Recurrent Diarrhoea Without Blood in Stools and Without Fever

CLINICAL DIAGNOSTIC MANUAL

Recurrent diarrhoea without blood in the stools and without fever is a condition that may indicate various underlying pathologies, ranging from functional disorders to metabolic or infectious problems.

This form of diarrhoea is typically not associated with signs of systemic infection, which can help differentiate it from other causes of acute or infectious diarrhoea. A detailed evaluation and complementary tests are essential to identify the underlying cause and provide appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Irritable bowel syndrome (IBS)	Chronic abdominal pain, diarrhoea alternating with constipation, pain relief after defecation	History of chronic symptoms, physical examination	Rome criteria, exclusion of other causes
Fecal impaction	Episodes of liquid diarrhoea, abdominal pain, sensation of abdominal mass, faecal incontinence	History of chronic constipation, physical examination	Abdominal X-ray, rectal examination
Malabsorption syndrome	Chronic diarrhoea, steatorrhoea, weight loss, abdominal distension, nutritional deficiencies	Clinical history, symptoms of malabsorption	Pancreatic function tests, intestinal biopsy, stool fat analysis
Drug-induced	Temporary diarrhoea associated with starting a new medication, no other infectious symptoms	History of medication use, physical examination	Medication history review, discontinuation test
HIV infection	Chronic diarrhoea, weight loss, constitutional symptoms, opportunistic infections	History of infection risk, physical examination	HIV test, CD4 count, viral load
Diabetic autonomic neuropathy	Nocturnal diarrhoea, faecal incontinence, peripheral neuropathy symptoms	History of diabetes, neurological symptoms	Autonomic function tests, electromyography (EMG), glucose levels
Thyrotoxicosis	Weight loss, palpitations, diarrhoea, heat intolerance, tremors	History of hyperthyroid symptoms, physical examination	Thyroid function tests (TSH, free T4)
Carcinoid syndrome	Watery diarrhoea, facial flushing, wheezing, abdominal pain, carcinoid heart disease	History of symptoms, physical examination	5-HIAA levels in urine, blood chromogranin A, abdominal CT scan