Diarrhea is one of the most common complaints about health. This can range from mild, temporary, to potentially life-threatening condition.
Globally, an estimated 2 billion cases of diarrheal disease occur per year, and 1.9 million children under the age of 5 years die from diarrhea, mainly in developing countries.
Diarrhea involves abnormally loose or watery stools.
Many people move stools daily but they are of normal quality. This is not for diarrhea. Similarly, babies that are breastfed sometimes go over loose, pasty stools. This is perfectly normal. It’s not diarrhea.
Fast facts on diarrhea
Here are some of the key points on diarrhea. The body of this article includes more specifics and supporting information.
- Most cases of diarrhea are caused by bacteria, viruses, or parasites
- Inflammatory bowel diseases (IBD) including Crohn’s disease and ulcerative colitis can cause chronic diarrhea
- Antidiarrheal medications can reduce diarrheal output and zinc supplement is effective in children
- Some nutritional and probiotic interventions may help prevent diarrhea
Causes
Most diarrhoea cases are caused by a gastrointestinal tract infection. The causative microbes for this infection include:
- bacteria
- viruses
- parasitic organisms
In the United States, the most commonly identified causes of acute diarrhea are the Salmonella, Campylobacter, Shigella, and Escherichia coli bacteria that produce shiga toxin.
Some cases of chronic diarrhea are called “functional,” because it is impossible to find a clear cause. Irritable bowel syndrome (IBS) is the most frequent cause of functional diarrhea in the developed world.
IBS is symptom complex. Abdominal pain cramps and altered bowel habits, including diarrhea, constipation, or both.
A further cause of chronic diarrhea is inflammatory bowel disease (IBD). It is a term used either to describe ulcerative colitis or Crohn’s disease. In both cases, blood also lies in the stool.
Other major causes of chronic diarrhea include:
- Microscopic colitis: This is a persistent diarrhea that usually affects older adults, often during the night.
- Malabsorptive and maldigestive diarrhea: The first is caused by impaired nutrient absorption, the second by impaired digestive function. Celiac disease is one example.
- Chronic infections: A history of travel or antibiotic use can be clues to chronic diarrhea. Various bacteria and parasites can be the cause.
- Drug-induced diarrhea: Laxatives and other drugs, including antibiotics, can trigger diarrhea.
- Endocrine causes: Sometimes hormonal factors cause diarrhea, for example, in the case of Addison disease and carcinoid tumors.
- Cancer causes: Neoplastic diarrhea is associated with a number of gut cancers.
Treatment
Mild cases of acute diarrhea may resolve untreated. Persistent or chronic diarrhea will be diagnosed and any underlying causes, in addition to the diarrhea symptoms, will be handled.
Dehydration
For all cases of diarrhea, rehydration is key:
- Fluids can be replaced by simply drinking more fluids, or they can be received intravenously in severe cases. Children and older people are more vulnerable to dehydration.
- Oral rehydration solution or salts (ORS) refers to water that contains salt and glucose. It is absorbed by the small intestine to replace the water and electrolytes lost in the stool. In developing countries, ORS costs just a few cents. The World Health Organization (WHO) says ORS can safely and effectively treat over 90 percent of non-severe diarrhea cases.
- Oral rehydration products, such as Oralyte and Rehydralyte, are available commercially. Zinc supplementation may reduce the severity and duration of diarrhea in children.
Antidiarrheal medication
Over-the-counter (OTC) antidiarrheal medicines are also available:
- Loperamide, or Imodium, is an antimotility drug that reduces stool passage. Loperamide and Imodium are both available to purchase over-the-counter or online.
- Bismuth subsalicylate, for example, Pepto-Bismol, reduces diarrheal stool output in adults and children. It can also be used to prevent traveler’s diarrhea.
There is some concern that antidiarrheal medicines could prolong bacterial infection by reducing pathogens removal via stools.
Antibiotics
Antibiotics are used only to treat diarrhea that is caused by a bacterial infection. If the cause is a certain drug, it could be possible to switch to another medicine.
Diet
Nutritionists from Stanford Health Care offer some nutritional tips for diarrhea:
- Sip on clear, still liquids such as fruit juice without added sugar.
- After each loose stool, replace lost fluids with at least one cup of liquid.
- Do most of the drinking between, not during meals.
- Consume high-potassium foods and liquids, such as diluted fruit juices, potatoes without the skin, and bananas.
- Consume high-sodium foods and liquids, such as broths, soups, sports drinks, and salted crackers.
