Diarrhea



Diarrhea


Diarrhea is one of the most common health complaints. It can range from a mild, temporary condition to a potentially life threatening one. Globally, an estimated 2 billion cases of diarrheal disease occur each year.

Diarrhea is loose, watery stools. You have diarrhea if you have loose stools three or more times in one day.


Diarrhea occurs when:

  • There is excessively rapid transit of intestinal contents through the small intestine

  • Decreased enzymatic digestion of foods

  • Decreased absorption of fluid & nutrients

  • Increased secretion of fluid in the GI tract



Different types of diarrhea


There are actually several different ways to classify diarrhea. These types of diarrhea include:

  • Acute diarrhea: The most common, acute diarrhea is loose watery diarrhea that lasts one to two days. This type doesn’t need treatment and it usually goes away after a few days.

  • Persistent diarrhea: This type of diarrhea generally persists for several weeks – two to four weeks

  • Chronic diarrhea: Diarrhea that lasts for more than four weeks or comes and goes regularly over a long period of time is called chronic diarrhea.




Causes


The most common causes of diarrhea include

  • Bacterial infections such as Clostridium difficile, E. coli, Salmonella

  • Viruses such as the flu, norovirus, rotavirus

  • Parasites, tiny organisms found in contaminated food or water

  • Certain medications such as antibiotics, cancer drugs, and antacids that contain magnesium or sorbitol-containing liquid medications

  • Laxative abuse

  • Food intolerances, sensitivities and/or allergies such as lactose intolerance

  • Diseases that affect the stomach, small intestine, or colon, such as Crohn's disease

  • Problems with how the colon functions, such as IBS

  • Post surgeries such as surgical bypass, gastric, intestinal resections or gallbladder removal

  • Certain foods that upset the GI: such as caffeine and alcohol

  • Disease such as hyperthyroidism, Addison’s disease, diabetes, microscopic colitis

  • Running (Some people get “runner’s diarrhea” for reasons that aren’t clear)

  • Cancer-related causes: Neoplastic diarrhea is associated with a number of gut malignancies





Symptoms


  • Cramps or pain in the abdomen

  • An urgent need to use the bathroom

  • Loss of bowel control

  • Nausea

  • Bloating

  • Fever

  • Bloody stools

  • Dehydration


Dehydration can be serious, especially for children, older adults, and people with weakened immune systems.




When to see a health care provider


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


Contact your health care provider if you have:


· Signs of dehydration such as

  • Dark urine

  • Smaller than usual amounts of urine

  • Rapid heart rate

  • Headaches

  • Confusion


· Diarrhea for more than 2 days, if you are an adult. For children, if it lasts more than 24 hours

· Severe pain in your abdomen or rectum

· A fever of 102 degrees or higher or that lasts more than 24 hours

· Stools containing blood or pus

· Stools that are black and tarry

· Nausea or throwing up that prevents you from drinking liquids to replace lost fluids

· Severe abdominal or rectal pain

· Diarrhea after coming back from a foreign country (traveller’s diarrhea)


Diagnosis


To find the cause of diarrhea, your health care provider may:


  • Complete a physical exam and consider your medical history

  • Ask about medications you are taking

  • Request laboratory tests to examine your stool, urine, or blood to look for bacteria, parasites, or other signs of disease or infection

  • Fasting tests to determine whether a food intolerance or allergy is the cause

  • Imaging tests to check for inflammation and structural abnormalities of the intestine

  • Colonoscopy to check the entire colon for signs of intestinal disease

  • Sigmoidoscopy to check the rectum and lower colon for signs of intestinal disease




Prevention


Prevention of diarrhea depends on the underlying cause.

If medications are causing a person to experience diarrhea, an alternative form (i.e. tablet instead of sorbitol-containing liquid) or type of medication should be explored, especially when diarrhea is chronic.

You can help prevent traveler's diarrhea by being careful about what you eat and drink when you are in developing countries:

  • Use only bottled or purified water for drinking, making ice cubes, and brushing your teeth

  • If you do use tap water, boil it or use iodine tablets

  • Make sure that the cooked food you eat is fully cooked and served hot

  • Avoid unwashed or unpeeled raw fruits and vegetables


Treatments


Diarrhea is treated by replacing lost fluids and electrolytes to prevent dehydration. Depending on the cause of the problem, you may need medicines to stop the diarrhea or treat an infection.


In the next blog post we will look at dietary management for diarrhea.