diarrhea

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is spelt in this way in British English and diarrhea in American English.

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For more information on diarrhea, visit Britannica.com.

Key Terms: Defecation, Dehydration, Electrolytes.

Description

Diarrhea is the abnormal increase of liquid in stool and increase in the frequency of passing stool (defecation). The person with diarrhea has watery or loose stool more than three times a day. Other symptoms include cramping, pain, feeling the urge to defecate, irritation of the skin around the anus (perianal), and inability to control defecation (fecal incontinence). Approximately 10% of the patients with advanced cancer suffer from diarrhea. Diarrhea lasting fewer than two weeks is called "acute diarrhea," and diarrhea lasting for longer than two months is called "chronic diarrhea."

Diarrhea is a debilitating condition that can significantly affect quality of life. Diarrhea can prevent patients from participating in social activities and going to work. Persons with diarrhea fear soiling their clothing or bed linens, a fear that prevents them from leaving home. Loss of sleep due to nighttime diarrhea can cause fatigue, which ultimately affects the patient's ability to function normally. Uncontrolled diarrhea can lead to chemical imbalances, loss of fluids (dehydration), and even death.

Causes

Although there are many causes of diarrhea, only those associated with cancer will be discussed. The most common cause of diarrhea in cancer patients is related to constipation or its treatment. Cancer patients may experience diarrhea as a result of their treatment, or it can be due to dietary changes, infections, hormone imbalances, digestion disorders, or inflammation. Treatment-related diarrhea can be caused by chemotherapy, hormone therapy, radiation therapy, biological response modifiers (drugs that improve the patient's immune system), or surgery. In addition, cancer patients may develop temporary lactose intolerance, which causes diarrhea.

Chemotherapy drugs kill the rapidly growing cancer cells. However, certain normal cells of the body are rapidly growing and they too are affected. Rapidly growing cells are found in the intestines, as well as other parts of the body. Diarrhea occurs as a result of injury to the cells of the intestine. These effects are temporary. Chemotherapy drugs, hormones, and biological response modifiers that frequently cause diarrhea include:

• Dactinomycin
• Daunorubicin
• Diethylstilbestrol diphosphate
• Doxorubicin
• Fluorouracil
• Flutamide
• Hydroxyurea
• Interferon
• Interleukin-2 (aldesleukin)
• Irinotecan
• Methotrexate
• Nitrosoureas
• Thioguanine

Radiation therapy can cause diarrhea if the intestines are in the treatment field. Diarrhea results from the injury and destruction of the cells lining the intestines, which leads to a decrease in the uptake (absorption) of fluids and an increase in the speed with which stool moves through the intestines. Radiation therapy can cause diarrhea, and other intestinal problems, many months or years after treatment has been completed.

Diarrhea usually develops within one week following pretreatment (chemotherapy and irradiation) for bone marrow transplantation. This diarrhea usually disappears within two weeks. Also, bone marrow transplant patients with graft-versus-host disease develop severe diarrhea.

Treatments

Prevention

There are some measures that can prevent diarrhea. Patients who are receiving abdominal radiation therapy can be put into certain positions to minimize exposure of healthy intestines to radiation. Diarrhea caused by chemotherapy cannot be prevented; however, the administration of atropine during treatment with irinotecan may prevent diarrhea. Patients should stop taking dietary supplements, as these can cause diarrhea.

There are many dietary changes that can be made to prevent or reduce diarrhea. Foods to avoid include:

• whole grain breads and cereals
• fresh or frozen fruits (except banana)
• dried fruits
• fruit juices with pulp and prune juice
• raw vegetables
• canned onions, corn, olives, pickles, and Brussels sprouts
• fatty foods
• dried beans
• rich desserts
• milk and milk products
• alcohol and caffeinated coffee and tea
• spicy foods
• fried foods

Management

Of the utmost importance in the treatment of diarrhea is the replacement of fluids lost by frequent, watery stools. The patient should drink six to eight glasses of fluid daily, including clear broth, ginger ale (without the fizz), water, weak tea, and commercial formulas that contain sugars and minerals (electrolytes). Patients with severe diarrhea may need intravenous fluid replacement either at home or in the hospital.

