Diarrhea

Answer 1

Definition

Diarrhea is loose, watery, and frequent stool. Diarrhea is considered chronic (long-term) when you have had loose or frequent stools for more than 4 weeks.

Alternative Names

Stools - watery; Frequent bowel movements; Loose bowel movements

Considerations

Diarrhea in adults is usually mild and goes away quickly without complications. In infants and children (especially under age 3), diarrhea can cause dangerous dehydration fairly quickly.

Common Causes

The most common cause of diarrhea is viral gastroenteritis, a mild viral infection that goes away on its own within a few days. This condition is often called the stomach flu. Viral gastroenteritis often occurs in mini-epidemics in schools, neighborhoods, or families.

Food poisoningand traveler's diarrhea are two other common causes of diarrhea. They occur as a result of eating food or drinking water contaminated with bacteria or parasites.

Medications, especially antibiotics, laxatives containing magnesium, and chemotherapy for cancer treatment, can also cause diarrhea.

The following medical conditions can also lead to diarrhea:

• Celiac disease
• Inflammatory bowel diseases (Crohn's disease and ulcerative colitis)
• Irritable bowel syndrome (IBS)
• Lactose intolerance
• Malabsorption syndromes (such as lactose intolerance)

Other less common causes of diarrhea include:

• Carcinoid syndrome
• Nerve disorders like autonomic neuropathy or diabetic neuropathy
• Partial removal of the stomach (gastrectomy)
• Radiation therapy
• Zollinger-Ellison syndrome

Home Care

• Drink plenty of fluid to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Milk may prolong loose stools, but also provides needed fluids and nourishment. Drinking milk may be fine for mild diarrhea. For moderate and severe diarrhea, electrolyte solutions available in drugstores are usually best.
• Active cultures of beneficial bacteria (probiotics) make diarrhea less severe and shorten its duration. Probiotics can be found in yogurt with active or live cultures and in supplements.
• Foods like rice, dry toast, and bananas can sometimes help with diarrhea.
• Avoid over-the-counter antidiarrhea medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever is causing it (contaminated food, virus, etc.). The medicine can interfere with this process.
• Get plenty of rest.

If you have a chronic form of diarrhea, such as is caused by irritable bowel syndrome, try adding bulk to your diet to thicken your stool and regulate bowel movements. Such foods include fiber from whole-wheat grains and bran. Psyllium-containing products such as Metamucil or similar products can also add bulk to stools.

Call your health care provider if

Call your doctor if:

• You have blood or pus in your stools
• Your stools are black
• You have abdominal pain that is not relieved by a bowel movement
• You have symptoms of dehydration such as light-headedness when sitting or standing up
• You have a fever above 101F, or your child has a fever above 100.4F, along with diarrhea
• You have foul-smelling or oily-looking stools
• You have recently traveled to a foreign country
• You have eaten with other people who also have diarrhea
• You have started on a new medication
• Your diarrhea does not get better in 5 days (2 days for an infant or child), or worsens before that
• Your or your child has been vomiting for more than 12 hours (in a newborn under 3 months you should call as soon as vomiting or diarrhea begins)

What to expect at your health care provider's office

Your doctor will take a complete medical history and do a physical examination, paying careful attention to your abdomen.

Questions that the doctor may ask include:

• When did your diarrhea start?
• What is the color and consistency of your stool?
• Do you have blood in your stool?
• Are you passing large amounts of mucus with your stool?
• What other symptoms do you have?
• Do you have abdominal pain or severe cramping with the diarrhea?
• Do you have fever or chills?
• Are any other family members sick?
• Have you recently traveled out of the country?
• Have you possibly been exposed to unpurified water or spoiled food?
• What makes your pain worse? Stress? Specific foods?
• Have you had abdominal surgery?
• Have you taken antibiotics recently?
• What medications do you take? Any recent changes to your medications?
• Do you drink coffee? How much?
• Do you drink alcohol? How much? How often?
• Do you smoke? How much each day?
• Are you on a special diet?

Your doctor may ask you to obtain one or more stool samples in special containers to test for signs of inflammation and infection and to identify an organism that may be causing infection.

If there are signs of dehydration in addition to the diarrhea, your doctor may order:

• Basic metabolic panel (to check electrolyte levels in your blood)
• BUN and serum creatininetests
• Urine specific gravity

Prevention

• Wash your hands often, especially after going to the bathroom and before eating.
• Teach children to not put objects in their mouth.
• When taking antibiotics, try eating food with Lactobacillus acidophilus, a healthy bacteria. This helps replenish the good bacteria that antibiotics can kill. Yogurt with active or live cultures is a good source of these healthy bacteria.
• Use alcohol-based hand gel frequently.

When traveling to underdeveloped areas, follow the steps below to avoid diarrhea:

• Drink only bottled water and do NOT use ice.
• Do NOT eat uncooked vegetables or fruits that do not have peels.
• Do NOT eat raw shellfish or undercooked meat.
• Do NOT consume dairy products.

References

Semrad CE, Powell DW. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 143.

