Factitious diarrhoea

Gastroenterologists often have to deal with patients with chronic diarrhoea. The vast majority will suffer from functional bowel syndrome. A few will present with a clear-cut organic disease. If chronic diarrhoea remains unexplained after extensive testing, if daily stool volume is high (greater than 500 g/24 h) and if the patient is female, factitious diarrhoea should be considered. Melanosis coli on sigmoidoscopy, cathartic colon on barium enema examination, a positive room search and chemical detection of the presence of specific laxatives in urine or stool may lead to the correct diagnosis. Treatment and management of such patients is difficult. Denial is the usual response to confrontation. Counselling and guidance by psychiatrists or psychologists is often not accepted by the patient. In many cases the role of the physician may be limited to preventing further potentially dangerous diagnostic and therapeutic interventions.