Diarrhea can cause the perianal skin to become irritated and painful; therefore, it needs to be cleaned thoroughly after each bout of diarrhea. Baby wipes or a mild soap with water can be used to clean the irritated skin. The area should be patted dry and occasionally exposed to air. Taking a sitz bath (sitting in a bathtub of shallow water) with lukewarm water may relieve the discomfort. Petroleum jelly or other type of barrier cream may be used.

The patient should eat small, frequent meals. Foods and drinks should be taken at room temperature. Foods that can help control diarrhea include:

• bananas
• applesauce
• boiled white rice
• tapioca
• white bread
• plain pasta
• creamed cereals
• eggs
• potatoes (without skin; mashed or baked)
• fish
• chicken or turkey (without skin)

There are some medications that can slow down the movement of stool through the intestines and increase intestinal water absorption. The patient may need a combination of drugs and/or dose adjustments to achieve relief. A physician should be consulted before any over-the-counter antidiarrheal medications are taken. Anti-diarrheal medications include:

• Atropine sulfate with diphenoxylate HCl (Lomotil)
• Codeine phosphate
• Loperimide HCl (Imodium-AD)
• Octreotide phosphate (Sandostatin)

These medications should not be used if infection as the cause of diarrhea has not been eliminated.

Patients who are experiencing diarrhea due to graft-versus-host disease will continue to take their immunosuppressant drugs. They may also be treated with corticosteroids and antidiarrheal medications.

Alternative and Complementary Therapies

Peppermint tea, chamomile tea, valerian capsules, or aloe vera juice may reduce cramping and intestinal spasms. An Ayurvedic physician may recommend taking equal parts of yogurt and water with fresh ginger, or a powder of beleric myrobalan fruit. Ginger capsules may relieve intestinal spasms and pain. Glutamine supplements may speed up the healing process and relieve irritated intestines.

Resources

Books

Lenhard, Raymond E, Robert T. Osteen, and Ted Gansler. Clinical Oncology. American Cancer Society, 2000.

Maleskey, Gale. Nature's Medicines: from Asthma to Weight Gain, from Colds to High Cholesterol—The Most Powerful All-Natural Cures. Emmaus, PA: Rodale Press, Inc., 1999.

Yarbro, Connie Henke, Margaret Hansen Frogge, and Michelle Goodman, editors. Cancer Symptom Management. 2nd ed. Sudbury, MA: Jones and Bartlett Publishers, 1999.

Yarbro, Connie Henke, Michelle Goodman, Margaret Hansen Frogge, and Susan L. Groenwald, editors. Cancer Nursing, Principles and Practice. 5th ed. Sudbury, MA: Jones and Bartlett Publishers, 2000.

Periodicals

Kornblau, Steven, Al B. Benson III, Robert Catalano, Richard E. Champlin, Constance Engelking, et al. "Management of Cancer Treatment—Related Diarrhea: Issues and therapeutic Strategies." Journal of Pain and Symptom Management 19, no. 2 (February 2000): 118-127.

Other

"What About Diarrhea?" American Cancer Society, Inc. 2000. [cited July 1, 2001]. .

—Belinda Rowland, Ph.D.

The passage of loose or watery stools, usually at more frequent than normal intervals. Diarrhea is a symptom of many diseases and may be accompanied by nausea, vomiting, griping, tenesmus, and other general or specific indications of a disease.

The more common specific disorders which may produce diarrhea include intestinal infections, such as dysentery, cholera, typhoid fever, food poisonings, and parasitic infestations; food sensitivities; drug and chemical irritation; and vitamin deficiency states.

Emotional and psychic disturbances frequently produce diarrhea and other visceral derangements. The poorly understood entities of regional enteritis and ulcerative colitis are perhaps related to these disturbances, as are other psychosomatic disorders.

