It’s no fun to talk about, and even less fun to experience. But chronic diarrhea disrupts more than just your daily routine. Its effect on hydration, electrolyte balance, and nutrient absorption can impact your health long-term.¹   

How does a natural treatment like Banatrol (active ingredients: banana flake fiber and prebiotics) compare to the drugs Pepto-Bismol (bismuth salicylate) and Imodium (loperamide)? We consulted Andrea Kent, MPH, RD, CNSC—a registered dietitian with a focus on clinical nutrition and digestive health—to understand how they work, when to use them, and long-term safety.

Combining Kent’s expertise with hands-on evaluations by TCD staff, we’ve reviewed these products for chronic diarrhea relief.

One clear winner stood out in terms of efficacy, ingredients / side effects, and long-term use. Read on to find out which.

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When to Seek Treatment for Diarrhea

“Diarrhea can have several causes,” Kent tells us. “Those include gut conditions like IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease), food intolerance, infections, and medications like antibiotics.”  

Regardless of the cause and treatment, see a doctor if diarrhea persists for more than two days, leads to severe dehydration, or is accompanied by pain, fever, or bloody stools, Kent advises.

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Choosing the Right Treatment

Banatrol is the only option here for long-term management of diarrhea, especially for chronic conditions. Banatrol contains soluble fiber (from banana flakes) and a patented prebiotic, Bimuno, comprised of galacto-oligosaccharides, also know as GOS. GOS is proven to reduce diarrhea and support gut health by decreasing the attachment rate of pathogens, leading to a more resilient digestive system.²

Chronic conditions, like IBS-D, and ongoing treatments like chemo, present a complex challenge for which Imodium and Pepto-Bismol are contraindicated or not safe long-term. In such cases, maintaining a balanced gut flora is crucial. Kent highlights the value of soluble and fermentable fibers, like those in Banatrol. "They create the right environment for beneficial gut bacteria, which can alleviate symptoms."

Imodium and Pepto-Bismol are only indicated for sudden, acute diarrhea episodes. Imodium slows down gut movement, allowing for more water absorption from the stool. Pepto coats the stomach and intestinal lining, which can soothe irritation and inflammation. Prolonged use of either Imodium or Pepto is not recommended and can lead to complications (we’ll discuss more below).

See below for a snapshot of the treatments we tested.

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Efficacy for Chronic Diarrhea: All-Natural Banatrol Wins

Banatrol is the best (and only) option in this group for long-term use. The soluble fiber from banana flakes promotes regular bowel movements without the risk of constipation, while prebiotics support a healthy gut microbiome. "Banatrol's approach to managing diarrhea addresses symptoms but also contributes to the overall health of the digestive system, making it my preferred choice for long-term use," says Kent, our Clinical Dietician. “Studies support the efficacy of prebiotics in enhancing gut health, with Banatrol’s galacto-oligosaccharides shown to increase beneficial bacteria levels, reducing the frequency and severity of diarrhea episodes over time.”⁵

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With long-term use, Loperamide (Imodium) can disrupt natural gut motility, leading to constipation and potentially more severe motility disorders. With extended use, bismuth subsalicylate (Pepto-Bismol) carries a risk of bismuth toxicity and exacerbation of underlying conditions such as ulcers or bleeding disorders.

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Efficacy for Acute Diarrhea: It’s a Tie for Banatrol & Imodium

Banatrol and Imodium show similar efficacy for acute diarrhea, with some important caveats. 

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Imodium quickly reduces gut motility and offers immediate symptom control in many cases of acute diarrhea. Clinical comparisons have shown it to generally outperform Pepto-Bismol in speed and quality of relief.³ Crucially, Imodium must not be used to treat dysentery or infections such as C.diff, where decreased gut movement is harmful.

Banatrol's efficacy comes from its combo of soluble fiber (banana flakes) and the prebiotic, GOS, which can quickly normalize stool consistency and promote healthy gut flora.⁴ Many users see benefits within 24 hours. "In many cases, Banatrol can be just as effective as Imodium, offering quick relief without some of the potential downsides associated with anti-motility agents," Kent points out. Since it does not impact gut motility, it’s a good choice for people suffering with any long-term conditions or illnesses that cause chronic diarrhea.

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Ingredients & Side Effects: Banatrol’s Proven Fruit and Prebiotic Combo Wins

While natural doesn’t necessarily mean better, we are reassured by Banatrol’s short, recognizable, clinically supported ingredients list: soluble fiber from banana flakes and the prebiotic, GOS. Banatrol is the only treatment here classified as a medical food (a product intended for specific dietary management of a disease or condition), vs. a drug treatment. Banatrol side effects are rare and include occasional bloating or gas.

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“That combo of soluble and fermentable dietary fiber actually create an environment to support commensal (desired) probiotics and hinder opportunistic (not desired) microbiota,” Kent adds.

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Imodium's active ingredient is loperamide, a synthetic opioid which acts on the gut's opioid receptors to slow intestinal movement, leading to firmer stools and a reduction in frequency and urgency, Kent explains. However, that same mechanism can lead to common side effects like constipation and abdominal distension. Rare but serious side effects include stomach/abdominal pain, uncomfortable fullness of the stomach/abdomen, fast/irregular heartbeat, severe dizziness, and fainting. 

Pepto-Bismol contains bismuth subsalicylate. It works by coating the stomach lining and soothing gastrointestinal irritation. Pepto is generally well tolerated but can lead to side effects like black tongue and black stools. Those are generally harmless, but can be alarming. Rare but serious side effects include ringing ears, hearing loss, and intestinal bleeding.

Tell your doctor if you experience any of the side effects above! It’s a good idea to check with your doctor before using these medications due to potential drug interactions. Importantly, neither Pepto nor Imodium are safe for long-term use due to the potential systemic side effects addressed below. 

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Form Factor: It’s a Tie

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These treatments come in a variety of form factors. Imodium as a small tablet in a blister pack, Pepto-Bismol as a liquid and tablet, and Banatrol as a powder, available in a tub for home use or on-the-go packets. Our testers found no form factor superior to the others.

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The Overall Winner for Chronic Diarrhea Treatment: Banatrol

What is the best chronic diarrhea treatment? After our thorough testing and analysis, we recommend the treatment that is clinically supported, all-natural, non-drug based, and appropriate for long-term use. And that’s Banatrol.

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Kent, our Clinical Dietician and GI nutrition expert, agrees. "Banatrol's blend of banana flakes and prebiotics not only swiftly alleviates symptoms but also plays a pivotal role in fortifying gut flora, essential for long-term gastrointestinal health and digestive wellness.”

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^{1. https://my.clevelandclinic.org/health/diseases/24311-chronic-diarrhea} 

^{2. https://academic.oup.com/jtm/article/24/5/tax057/4085921} 

^{3. https://pubmed.ncbi.nlm.nih.gov/2192553/} 

^{4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780623/} 

^{5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9485631/} 

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