Diarrhea

Diarrhea is the frequent passage of loose, watery, soft stools with or without abdominal bloating, pressure, and cramps commonly referred to as gas. Diarrhea can come on suddenly, run its course, and be helped with home care to prevent complications such as dehydration.

• Diarrhea is one of the most common illnesses in all age groups and ranks along with the common cold as a main cause of lost days of work or school.
  • People of all ages can suffer from diarrhea, and the average adult has one episode of acute diarrhea per year, and young children average two acute episodes per year.
• Diarrhea and related complications can cause severe illness. The most significant cause of severe illness is loss of water and electrolytes. In diarrhea, fluid passes out of the body before it can be absorbed by the intestines. When the ability to drink fluids fast enough to compensate for the water loss because of diarrhea is impaired, dehydration can result. Most deaths from diarrhea occur in the very young and the elderly whose health may be put at risk from a moderate amount of dehydration.
• Diarrhea can be further defined in the following ways:
• chronic diarrhea is the presence of loose or liquid stools for over two weeks;
• acute enteritis is inflammation of the intestine;
• gastroenteritis (stomach flu) is diarrhea associated with nausea and vomiting; or
• dysentery is diarrhea that contains blood, pus, or mucus.

• Diarrhea Causes

  
  
  The following are the common causes of diarrhea caused by viral infections:Viral infectionscause most cases of diarrhea and are typically associated with mild-to-moderate symptoms with frequent, watery bowel movements, abdominal cramps, and a low-grade fever. Viral diarrhea generally lasts approximately 3 to 7 days.
  
  
  • rotavirus is a common cause of diarrhea in infants;
  • norovirus (for example, Norwalk virus, caliciviruses) is the most common cause of epidemics of diarrhea among adults and schoolage children (for example, cruise ship infection, schools, nursing homes, day care facilities, and restaurants); and
  • adenovirus infections are common in all age groups.
  Bacterial infections cause the more serious cases of diarrhea. Typically, infection with bacteria occurs from contaminated food or drinks (foodpoisoning). Bacterial infections also cause severe symptoms, often with vomiting, fever, and severe abdominal cramps or abdominal pain. Bowel movements occur frequently and may be watery.
  The following are examples of diarrhea caused by bacterial infections: 
  • In more serious cases, the stool may contain mucus, pus, or blood. Most of these infections are associated with local outbreaks of disease. Family members or others eating the same food may have similar illnesses.
  • Foreign travel is a common way for a person to contract traveler's diarrhea.
  • Campylobacter, salmonellae, and shigella organisms are the most common causes of bacterial diarrhea.
  • Less common causes are Escherichia coli (commonly called E coli)Yersinia, and listeria.
  • Use of antibiotics can lead to an overgrowth of Clostridium difficile (C diff) bacteria in the intestines.
  Parasites cause infection of the digestive system by the use of contaminated water. Common parasitic causes of diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
  Intestinal disorders or diseases including inflammatory bowel disease, irritable bowel syndrome (IBS), diverticulitis, microscopic colitis, and celiac disease can cause diarrhea.
  Reaction to certain medications can cause diarrhea. Common medications include antibiotics, blood pressure medications, cancer drugs,gout medications, weight loss drugs, and antacids (especially those containing magnesium).
  Intolerance to foods such as artificial sweeteners and lactose (the sugar found in milk) can cause diarrhea.

• Diarrhea Symptoms
• Watery, liquid stools: The stools may be any color. The passage of red stools suggests intestinal bleeding and could be a sign of a more severe infection. The passage of thick, tarry black stools suggests significant bleeding in the stomach or upper portions of the intestine and is not usually caused by acute infections.
• Abdominal cramps: Occasionally diarrhea is accompanied with mild-to-moderate abdominal pain. Severe abdominal or stomach pain is not common and, if present, may suggest more severe disease.
• Fever: A high fever is not common. If present, the affected person may have a more severe illness than acute diarrhea.
• Dehydration: If diarrhea leads to dehydration, it is a sign of potentially serious disease.
• Signs and symptoms of dehydration include:
• Adults may be very thirsty and have a dry mouth.
• The skin of older people may appear to be loose. The elderly may also become very sleepy or have behavioral changes and confusion when dehydrated.
• Dehydrated infants and children may have sunken eyes, dry mouths, and urinate less frequently than usual. They may appear very sleepy or may refuse to eat or drink.

• When to Seek Medical Care

  Diarrhea can usually be treated with home care. In some cases, it may become more severe. A person should go to a hospitalemergency department in the following situations:
  • if the person has diarrhea along with high fever, moderate-to-severe abdominal pain, or dehydration that cannot be managed by drinking fluids;
  • if the diarrhea appears to contain blood (it may be bright red or may look like black, thick tar); or
  • if the person is sleepy and is not acting like their usual selves (others may notice this and take the person to the emergency department).
  Call a health care professional if a person has any of these complications:
  • vomiting and inability to tolerate any food or drink;
  • signs of dehydration;
  • high fever, significant abdominal pain, frequent loose bowel movements, or bloody diarrhea;
  • if he or she is elderly or has serious underlying medical problems, particularly diabetes, heart, kidney, or liver disease, or HIV or AIDS (contact a health care professional when diarrhea first begins as the person may be at higher risk for developing complications);
  • a parent or caregiver needs advice about preventing dehydration in newborns and infants;
  • symptoms do not improve in two to three days or appear to become worse; or
  • if he or she develops diarrhea after travel within their home country, or foreign travel.
  
