Diarrhea

Overview

Diarrhea·loose watery stools occurring more than three times in one day·is a common problem that usually lasts a day or two and goes away on its own without any special treatment. However prolonged diarrhea can be a sign of other problems. Diarrhea can cause dehydration which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and the elderly and it must be treated promptly to avoid serious health problems. People of all ages can get diarrhea. The average adult has a bout of diarrhea about four times a year.

Causes

As a rule the large intestine (colon) can absorb several times more fluid than is required on a daily basis. However when the organ becomes overwhelmed by the amount of fluid it has to deal with diarrhea occurs.

Diarrhea may be caused by a temporary problem such as an infection or a chronic problem like an intestinal disease. A few of the more common causes of diarrhea are:

Viral infections. The most common cause of diarrhea is a mild viral infection. This is called viral gastroenteritis or so-called "stomach flu." (although it is not a flu at all). Many viruses cause diarrhea including rotavirus Norwalk virus cytomegalovirus herpes simplex virus and viral hepatitis. Viral gastroenteritis often appears in mini-epidemics in schools neighborhoods or families.

  • Bacterial infections. Several types of bacteria consumed through contaminated food or water can cause diarrhea. Common culprits include Campylobacter Salmonella Shigella and Escherichia coli.
  • Food intolerances. Some people are unable to digest some component of food such as lactose the sugar found in milk. Olestra an ingredient found in fat-free potato chips and ice cream can also cause diarrhea.
  • Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia Entamoeba histolytica and Cryptosporidium.
  • Reaction to drugs such as antibiotics blood pressure medications and antacids containing magnesium. Even too much caffeine can cause diarrhea.
  • Intestinal diseases like inflammatory bowel disease or celiac disease.
  • Functional bowel disorders such as irritable bowel syndrome in which the intestines do not work normally.

Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon that can occur after gallbladder surgery.

In many cases the cause of diarrhea cannot be found. As long as diarrhea goes away on its own an extensive search for the cause is not usually necessary.

People who visit foreign countries are at risk for traveler's diarrhea which is caused by eating food or drinking water contaminated with bacteria viruses or sometimes parasites. Traveler's diarrhea is a particular problem for people visiting developing countries.

Symptoms

Diarrhea may be accompanied by cramping abdominal pain bloating nausea or an urgent need to use the bathroom. Depending on the cause a person may have a fever or bloody stools.

Diarrhea can be either acute (short-term) or chronic (long-term). The acute form which can last for as little as 24 hours or up to 4 weeks is usually related to a bacterial viral or parasitic infection. Chronic diarrhea lasts more than 4 weeks and is usually related to functional disorders such as irritable bowel syndrome or inflammatory bowel diseases like celiac disease.

Diarrhea in Children

Children can have acute or chronic forms of diarrhea. Causes include bacteria viruses parasites medications functional disorders and food sensitivities. Infection with the rotavirus is the most common cause of acute childhood diarrhea. Rotavirus diarrhea usually resolves in 3 to 9 days.

Medications to treat diarrhea in adults can be dangerous to children and should be given only under a doctor's guidance.

Diarrhea can be dangerous in newborns and infants. In small children severe diarrhea lasting just a day or two can lead to dehydration. Because a child can die from dehydration within a few days the main treatment for diarrhea in children is rehydration.

Take your child to the doctor if any of the following symptoms appear:

  • stools containing blood or pus or black stools
  • temperature above 101.4 degrees Fahrenheit
  • no improvement after 24 hours
  • signs of dehydration (see below)

What is dehydration?

General signs of dehydration include

  • thirst
  • less frequent urination
  • dry skin
  • fatigue
  • light-headedness
  • dark colored urine

Signs of dehydration in children include

  • dry mouth and tongue
  • no tears when crying
  • no wet diapers for 3 hours or more
  • sunken abdomen eyes or cheeks
  • high fever
  • listlessness or irritability
  • skin that does not flatten when pinched and released

If you suspect dehydration call the doctor immediately. Severe dehydration may require hospitalization.

Although usually not harmful diarrhea can become dangerous or signal a more serious problem. You should see the doctor if any of the following is true:

  • You have diarrhea for more than 3 days.
  • You have severe pain in the abdomen or rectum.
  • You have a fever of 102 degrees Fahrenheit or higher.
  • You see blood in your stool or have black tarry stools.
  • You have signs of dehydration.

If your child has diarrhea do not hesitate to call Telehealth Ontario at 1-866-797-0000 or ask your doctor for advice.

Diarrhea can be dangerous in children if too much fluid is lost and not replaced quickly. Your doctor will ask you to obtain one or more stool samples in special containers to test for signs of inflammation and infection and to identify the organism causing infection in case there is a need for further treatment.

Treatment

In most cases replacing lost fluid to prevent dehydration is the only treatment necessary. (See below.) Medicines that stop diarrhea may be helpful in some cases but they are not recommended for people whose diarrhea is caused by a bacterial infection or parasite·stopping the diarrhea traps the organism in the intestines prolonging the problem. Instead doctors usually prescribe antibiotics. Viral causes are either treated with medication or left to run their course depending on the severity and type of the virus.

Preventing Dehydration

Dehydration occurs when the body has lost too much fluid and electrolytes (the salts potassium and sodium). The fluid and electrolytes lost during diarrhea need to be replaced promptly·the body cannot function properly without them. Dehydration is particularly dangerous for children who can die from it within a matter of days.

Although water is extremely important in preventing dehydration it does not contain electrolytes. To maintain electrolyte levels you could have broth or soups which contain sodium and fruit juices soft fruits or vegetables which contain potassium.

For children doctors often recommend a special rehydration solution that contains the nutrients they need. You can buy this solution without a prescription. Examples include Pedialyte Ceralyte and Infalyte. 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 teaspoon.
  • Baking powder -- 1 teaspoon.
  • Orange juice -- 1 cup.
  • Water -- 1 quart or liter.

Tips about Food

Until diarrhea subsides try to avoid milk products and foods that are greasy high-fiber or very sweet. These foods tend to aggravate diarrhea.

As you improve you can add soft bland foods to your diet including bananas plain rice boiled potatoes toast crackers cooked carrots and baked chicken without the skin or fat. For children a doctor may recommend what is called the BRAT diet: bananas rice applesauce and toast.

Preventing Traveler's Diarrhea

Each year thousands of Canadian sun-seekers return home with more than just memories from their trip. Nausea stomach cramps vomiting and diarrhea can be some of the more unpleasant side-effects from a winter get-away in the sun if simple precautions for food and water are not followed. Traveler's diarrhea happens when you consume food or water contaminated with bacteria viruses or parasites. You can take the following precautions to prevent traveler's diarrhea when you go abroad:

  • Eat food that has been well cooked and is still hot when served.
  • Drink only purified water that has been boiled or disinfected with chlorine or iodine or commercially bottled water. Make sure that bottled water is in a sealed container.
  • Carbonated drinks without ice including beer are usually safe.
  • Avoid ice unless it has been made with purified water.
  • Unpasteurized milk should be boiled.
  • Avoid unpasteurized dairy products and ice cream.
  • Avoid uncooked foods especially shellfish and salads. Fruit which can be peeled is usually safe.
  • Avoid food from street vendors.

Depending on where you are going and how long you are staying your doctor may recommend that you take antibiotics before leaving to protect you from possible infection.

General 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 using Lactobacillus acidophilus a probiotic or healthy bacteria. This helps replenish the good bacteria that antibiotics can kill.

Additional Resources

Diarrhea Associated with Travel to the Tropics (Health Canada)

Don't Drink the Water (Health Canada)