Diarrhea is a common problem and it is not an illness but a symptom. It is characterized by increased water content in the stool as well as an increase in frequency. Diarrhea occurs when there is higher secretion of fluids or when the ingested food or water enters the intestine very quickly, preventing proper absorption of fluids. Diarrhea can be acute, usually lasting 1 to 4 weeks, or chronic, when it lasts for more than 4 weeks. It can affect anybody at any age.
Acute diarrhea in adults is not seen as a serious condition since it often disappears without any treatment and usually has no complications. Children and infants are more vulnerable to complications such as dehydration. It is sometimes harder to distinguish if a child has loose stool or diarrhea due to their different patterns of bowel movements. Infant's stool has different consistency: it is usually soft and shapeless, particularly in babies that are breastfed. Therefore, in order to tell if a baby is having diarrhea, it is important to observe and monitor her bowel movement. If a baby defecates more frequently than usual and the stool is more watery, parents should be cautious and aware.
There are many different factors that can cause diarrhea. Lactose intolerance is characterized by sensitivity to food products that contain lactose like milk and other dairy products and frequently results in diarrhea. This may occur temporarily in some children or babies. When an adult, baby or child can't tolerate lactose, it means that their body does not have enough lactase (an enzyme) to breakdown lactose. In babies, teething is also a common cause of mild diarrhea.
Certain parasites and bacteria may cause infection in the intestine. These infectious agents enter our body after ingestion of contaminated water and food. The following are common parasites that can cause diarrhea:
- Giardia lamblia
- Cryptosporidium - normally found in house pets and farm animals and can be spread in different locations especially in a crowded areas like day care centers.
- Entamoeba histolytica
- Shigella (bacteria)
- Escherichia coli (E. Coli - bacteria) – common cause of traveler's diarrhea.
- Campylobacter (bacteria)
- Salmonella (bacteria)
- Clostridium difficile (bacteria) – infection occurs in people who are taking antibiotics and is the most common nosocomial infection which can be acquired in the hospital.
Many medications have diarrhea as a side effect. In many instances, this occurs due to the change of the intestinal flora (“good bacteria”) elicited by these medications. Classes of drugs known to cause diarrhea are: cancer drugs (and radiotherapy); antibiotics (kill both “good” and “bad” bacteria); drugs that contain magnesium like antacids; blood pressure drugs; nonsteroidal anti-inflammatory drugs (NSAIDs) and antiarrhythmic drugs.
Food allergies, food poisoning, laxative or alcohol abuse are conditions known to produce diarrhea. Diarrhea can also result from frequent ingestion of simple carbohydrates such as mannitol and sorbitol found in artificial sweeteners, fruit juice, bubble gums and zero sugar beverages.
Malabsorption, digestive tract surgery and autonomic neuropathy are additional conditions where diarrhea often appears.
- Rotavirus – this is the most common type of virus.
- Norovirus – also known as Norwalk agent.
- Caliciviruses - common cause of epidemic diarrhea in locations such as cruise ships.
- Enteroviruses – specifically coxsackievirus. Infection with this virus usually takes place at some point during the summer.
Watery stool is the symptom that defines diarrhea. Nonetheless, there are many other associated symptoms that may occur concurrently:
- Nausea and vomiting
- Abdominal pain
- Weight loss
- Abdominal cramps
- Frequent defecation
- Fecal incontinence
- Bloody stool or black tarry stool
- Dehydration – in infants and children. Dehydration is dangerous as it can cause death within a few days.
- Pale dry skin
- Dry mouth
- Less urination
- Rapid heart rate
- Infants and children:
- Skin does not go back when pinched.
- Always sleepy
- Does not like to eat or drink.
- Dry mouth
- Sunken eyes
- Sunken abdomen
- Less urination (diaper is not wet within 3 hours)
- Cries with no tears
Examination begins with a questionnaire to the patient or tutor (for babies). It is important to obtain information about medical history, previous medications used, dietary history, recent travel, and a description of the changes in bowel movements and stool appearance. This is normally followed by a physical examination to assess presence of dehydration and pain. There are other diagnostic tests that can be used to confirm the symptoms. These include:
- Stool examination and culture – the doctor will need a sample of the patient's stool. The stool is used to check for presence of bacteria, parasites and other infectious agents.
- Blood test – to check for any infection or other causative agents.
- Computed tomography
- Hydrogen breath test – to check for any abnormal bacterial growth in the intestine and it's indicated for patients who cannot absorb sugar. It is used to determine presence of hydrogen in the breath.
- Colonoscopy - a procedure that allows the doctor to assess the colon. It uses a colonoscope (bendable, long tube with a camera and a light at the end). The doctor inserts the colonoscope gradually into the anus all the way to the colon.
- Esophagogastroduodenoscopy or EGD - a procedure that allows the doctor to assess the esophagus, stomach, and duodenum using an endoscope (slim, bendable tube with a camera and a light at the end).
- Fasting tests – the doctor will instruct the patient not to eat certain foods to determine what causes the diarrhea.
- Barium enema – uses a white liquid with barium to coat the colon in order for doctors to check any anatomical abnormalities. This procedure is done by inserting a catheter in the anus and rectum. Then the white liquid is introduced until it fills up the colon. An X-ray machine is used to capture images of the colon.
