| |
 |
|
| Medical Edge |
|
|
|
Medical Edge Newspaper Column from Mayo Clinic
GETTING A DIAGNOSIS FIRST STEP IN TREATING ‘EXPLOSIVE DIARRHEA’
DEAR MAYO CLINIC: I’m 25 and have had insulin dependent diabetes since age 19. I’ve had problems with peripheral neuropathy and burning in my feet and legs. Those symptoms are now under control, but for the past three years, I’ve had explosive diarrhea every day. I’ve been to three different gastroenterologists, undergone many tests and taken medications. Nothing has helped. What should I do next? — Atlanta
ANSWER: Not only can chronic diarrhea wreak havoc on a person’s daily life, it may be a sign of other underlying health problems, particularly in individuals who have diabetes. That’s why the next thing you need to do is obtain a comprehensive evaluation of your situation so you can get an accurate diagnosis. Identifying the cause of the diarrhea and understanding the underlying source of the problem will pave the way for successful treatment.
There are a variety of potential culprits that could be causing your diarrhea. Inflammatory bowel disease, chronic infections, celiac disease and gastrointestinal motility disorders — such as irritable bowel syndrome and dumping syndrome — are some of the many conditions that need to be considered. Chronic diarrhea also can be caused by medications and lactose intolerance.
Autonomic neuropathy — a condition involving damage to the nerves that regulate your digestion and other autonomic functions — also is a possibility that needs to be explored. Autonomic neuropathy of the gastrointestinal tract is common in people with diabetes who have peripheral neuropathy, which affects the nerves in your arms, legs, feet and torso. Autonomic neuropathy can result in bacterial overgrowth in the small intestine, as well as gastrointestinal motility problems, which affect the ability of your intestinal muscles to move food through your digestive tract. Bacterial overgrowth and intestinal movement problems may cause diarrhea or a change in bowel habits.
You mention that you’ve already had many tests, but to effectively identify the cause of your diarrhea, you need a comprehensive, detailed evaluation of your entire gastrointestinal system. Ideally, this evaluation should be done by a gastroenterologist familiar with diabetes. The evaluation should include tests that study how long it takes food to move through your small and large intestine, as those tests may reveal motility disorders.
Once the source of the diarrhea has been identified, effective treatments usually are available. For example, medications can help improve motility, and bacterial overgrowth can be treated with antibiotics. For individuals with celiac disease, a gluten-free diet may resolve chronic diarrhea. For individuals diagnosed with autonomic neuropathy, careful control of blood sugars is critical to prevent or delay progression of the nerve damage. That may call for intensive insulin treatment, either with multiple daily injections or an insulin pump, for those with type 1 diabetes.
Armed with an accurate diagnosis, your physician likely will be able to develop a treatment plan that is right for you.
The bottom line is that control of blood sugars and a systematic investigation to determine the underlying cause of the diarrhea, followed by treatment specifically directed at that cause, will offer you the greatest chance of success.
— M. Regina Castro, M.D., Endocrinology, and
Amy Foxx Orenstein, D.O., Gastroenterology and Hepatology,
Mayo Clinic, Rochester, Minn.
Additional Resources:
Information on Diarrhea
Appointment Information
More Information on Diarrhea
- - -
Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave.,
Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2005 TRIBUNE MEDIA SERVICES, INC.
|
|