Diarrhea is a common symptom in gastrointestinal obstruction or in inflammations from local infections or tumor invasion. See also Bacillary dysentery; Food poisoning; Medical parasitology.

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n

Definition: loose bowels
Antonyms: constipation

Definition

To most individuals, diarrhea means an increased frequency or decreased consistency of bowel movements; however, the medical definition is more exact than this. Diarrhea best correlates with an increase in stool weight; this increase is mainly due to excess water, which normally makes up 60 to 85 percent of fecal matter. In this way, true diarrhea is distinguished from diseases that cause only an increase in the number of bowel movements (hyperdefecation) or incontinence (involuntary loss of bowel contents).

Diarrhea is also classified by physicians as acute, which lasts one to two weeks, and as chronic, which continues for longer than two or three weeks. Viral and bacterial infections are the most common causes of acute diarrhea.

Description

In many cases, acute infectious diarrhea is a mild, limited annoyance common to adults and children. Chronic diarrhea, though, can have considerable effect on health and on social and economic well-being. People with celiac disease, inflammatory bowel disease, and other prolonged diarrheal illnesses develop nutritional deficiencies that diminish growth and immunity. They affect social interaction and result in the loss of many working hours. Rapid diagnosis and proper treatment can prevent much of the suffering associated with these illnesses.

Demographics

Worldwide, acute infectious diarrhea has a huge impact, causing over 5 million deaths per year. While most deaths are among children under five years of age in developing nations, the impact, even in developed countries, is considerable. For example, over 250,000 individuals are admitted to hospitals in the United States each year because of one of these episodes.

Causes and Symptoms

Diarrhea occurs because more fluid passes through the large intestine (colon) than that organ can absorb. As a rule, the colon can absorb several times more fluid than is required on a daily basis. However, when this reserve capacity is overwhelmed, diarrhea occurs.

Diarrhea is caused by infections or illnesses that either lead to excess production of fluids or prevent absorption of fluids. Also, certain substances in the colon, such as fats and bile acids, can interfere with water absorption and cause diarrhea. Rapid passage of material through the colon can also do the same.

Symptoms related to any diarrheal illness are often those associated with any injury to the gastrointestinal tract, such as fever, nausea, vomiting, and abdominal pain. All or none of these may be present depending on the disease causing the diarrhea. The number of bowel movements can vary—up to 20 or more per day. In some persons, blood or pus is present in the stool. Bowel movements may be difficult to flush (float) or contain undigested food material.

The most common causes of acute diarrhea are infections (the cause of traveler's diarrhea), food poisoning, and medications. Medications are a frequent and often over-looked cause, especially antibiotics and antacids. Less often, various sugar-free foods, which sometimes contain poorly absorbable materials, cause diarrhea.

Chronic diarrhea is frequently due to many of the same things that cause the shorter episodes (infections, medications, etc.); however, symptoms last longer. Some infections can become chronic. This occurs mainly with parasitic infections (such as Giardia) or when people have altered immunity (such as AIDS). In children, more common causes of chronic diarrhea are food allergy and lactose intolerance. Toddlers who drink too much juice can have frequent, loose stools.

When to Call the Doctor

A physician or other healthcare provider should be contacted when the number of bowel movements exceeds three per day for 2 days or more or when fecal material contains blood. A doctor should be called if a person becomes dehydrated. Signs of dehydration include decreased urination, lethargy, poor skin tone, and generalized weakness. In very young children, the parents should call a doctor if they observe these symptoms of dehydration:

• dry mouth or tongue
• few or no tears when crying
• no wet diapers for three hours or more
• sunken eyes, cheeks, and fontanel (soft spot on the head of infants)
• irritability and listlessness
• skin that flattens slowly when pinched

Parents should also call the doctor if a child is vomiting so often that he or she cannot keep fluids down, has a high fever, complains of severe abdominal pain, or shows no improvement in symptoms after 24 hours.

