Chronic diarrhea is considered to be loose or watery stools that lasts beyond 4 weeks. It can be defined as increased frequency and/or decreased form of stool. A type 6 or 7 on the Bristol Stool Chart is considered diarrhea. In terms of frequency, if you are passing more than 3 bowel movements in a day, this would also be considered diarrhea.

Alarm features such as blood in stool, weight loss, worsening pain, and diarrhea during sleeping hours suggests a more serious underlying cause and should be investigated right away.

However, once these have been ruled out some of the common causes for chronic diarrhea include IBS & functional diarrhea (both of which are Disorders of Gut Brain Interaction), IBD, celiac disease, a food intolerance (eg. lactose intolerance), SIBO, chronic infections (eg. H pylori, Giardiasis), pancreatic insufficiency, bile acid malabsorption, the side effect from a medication, thyroid disorder, etc.

Traditionally, chronic constipation is defined as having 3 or fewer bowel movements per week for longer than 3 months. However, from a functional perspective suffering from any of the following may indicate that you have constipation:

- Fewer than 1 bowel movement/day

- A feeling of incomplete evacuation after a bowel movement

- Lumpy/pebbly or hard to pass stool (typically defined as type 1 or 2 on the Bristol Stool Chart)

- Reliance on laxatives to have a bowel movement

- Straining and/or pain with evacuation

There many things that can cause constipation, however it is important to be aware of certain red flag symptoms that warrant a more urgent workup from a primary care provider, which includes:

- new onset of constipation over the age of 50

- symptoms that wake you up at night

- unexplained anemia

- blood in your stool

- significant unintentional weight loss

- a palpable masses in the abdomen and/or rectum

- a sudden change in your bowel habits regardless of age

- family history positive for colorectal cancer and inflammatory bowel disease

In most cases of chronic constipation, the cause is benign (although this doesn’t mean it isn’t having a significant negative impact on your quality of life!) and includes things such as IBS-C & functional constipation (both of which are Disorders of Gut Brain Interaction), pelvic floor dysfunction, a diet low in fibre or insufficient caloric intake, the effects of chronic stress, endocrine abnormalities (such as hypothyroidism), celiac disease, the side effect of certain medications/supplements (eg. iron, anti-depressants, pain killers/opioids, NSAID’s, antacids), etc.

Chronic bloating can be either physical distention (where you tummy physically distend outward) or the having the sensation of bloating/discomfort. The latter is usually due to something called visceral hypersensitivity, which is where the “volume” on the pain receptors in the gut are turned up, causing your brain to pick up on small/normal changes in gas & motility. This is very common in those who have Disorders of Gut Brain Interaction such as IBS.

There are a very large number of things that can cause chronic bloating both inside & outside the gut, so it’s important that you have this assessed by a primary care provider. However, when it comes to the gut, here are a few common causes: IBS (both IBS-C & IBS-D), functional bloating , food intolerances, SIBO, celiac disease, poor eating habits, chronic stress, under-eating & eating disorders, aerophagia, abdomino-phrenic dyssynergia (also part of DGBI’s), excessive consumption of gas-forming foods, etc

While it is normal to produce some gas, especially after eating high fibre foods, if this gas feels excessive and/or is really smelly this could indicate a problem. Some common causes include eating too quickly, enzyme deficiencies (eg. lactose intolerance), bacterial imbalances in your gut, chronic stress, aerophagia, celiac disease, malabsorption syndromes, etc.

Alarm features such as blood in stool, weight loss, worsening pain, and diarrhea during sleeping hours suggests a more serious underlying cause and should be investigated right away.

However, once these have been ruled out some of the common causes for chronic diarrhea include IBS & functional diarrhea (both of which are Disorders of Gut Brain Interaction), IBD, celiac disease, a food intolerance (eg. lactose intolerance), SIBO, chronic infections (eg. H pylori, Giardiasis), pancreatic insufficiency, bile acid malabsorption, the side effect from a medication, thyroid disorder, etc.

Pain is subjective, which is part of what makes it difficult to quantify & define. Some of the common descriptors for abdominal pain include “sharp”, “stabbing”, “dull”, “cramping” and “aching”. Bloating can also cause pain. Chronic abdominal pain is that which has been occurring for longer than 3 months.

The location of pain is also important, as it can help to pinpoint what part of the gut is involved. Pain in the throat or mid sternum can be coming from the esophagus and/or stomach. Pain in the epigastric region is typically the stomach. Pain in the soft part of your belly can be either the small or large intestine. However, keep in mind 2 VERY important points:

1. There are many organs/tissues/muscles in close proximity to the gut, making it important to work with a qualified healthcare practitioner to determine the source.

2. Pain can be referred, meaning something farther away can cause pain in the area you are experiencing it.

Here are some common causes of chronic abdominal pain: GERD, functional dyspepsia, chronic gastritis or ulcer disease, IBS, functional constipation, Inflammatory Bowel Disease, abdominal pain syndrome, cealiac, etc.

Alarm features such as blood in stool, weight loss, worsening pain, and diarrhea during sleeping hours suggests a more serious underlying cause and should be investigated right away.

However, once these have been ruled out some of the common causes for chronic diarrhea include IBS & functional diarrhea (both of which are Disorders of Gut Brain Interaction), IBD, celiac disease, a food intolerance (eg. lactose intolerance), SIBO, chronic infections (eg. H pylori, Giardiasis), pancreatic insufficiency, bile acid malabsorption, the side effect from a medication, thyroid disorder, etc.

Heartburn is the sensation of burning/discomfort in the throat or chest region. Heartburn is caused by reflux of acid & sometimes other stomach contents into the throat, which is why it’s often accompanied by regurgitation.

The most common cause of chronic heartburn is GERD (a form of erosive esophagitis). However, there are many other gut-related conditions that can mimic this including functional heartburn, reflux hypersensitivity, peptic ulcer disease, pill esophagitis, eosinophilic esophagitis, as well as other conditions non-gut conditions.

In chronic heartburn it is important that you get a proper assessment including endoscopy if you are not responding to conventional treatments (PPI therapy, diet modification, weight loss, etc).

Alarm features such as blood in stool, weight loss, worsening pain, and diarrhea during sleeping hours suggests a more serious underlying cause and should be investigated right away.

However, once these have been ruled out some of the common causes for chronic diarrhea include IBS & functional diarrhea (both of which are Disorders of Gut Brain Interaction), IBD, celiac disease, a food intolerance (eg. lactose intolerance), SIBO, chronic infections (eg. H pylori, Giardiasis), pancreatic insufficiency, bile acid malabsorption, the side effect from a medication, thyroid disorder, etc.

Having reactions to a large number of foods is a sign that something isn’t working properly in the gut. Symptoms can occur immediately or up to a day after consuming a certain “trigger” food. Gut-related symptoms can include bloating, gas, diarrhea, constipation, abdominal pain & excessive belching.

Common causes for this include IBS, functional constipation, carbohydrate intolerances (eg. lactose intolerance, fructose intolerance), celiac disease, non-celiac gluten sensitivity, SIBO & chronic stress.

While avoiding foods that cause you discomfort is helpful short-term plan, it is important to work with a qualified health professional to help you identify & treat (if possible) the underlying cause. Long-term restrictive diets can cause a lot of harm to your gut microbiota, your nutritional status, your mental health (leading to disordered eating & eating disorders) & other aspects of your well-being (eg. your social life).