By Christine Bowen / Special to The Herald

Diarrhea, or the presence of loose or liquid bowel movements, is extremely common and happens to nearly everyone at least a couple of times per year.

Many of these episodes of diarrhea will resolve on their own without creating lasting pain or discomfort. But if it is happening more frequently than once in a rare while or hasn’t resolved on its own within four weeks, then it has turned into persistent or even chronic diarrhea.

Though we think of diarrhea as uncomfortable or inconvenient, the truth is that diarrhea kills 2,195 children a day globally, according to the Center for Disease Control. That is more than HIV, measles and malaria combined! This is due to a lack of access to clean water and sanitation in many parts of the world. Access to clean water and basic sanitation is still a global health crisis.

For our purposes in this column, I will focus on what the most likely causes of diarrhea are for our readers.

Diarrhea can be associated with urgent or frequent bathroom trips. Sometimes we might have no warning and not make it to the bathroom in time! This can be uncomfortable or even horribly embarrassing when it happens (trust me, I know).

The most common cause of diarrhea is a viral intestinal infection (also known as acute viral gastroenteritis) aka or stomach flu. In addition to viral infections causing diarrhea, bacteria, parasites, yeast and other nasty “bugs” can also cause gut infections.

If you have ever had diarrhea and vomiting at the same time, you likely had food poisoning. This is most likely due to bacterial infections. If your diarrhea starts suddenly or starts with nausea or vomiting, this might be an acute gut infection and you may need to see a doctor for help — especially if the symptoms are severe and persist beyond a day or two.

Make sure you see a doctor if you have diarrhea that includes blood or mucus in the stool; is accompanied by fever; severe abdominal pain; dark urine, small amounts of urine/loss of urine production; rapid heart rate; headaches; flushed and dry skin; irritability and confusion; light-headedness and dizziness; severe nausea and vomiting; or the inability to tolerate food or keep from vomiting it back up.

If you are newly experiencing diarrhea or, even if it has been happening for a while, think back to what changed or what was happening when it started. Often, this information contains a key clue about what is causing your diarrhea. Did you start a new medication? Did you travel? Did you have high stress? Did you live in a moldy house? Almost anything that changed in our environment could contribute to a change in our gut health.

If you go to your doctor with chronic diarrhea, it is likely they will diagnose you with irritable bowel syndrome with diarrhea (IBS-D). IBS is a diagnosis that is just associated with symptoms but doesn’t actually tell us why you have it.

Remember, from my last column, that 60% or more of IBS is due to a testable and treatable condition called small intestine bacterial overgrowth.

You may also receive a recommendation to take medicines like Pepto Bismol or Imodium, but taking these products shouldn’t be considered a long-term solution and doesn’t help us get to the root cause of why you are having diarrhea in the first place. I used to work in a pharmacy and was shocked by the quantity of Imodium that flew off the shelves every day, we could barely keep it in stock! This reinforces how common diarrhea is.

In order to get to the heart of why you are having diarrhea, I have outlined some things to explore to see if you can get help with some simple measures. In my experience, testing for infections, allergies and autoimmune diseases is how we get to the root of what is causing your diarrhea.

These are my top considerations for helping to resolve chronic diarrhea. Addressing these conditions can help your bowel movements stop being runny and go back to being healthy.

Rule out allergies and intolerances. Celiac disease is a true allergy to gluten (in many cereal grains, including wheat). This is actually an autoimmune disease (the immune system attacks the gut lining) that causes damage when exposed to even teeny amounts of gluten. Testing for Celiac disease is best done while eating gluten and with blood work or an intestinal biopsy.

Food allergy testing is typically done through blood tests or skin prick testing by an allergy specialist or other provider. Naturopathic doctors can help you order these types of tests or can help you to follow an allergy elimination diet.

Many of you have heard of or experienced lactose intolerance. Lactose is milk sugar, and many guts have a hard time breaking it down. If you suspect that you may not tolerate lactose (highest amounts in milk, cream, yogurt, cottage cheese, ice cream and sour cream), you could try removing high-lactose foods from your diet for a couple of weeks to see if it makes a difference.

Consider other dietary factors. Acidic foods like coffee, tomatoes, citrus, spicy foods, fried foods, highly processed and low nutrition foods like fast food, candy, pop or junk food can really upset the gut. Consider reducing or even removing these foods from your diet to see how your gut responds. Your doctor may suggest a BRAT diet to see if this helps with your diarrhea — which stands for bananas, rice, applesauce and toast — if you are having persistent diarrhea. Sometimes the fiber content of a diet (fruit, veggies and whole grains) might not be right for your gut. You might need to eat fewer grains or only eat cooked fruit and veggies to help your gut readjust. Fermented foods like yogurt and sauerkraut may help to give your gut better bacterial balance.

Screen for medication reactions. More than 700 medications have been linked to diarrhea. Some of the top medications linked to diarrhea are antibiotics, heartburn medications like antacids or proton pump inhibitors (like Prilosec), certain diabetes medications like Metformin or Glucophage, antidepressants, ace inhibitors (for blood pressure), colchicine (for gout), non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or Aleve and chemotherapy. Vitamin C and magnesium containing supplements or drinks may also contribute to diarrhea.

Test for acute or chronic infections or gut imbalances. I find that getting a three-day stool test (ordered through naturopathic doctors) can shed some light on which bugs could be at play in causing your diarrhea. If infections or imbalances in our gut bugs are found, the solutions may be as simple as taking some herbs or nutrients like probiotics (good bacteria in a capsule).

Rule out autoimmune diseases. Inflammatory bowel disease and sarcoidosis are just two types of many autoimmune (when the immune system attacks our tissues) conditions that may create diarrhea. This may be done by your doctor or specialists, who can do blood or stool tests to rule out inflammatory or autoimmune responses. Diagnosing and managing these conditions will help with controlling diarrhea. I will explore the subjects of inflammatory bowel disease and other autoimmune diseases more in the coming months.

Consider stress, trauma and emotional well-being. Stress or anxiety might not be the only underlying cause, but it may be a contributing factor. Whenever possible, double down on self-care and ask for help and support navigating stress and trauma in your life.

If you haven’t seen improvement in your diarrhea with some of the considerations above or if you have any of the worrisome symptoms, get a referral to a digestive health specialist like a gastroenterologist. If diarrhea isn’t resolving, other problems like dehydration, lack of nutrition or even organ damage could result. If these tests and their treatments don’t resolve your diarrhea, continue to ask for help or referrals to get to the heart of why you are having diarrhea so you and your gut can live in peace.

Dr. Christine Bowen of Everett is a licensed naturopathic doctor, keynote speaker and has been published in the Townsend Letter. In practice since 2005, Bowen specializes in holistic approaches for digestive health and autoimmunity. Go to www.bothellnaturalhealth.com for more information. Connect with her via Facebook drchristinebowen or Instagram @drchristinebowen.