Diagnosis

Most cases of acute diarrhea never need diagnosis or treatment, as many are mild and produce few problems. But persons of any age with fever over 102°F (38.9°C), signs of dehydration, bloody bowel movements, severe abdominal pain, known immune disease, or prior use of antibiotics need prompt medical evaluation.

When diagnostic studies are needed, the most useful are stool culture and examination for parasites; however, these are often negative, and a cause cannot be found in a large number of people. The earlier cultures are performed, the greater the chance of obtaining a positive result. For those with a history of antibiotic use in the preceding two months, stool samples need to be examined for the toxins that cause antibiotic-associated colitis. Tests are also available to check stool samples for microscopic amounts of blood and for cells that indicate severe inflammation of the colon. Examination with an endoscope is sometimes helpful in determining severity and extent of inflammation. Tests to check changes in blood chemistry (potassium, magnesium, etc.) and a complete blood count (CBC) are also often performed.

Chronic diarrhea is quite different, and most persons with this condition receive some degree of testing. Many exams are the same as for an acute episode, as some infections and parasites cause both types of diarrhea. A careful history to evaluate medication use, dietary changes, family history of illnesses, and other symptoms is necessary. Key points in determining the seriousness of symptoms are weight loss of over 10 lbs (4.5 kg), blood in the stool, and nocturnal diarrhea (symptoms that awaken an individual from sleep).

Both prescription and over-the-counter medications can contain additives, such as lactose and sorbitol, that will produce diarrhea in sensitive individuals. Review of allergies or skin changes may also point to a cause. Social history may indicate that stress is playing a role or may identify activities which can be associated with diarrhea (for example, diarrhea that occurs in runners).

A combination of stool, blood, and urine tests may be needed in the evaluation of chronic diarrhea; in addition, a number of endoscopic and x-ray studies are frequently required.

Treatment

Treatment is ideally directed toward correcting the cause; however, the first aim should be to prevent or treat dehydration and nutritional deficiencies. The type of fluid and nutrient replacement depends on whether oral feedings can be taken and on the severity of fluid losses. Oral rehydration solution (ORS) or intravenous fluids are the choices; ORS is preferred if possible.

A physician should be notified if a person is dehydrated. If oral replacement is suggested then commercial (Pedialyte and others) or homemade preparations can be used. The World Health Organization (WHO) has provided this easy recipe for home preparation, which can be taken in small frequent sips:

• table salt, 3/4 tsp
• baking powder, 1 tsp
• orange juice, 1 c
• water, 1 qt

When feasible, food intake should be continued even in those people with acute diarrhea. A physician should be consulted regarding what type and how much food is permitted.

Anti-motility agents (loperamide, diphenoxylate) are useful for those with chronic symptoms; their use is limited or even contraindicated in most individuals with acute diarrhea, especially in those with high fever or bloody bowel movements. They should not be taken without the advice of a physician, and should not be used in children.

Other treatments are available, depending on the cause of symptoms. For example, the bulk agent psyllium helps some people by absorbing excess fluid and solidifying stools; cholestyramine, which binds bile acids, is effective in treating bile-salt-induced diarrhea. Low fat diets or more easily digestible fat is useful in some people. Antidiarrheal drugs that decrease excessive secretion of fluid by the intestinal tract is another approach for some diseases. Avoidance of medications or other products that are known to cause diarrhea (such as lactose) is curative in some people but should be discussed with a physician.

Alternative Treatment

It is especially important to find the cause of diarrhea, since stopping diarrhea when it is the body's way of eliminating something foreign is not helpful and can be harmful in the long run.

One effective alternative approach to preventing and treating diarrhea involves oral supplementation of aspects of the normal flora in the colon with the yeasts Lactobacillus acidophilus, L. bifidus, or Saccharomyces boulardii. In clinical settings, these "biotherapeutic" agents have repeatedly been helpful in the resolution of diarrhea, especially antibiotic-associated diarrhea.

