Diarrhea

Diarrhea

Diarrhea-loose, watery stools occurring more than three times in one day--is a common problem that usually lasts a day or two and goes away on its own without any special treatment. However, prolonged diarrhea can be a sign of other problems.

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Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and the elderly, and it must be treated promptly to avoid serious health problems. Dehydration is discussed below.

People of all ages can get diarrhea. The average adult has a bout of diarrhea about four times a year.

What Causes Diarrhea?

Diarrhea may be caused by a temporary problem, like an infection, or a chronic problem, like an intestinal disease. A few of the more common causes of diarrhea are:

• Bacterial infections - Several types of bacteria, consumed through contaminated food or water, can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli.
• Viral infections - Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.
• Food intolerances - Some people are unable to digest a component of food, such as lactose, the sugar found in milk.
• Parasites - Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
• Reaction to medicines, such as antibiotics, blood pressure medications, and antacids containing magnesium.
• Intestinal diseases, like inflammatory bowel disease or celiac disease.
• Functional bowel disorders, such as irritable bowel syndrome, in which the intestines do not work normally.

Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon that can occur after gallbladder surgery.

In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.

People who visit foreign countries are at risk for traveler's diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or, sometimes, parasites. Traveler's diarrhea is a particular problem for people visiting developing countries. Visitors to the United States, Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler's diarrhea.

What Are the Symptoms of Diarrhea?

Diarrhea may be accompanied by cramping abdominal pain, bloating, nausea, or an urgent need to use the bathroom. Depending on the cause, a person may have a fever or bloody stools.

Diarrhea can be either acute or chronic. The acute form, which lasts less than 3 weeks, is usually related to a bacterial, viral, or parasitic infection. Chronic diarrhea lasts more than 3 weeks and is usually related to functional disorders like irritable bowel syndrome or diseases like celiac disease or inflammatory bowel disease.

Diarrhea in Children

Children can have acute (short-term) or chronic (long-term) forms of diarrhea. Causes include bacteria, viruses, parasites, medications, functional disorders, and food sensitivities. Infection with the rotavirus is the most common cause of acute childhood diarrhea. Rotavirus diarrhea usually resolves in 5 to 8 days.

Medications to treat diarrhea in adults can be dangerous to children and should be given only under a doctor's guidance.

Diarrhea can be dangerous in newborns and infants. In small children, severe diarrhea lasting just a day or two can lead to dehydration. Because a child can die from dehydration within a few days, the main treatment for diarrhea in children is rehydration. Rehydration is discussed below.

Take your child to the doctor if any of the following symptoms appear:

• Stools containing blood or pus, or black stools
• Temperature above 101.4 degrees Fahrenheit
• No improvement after 24 hours
• Signs of dehydration (see below)

What Is Dehydration?

General signs of dehydration include:

• Thirst
• Less frequent urination
• Dry skin
• Fatigue
• Light-headedness
• Dark colored urine

If you suspect that you or your child is dehydrated, call the doctor immediately. Severe dehydration may require hospitalization.

When Should a Doctor Be Consulted?

Although usually not harmful, diarrhea can become dangerous or signal a more serious problem.

You should see the doctor if:

• You have diarrhea for more than 3 days.
• You have severe pain in the abdomen or rectum.
• You have a fever of 102 degrees Fahrenheit or higher.
• You see blood in your stool or have black, tarry stools.
• You have signs of dehydration.

If your child has diarrhea, do not hesitate to call the doctor for advice. Diarrhea can be dangerous in children if too much fluid is lost and not replaced quickly.

What Tests Might the Doctor Do?

Diagnostic tests to find the cause of diarrhea include the following:

• Medical history and physical examination - The doctor will need to know about your eating habits and medication use and will examine you for signs of illness.
• Stool culture - Lab technicians analyze a sample of stool to check for bacteria, parasites, or other signs of disease or infection.
• Blood tests - Blood tests can be helpful in ruling out certain diseases.
• Fasting tests - To find out if a food intolerance or allergy is causing the diarrhea, the doctor may ask you to avoid lactose (found in milk products), carbohydrates, wheat, or other foods to see whether the diarrhea responds to a change in diet.
• Sigmoidoscopy - For this test, the doctor uses a special instrument to look at the inside of the rectum and lower part of the colon.
• Colonoscopy - This test is similar to sigmoidoscopy, but the doctor looks at the entire colon.

What Is the Treatment?

In most cases, replacing lost fluid to prevent dehydration is the only treatment necessary. (See "Preventing Dehydration" below.) Medicines that stop diarrhea may be helpful in some cases, but they are not recommended for people whose diarrhea is from a bacterial infection or parasite--stopping the diarrhea traps the organism in the intestines, prolonging the problem. Instead, doctors usually prescribe antibiotics. Viral causes are either treated with medication or left to run their course, depending on the severity and type of the virus.

Preventing Dehydration

Dehydration occurs when the body has lost too much fluid and electrolytes (the salts potassium and sodium). The fluid and electrolytes lost during diarrhea need to be replaced promptly--the body cannot function properly without them. Dehydration is particularly dangerous for children, who can die from it within a matter of days.

Although water is extremely important in preventing dehydration, it does not contain electrolytes. To maintain electrolyte levels, you could have broth or soups, which contain sodium, and fruit juices, soft fruits, or vegetables, which contain potassium.

For children, doctors often recommend a special rehydration solution that contains the nutrients they need. You can buy this solution in the grocery store without a prescription. Examples include Pedialyte, Ceralyte, and Infalyte.

Tips About Food

Until diarrhea subsides, try to avoid milk products and foods that are greasy, high-fiber, or very sweet. These foods tend to aggravate diarrhea.

