the day before the examination, and adjust the body position as prescribed by the doctor during the examination.
Abdominal CT
It can observe the shape, size and structure of the abdominal organs, and find out whether there are occupying lesions, cirrhosis and gallstones.
If occupying lesions are found, it can also roughly determine the benign or malignant.
Precautions
Fasting for at least 4 hours before the abdominal scanning and enhanced CT examination.
Remove any metal objects, such as headdresses, hairpins, keys, etc., from the body before the examination.
Diagnostic Criteria
At least 75% of the feces are loose (pasty) or watery stools, not accompanied by abdominal pain or abdominal discomfort.
Symptoms have been present for at least 6 months prior to diagnosis, the diagnostic criteria have been met in the last 3 months, and relevant laboratory tests exclude infectious diarrhea, organic intestinal pathology, other organ pathology, endocrine disease, and diarrheal irritable bowel syndrome.
Differential diagnosis
Functional diarrhea needs to be differentiated from diarrhea with a clear etiology (e.g., tumors, ulcers and other diseases), and the diagnosis can be made only after excluding the relevant etiology.
Some patients with hepatitis, cirrhosis, hepatocellular carcinoma, pancreatitis, pancreatic cancer, and hyperthyroidism may also have diarrhea, but the primary disease is obvious, so the differential diagnosis is usually not made.
Diarrhea-type irritable bowel syndrome
Similarity: both have diarrhea.
Difference: Diarrhea-type irritable bowel syndrome is a functional bowel disease characterized by abdominal discomfort or pain accompanied by changes in bowel habits, with a higher incidence in children. Diarrhea-type irritable bowel syndrome has obvious abdominal pain manifestation can be differential diagnosis.
Intestinal tumor
Similarity: both have diarrhea manifestations.
Differences: patients with intestinal tumors may have pus and blood in diarrhea, accompanied by abdominal pain, emaciation and other manifestations, and some patients may have lumps in the abdomen. Enteroscopy can further determine the diagnosis.
Inflammatory bowel disease
Similarity: both have diarrhea.
Differences: patients present with abdominal pain, stools may be paste or mucus, pus and blood. Functional diarrhea has no such manifestations.
Intestinal tuberculosis
Similarity: both have diarrhea.
Differences: patients with intestinal tuberculosis have low-grade fever, night sweats, and emaciation. Tuberculin test can be used to confirm the diagnosis of intestinal tuberculosis.
Amebic enteropathy
Similarity: both have diarrhea.
Difference: the clinical manifestations of amoebic enteropathy and functional diarrhea are similar, but the fecal examination can see the amoebic pathogens, which can clarify the differential diagnosis.
Chronic bacillary dysentery
Similarity: both have diarrhea manifestations.
Difference: patients with chronic bacillary dysentery often present with fever, abdominal pain, and positive fecal culture of Shigella spp. can be clearly differentiated.
Treatment
Treatment principle: eliminate the patient’s concern, improve the symptoms, improve the quality of life.
General treatment
Adjustment of diet
Do not consume stimulating food, do not drink large amounts of drinks containing caffeine, do not consume large amounts of sorbitol, fructose, etc.
Psychotherapy
Psychological counseling for patients with anxiety and depression problems.
Rehydration therapy
For patients with dehydration, rehydrate according to the patient’s condition to prevent further development of dehydration.
Medication
Astringent and antidiarrheal drugs
Such as montelukast can protect the mucous membrane of gastrointestinal tract, adsorb the water in feces and regulate the function of colonic motility.
Intestinal microecological agents
Such as bifidobacteria preparation, lactobacillus preparation, etc., can correct the imbalance of intestinal flora.
Opioids
Loperamide: can inhibit intestinal peristalsis, increase intestinal absorption of water and salt components in feces, improve diarrhea and urgency of defecation; only for those with severe diarrhea, and should not be used for a long time.