Proctor DD. Approach to the patient with gastrointestinal disease. In: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 134.

Answer 2

Diarrhea is a serious condition that leads to extensive dehydration unless properly treated. Diarrhea caused by bacterial infection or maldigestion is one of the leading causes of death in children worldwide. A balanced diet and energized immune system is the best defense against this condition. Treatment options for diarrhea include zinc tablets and rehydration salts.

Main Causes of Diarrhea

Bacterial and viral diarrhea is the most common form. The rotavirus is the main culprit in young children. Bacterial infections affect travelers, especially those who consume water that is unsafe. Giardia is a parasite living in stream and pond water, causing severe bouts of diarrhea if not diagnosed in its early stages of reproduction in the body.

Less common causes of diarrhea include cholera toxin, which inhibits absorption of fluids. Chloride ions are secreted and greatly affect the body's ability to process water. Maldigestion can lead to osmotic causes of diarrhea, where an excess amount of water is drawn directly into the bowels. Disorders in the small bowel can also result in malabsorption. This is usually caused by food or lactose intolerance and certain food Allergies. People who have an intolerance to certain foods may have a disruption of the normal digestive process. Excess fluids are drawn to the GI tract and diarrhea is the result.

Preventing Diarrhea

Vaccines against rotavirus are available worldwide. Since most cases of diarrhea are caused by this virus, individuals need to practice good sanitation such as cleaning bathroom areas and washing hands frequently. Water needs to be treated before consumption, either by the water supply company or through self-treatment methods such as boiling. Travelers often come into contact with bacteria unrecognized by their defense systems, therefore bathing frequently and avoiding local untreated water is highly advised.

Oral rehydration treatment is the taking of salt and sugar together in a solution. Ingested orally, this treatment is most commonly practiced with children suffering from dehydration due to diarrhea. Soups containing salt are also a recommended treatment for diarrhea in children. In extreme cases individuals may require an intravenous rehydration procedure to make up for lost fluids. Codeine has also been used to slow the passing of feces through the bowels, allowing a greater percentage of the water mass to be reabsorbed.

Answer 3

Definition

Diarrhea is loose, watery, and frequent stools. Diarrhea is considered long-term (chronic) when you have had loose or frequent stools for more than 4 weeks.

Alternative Names

Stools - watery; Frequent bowel movements; Loose bowel movements

Considerations

Diarrhea in infants and children (especially under age 3) can caused dangerous dehydration very quickly.

Diarrhea in adults is usually mild and goes away quickly without complications.

Common Causes

The most common cause of diarrhea is viral gastroenteritis, or the stomach flu. This is a mild viral infection that goes away on its own within a few days.

Eating or drinking contaminated food or water can also lead to diarrhea. Such common causes of diarrhea include:

• Food poisoning
• Traveler's diarrhea

Certain medications may also cause diarrhea, including:

• Certain antibiotics
• Chemotherapy
• Laxatives containing magnesium

Diarrhea may also be caused by certain medical conditions, including:

• Celiac disease
• Inflammatory bowel diseases (Crohn's disease and ulcerative colitis)
• Irritable bowel syndrome (IBS)
• Lactose intolerance
• Malabsorption syndromes

Less common causes of diarrhea include:

• Carcinoid syndrome
• Nervous systems disorders, including autonomic neuropathy or diabetic neuropathy
• Partial removal of the stomach (gastrectomy)
• Radiation therapy
• Zollinger-Ellison syndrome

Home Care

It is important to drink plenty of fluids to prevent dehydration. Dehydration means your body does not have the proper amount of water and fluids. Dehydration can be especially dangerous for infants and young children and people who live in a hot climate.

Signs of severe dehydration include:

• Decreased urine (fewer wet diapers in infants)
• Dry mouth
• Sunken eyes
• Few tears when crying

Children with diarrhea should be given fluids only for the first 4 to 6 hours.

• Try 2 tablespoons (1 ounce) of fluid every 30 to 60 minutes.
• Brands such as Pedialyte can be helpful. Do not water down these fluids.
• Pedialyte popsicles are also available.
• Watered-down fruit juice or broth may also help.

If you are breastfeeding your infant, continue to do so.

If you are using formula, use it at half strength for 2 to 3 feedings after the child's diarrhea starts. You can use the regular amount of formula after this.

Adults and older children who have diarrhea may feel better by following these steps:

• Drink 8 to 10 glasses of clear fluids every day. Water is best.
• Drink at least 1 cup of liquid every time you have a loose bowel movement.
• Eat small meals throughout the day, instead of 3 big meals.
• Eat salty foods, such as pretzels, soup, and sports drinks.
• Eat high potassium foods, such as bananas, potatoes without the skin, and watered-down fruit juices.
• Get plenty of rest.

Avoid over-the-counter antidiarrhea medications unless instructed to use them by your doctor. Certain infections can be made worse by these drugs.

If you have a chronic form of diarrhea, such as is caused by irritable bowel syndrome, try adding bulk to your diet to thicken your stool and regulate bowel movements. Such foods include fiber from whole-wheat grains and bran. Psyllium-containing products such as Metamucil or similar products can also add bulk to stools and help solidify them.