Nutrient replacement also plays a role in preventing and treating episodes of diarrhea. Zinc especially appears to have an effect on the immune system, and deficiency of this mineral can lead to chronic diarrhea. Also, zinc replacement improves growth in young persons. To prevent dehydration, individuals suffering from diarrhea should take plenty of fluids, especially water. The BRAT diet also can be useful in helping to resolve diarrhea. This diet limits food intake to bananas, rice, applesauce, and toast. These foods provide soluble and insoluble fiber without irritation. If the toast is slightly burnt, the charcoal can help sequester toxins and pull them from the body.

Acute homeopathic remedies can be very effective for treating diarrhea especially in infants and young children.

Prognosis

Prognosis is related to the cause of the diarrhea; for most individuals in developed countries, a bout of acute, infectious diarrhea is at best uncomfortable. However, in both industrialized and developing areas, serious complications and death can occur.

For those with chronic symptoms, an extensive number of tests are usually necessary to make a proper diagnosis and begin treatment; a specific diagnosis is found in 90 percent of people. In some, however, no specific cause is found and only treatment with bulk agents or anti-motility agents is indicated.

Prevention

Proper hygiene and food handling techniques can prevent many cases. Traveler's diarrhea can be avoided by people using products containing bismuth, such as Pepto-Bismol and/or antibiotics. The most important action is to prevent the complications of dehydration.

Nutritional Concerns

Replacement of fluids and electrolytes is important for people experiencing diarrhea. These individuals should take in foods that contain salt, potassium, phosphates, and sugar. Most sodas, sport drinks and non-cream soups are good sources of electrolytes.

Parental Concerns

Parents should be sure that their children who experience diarrhea drink plenty of fluids and replace electrolytes with an oral rehydration solution. A doctor should be called if the parent suspects a child is becoming dehydrated. Severe dehydration requires intravenous fluid administration in a medical setting. Antidiarrheal medications should be be given only on the advise of a physician.

Resources

Books

Ahlquist, David A., and Michael Camilleri. "Diarrhea and Constipation." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 241–9.

Ghishan, Fayez K. "Chronic Diarrhea." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 1276–80.

Greenbaum, Larry A. "Acute Diarrhea and Oral Rehydration." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 249–50.

——. "Diarrhea in Chronically Malnourished Children." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 2250–1.

Sack, R. Bradley. "The Diarrhea of Travelers." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 1864–5.

Semrad, Carol E. and Don W. Powell. "Approach to the Patient with Diarrhea and Malabsorption." In Cecil Textbook ofMedicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 842–60.

Organizations

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007–1098. Web site: www.aap.org.

American College of Gastroenterology. 4900 B South 31st Street, Arlington VA 22206. Web site: www.acg.gi.org/.

Web Sites

"Diarrhea." Centers for Disease Control and Prevention. Available online at www.cdc.gov/ncidod/dpd/parasiticpathways/diarrhea.htm (accessed January 5, 2005).

"Diarrhea." Merck Manual. Available online at www.merck.com/mrkshared/mmanual/section3/chapter27/27b.jsp (accessed January 5, 2005).

"Diarrhea." National Digestive Diseases Information Clearinghouse. Available online at (accessed January 5, 2005).

"Diarrhea." MedlinePlus. Available online at www.nlm.nih.gov/medlineplus/diarrhea.html (accessed January 5, 2005).

"Traveler's Diarrhea." American Academy of Family Practice. Available online at (accessed January 5, 2005).

[Article by: L. Fleming Fallon, Jr., MD, DrPH]

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Diarrhea, a condition that has a major impact on global health, is highly correlated with nutritional status. It is an important area of focus due not only to its high worldwide prevalence and health costs, but also because it can be significantly reduced by appropriate interventions and treatment.

Diarrhea has various causes and symptoms, resulting in a wide range of definitions for this illness. The U.S. National Institutes of Health (NIH) defines diarrhea as loose, watery stools occurring more than three times a day, which is the most common definition. The term acute diarrhea is used to describe an episode lasting less than three weeks. Persistent diarrhea is an episode that lasts more than fourteen days, and chronic diarrhea is the term for recurring episodes of diarrhea. Dysentery is diarrhea that contains blood. The severity of diarrhea ranges from asymptomatic to severe dehydration resulting in death.

