Diarrhea

Overview

Diarrhea is a common digestive condition characterized by loose, watery, and possibly more-frequent bowel movements. It can be accompanied by other symptoms, such as abdominal pain, bloating, nausea, vomiting, fever, or blood and mucus in the stool. Diarrhea typically lasts for a few days and resolves without treatment, but if it persists for weeks, it may indicate a more serious underlying issue, such as irritable bowel syndrome (IBS) or an ongoing infection. If diarrhea is severe or persists for an extended period, it is important to consult a healthcare professional.

Understanding the disease

Symptoms

Symptoms associated with diarrhea (loose, watery stools) may include belly cramps or pain, bloating, nausea, vomiting, fever, blood in the stool, mucus in the stool, and an urgent need to have a bowel movement. If diarrhea persists for more than two days or if you experience severe symptoms such as dehydration, bloody or black stools, or a high fever, it's important to seek medical attention.

Risk Factors

Risk factors for developing diarrhea include:

1. Weakened immune system due to an underlying illness or immune-suppressing medications.
2. Certain chronic conditions such as diabetes, inflammatory bowel disease, severe kidney, liver, or heart disease.
3. People who take acid blockers or antacids, as these can reduce stomach acid, allowing bacteria to survive.
4. Travelers to certain regions during specific seasons, such as South Asia during the hot months just before the monsoons.
5. Difficulty in digesting fructose, a sugar found in fruits and some beverages.
6. Consumption of artificial sweeteners like sorbitol, erythritol, and mannitol, commonly found in sugar-free products.
7. Recent surgery, such as partial intestine or gallbladder removal.
8. Other digestive disorders like IBS, Crohn's disease, ulcerative colitis, celiac disease, microscopic colitis, and small intestinal bacterial overgrowth (SIBO). If diarrhea persists for more than two days, leads to dehydration, or is accompanied by a fever above 102 F (39 C), bloody or black stools, it is crucial to seek medical help.

Development

Diarrhea can develop due to various causes, including viral, bacterial, or parasitic infections, as well as certain medical conditions or medications. Some of the main causes of diarrhea include:

1. Viruses: Many viruses can cause diarrhea, such as Norwalk virus (also known as norovirus), enteric adenoviruses, astrovirus, cytomegalovirus, and viral hepatitis. Rotavirus is a common cause of acute childhood diarrhea, and the virus that causes COVID-19 has also been associated with gastrointestinal symptoms, including nausea, vomiting, and diarrhea.
2. Bacteria and parasites: Exposure to certain bacteria, such as E. coli or parasites through contaminated food or water, can lead to diarrhea. When traveling in developing countries, diarrhea caused by bacteria and parasites is often called traveler's diarrhea. Clostridioides difficile (also known as C. diff) is another type of bacterium that causes diarrhea and can occur after a course of antibiotics or during a hospitalization.
3. Medical conditions: Certain medical conditions, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or celiac disease, can cause ongoing diarrhea. In these cases, diarrhea may persist beyond a few days and last for weeks or longer.
4. Medications: Certain medications, such as antibiotics, can disrupt the normal balance of bacteria in the gut, leading to diarrhea. In some cases, diarrhea may be a side effect of certain medications. To prevent diarrhea, it's essential to practice good hygiene, particularly when traveling to areas with a higher risk of contaminated food or water. Wash your hands frequently, avoid consuming contaminated food or water, and be cautious about consuming raw or undercooked foods. If you experience diarrhea, it's essential to stay hydrated and consult with a healthcare professional if symptoms persist or worsen.

Assessment and Diagnosis

Triage

You should see a doctor if you have diarrhea for more than two days, especially if you have any of the following symptoms:

• Persistent diarrhea with no improvement
• Severe abdominal or rectal pain
• Bloody or black stools
• Fever above 102 F (39 C)
• Signs of dehydration, such as dry mouth, little or no urination, severe weakness, dizziness on standing, or lightheadedness
• Vomiting frequently
• Black or tarry stool or stool containing blood or pus For children, especially young children, it's important to seek medical attention if diarrhea persists for more than 24 hours or if the child has any of the above symptoms, as well as a fever above 102 F (39 C) or signs of dehydration.

Diagnosis

To diagnose diarrhea, a health care professional will typically start by asking about the patient's medical history, reviewing their medications, conducting a physical exam, and may order tests. Some possible tests include a blood test, stool test, hydrogen breath test, and colonoscopy or flexible sigmoidoscopy. The health care professional will also inquire about the patient's symptoms, such as the presence of blood or pus in the stools, fever, abdominal pain, and changes in the severity of symptoms over time. If necessary, additional testing may be performed to rule out other causes for the symptoms.

Management and Treatment

Complications

Diarrhea can lead to several complications, the most significant of which is dehydration due to the loss of fluids and electrolytes. Severe dehydration can be life-threatening and may cause symptoms such as a very dry mouth, intense thirst, little or no urination, dizziness, and weakness. Another potential complication of diarrhea is electrolyte imbalances, which can affect the body's muscle and nerve function. In severe cases, diarrhea can result in malnutrition if it persists for an extended period, leading to weight loss and weakened immunity. In rare cases, diarrhea can cause a bacterial infection in the blood (sepsis) or inflammation of the colon (colitis).

