Chronic Diarrhoea


Chronic diarrhoea may be defined as the abnormal passage of 3 or more loose or liquid stools per day for more than 4 weeks


Please refer if likely organic (as opposed to a functional) diarrhoea

  • age 45 and over at onset
  • nocturnal / continuous (as opposed to intermittent) diarrhoea
  • weight loss
  • absence of abdominal pain
  • rectal bleeding
  • abnormal investigations
  • family history of GI disease


Consider IBS (functional diarrhoea) in patients if


  • abdominal pain, bloating and a change in bowel habit
  • age < 45 years old at onset
  • no alarm features
  • no weight loss
  • no nocturnal or continuous (as opposed to intermittent) diarrhoea
  • normal investigations (FBC CRP Coeliac screen)


See IBS referral criteria


Investigations prior to referral

  • Stool MCS
  • coeliac serology
  • B12 folate ferritin


2 week wait criteria

Upper GI red flags/2ww criteria: 

Refer for direct access gastroscopy:   

  • Dysphagia
  • Aged 55 or over with weight loss AND any of the following:
    • Reflux
    • Abdominal pain
    • Dyspepsia

Refer to the upper GI 2ww service: 


  • Ultrasound indicates gall bladder cancer
  • CT indicates pancreatic cancer
  • Ultrasound indicates pancreatic cancer
  • Upper abdominal mass consistent with gastric cancer
  • Any patient with jaundice
  • Aged 60 or over with weight loss AND any of the following:
    • Diarrhoea
    • Back pain
    • Abdominal pain
    • Nausea
    • Vomiting
    • Constipation
    • New onset diabetes

Lower GI red flags/2ww criteria: 



Clinics available

Diarrhoea or change in bowel habit +/- pain               Age<45           OP medical

   Age >45          OP colorectal/lower GI medical unless 2ww

Referrals for IBS will be rejected if primary care management is incomplete



Reference/Further Reading


British Society of Gastroenterology. Guidelines for the investigation of chronic diarrhoea 2003: