Causes of loose stool
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Key Causes of Loose Stool: Infection, Malabsorption, and Functional Disorders
Loose stool, often described as diarrhea, can result from a variety of causes. Infections by viruses, bacteria, or parasites are common triggers, especially in children, and are often linked to poor hygiene, contaminated food, or unclean water. These infections can lead to the passage of frequent, watery stools and may be accompanied by symptoms like abdominal pain, cramps, and fever 69.
Malabsorption syndromes, such as those caused by congenital sucrase-isomaltase deficiency (CSID) or celiac disease, can also lead to chronic loose stools. In these cases, the body is unable to properly digest or absorb certain nutrients, resulting in osmotic diarrhea where undigested substances draw water into the intestines 239. Fat malabsorption (steatorrhea) and bile acid malabsorption, which can occur after surgeries like right-sided hemicolectomy, are additional causes 137.
Functional gastrointestinal disorders, such as irritable bowel syndrome with diarrhea (IBS-D) and functional diarrhea, are also frequent causes of loose stools. These conditions are often linked to gut microbiota imbalances, increased intestinal sensitivity, stress, and changes in gut motility 3510.
Mechanisms: Secretory and Osmotic Diarrhea
Loose stools can be classified based on their underlying mechanisms. Secretory diarrhea occurs when the intestine fails to absorb electrolytes and water, often due to infections, toxins, or certain medications. This type of diarrhea can also result from diseases that reduce the absorptive surface of the intestine or from hormonal imbalances 49.
Osmotic diarrhea, on the other hand, is caused by the presence of non-absorbable, osmotically active substances in the gut, such as undigested carbohydrates or laxatives, which draw water into the bowel 349.
Stool Consistency and Water Content
The looseness of stool is directly related to its water content. In normal conditions, the intestine maintains a consistent ratio of water to solids in the stool. In diarrhea, this balance is disrupted, leading to increased water content and looser stools. The presence of fat in the stool (steatorrhea) can make stools even looser for a given water content. Additionally, a low output of insoluble solids without a corresponding reduction in water output can also result in loose stools .
Genetic and Post-Surgical Factors
Certain genetic factors, such as hypomorphic variants in the sucrase-isomaltase (SI) gene, are associated with chronic loose stools in children. These genetic differences can lead to more frequent and looser stools, as well as increased gastrointestinal symptoms . Surgical procedures, particularly those involving the removal of parts of the intestine (e.g., right-sided hemicolectomy), can disrupt normal absorption and lead to chronic loose stools due to bile acid malabsorption or changes in gut bacteria .
Conclusion
Loose stool can be caused by a wide range of factors, including infections, malabsorption syndromes, functional gastrointestinal disorders, genetic variants, and surgical changes to the gut. The underlying mechanisms often involve disruptions in water and electrolyte absorption (secretory diarrhea) or the presence of non-absorbable substances in the gut (osmotic diarrhea). Understanding the specific cause is important for effective management and treatment.
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