Other advice from the nutritionists is to:
- eat foods high in soluble fiber, such as banana, oatmeal and rice, as these help thicken the stool
- limit foods that may make diarrhea worse, such as creamy, fried, and sugary foods
Foods and drinks that might make the diarrhea worse include:
- sugar-free gum, mints, sweet cherries, and prunes
- caffeinated drinks and medication
- fructose in high amounts, from fruit juices, grapes, honey, dates, nuts, figs, soft drinks, and prunes
- lactose in dairy products
- magnesium
- olestra, or Olean, a fat substitute
Probiotics
Mixed evidence exists as to the role of probiotics in diarrhea. They can help prevent diarrhea for travelers. There is evidence in children that they could reduce diarrheal disease by 1 day.
The use of probiotics that minimize antibiotic-associated diarrhea, as may Clostridium difficile-related diarrhea, though the evidence is mixed.
People should seek advice from their doctor, since there are many strains. Probiotics focused on Lactobacillus rhamnosus and Saccharomyces boulardii are the strain most studied for antibiotic-associated diarrhoa.
In a trial published in The Lancet, probiotics were investigated for helping with Clostridium difficile and antibiotic diarrheas. They found no evidence that bacteria’s multi-strain preparation was effective in preventing these conditions, calling for a better understanding of the antibiotic-associated diarrhea growth.
Probiotics are sold in capsules, tablets, liquids, and powders.
Symptoms
Diarrhea refers to watery stools, but it may be accompanied by other symptoms.
These include:
- stomach pain
- abdominal cramps
- bloating
- thirst
- weight loss
- fever
Diarrhea is a symptom of other conditions, some of which can be serious.
Other possible symptoms are:
- blood or pus in the stools
- persistent vomiting
- dehydration
If these accompany diarrhea, or if the diarrhea is chronic, it may indicate a more serious illness.
Complications
Two potentially serious complications of diarrhea are:
- dehydration, with acute or chronic diarrhea
- malabsorption, with chronic diarrhea
Diarrhea can also be a symptom of a vast array of chronic underlying conditions. Treatment of these disorders must be treated to avoid further complications.
Tests and diagnosis
The doctor will inquire about the symptoms and any current medications, previous history of medicine and other medical conditions.
They will also ask:
- when the problem started
- how frequent the stools are
- whether blood is present in the stool
- whether there has been vomiting
- whether the stools are watery, mucus- or pus-filled, and how much stool there is
The health care provider will also look for signs of dehydration.
Severe dehydration can be fatal unless urgent treatment is given with rehydration therapy.
Tests for diarrhea
Most diarrhea cases resolve without treatment and sometimes a doctor will be able to diagnose the problem without tests.
However, a stool test may be needed in more serious cases, especially where the patient is very young or old.
Additional testing may also be recommended for patient:
- has signs of fever or dehydration
- has stools with blood or pus
- has severe pain
- has low blood pressure
- has a weakened immune system
- has recently traveled to places outside Western Europe, North America, Australia, and New Zealand
- has recently received antibiotics or been in hospital
- has diarrhea persisting for more than 1 week
If an patient has chronic or recurrent diarrhea, the doctor will order tests based on the possible underlying cause.
These may include the following investigations:
- Full blood count: Anemia or a raised platelet count will suggest inflammation.
- Liver function tests: This will include testing albumin levels.
- Tests for malabsorption: These will check the absorption of calcium, vitamin B-12, and folate. They will also assess iron status and thyroid function.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Raised levels may indicate inflammatory bowel disease (IBD).
- Testing for antibodies: This may detect celiac disease.
When to see a doctor
Diarrhea sometimes recovers without medical specialist care, but it is sometimes important to seek the aid of a doctor.
Children under the age of 1 should see a doctor if they have had 6 diarrhoea bouts or 3 vomiting bouts within 24 hours.
Children over 1 year should see a doctor if they have had 6 or more episodes of diarrhea in 24 hours, or if there is severe diarrhea and vomiting.
In the following cases it’s important to seek medical help:
- persistent vomiting
- persistent diarrhea
- dehydration
- significant weight loss
- pus in the stool
- blood in the stool, which may turn the stool black
Anyone who has diarrhea following surgery, after spending time in hospital, or after using antibiotics should seek medical assistance.
Adults whose diarrhea persistently disturbs their sleep may be able to get help to solve this problem.
Prevention
Dirty prevention may be more difficult in developing countries, due to dirty water and poor sanitation.
The following can help prevent diarrhea:
- clean and safe drinking water
- good sanitation systems, for example, waste water and sewage
- good hygiene practices, including handwashing with soap after defecation, after cleaning a child who has defecated, after disposing of a child’s stool, before preparing food, and before eating
- breastfeeding for the first 6 months of life
- education on the spread of infection
There is evidence that public health measures to promote hand-washing can reduce diarrhea levels by about one-third.