Causes of Diarrhea
Diarrhea can present in many ways because it has many potential causes. Most cases of diarrhea are caused by some type of infection. For example, surveillance studies in rural Bangladesh have cited infection as the cause of 86 percent of the cases of diarrhea in that population. This is the case in much of the developing world. Regardless of the cause, diarrhea results from an alteration of the lining of the wall of the intestines. Normal digestion occurs when there is a balance of fluid and nutrients across the bowel wall. Disruption of this process can be caused directly by organisms, toxins, or immune reactions. Any imbalance alters the composition of the stool and the motility (motion) of the bowel wall, resulting in an increased loss of fluid and nutrients. Dehydration is the result of loss of body fluids and electrolytes. A loss of 5 percent of body weight can result in a rapid heart rate, dizziness, decreased urination, disorientation, and even coma. A 10 percent loss of body weight caused by severe diarrhea can lead to acidosis, shock, and death.

People in developing countries suffer most from infectious forms of diarrhea. Most infections pass through a fecal-oral route. This results from environmental causes such as poor sanitation, decreased access to clean water, and a poor understanding of transmission and treatment of disease. These are conditions that arise most frequently in the developing world, though they affect both rural and urban populations. Improvements in these areas result in a dramatic reduction of cases of infectious diarrhea, as shown in studies in numerous developing nations, such as India, Gambia, and elsewhere, where poor socioeconomic status affects a large percentage of the population. Traveler's diarrhea is the result of exposure to such infectious agents when visiting countries where sanitation is inadequate.

Diarrhea in Developing Nations
Diarrhea is a major cause of death in much of the world, particularly in developing nations, where the effect is greatest among the young. The World Health Organization (WHO) attributes 3.5 million deaths a year to diarrhea, with 80 percent of these deaths occurring in children under the age of five, and most occurring in children between six months and three years of age. Children are the most susceptible because a smaller amount of fluid loss is necessary to result in significant dehydration, because they have fewer internal resources, and because their energy requirements are higher.

Causes	Examples
Viral infections	Rotavirus, Norwalk virus
Bacterial infections	E. coli, Vibrio cholerae, Campylobacter, Shigella
Parasites	Giardia, Entamoeba
Helminths (intestinal worms)	Strongyloides
Allergic	Lactose intolerance, celiac sprue, medication side effects
Autoimmune	Ulcerative colitis, Crohn's disease
Malabsorptive	Pancreatic deficiency, biliary disease
Nutritional	Zinc deficiency, vitamin A deficiency, enteral feedings consisting of liquid nutritional formulas delivered straight to the bowels
Functional	Irritable bowel syndrome, short bowel syndrome, cancer

Children in developing nations suffer from an average of four cases of diarrhea a year. Most of these cases are infectious diarrhea. Infectious diarrhea also contributes to malnutrition due to a decreased nutritional intake and diminished absorption of vital nutrients during the acute episode and recovery period. Malnutrition, in turn, decreases the ability of the immune system to fight further infections, making diarrheal episodes more frequent.

Studies have shown that poor nutritional status can double the risk of contracting diarrhea when exposed to an infectious agent. In addition, the duration of the acute episode can be up to three times as long in malnourished children. In addition, reduced immunity and deficiencies of nutrients such as vitamin A and zinc, which are common in malnourished individuals, can increase the health risks from diarrhea. Diarrhea also causes decreased appetite and food intake, decreased absorption of nutrients from the food that is ingested, and increased catabolism of body proteins. The resulting undernutrition stunts future mental and physical development.