As you improve, you can add soft, bland foods to your diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. For children, the pediatrician may recommend what is called the BRAT diet: bananas, rice, applesauce, and toast.

Preventing Traveler's Diarrhea

Traveler's diarrhea happens when you consume food or water contaminated with bacteria, viruses, or parasites. You can take the following precautions to prevent traveler's diarrhea when you go abroad:

• Do not drink any tap water, not even when brushing your teeth.
• Do not drink unpasteurized milk or dairy products.
• Do not use ice made from tap water.
• Do not eat raw or rare meat and fish.
• Do not eat meat or shellfish that is not hot when served to you.
• Do not eat food from street vendors.
• Avoid all raw fruits and vegetables (including lettuce and fruit salad) unless they can be peeled and you peel them yourself.

You can safely drink bottled water (if you are the one to break the seal), carbonated soft drinks, and hot drinks like coffee or tea.

Depending on where you are going and how long you are staying, your doctor may recommend that you take antibiotics before leaving to protect you from possible infection.

Points to Remember

• Diarrhea is a common problem that usually resolves on its own.
• Diarrhea is dangerous if a person becomes dehydrated.
• Causes include viral, bacterial, or parasitic infections; food intolerance; reactions to medicine; intestinal diseases; and functional bowel disorders.
• Treatment involves replacing lost fluids and electrolytes. Depending on the cause of the problem, a person might also need medication to stop the diarrhea or treat an infection. Children may need an oral rehydration solution to replace lost fluids and electrolytes.
• Call the doctor if a person with diarrhea has severe pain in the abdomen or rectum, a fever of 102 degrees Fahrenheit or higher, blood in the stool, signs of dehydration, or diarrhea for more than 3 days.

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What is it?

The word diarrhea comes from the Greek word “to flow”. The official definition is a decrease in fecal consistency (loose stools), lasting for four or more weeks.

Why does it happen?

Many disorders have been associated with chronic diarrhea. Multiple medications can be the source of problems. In developing countries, it is usually linked to infections, bacterial or parasitic. Functional disorders, problems absorbing nutrients and inflammatory conditions are also possible causes.

Diarrhea can be grouped into four main categories:

1. Osmotic. Extra water is getting into the colon causing increased bowel movements.
2. Malabsorption. Trouble digesting specific foods leading to diarrhea.
3. Inflammation.
4. Secretory. Certain laxatives, bacterial toxins or other issue causes diarrhea.

Some of the most common causes of chronic diarrhea include:

• Irritable bowel syndrome: This can cause lower abdominal pain and changes in your typical bowel pattern. This change can be diarrhea, constipation or both. It is usually diagnosed as a young adult, but might not show up until you are elderly. Females are more often affected than males and psychological stress can lead to worsening symptoms. This condition can also develop after an infection.
• Inflammatory bowel disease. This is an umbrella term for several different disorders where the body’s immune system attacks the tissue of the GI tract. The most common disorders are Crohn's disease and Ulcerative Colitis.
• Infections. These can develop after travel, after eating contaminated food or water or raw, unpasteurized milk.
• Endocrine problems. Several conditions of the endocrine system can cause diarrhea such as diabetes. A too active thyroid gland can cause chronic diarrhea and weight loss.
• Food allergy or sensitivity.
• Impaired absorption of nutrients from the GI tract. The impairment can be present from birth or developed with other conditions such as Crohn’s disease, celiac or through surgeries. You may have pale, greasy, large volume, foul smelling stools and weight loss. Often people will have mild symptoms.
• Medications. This includes prescription, over-the-counter medicines, herbs, and dietary supplements.
• After gallbladder surgery. In 5-12% of patients after their gallbladder is removed, diarrhea can be present. Typically, it resolves over weeks to months. Normally, bile drains from the liver into the gallbladder, when needed; it will be squeezed into the small intestine. Bile is necessary to help break down and absorb specific nutrients. These bile salts are recycled at the last portion of the small intestine and returned to the liver to be reprocessed for use. After the gallbladder has been removed, bile constantly drains into the small intestine and can overwhelm the ability to reabsorb the bile and some enters the large intestine leading to diarrhea.

Who gets it?

It is thought that 5% of people in developed countries have chronic diarrhea. It is a significant problem and has been estimated to cost more than $350,000,000 a year from work-loss alone.

What are the symptoms?

The stool frequency can range from inconvenient to disabling or even life-threatening because of dehydration.

How is it diagnosed?

A cause of the chronic diarrhea can be identified in more than 90% of patients. Based on your symptoms, and physical examination, your health care provider may order specific tests including:

• Blood tests
• Stool tests
• Imaging of the GI tract may be performed with an x-ray
• Procedures such as a colonoscopy, sigmoidoscopy or upper endoscopy.

How is it treated?

The goal of treatment is to correct the cause, if possible
If the cause can be identified, it will be treated:

• Infections will be treated with antibiotics.
• Inflammatory conditions will be treated with appropriate medicines.
• If a food allergy or intolerance is identified, this specific product will be avoided.
• If dietary ingredients such as a sugar free product or medicine seem to be a cause, these will be eliminated.
• If due to bile entering the colon, a medication can be given to bind the bile.

The symptoms of loose frequent stools can also be treated.

• Bulking agents such as high fiber food or a fiber supplement
• Probiotics such as, Lactobacillus or bifidobacterium
• Antidiarrheal medicines such as, Imodium or Lomotil
• Colon antispasm medications such as hyoscyamine.

What are the complications?

Dehydration: Be sure to drink plenty of liquids. You can gage of how hydrated you are by the color of your urine. It should be a light yellow color. If you are not able to drink enough fluids, you may need to receive fluid and electrolytes through your blood stream with an IV.

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