Diarrhea

Diarrhea – Definition

Diarrhea is more than three loose, liquid stools in a single day. It depletes your body of fluids and electrolytes. Diarrhea can be:

• Acute — occurring suddenly and lasting briefly
• Chronic — long-term
• Recurring — coming and going

If you lose too much fluid, you can become dehydrated. Dehydration is especially dangerous for babies, young children, and elderly people.

Diarrhea – Causes

Causes may include:

• Food intolerance, such as lactose intolerance
• Medicines, including:
  • Antibiotics
  • Magnesium-containing antacids
  • High blood pressure medications
  • Quinine
  • Cancer chemotherapy
  • Laxatives
• Irritable bowel syndrome (episodes of diarrhea often alternate with periods of constipation)
• Injury to the bowel after radiation treatments for cancer
• Malabsorption syndromes, such as:
  • Celiac disease
  • Tropical sprue
  • Short bowel syndrome
  • Whipple’s disease
  • Intestinal lymphangiectasia
• Diseases of the pancreas and/or gallbladder
• Inflammatory bowel diseases ( ulcerative colitis, Crohn’s disease)
• Chronic diseases, such as:
  • Liver disease
  • Diabetes
  • Hyperthyroidism
  • Addison’s disease
  • Pellagra
  • Scleroderma
  • Amyloidosis
  • AIDS
  • Colon cancer
• Intestinal surgery
• Infections, including food poisoning, such as:
  • Bacterial: Campylobacter, Clostridium difficile, Salmonella, Shigella, and Escherichia coli
  • Viral: rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis
  • Parasitic: Giardia lamblia, Entamoeba histolytica, Cryptosporidium, tapeworm, roundworm, flukes
  • Fungal: Candida (yeast)

Diarrhea – Risk Factors

Risk factors include:

• Traveling to a developing country where the water and food supply may be contaminated
• Having a severely weakened immune system, such as with AIDS or after an organ transplant
• Taking certain medicines

Diarrhea – Symptoms

Symptoms may include:

• Frequent, loose, liquid stools
• Abdominal pain, cramping
• Urgent need to defecate
• Blood and/or mucus in stool
• Fever
• Dehydration
• Nausea, vomiting
• Muscle aches and pains
• Weight loss
• Malnutrition

Diarrhea – When Should I Call My Doctor?

Call your doctor if you:

• Have diarrhea that lasts longer than three days
• Are not able to eat or drink to stay hydrated
• Have a fever

Call the doctor if your young child:

• Has diarrhea lasting longer than a day
• Has pus in stool
• Is dehydrated (no wet diapers in three hours, dry mouth, crying without tears, skin that stays up after being pinched)
• Is sleepy or irritable
• Has a fever

When Should I Call for Medical Help Immediately?

Call for medical help or go to the emergency room right away if you or your child:

• Has severe abdominal pain and cramping
• Has bloody or black stool

Diarrhea – Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. To determine the cause of your diarrhea, the doctor will ask questions, such as:

• Does anyone else in your family have diarrhea?
• What kinds of food have you eaten recently?
• Do you drink well water?
• Do your children attend daycare?
• Have you traveled recently?
• Do you use laxatives?
• What medicines do you take?
• Do you have any symptoms other than diarrhea (eg, fever, rash, aching joints)?
• What is your sexual history?
• Have you ever had abdominal surgery?

Tests may include:

• Laboratory analysis of a stool sample
• Blood tests
• Fasting or food elimination tests
• Digital rectal exam — examination of the rectum with the doctor’s gloved finger inserted into your rectum
• Flexible sigmoidoscopy — a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon.
• Colonoscopy — a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon
• Biopsy — removal of a sample of colon tissue for testing (may be done as part of a flexible sigmoidoscopy or colonoscopy)
• Upper Gastrointestinal (GI) Series — a series of x-rays of the upper digestive system taken after drinking a barium solution
• Barium enema — insertion of fluid into the rectum that makes the lining of your colon show up on an x-ray

Diarrhea – Treatment

Treating the underlying condition may help to relieve the diarrhea.

General recommendations for treating diarrhea include:

Drink Lots of Fluids

Plain water will not replace the electrolytes lost through diarrhea. For adults and children, look for age specific oral rehydration solutions. Avoid fruit juices and soda. For young children, continue with breastfeeding or formula feeding.

Ask Your Doctor What You Should Eat

Doctors differ in their approach to treating diarrhea. For example, your doctor may recommend that you:

• Drink only clear fluids during severe phases of diarrhea.
• Avoid certain foods, such as: very spicy foods, fatty foods, greasy foods, high-fiber foods, dairy products in large amounts, caffeinated drinks.
• Eat certain foods, such as: complex carbohydrates (eg, pasta, rice), yogurt, fruits and vegetables, lean meats.

Ask your doctor which dietary guidelines you should follow. As your diarrhea subsides, your usual healthy foods can be reintroduced.

Treat Abdominal Pain With Heat

Use a hot water bottle or heating pad on your abdomen to relieve cramps and pain.

Medications

Your doctor may recommend medicines, such as:

• Antidiarrheal medicine (eg, bismuth subsalicylate, loperamide hydrochloride)
• Antibiotics — may be needed if a bacterial infection is causing diarrhea
• Probiotics (eg, Lactobacillus casei, Enterococcus faecium, Saccharomyces boulardii) — may be beneficial in some cases
• Zinc supplementation — may be recommended in some cases

Children should not be given medicine unless specifically recommended by the doctor.

Hospitalization

Diarrhea can cause severe dehydration. You may need to be hospitalized. Fluids will be delivered through an IV.

Diarrhea – Prevention

To reduce your chance of getting diarrhea:

• Practice good handwashing.
• Practice safe food preparation and food storage.
• If you have diarrhea, do not prepare food for others.
• If you are traveling:
  • Drink bottled water.
  • Use bottled water when brushing your teeth.
  • Avoid drinks that contain ice.
  • Do not eat food purchased from street vendors.
  • Do not eat raw vegetables or fruits. (All produce should be peeled and/or cooked.)
  • Make sure meats are cooked thoroughly.
  • Eat only pasteurized dairy products.
  • If you eat seafood, make sure it is very hot.

Rotavirus is a common cause of diarrhea in children under five years of age. There is a vaccine to prevent rotavirus. The first dose is given at age two months. Make sure your infant has received this vaccine.