Eating patterns before and after diarrheal episodes play an important role in this cycle. In developing countries, environmental factors, such as pervasive bacterial contamination of water used for drinking, cooking, and cleaning, contribute to continued exposure to agents that cause diarrhea. Maternal practices related to feeding are also a factor. Reduced breastfeeding rates in developing nations mean that fewer children receive the protective and nutritional benefits of breast milk. Nursing allows for the delivery of milk high in fats, proteins, and calories in a sterile fashion. When illness causes mothers to wean their children too early, nutritious breast milk is replaced with cereals and gruels that are often low in calories and proteins and are made with contaminated water. Commercial formulas are also often diluted with contaminated water and put in bottles that are not sterile.

A lack of maternal education often leads to the common practice of withholding food during acute episodes of diarrhea out of fear that eating will exacerbate the symptoms. Because of the nutritional losses from diarrhea, children actually need up to a 30 percent increase in calories and a 100 percent increase in protein intake during the acute and recovery stages of diarrhea. Studies have shown that children who receive increased nourishment during this time suffer less from the acute and long-term effects of diarrhea. The WHO recommends the continuation of breastfeeding throughout an acute episode, as well as the use of mixed food cereals high in calories and protein. There is also evidence to support zinc supplementation, which can reduce the morbidity rates from diarrhea.

Treatment
The mainstay of treatment for diarrhea is rehydration to replace the fluid and electrolyte losses. This is the cornerstone of oral rehydration therapy (ORT), which has greatly reduced the morbidity and mortality from diarrheal illnesses throughout the world. Rehydration must be combined with the fulfillment of increased nutritional demands. Antibiotics have a very limited role in effectively reducing morbidity and mortality from diarrhea, and antimotility and absorbent agents have virtually no role.

It is evident that the morbidity and mortality from diarrhea results from a complex interplay of environmental hazards, risk factors, and treatment response. Interventions to reduce the global impact of diarrhea must therefore be multifactorial in their approach. This is an illness that imposes a large health burden on society, but has avenues for effective intervention.

See also Malnutrition; Oral rehydration therapy.

Bibliography
Basch, Paul (1999). Textbook of International Health. New York: Oxford University Press.
Chen, Lincoln, and Scrimshaw, Nevin (1983). Diarrhea and Malnutrition: Interactions, Mechanisms, and Interventions. New York: Plenum Press.
Semba, Richard, and Bloem, Martin (2000). Nutrition and Health in Developing Countries. Totowa, NJ: Humana Press.

Internet Resources
National Institutes of Health. http://www.nih.gov
World Health Organization. http://www.who.int

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(deye-uh-ree-uh)

The frequent passage of abnormally watery feces, which is a sign of illness.

sign description: The sign for FECES is repeated.

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Rapid movement of fecal matter through the intestine resulting in poor absorption of water, nutritive elements and electrolytes, and producing abnormally frequent evacuation of watery droppings. The major causes are local irritation of the intestinal mucosa by infectious or chemical agents (gastroenteritis). In all types of diarrhea there is rapid evacuation of water and electrolytes resulting in a loss of these essential substances. Base (bicarbonate) especially is depleted by diarrhea, thus producing acidosis as well as fluid volume deficit.