Treatment of diarrhea depends on the severity of the condition and on the causative agents. Some people do not need treatment since it goes away in a few days. But patients that need medical help might benefit from one or several treatment options from the many available.
During prolonged diarrhea, the patient might become dehydrated and fluid therapy is recommended to replace what was lost. Intravenous fluid replacement is given to patients who are weak and can no longer drink water or when their stomach is upset. Oral rehydration solutions (ORS) will help restore bodily fluids that are lost as well as rehydrate the patient. They contain electrolytes and glucose and can be given with the proper care to adults (Naturalyte, Rehydralyte or even sport or soft drinks) or infants and children (Pedialyte, Ceralyte, and Infalyte).
Antibiotics should only be administered to patients when the causative agent is a bacterium. They will not work on viruses. Anti-motility medication decreases and slows the movement of the intestine and affect the peristaltic activity of the gastrointestinal tract. Loperamide is the most commonly used drug of this kind and it is also known to be safe and effective.
Absorbent drugs (such as polycarbophil and attapulgite) attach to harmful chemicals produced by bacteria and also absorb fluids in the intestine, thereby reducing the amount of water in the stool. Bismuth compounds neutralize the fluid movements and are particularly effective when there is vomiting.
Infants and children can easily be dehydrated and that is the reason why it is important to rehydrate them as soon as possible. Breastfeeding should be continued during the course of treatment unless vomiting occurs. Particular caution needs to be taken before administering any medication to children; antidiarrheal or antimotility drugs should not be given unless they are recommended by the doctor, because they could cause serious and dangerous complications. For lactose intolerant patients and patients suffering from temporary lactose intolerance associated with the diarrhea, a special lactose free formula, soy milk or a drink that is diluted is recommended. While water might seem an ideal remedy for rehydration, by itself it does not provide energy and electrolytes. A diet consisting in banana, rice, applesauce and toast (BRAT) helps to alleviate diarrhea and at the same time provides energy and electrolytes. If there is nausea, the children may suck ice chips or eat salted crackers. BRAT diet is also applicable to adults.
There are many useful alternative treatments for diarrhea. In particular, probiotics containing live and active bacteria called lactobacillus are an excellent treatment for this condition. These bacteria are similar to the ones found in our digestive tract and help to regenerate the gastrointestinal flora. They protect the body as well as help digest the food. Other treatments such as chamomile tea, acupressure, herbal medicines containing tannins (raspberry, blueberry and blackberry leaves) and aromatherapy help to reduce inflammation, relieve diarrhea and relax your body for a faster recovery.
Don't forget to seek immediate medical help if:
- There is blood in the stool.
- Stool is oily and has a foul smell.
- Diarrhea has not disappeared within 5 days (adults) or 2 days (children).
- Fever is high.
- Infant keeps on vomiting for more than 12 hours.
- Symptoms of dehydration are present.
- There is pain in the abdomen or rectum.
Acute diarrhea can disappear by itself without having any treatment while chronic diarrhea, especially in infants and children who suffer from dehydration, needs immediate medical attention.
In most people, the prognosis of diarrhea is good when it is treated early and there are no severe complications. Prognosis depends on the causative factor underlying the appearance of diarrhea. This may be a symptom of serious or chronic conditions such as Crohn's disease or irritable bowel syndrome.
The prevention of diarrhea is difficult as there are many potential causative agents. Therefore, there are many behaviors that may help in preventing diarrhea from happening or reoccurring:
- Always observe proper hand washing.
- Do not eat unpasteurized dairy products or milk.
- Drink plenty of fluids.
- Eat foods that are rich in probiotics or Lactobacillus.
- Refrigerate leftover foods to avoid bacterial growth.
- Do not eat uncooked meat or fish.
- Avoid eating too much sweet foods.
- Make sure the water is clean before drinking or drink from bottled water.
- Avoid taking antibiotics or other medications without consulting a doctor.
- Avoid eating street foods.
- Have enough sleep and rest.
- Avoid eating greasy foods.
- Lessen or avoid eating foods that are rich in fiber.
- Avoid caffeine.
- Avoid doing strenuous exercise until you feel better because it can increase dehydration.
- Do not abuse laxatives.
- Stop drinking alcohol.
Almost everyone has experienced diarrhea. It is one of the most common conditions in the world. You should gather information regarding your condition as this can help you make decisions on what course of action you must choose. Also, this will make you aware of the possible complications and reduce the risk of leaving it unchecked. Always seek medical help when symptoms persist.
For infants and children, parents should monitor them closely as dehydration can occur during diarrhea. Seek medical help immediately when the diarrhea has not disappeared within 24 hours and symptoms persist.
Diarrhea is a particularly challenging research topic due to its diverse etiology. One of the areas of current research efforts attempts to clarify the pathology and epidemiology of agents that cause diarrhea in large populations. Recent studies have performed large-scale genomic testing of stools from diarrhea patients to determine what agents are responsible and their genetic fingerprint; the effects of virus vaccines are being evaluated in large populations to prevent the occurrence of severe diarrhea; the association between influenza virus and diarrhea is also under study.
New therapeutic options are also being explored for general and infectious diarrhea. On the other hand, the developmental effects of chronic diarrhea are being clarified.