Diarrhoea persistent causes in older adults

Overview

Diarrhoea that lasts for more than a few weeks is called persistent diarrhoea. In older adults, it can be a sign of an underlying health problem and may lead to dehydration more quickly than in younger people.

Persistent diarrhoea is not uncommon in older adults, but it is not a normal part of aging. It should always be checked by a healthcare provider.

It mainly affects adults over 65, especially those who live in care homes, take multiple medications, or have weakened immune systems.

Symptoms

Common symptoms

• Loose or watery stools
• Bowel movements that happen more often than usual
• Urgent need to go to the toilet
• Stomach cramps or bloating

Symptoms in children

• This section is for older adults. In children, symptoms may include fussiness, crying, and refusing to eat or drink.

Symptoms in older adults

• Diarrhoea lasting more than 3 weeks
• Unexplained weight loss
• Feeling weak or dizzy
• Signs of dehydration: dry mouth, sunken eyes, little or no urine, confusion

Causes

Main causes

• Medication side effects — such as antibiotics, laxatives, or heart medications
• Irritable bowel syndrome (IBS) — a common gut condition causing diarrhoea, cramps, and bloating
• Inflammatory bowel disease (IBD) — such as Crohn's disease or ulcerative colitis
• Gut infections that have not cleared — caused by bacteria or parasites
• Problems with digestion — such as lactose intolerance or gut surgery after-effects
• Overactive thyroid or diabetes
• Problems with the pancreas or bile acid

Risk factors

• Taking multiple medicines (polypharmacy)
• Recent hospital stay or antibiotic use
• Weak immune system (due to illness or treatments)
• Living in long-term care facilities
• Chronic conditions like diabetes or thyroid disease

When to see a doctor

See a doctor urgently if:

• Blood in your stool
• Diarrhoea with severe stomach pain
• Signs of dehydration not improving with drinking
• Confusion or feeling very weak

Book a routine appointment if:

• Diarrhoea that lasts more than 2 weeks
• Losing weight without trying
• Diarrhoea that wakes you up at night
• Pain or bloating that is constant

Diagnosis

Your doctor will ask about your symptoms, medications, and medical history. They may examine your abdomen and check for signs of dehydration.

Tests that may be done

• Stool sample to check for infection or inflammation
• Blood tests to look for anaemia, thyroid function, or signs of inflammation
• Breath test for lactose intolerance or bacterial overgrowth
• Colonoscopy — a camera test to look inside the bowel, especially if you have blood or weight loss

What to expect at your appointment

Tests are usually straightforward. A colonoscopy requires some preparation (clearing the bowel) and is done with sedation so you are comfortable. Most people go home the same day.

Treatment

Treatment depends on the cause. For many people, a combination of self-care and medical management can help control symptoms and restore normal bowel function.

Self-care at home

• Drink plenty of fluids — oral rehydration salts from the pharmacy can help replace lost salts
• Eat small, frequent meals of plain foods (like rice, bananas, toast)
• Avoid caffeine, alcohol, and high-fibre foods until the diarrhoea settles
• Keep a diary of what you eat and your bowel habits to share with your doctor

Medical treatments

Your doctor may prescribe treatments depending on the cause: for example, antibiotics if an infection is found, medicines to slow the bowel or reduce inflammation, or adjustments to your current medications. Do not change or stop any prescribed medicines without talking to your doctor first.

When is surgery considered?

Surgery is rarely needed for diarrhoea itself, but may be considered if tests find a condition like a growth or severe inflammatory bowel disease that does not improve with medication.

Living with this condition

Living with persistent diarrhoea can be challenging, but many people find relief with treatment. Plan ahead — know where toilets are when you go out, and carry a change of clothes and wipes.

Lifestyle tips

• Stay hydrated — take small sips of water or rehydration drinks throughout the day
• Manage stress — gentle activity like walking or deep breathing can help
• Keep a symptom diary to identify triggers
• Talk to your doctor before taking over-the-counter antidiarrhoea medicines

Diet and exercise

Eat plain, low-fibre foods when symptoms flare. Gradually reintroduce fibre as you improve. Gentle exercise like walking or stretching can help digestion and overall wellbeing.

Mental health and emotional wellbeing

Ongoing diarrhoea can cause anxiety, embarrassment, and feelings of isolation. It is normal to feel worried. Let your healthcare team know how it affects your daily life — they can help you cope.

Prevention

Not all cases can be prevented, but you can reduce your risk. Avoid unnecessary use of antibiotics and laxatives. Wash hands well to prevent infections. Keep a list of your medications and review them with your doctor regularly.

Vaccines

There are vaccines for some causes of infectious diarrhoea, but they are not routinely recommended for older adults. Ask your doctor if any vaccines are appropriate for you.

Screening programmes

Routine screening for bowel cancer is recommended for people over 50 in many countries. This can help find problems early, including some that cause diarrhoea.

Complications

If left untreated

• Dehydration and electrolyte imbalance, which can be dangerous for older adults
• Malnutrition and weight loss
• Kidney problems from long-term dehydration
• Worsening of existing health conditions

Long-term outlook

With proper care, most people find that their diarrhoea improves or is well managed. Finding the cause can take time, but the outlook is often good. Your healthcare team is there to help you every step of the way.

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