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Harvard Medical School
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General Medical Questions
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Question : I've had chronic diarrhea for 3 months. My colonoscopy and stool both tested normal. My endocrinologist re-tested my thyroid and adjusted my medicine. I've kept a food journal, but I still get diarrhea no matter what I eat. Do you have any suggestions?
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The Trusted Source
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Stephen E. Goldfinger, M.D., is the faculty dean for Continuing Education and a professor of medicine at Harvard Medical School. He is a graduate of Columbia College of Physicians and Surgeons, and his clinical base is at the Massachusetts General Hospital.

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May 25, 2011
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A:

Although your stool testing and colonoscopy have been negative, there are many possible causes of diarrhea that have not been excluded.

Among these are such things as:

  • Irritable bowel syndrome
    Some people with irritable bowel syndrome have a type that is called "diarrhea predominant." Stress can worsen symptoms.
  • A side effect from a drug you may be taking
  • Celiac disease or another malabsorption disorder
    People with malabsorption disorders cannot digest food properly. Undigested fats and carbohydrates carry water out of the bowel.
  • Bowel inflammation from Crohn's disease
  • Rare tumors that secrete substances into the blood stream that lead to diarrhea.

Although it may not be the main cause, lactose intolerance may be making the diarrhea worse. Keeping a food journal was a good idea.

Finding the cause of your diarrhea will require a careful investigation by your doctor. Your doctor will ask:

  • Whether you can sleep through the night without having a bowel movement. People with irritable bowel syndrome usually don't wake up to have a bowel movement.
  • Whether you are having a high degree of stress in you life.
  • Whether you have any pain, fever or weight loss. (These symptoms may suggest Crohn's disease as the cause.)

The doctor will also review all the medications you are taking.

You may need a blood test to look for the possibility of celiac disease. You may need a scan of your small intestine to explore the possibility of Crohn's disease.

Other tests exist, but the value and order of testing depends upon the answers to the questions above and what your doctor finds from a physical exam. I suggest you visit a gastroenterologist. This specialist can more fully address your problem and, I hope, solve it.

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diarrhea,crohn's disease,irritable bowel syndrome,bowel,bowel movement.,celiac disease
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