• acute idiopathic d. — acute diarrhea syndromes in horses which are not diagnosable, such as salmonellosis, strongylosis, cyathostomiasis, Potomac horse fever, colitis-X, antibiotic-induced diarrhea (above), intestinal clostridiosis.
• acute undifferentiated d. of the horse — severe, acute diarrhea likely to be fatal may be related to stress or antibiotic therapy. See also colitis-X, intestinal clostridiosis, salmonellosis.
• antibiotic-associated d. — results from disruption of the normal bowel flora as a result of antimicrobial therapy for any reason. May occur as moderate diarrhea or as a life threatening syndrome often with severe colitis or pseudo-membranous colitis. See also antibiotic-associated colitis.
• bovine virus d. — see bovine virus diarrhea.
• campylobacter d. — watery diarrhea without other obvious signs and without other obvious cause in yearling sheep, calves and foals. Campylobacter fetus subspp. jejuni and intestinalis have been suggested as causes. See also winter dysentery.
• chronic undifferentiated d. of the horse — chronic, very watery diarrhea for very long periods but the horse has normal appetite and loses weight only gradually. Esthetically very displeasing to pleasure horse owners. Irreversible but not usually fatal.
• ciliate d. — colitis caused by troglodytella in primates.
• dietary d. — a result of dietary indiscretion; occurs in all species. It is caused by the chemical or physical nature of the ingested material. The commonest occurrence of the syndrome is in newborn animals, especially those who ingest too much milk. There is often a history of access to an oversupply of milk or of a recent change of source to an over-rich milk replacer or indigestible components in replacer. It is also caused by too-rapid drinking. Affected animals are bright and alert and have a normal appetite but the feces are voluminous, soft to fluid and evil-smelling. Secondary bacterial enteritis may ensue but most cases recover spontaneously when the diet is adjusted. Scavenging dogs and cats (‘garbage eaters’) commonly ingest food that is spoiled or to which they are unaccustomed, resulting in various degrees of vomiting or diarrhea. Called also dietetic scours.
• effusion d. — caused by an increase in the transepithelial hydrostatic pressure gradient, such as occurs in congestive heart failure and hepatic portal hypertension.
• epizootic porcine d. — at least two types of epidemic diarrhea occur in pigs which are not transmissible gastroenteritis or due to other known cause.
• large bowel d. — in dogs and cats, signs referable to the site of enteric disease responsible for the diarrhea being the large intestine include tenesmus, mucus, hematochezia, and increased frequency of defecation.
• malabsorptive d. — villous atrophy, such as occurs with some viral infections, causes malabsorption diarrhea because of the reduction in area of absorptive intestinal epithelium.
• nursery d. — see nursery diarrhea.
• osmotic d. — an overload of unabsorbed osmotically active particles will attract and retain water, increasing fecal volume and causing diarrhea. Associated with maldigestion, malabsorption, overeating, excessive carbohydrates or fats. The basis for the laxative effect of magnesium sulfate, sodium sulfate or sodium phosphate.
• psychogenic d. — see irritable colon syndrome.
• secretory d. — derangement of normal secretory and absorptive functions of intestinal epithelium such as occurs with bacterial enterotoxins may result in excessive secretion and a resulting diarrhea. Escherichia coli is the prime example of an infection with this effect.
• small bowel d. — in dogs and cats, signs referable to the site of enteric disease responsible for the diarrhea being the small intestine include lack of tenesmus or mucus, increased fecal volume, melena and weight loss.
• undifferentiated d. of the newborn — the situation in which a newborn animal (less than 7 days old) has life-threatening acute diarrhea. There is insufficient time and it would cost too much to differentiate between all of the possible causes. Added to this is the common occurrence in which there are two or more agents present, often acting in concert. Because of the need to treat these cases urgently and effectively if their lives are to be saved it has become the practice to group them together for the purposes of treatment and prognosis.

n

The frequent passage of loose, watery stools. The stool may also contain mucus, pus, blood, or excessive amounts of fat. Diarrhea is usually a symptom of some underlying disorder. See antidiarrheals

For a list of words related to diarrhea, see:

• Signs and Symptoms - diarrhea: frequent bowel evacuation, esp. of soft or liquid feces; Montezuma’s revenge; runs

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See words rhyming with "diarrhoea."

  See crossword solutions for the clue Diarrhoea.

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Dansk (Danish)
n. - diarré

Français (French)
n. - diarrhée

Deutsch (German)
n. - Durchfall

Ελληνική (Greek)
n. - (παθολ.) διάρροια

Italiano (Italian)
diarrea

Português (Portuguese)
n. - diarréia (f)

Русский (Russian)
понос

Español (Spanish)
n. - diarrea

Svenska (Swedish)
n. - diarré

中文（简体）(Chinese (Simplified))
腹泻

中文（繁體）(Chinese (Traditional))
n. - 腹瀉

한국어 (Korean)
n. - 설사

日本語 (Japanese)
n. - 下痢

עברית (Hebrew)
n. - ‮שלשול‬

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