Prevention

Certain measures can help prevent diarrhea. Some preventive actions include:

1. Reducing constipation: Eating high-fiber foods, drinking plenty of fluids, and engaging in regular exercise can help prevent constipation, which may lead to diarrhea.
2. Controlling diarrhea: Treating the underlying cause of diarrhea, such as an intestinal infection, can help avoid further episodes of fecal incontinence.
3. Avoiding straining during bowel movements: Straining can weaken anal sphincter muscles or damage nerves, which may contribute to diarrhea.
4. Practicing good hygiene: Washing hands before handling food, cooking food thoroughly, and avoiding raw or undercooked meats and dairy products can help prevent the spread of diarrhea-causing pathogens.
5. Being cautious while traveling: Drinking bottled water, avoiding raw fruits and vegetables, and taking necessary precautions to prevent exposure to contaminated food or water can reduce the risk of traveler's diarrhea. Remember, it's important to consult a healthcare professional if diarrhea persists for more than two days or if dehydration occurs.

Home Remedies

Home remedies for diarrhea may help alleviate symptoms, but it's essential to consult a healthcare professional if the issue persists or is severe. Here are some home remedies to consider:

1. Stay hydrated: Drink plenty of fluids, such as water, clear broths, frozen water or ice chips, clear juices, or sports drinks like Gatorade to replace lost electrolytes. Avoid drinks with caffeine or alcohol.
2. BRAT diet: Follow a bland diet of bananas, rice, applesauce, and toast (BRAT) for a short period. This diet can help bind loose stools and reduce symptoms, but it's not suitable for everyone and should be used under medical guidance.
3. Probiotics: Include probiotic-rich foods like yogurt, kefir, or fermented foods like kimchi in your diet. These may help restore the balance of good bacteria in your gut, potentially easing diarrhea symptoms.
4. Ginger: Ginger has natural anti-inflammatory properties and can help alleviate nausea and diarrhea. Try ginger tea, ginger candies, or ginger chews.
5. Avoid irritants: Steer clear of spicy, fatty, or greasy foods, as well as foods high in sugar, as they can exacerbate diarrhea symptoms.
6. Avoid dairy products: Lactose intolerance can worsen diarrhea. Avoid milk, cheese, and other dairy products until your symptoms subside.
7. Prebiotics: Consume foods high in prebiotics, such as onions, garlic, leeks, asparagus, and whole grains, to help support a healthy gut microbiome.
8. Chamomile tea: This herbal tea can help soothe an upset stomach and reduce diarrhea symptoms.
9. Peppermint oil: In some cases, peppermint oil in capsules or as a liquid can help relieve symptoms of diarrhea, but consult a healthcare professional before using it

Treatment

If you are experiencing diarrhea, there are several steps you can take to help manage your symptoms. These may include:

1. Drinking plenty of fluids: Staying hydrated is essential in treating diarrhea. Drink water, broths, and juices to replace lost fluids. Avoid caffeine and alcohol, as they can make diarrhea worse.
2. Adding semisolid and low-fiber foods: Gradually reintroduce semisolid and low-fiber foods to your diet as your bowel movements return to normal. Examples include soda crackers, toast, eggs, rice, and chicken.
3. Changing your diet: Consult your doctor about following a low-fat, low-fiber diet. Eliminate foods that may exacerbate your symptoms, such as dairy products, gluten, caffeine, and sugar.
4. Discontinuing certain medications: If your diarrhea is caused by a medication, inform your doctor, and they may suggest discontinuing it or switching to an alternative.
5. Using over-the-counter medications: If your symptoms persist, your doctor may recommend anti-diarrheal medications like loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol). In more severe cases, they may prescribe steroids or medications that block bile acids, such as cholestyramine/aspartame or cholestyramine (Prevalite), or colestipol (Colestid).
6. Seeking medical attention for severe cases: If your diarrhea is persistent, bloody, or accompanied by other severe symptoms, consult a healthcare professional immediately. Remember that it's essential to drink plenty of fluids and seek medical advice if your symptoms persist or worsen.

Preparing for medical consultation

To prepare for an appointment for diarrhea, you should:

1. Make an appointment with your primary healthcare provider or a gastroenterologist, depending on the severity and duration of your symptoms.
2. In advance of the appointment, create a list of your symptoms, including when they began and any unrelated symptoms you're experiencing.
3. Gather information about your personal history, including any major stresses, recent life changes, or travel.
4. Compile a list of medications, vitamins, or supplements you're currently taking, including doses.
5. Prepare a list of questions to ask your healthcare professional, such as the likely cause of your diarrhea, potential tests needed, the best course of action, and how to manage other health conditions alongside your diarrhea.
6. Consider taking probiotics, which may help restore a healthy balance in the intestinal tract, although more research is needed to determine their effectiveness.
7. Inform your healthcare provider if you have a fever, ongoing vomiting, or signs of severe dehydration.
8. If you have diarrhea after returning from a trip abroad, share that information with your doctor when making the appointment. Remember to bring a family member or friend along to the appointment to help you remember the information provided by your healthcare professional.