Diabetes and Diarrhea
About 5% of people with diabetes experience frequent bouts of diarrhea. Diarrhea is especially common among people who have had diabetes for a long time and among those who use insulin. The causes of diabetic diarrhea are not completely clear. It may be a result of neuropathy. The nerves that control movement of food through the bowel and the absorption of fluid from food don’t function properly. You can also be affected by fecal incontinence, when the nerves that control the anal sphincter muscles are damaged and interfere with the normal way you sense the need to defecate.
Diarrhea may also be triggered by ingestion of artificial sweetners, particularly sorbitol, a practice common among people with diabetes. Diarrhea may also be caused by the overgrowth of bacteria in the colon, because the muscles that move food along naturally do not function properly. This causes food to sit longer in the digestive tract, allowing bacteria to flourish.
Diarrhea could also be triggered by a problem with the production of bile acid, which helps you digest fat. Whatever the cause, the symptoms can be severe enough to keep you from wanting to go out of your home.
DIABETES DIARRHEA SYMPTOMS
The main symptoms of diarrhea is a loose, watery bowel movement. It can occur at any time, often with little warning. Often, people with diabetic diarrhea experience fecal incontinence, an inability to control bowel movements. You may find that you leak stool, but don’t feel the urge to defecate. Episodes of diarrhea often, but not always, occur at night.
Diarrhea can last from a few hours to a few weeks. You may have periods of remission, in which you have no diarrhea. You may even have periods in which you are constipated. During episodes of diarrhea, you will probably notice an increase in the frequency and the amount of bowel movements.
What You Should Do When You Have Diabetes Diarrhea
If you have episode of diarrhea that lasts more than a day, contact your doctor. If diarrhea is severe, you need to watch out for dehydration, especially if you also have any kind of nausea or vomiting. Make sure to test your blood glucose levels more frequently. If there is any evidence of hypoglycemia or hyperglycemia, treat right away and call your doctor.
If your diarrhea occurs without the threat of dehydration, it is less of an emergency, but it nevertheless may be distressing enough to require prompt treatment. This is especially true if you have frequent episodes. Talk to your doctor about the problem, in order to begin treatment as soon as possible.
DIABETES DIARRHEA TREATMENT
Diarrhea can have several causes, so you and your doctor may have to try several different approached to find the one that works for you. If neuropathy is causing your diarrhea, then you probably have reduced sensation around your anus. Your doctor can detect this with a pin. If you have neuropathy, you may be unable to sense a pin prick. Your doctor may also give you a rectal exam. If you have neuropathy, you may have a lax anal sphincter muscle.
When a finger is inserted, the sphincter muscle will fail to contract. You may also show a loss of the anal wink reflex. This is a contraction of the anus in a ‘wink’ when the skin around the anus is stroked. There may also be a loss of the bulbocavernosus reflex in men. This occurs when the anus contracts as the glans penis is squeezed between the fingers. Your doctor may test all or some of these reflexes to see if neuropathy is the cause of the diarrhea.
Before conducting any further tests, you and your doctor may want to go over all the food in your diet to see if anything you are eating or drinking could be causing the problem. For example, many foods contain sorbitol, which can trigger diarrhea in some people.
Check the labels of everything you eat, including any diet drinks, sugar-free candies or even gum. Excessive amounts of caffeine, found in coffee, tea, chocolate and cocoa, and many soft drinks, can also trigger diarrhea. Many people with diabetes take magnesium-based antacids, which can contribute to diarrhea. Go over all the medications you are taking, including over-the-counter drugs. Some medications, such as metformin, can cause diarrhea.
If you fail to find an obvious dietary cause of diarrhea, your doctor may suggest a wheat gluten-free diet. This is because the gluten in wheat can cause an allergic reaction in some people that triggers diarrhea. Other food allergies may also be the culprit. A visit to an allergy specialist may be in order.
You doctor may suggest that you take a course of antibiotics to control the possible overgrowth of bacteria in your bowel. Your doctor may first want to test your bowel to see if you have too many bacteria growing there. If the test reveals that you have more than 100,000 microorganisms per milliliter, then you may need an antibiotic. You will probably be prescribed an oral antibiotic for 10 days. Make sure to take the entire dose of drug for the whole 10 days, even if your diarrhea goes away before then.
If antibiotics fail to improve your condition, you may be given an anti-diarrheal drug, such as diphenoxylate (Lomotil). If your condition shows no improvement, your doctor may then conduct an upper-GI endoscopy exam. This test allows a look at the lining of your small intestine. Your doctor may also collect a sample of bacteria to see if a bacterial infection in the small intestine could be causing the problem.
If rare cases, diarrhea is caused by poor action of pancreatic enzymes. This can be tested by collecting a 72-hour stool sample. If you have pancreatic enzyme insufficiency, you may be given supplementary pancreatic enzymes for treatment.
Problems with the absorption of the bile acids produced by your gallbladder have also been implicated as a cause of diarrhea. However, this is fairly rare. Your doctor may suggest taking a medication such as cholestyramine, which binds bile acids, or loperamide (Imodium), which slows the amount of time food spends in the small intestine.
Once your diarrhea is under control, your doctor can then help you control fecal incontinence. Often fecal incontinence is confused with diarrhea, but they are two different conditions. Fecal incontinence refers to the inability to detect or control bowel movements and often coexists with diarrhea. One way you can control fecal incontinence is by using biofeedback techniques. Another is to do specific exercises called Kegel exercises to train your anal sphincter muscle.
A nurse educator or physical therapist can show you how to do these exercises. Basically, they work by squeezing your lower abdomen and pelvis as though you are trying to prevent urine or stool from coming out. You can try doing these exercises several times a day, whenever you have free time. Try it when you are sitting at a stoplight or standing in line at the grocery store. In people with good rectal sensation, these exercises, along with biofeedback techniques, reduce fecal incontinence 70% of the time. Your doctor may also suggest the drug octreotide acetate (Sandostatin), which frequently works with great success.
Diarrhea can be an embarrassing condition, and you may feel uncomfortable discussing it with your doctor. However, the sooner you talk to your doctor about it, the sooner you can begin treatment to alleviate the problem
DIABETES DIARRHEA PREVENTION
Diarrhea may be prevented by avoiding foods and medications that may trigger the condition. Over the long term, controlling your blood glucose levels may also reduce or prevent the neuropathy that can lead to diarrhea and rectal incontinence
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Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Chronic Diarrhea in Diabetes Mellitus: Mechanisms and an Approach to Diagnosis and Treatment by M A Valdovinos, M Camilleri and B R Zimmerman
Rich Health Editorial Team
Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner
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