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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, and 1.9 million
children under the age of 5 years, mostly in developing countries, die from diarrhea.
Some people frequently pass stools, but they are of normal consistency. This is not diarrhea.
Similarly, breastfed babies often pass loose, pasty stools. This is normal. It is not diarrhea.
Here are some key points about diarrhea. More detail and supporting information is in the body of this
article.
Causes
Most cases of diarrhea are caused by an infection in the gastrointestinal tract. The microbes responsible
for this infection include:
bacteria
viruses
parasitic organisms
The most commonly identified causes of acute diarrhea in the United States are the bacteria Salmonella,
Campylobacter, Shigella, and Shiga-toxin-producing Escherichia coli.
Some cases of chronic diarrhea are called "functional" because a clear cause cannot be found. In the
developed world, irritable bowel syndrome (IBS) is the most common cause of functional diarrhea.
IBS is a complex of symptoms. There is cramping abdominal pain and altered bowel habits, including
diarrhea, constipation, or both.
Inflammatory bowel disease (IBD) is another cause of chronic diarrhea. It is a term used to describe either
ulcerative colitis or Crohn's disease. There is often blood in the stool in both conditions.
Microscopic colitis: This is a persistent diarrhea that usually affects older adults, often during the
night.
Malabsorptive and maldigestive diarrhea: The first is caused by impaired nutrient absorption,
the second by impaired digestive function. Celiac disease is one example.
Chronic infections: A history of travel or antibiotic use can be clues to chronic diarrhea. Various
bacteria and parasites can be the cause.
Drug-induced diarrhea: Laxatives and other drugs, including antibiotics, can trigger diarrhea.
Endocrine causes: Sometimes hormonal factors cause diarrhea, for example, in the case of
Addison disease and carcinoid tumors.
Cancer causes: Neoplastic diarrhea is associated with a number of gut cancers.
Treatment
Mild cases of acute diarrhea may resolve without treatment. Persistent or chronic diarrhea will be
diagnosed and any underlying causes will be treated in addition to the symptoms of diarrhea.
Dehydration
Fluids can be replaced by simply drinking more fluids, or they can be received intravenously in
severe cases. Children and older people are more vulnerable to dehydration.
Oral rehydration solution or salts (ORS) refers to water that contains salt and glucose. It is
absorbed by the small intestine to replace the water and electrolytes lost in the stool. In
developing countries, ORS costs just a few cents. The World Health Organization (WHO) says
ORS can safely and effectively treat over 90 percent of non-severe diarrhea cases.
Oral rehydration products, such as Oralyte and Rehydralyte, are available commercially. Zinc
supplementation may reduce the severity and duration of diarrhea in children. Various products
are available to purchase online.
Antidiarrheal medication
Loperamide, or Imodium, is an antimotility drug that reduces stool passage. Loperamide and
Imodium are both available to purchase over-the-counter or online.
Bismuth subsalicylate, for example, Pepto-Bismol, reduces diarrheal stool output in adults and
children. It can also be used to prevent traveler's diarrhea. The can be bought online as well as
over-the-counter.
There is some concern that antidiarrheal medications could prolong bacterial infection by reducing the
removal of pathogens through stools.
Antibiotics
Antibiotics are only used to treat diarrhea caused by a bacterial infection. If the cause is a certain
medication, switching to another drug might be possible.
Diet
Nutritionists from Stanford Health Care offer some nutritional tips for diarrhea:
Sip on clear, still liquids such as fruit juice without added sugar.
After each loose stool, replace lost fluids with at least one cup of liquid.
Do most of the drinking between, not during meals.
Consume high-potassium foods and liquids, such as diluted fruit juices, potatoes without the skin,
and bananas.
Consume high-sodium foods and liquids, such as broths, soups, sports drinks, and salted crackers.
eat foods high in soluble fiber, such as banana, oatmeal and rice, as these help thicken the stool
limit foods that may make diarrhea worse, such as creamy, fried, and sugary foods
Foods and drinks that might make the diarrhea worse include:
Probiotics
There is mixed evidence for the role of probiotics in diarrhea. They may help prevent traveler's diarrhea.
In children, there is evidence that they might reduce diarrheal illness by 1 day.
Antibiotic-associated diarrhea might be reduced by the use of probiotics, as may diarrhea related to
Clostridium difficile, although the evidence is mixed.
People should ask their doctor for advice, as there are numerous strains. The strain most studied for
antibiotic-associated diarrhea are probiotics based on Lactobacillus rhamnosus and Saccharomyces
boulardii.
Probiotics to help with Clostridium difficile and antibiotic diarrheas were investigated in a trial published
in The Lancet. They found no evidence that a multi-strain preparation of bacteria was effective in
preventing these conditions, calling for a better understanding of the development of antibiotic-associated
diarrhea.
Probiotics are available in capsules, tablets, powders, and liquids, and may be purchase online.
Symptoms
These include:
stomach pain
abdominal cramps
bloating
thirst
weight loss
fever
If these accompany diarrhea, or if the diarrhea is chronic, it may indicate a more serious illness.
Complications
Diarrhea can also be a sign of a wide range of underlying chronic conditions. These conditions need to be
diagnosed treated to prevent further problems.
The doctor will ask about the symptoms and about any current medications, past medical history, and
other medical conditions.
Severe dehydration can be fatal if treatment with rehydration therapy is not given urgently.
Tests for diarrhea
Most cases of diarrhea resolve without treatment, and a doctor will often be able to diagnose the problem
without tests.
However, in more severe cases, a stool test may be needed, especially if the patient is very young or old.
If a person has chronic or persistent diarrhea, the doctor will order tests according to the suspected
underlying cause.
Full blood count: Anemia or a raised platelet count will suggest inflammation.
Liver function tests: This will include testing albumin levels.
Tests for malabsorption: These will check the absorption of calcium, vitamin B-12, and folate.
They will also assess iron status and thyroid function.
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Raised levels may indicate
inflammatory bowel disease (IBD).
Testing for antibodies: This may detect celiac disease.
Diarrhea often resolves without specialist medical treatment, but sometimes it is important to seek a
doctor's help.
Infants under 1 year should see a doctor if they have had 6 bouts of diarrhea or 3 bouts of vomiting within
24 hours.
Children over 1 year should see a doctor if they have had 6 episodes or more of diarrhea in 24 hours, or if
there is diarrhea and vomiting at the same time.
persistent vomiting
persistent diarrhea
dehydration
significant weight loss
pus in the stool
blood in the stool, which may turn the stool black
Anyone who experiences diarrhea after surgery, after spending time in hospital, or after using antibiotics,
should seek medical assistance.
Adults whose sleep is persistently disturbed by diarrhea may be able to get help to solve this problem.
Prevention
In developing countries, prevention of diarrhea may be more challenging due to dirty water and poor
sanitation.
There is evidence that interventions from public health bodies to promote hand washing can cut diarrhea
rates by about one-third.