Call your health care provider if

Call for an appointment with your health care provider if you have:

• Blood or pus in your stools
• Black stools
• Stomach pain that does not go away after a bowel movement
• Symptoms of dehydration (thirst, dizziness, lightheadedness)
• Diarrhea with a fever above 101°F (100.4 °F in children)
• Recently traveled to a foreign country and developed diarrhea

Also call your doctor if:

• The diarrhea gets worse or does not get better in 2 days for an infant or child, or 5 days for adults
• A child over 3 months old has been vomiting for more than 12 hours; in younger babies, call as soon as vomiting or diarrhea begins

What to expect at your health care provider's office

Your doctor perform a physical exam and ask you questions about your medical history and symptoms, including:

• When did your diarrhea start?
• What is the color and consistency of your stool?
• Do you have blood in your stool?
• Are you passing large amounts of mucus with your stool?
• What other symptoms do you have?
• Do you have abdominal pain or severe cramping with the diarrhea?
• Do you have fever or chills?
• Are any other people in your house sick?
• Have you recently traveled out of the country?
• Have you possibly been exposed to unpurified water or spoiled food?
• What makes your pain worse? Stress? Specific foods?
• Have you had abdominal surgery?
• Have you taken antibiotics recently?
• What medications do you take? Any recent changes to your medications?
• Do you drink coffee? How much?
• Do you drink alcohol? How much? How often?
• Do you smoke? How much each day?
• Are you on a special diet?

Laboratory tests may be done on your stools to determine the cause of your diarrhea. If there are signs of dehydration in addition to the diarrhea, your doctor may order:

• Basic metabolic panel
• Urine specific gravity

Prevention

Over-the-counter supplements that contain healthy bacteria, called probiotics, may help prevent diarrhea associated with antibiotics. Yogurt with active or live cultures is a good source of these healthy bacteria.

The following healthy steps can help you prevent illnesses that cause diarrhea:

• Wash your hands often, especially after going to the bathroom and before eating.
• Use alcohol-based hand gel frequently.
• Teach children to not put objects in their mouth.

When traveling to underdeveloped areas, follow the steps below to avoid diarrhea:

• Drink only bottled water and do not use ice, unless it is made from bottled or purified water.
• Do NOT eat uncooked vegetables or fruits that do not have peels.
• Do NOT eat raw shellfish or undercooked meat.
• Do NOT consume dairy products.

References

Schiller RL, Sellin JH. Diarrhea. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 15.

Semrad CE, Powell DW. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 143.

Reviewed By

Review Date: 02/16/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 4

Diarrhea isn't something most people want to talk about, much less have. Not only can diarrhea be uncomfortable, with gas, bloating, and that mad dash to the toilet, but it's a sign that you're either sick, or you've eaten something that really didn't agree with you.

With diarrhea, the stools become loose and watery instead of solid. If you have diarrhea, there's a good chance you picked up a stomach virus. Or, you may have gotten food poisoning from eating food or drinking water that was contaminated with bacteria. A lot of people get sick from tainted food while traveling, because they're not used to the food and water in the foreign country. This is called traveler's diarrhea.

Certain diseases that affect your intestines can cause diarrhea, including celiac disease, irritable bowel syndrome, Crohn's disease, and ulcerative colitis. If you've taken medications such as antibiotics or laxatives, diarrhea can be an unpleasant side effect.

Protect your stomach by giving it healthy bacteria called probiotics. You can find them in yogurt and supplements. Among other things, probiotics help crowd out the bad bacteria that cause diarrhea.

To avoid getting sick, wash your hands or use an alcohol-based hand sanitizer so bacteria can't get into your body. And when you travel to areas that may have unclean water, drink only bottled water without ice. Also avoid eating any uncooked fruits or vegetables that don't have a peel.

Usually diarrhea goes away by itself pretty quickly, but it can stick around for a few days or even weeks. Loose stools are very watery, and they can dehydrate you pretty quickly. Stay hydrated by drinking at least 8 to 10 glasses of clear liquids a day. Drink one glass every time you have a loose bowel movement. To replace the electrolytes you're also losing with diarrhea, consider an electrolyte drink or rehydration solution. Also you may want to eat soup, pretzels, and other salty foods, as well as bananas and other high-potassium foods.

Infants and children are especially likely to get dehydrated from diarrhea, and this can be really dangerous. You can tell your baby is dehydrated because his mouth will be dry, he'll make fewer wet diapers, and he won't produce tears when he cries. To keep your child hydrated, give 2 tablespoons of fluid every 30 to 60 minutes. You can use breast milk, formula, broth, or a solution like B.R.A.T. or Pedialyte, which also comes in a kid-friendly popsicle form.

Diarrhea is an unpleasant, but fortunately short-term affliction most of the time. If it does stick around, call your doctor. The doctor will ask questions about your symptoms, where you've been traveling, and what new medicines you've taken or foods you've eaten. Until you're feeling better, drink plenty of fluids so you don't get dehydrated.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.