Diarrhea


Diarrhea: Causes, Prevention and Treatment

Diarrhea, also spelled diarrhoea, is the condition of having at least three loose or liquid bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are breastfed, however, may be normal.

Diarrhea is an increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool). Although changes in frequency of bowel movements and looseness of stools can vary independently of each other, changes often occur in both.

Diarrhea needs to be distinguished from four other conditions. Although these conditions may accompany diarrhea, they often have different causes and different treatments than diarrhea. These other conditions are:

  1. Incontinence of stool, which is the inability to control (delay) bowel movements until an appropriate time, for example, until one can get to the toilet
  2. Rectal urgency, which is a sudden urge to have a bowel movement that is so strong that if a toilet is not immediately available there will be incontinence
  3. Incomplete evacuation, which is a sensation that another bowel movement is necessary soon after a bowel movement, yet there is difficulty passing further stool the second time
  4. Bowel movements immediately after eating a meal

Diarrhea facts

  • Diarrhea is an increase in the frequency of bowel movements, an increase in the looseness of stool or both.
  • Diarrhea is caused by increased secretion of fluid into the intestine, reduced absorption of fluid from the intestine or rapid passage of stool through the intestine.
  • Symptoms associated with diarrhea include abdominal pain, especially cramping. Other symptoms depend on the cause of the diarrhea.
  • Diarrhea can be defined absolutely or relatively. Absolute diarrhea is defined as more than five bowel movements a day or liquid stools. Relative diarrhea is defined as an increase in the number of bowel movements per day or an increase in the looseness of stools compared with an individual’s usual bowel habit.
  • Diarrhea may be either acute or chronic, and each has different causes and treatments.
  • Complications of diarrhea include dehydration, electrolyte (mineral) abnormalities, and irritation of the anus.
  • Tests that are useful in the evaluation of acute diarrhea include examination of stool for white blood cells or enzymes that they produce, parasites, cultures of stool for bacteria, testing of stool for the toxins of C. difficile, and blood tests for electrolyte abnormalities.
  • Tests that are useful in the evaluation of chronic diarrhea include examination of stool for parasites, upper gastrointestinal X-rays (UGI series), barium enema, esophago-gastro-duodenoscopy (EGD) with biopsies, colonoscopy with biopsies, small intestinal endoscopy, hydrogen breath testing, measurement of fat in the stool, and pancreatic function tests.
  • Dehydration can be treated at home with home remedies, oral rehydration solutions.
  • Absorbents (that absorb water in the intestine), anti-motility medications, bismuth compounds, and IV fluids if necessary.
  • Antibiotics should not be used in treating diarrhea unless there is a culture-proven bacterial infection that requires antibiotics, severe diarrhea that is likely to be infectious in origin, or when an individual has serious underlying diseases.

Diarrhea Causes

About DiarrheaDiarrhea is characterized by loose, watery stools or a frequent need to have a bowel movement. It usually lasts a few days and often disappears without any treatment. Diarrhea can be acute or chronic. Acute diarrhea occurs when the condition lasts for one to two days. You might experience diarrhea as a result of a viral or bacterial infection. Other times, it could be due to food poisoning. There’s even a condition known as traveler’s diarrhea, which happens when you have diarrhea after being exposed to bacteria or parasites while on vacation in a developing nation. Acute diarrhea is fairly common.Chronic diarrhea refers to diarrhea that lasts for at least four weeks. It’s usually the result of an intestinal disease or disorder, such as celiac disease or Crohn’s disease.

You may experience diarrhea as a result of a number of conditions or circumstances. Potential causes of diarrhea include:

  • a food intolerance, such as lactose intolerance
  • a food allergy
  • an adverse reaction to a medication
  • a viral infection
  • a bacterial infection
  • an intestinal disease
  • a parasitic infection
  • gallbladder or stomach surgery

Diarrhea is also a common side effect of diarrhea.

Chronic diarrhea may be a symptom of a more serious condition such as irritable bowel syndrome or inflammatory bowel disease. Frequent and severe diarrhea could be a sign of intestinal disease or a functional bowel disorder.

The most common causes of Diarrhea

Sanitation

Open defecation is a leading cause of infectious diarrhea leading to death.

Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. “Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste (sanitation), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea… Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care.

Water

One of the most common causes of infectious diarrhea, is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human pathogens.

Nutrition

Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency, a condition often found in children in developing countries can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can cause an increase in the severity of diarrhea episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, others suggest an increase in the rate associated with deficiency.

Medications

Some medications, such as the penicillum can cause diarrhea. Over 700 medications are known to cause diarrhea. The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements.

Diarrhea Treatment

The treatment for diarrhea usually requires replacing lost fluids. This simply means you need to drink more water or electrolyte replacement beverages, such as sports drinks. In more serious cases, you may get fluids through intravenous therapy. If a bacterial infection is the cause of your diarrhea, your doctor may prescribe antibiotics.

Your doctor will decide your treatment based on:

  • the severity of the diarrhea and related condition
  • the frequency of the diarrhea and related condition
  • the degree of your dehydration status
  • your health
  • your medical history
  • your age
  • your ability to tolerate different procedures or medications
  • expectations for improvement of your condition

Most cases of diarrhea clear on their own within a couple of days without treatment. If you’ve tried lifestyle changes and home remedies for diarrhea without success, your doctor might recommend medications or other treatments.

Antibiotics

Antibiotics might help treat diarrhea caused by bacteria or parasites. If a virus is causing your diarrhea, antibiotics won’t help.

Treatment to replace fluids

Your doctor likely will advise you to replace the fluids and salts. For most adults, that means drinking water, juice or broth. If drinking liquids upsets your stomach or causes diarrhea, your doctor might recommend getting fluids through a vein in your arm (intravenously).

Water is a good way to replace fluids, but it doesn’t contain the salts and electrolytes — minerals such as sodium and potassium — you need to maintain the electric currents that keep your heart beating. You can help maintain your electrolyte levels by drinking fruit juices for potassium or eating soups for sodium. Certain fruit juices, such as apple juice, might make diarrhea worse.

For children, ask your doctor about using an oral rehydration solution, such as Pedialyte, to prevent dehydration or replace lost fluids.

Adjusting medications you’re taking

If your doctor determines that an antibiotic caused your diarrhea, your doctor might lower your dose or switch to another medication.

Treating underlying conditions

If your diarrhea is caused by a more serious condition, such as inflammatory bowel disease, your doctor will work to control that condition. You might be referred to a specialist, such as a gastroenterologist, who can help devise a treatment plan for you.

Prevent Diarrhea

Though some types of diarrhea, such as those due to other medical conditions, are unavoidable, infectious diarrhea can be prevented.

The most important way to avoid diarrhea is to avoid coming into contact with infectious agents that can cause it. This means that good hand washing and hygiene are very important.

Also, if you travel to developing countries, you should take the following precautions:

  • Drink only bottled water, even for tooth brushing.
  • Avoid eating food from street vendors.
  • Avoid ice made with tap water.
  • Eat only those fruits or vegetables that are cooked or can be peeled.
  • Be sure that all foods you eat are thoroughly cooked and served steaming hot.
  • Never eat raw or undercooked meat or seafood.
  • Obtain a hepatitis A vaccination prior to travel, if indicated for that region.
Reviewed by the QSota Medical Advisory Board