Diphenoxylate: can inhibit intestinal peristalsis, slow down the operation of intestinal contents, relieve diarrhea symptoms.
Ion exchange resins
Such as Kaurenamine, etc., can bind bile acids, improve bile malabsorption and relieve diarrhea symptoms.
Antidepressant and anxiety treatment
Applicable to patients with obvious psychiatric and psychological disorders, poor conventional drug treatment, such as patients without psychiatric and psychological disorders, conventional drug treatment for 4~8 weeks is not ideal when also using antidepressant drug treatment.
Amitriptyline, promethazine, can improve diarrhea symptoms in people with anxiety and other psychosomatic disorders.
Long-term use may lead to mild constipation.
Proprietary Chinese medicines
Liver depression and spleen weakness: choose drugs that inhibit the liver and support the spleen, such as Easy Pills and Pain and Diarrhea Granules.
Weakness of the spleen and stomach: choose drugs that benefit the qi and strengthen the spleen and stop diarrhea by seeping dampness, such as Si Jun Zi Pill, Liu Jun Zi Pill, Cen Ling Bai Shu Pill.
Dampness-heat internalization syndrome: choose drugs that benefit qi and strengthen the spleen, ooze dampness to stop diarrhea, such as Ge Ge Gen Scutellaria Lian Lian Tablet and Xiang Lian Pill.
Cold-heat mixed syndrome: choose drugs that are pungent, bitter and subdued, and calmly regulate cold and heat, such as Semixia Laxative Heart Pill.
Spleen and kidney yang deficiency: choose warming the kidney and strengthening the spleen, fixing and stopping diarrhea type of drugs, such as Si Shen Wan.
Traditional Chinese Medicine (TCM)
Functional diarrhea belongs to the category of “diarrhea” and “prolonged diarrhea” in Chinese medicine, and the basic pathogenesis is liver depression and spleen deficiency, spleen and stomach weakness, dampness and heat within the spleen, resulting in spleen deficiency and dampness and internal dysfunction of internal organs, which leads to stagnation of water and grains, indistinguishability of clear and turbid, and conductivity disorder. Clinically, treatment should be provided by a professional Chinese medicine practitioner to identify and treat the symptoms.
Chinese herbal tonics
Liver Depression and Spleen Weakness: Choose Easy San combined with Pain and Diarrhea Essentials Formula with additions and subtractions.
Weakness of the spleen and stomach: Ginseng Ling Bai Zhu San plus subtractions.
Dampness-heat syndrome: add or subtract Ge Gen Cen Lian Tang.
Cold-heat syndrome: add or subtract Semixia Diarrhea Heart Tang.
Yang deficiency of the spleen and kidney: add or subtract Radix Rehmanniae Tong combined with Si Shen Wan.
Others
Acupuncture, acupoint patch, umbilical cord therapy, Chinese herbal enema, etc.
Prognosis
Cure
After timely treatment, the general prognosis is good.
Some people with mild symptoms may recover spontaneously after adjusting their diet and relieving their emotions.
Harmfulness
Functional diarrhea may cause persistent diarrhea, which may affect the patient’s daily work and life.
Prolonged functional diarrhea may lead to dehydration or malnutrition, seriously affecting the patient’s health.
Daily
Daily Management
Dietary management
Do not drink raw or cold water and do not consume irritating food.
Eat lightly and regularly without overeating.
Abstain from alcohol.
Life Management
Quit smoking.
Adopt good working and living habits, do not stay up late.
Prepare in advance for changes in climate and seasons to avoid gastrointestinal disorders caused by cold and other factors.
Emotional management
Family members should accompany the patient to relieve tension and anxiety, and those with serious psychological disorders can go to the psychological outpatient clinic for treatment.
Prevention
Adopt good dietary habits, eat normally and regularly, do not overeat, and do not eat stimulating foods.
Exercise actively, do not stay up late, and develop good living habits.
Quit smoking and drinking.
Adjust your mood to avoid depression and anxiety.