  

• Diarrhea Diagnosis

  In healthy people with diarrhea, and who appear well otherwise, the health care professional may elect to do no tests at all. Stool cultures (when a sample of the stool is taken and examined in the lab for certain bacteria or parasites) are not usually necessary unless there is high fever, blood in the stool, recent travel, or prolonged disease.

  • In some cases, the health care professional may send a sample of the stool (or sometimes a cotton swab from the patient's rectum) to the laboratory to evaluate if the cause of diarrhea can be determined (such as certain bacteria or parasites present in the body). It usually takes approximately one to two days for the results of these tests.
  • Blood tests are sometimes necessary for patients with other medical problems or with severe disease.
  • A colonoscopy is an endoscope procedure that allows the physician to view the entire colon to evaluate for infections or structural abnormalities that could cause diarrhea.
  • Imaging tests such as X-rays or CT scans are performed to rule out structural abnormalities as the cause of diarrhea, particularly when pain is a prominent symptom

  
  

• Diarrhea Treatment Acute diarrhea may be treated at home. Diarrhea will generally subside in two to three days without specific medical therapy. 

• Diarrhea Self-Care at Home and Remedies

  Diarrhea Treatment in Adults
  Adults should drink plenty of fluids to avoid dehydration.
  • Replenishing water loss (due to diarrhea) is important. Avoid milk as it can make diarrhea worse. Sports beverages (for example, Gatorade or Powerade) can be beneficial because they replenish electrolytes in addition to providing hydration.
  • If the affected person is able to eat, avoid greasy or fatty foods. Adults, infants, toddlers, and children should be encouraged to follow the "BRAT" diet (bananas, rice, applesauce, and toast). The BRAT diet (diarrhea diet) is a combination of foods used for decades to treat diarrhea. If diarrhea is accompanied by nausea, have the person suck on ice chips until the nausea stops. After the diarrhea subsides, avoid alcoholic beverages and spicy foods for two additional days.
  • Individuals should continue their usual activities if they are mildly ill with diarrhea; however, strenuous exercise should be avoided because exercise increases the risk of dehydration.
  • Pregnant women with diarrhea should make sure to rehydrate to avoid dehydration, and should consult their physician.
  Diarrhea Treatment in Children
  Dehydration in children and toddlers can be a great concern.
• Infants and toddlers pose special problems because of their increased risk of dehydration. They should be offered a bottle frequently. Solutions such as Pedialyte may be more appealing than water. These fluids also contain necessary electrolytes lost with diarrhea. Never use salt tablets as they may worsen diarrhea.
• Children with frequent stools, fever, or vomiting should stay at home and avoid school and day-care until these symptoms go away. This allows the child to rest and recover and prevents other children from being exposed to possible infection.
• As mentioned previously, infants, toddlers, and children should be encouraged to follow the "BRAT" diet (bananas, rice, applesauce, and toast). The BRAT diet (diarrhea diet) is a combination of foods used for decades to treat diarrhea. 

• Diarrhea Medical Treatment

  To replace fluids, the health care professional will often start an IV line if the patient is dehydrated and cannot eat or drink. Solutions administered through IV replace the lost fluids and electrolytes, and often brings quick relief to the patient.
  Antibiotics
  Antibiotics are not effective in diarrhea caused by viruses. Even the more severe diarrhea caused by bacteria will usually go away in a few days without antibiotics. Antibiotics appear to make some bacterial diarrhea worse, specifically those caused by the E coli bacterium (often a source of food poisoning).
  In some cases, antibiotics may benefit some adults with diarrhea. If selected carefully, antibiotics may decrease the severity of illness and shorten the duration of symptoms. If a person has recently traveled to another country or has been camping (and may have been exposed to contaminated water in the wilderness), a health care professional may prescribe specific medication used to treat traveler's diarrhea for certain intestinal parasites.
  Over-the-counter antidiarrheal medications
  The health care professional may recommend using over-the-counter antidiarrheal medications. These drugs, such as loperamide (Imodium) andbismuth subsalicylate (Pepto-Bismol, Kaopectate, etc.) may help some individuals with diarrhea, but should be avoided by others. Antidiarrheal medications are not usually recommended for infants and children with diarrhea.
  Hospitalization
  If a person has severe diarrhea, especially accompanied with dehydration, he or she may require hospitalization to receive IV fluids and to be observed

• Diarrhea Medications

  The use of anti-motility medications, although controversial, does provide relief from diarrhea. These drugs slow down the intestinal movement. These medications include loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate, etc).
  • Such medications are not recommended for infants and children younger than 5 years of age.
  • In otherwise healthy adults who are not severely ill with diarrhea, loperamide is probably safe and is effective in decreasing the number of stools per day and the total duration of the diarrhea.
  • Bismuth subsalicylate is also useful and may be more effective than loperamide when vomiting accompanies the diarrhea.
  • Adults with other serious medical problems and those with severe diarrhea (high fever, abdominal pain, or bloody stool) should see a health care professional before using either medication.
  Electrolyte solutions are available to prevent salt deficiency.
  • Oral electrolyte solutions are available at grocery and drug stores (Pedialyte, Rehydralyte, Naturalyte Solution).
  • Follow label directions, which may specify 1 teaspoonful every 15 minutes. If the child retains the initial doses, increase the dose to 1 tablespoonful every 15 minutes until the diarrhea stops.