Diarrhea

Definition

Diarrhea is more than three loose, liquid stools in a single day. It depletes your body of fluids and electrolytes. Diarrhea can be:

  • Acute—occurring suddenly, and lasting briefly
  • Chronic—long-term
  • Recurring—occurring in recurrent episodes

If you lose too much fluid, you can become dehydrated. It is particularly dangerous for babies, young children, and elderly people.

Causes

Causes may include:

Risk Factors

Factors that can increase your chance of getting diarrhea include:

  • Traveling to a developing country where the water and food supply may be contaminated
  • Having a severely weakened immune system, such as with AIDS or after an organ transplant
  • Taking certain medications

Symptoms

Symptoms include:

  • Frequent, loose, liquid stools
  • Abdominal pain, cramping
  • Urgent need to defecate
  • Blood and/or mucus in stool
  • Fever
  • Dehydration
  • Nausea, vomiting
  • Muscle aches and pains
  • Weight loss
  • Malnutrition

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. To determine the cause of your diarrhea, the doctor will ask questions, such as:

  • Does anyone else in your family have diarrhea?
  • What kinds of food have you eaten recently?
  • Do you drink well water?
  • Do your children attend daycare?
  • Have you traveled recently?
  • Do you use laxatives?
  • What medications do you take?
  • Do you have any symptoms other than diarrhea (eg, fever, rash, aching joints)?
  • What is your sexual history?
  • Have you ever had abdominal surgery?

Tests may include:

  • Laboratory analysis of a stool sample
  • Blood tests
  • Fasting or food elimination tests
  • Digital rectal exam—examination of the rectum with the doctor's gloved finger inserted into your rectum
  • Flexible sigmoidoscopy—a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon.
  • Colonoscopy—a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon
  • Biopsy—removal of a sample of colon tissue for testing. This may be performed as part of a flexible sigmoidoscopy or colonoscopy
  • Upper GI Series—a series of x-rays of the upper digestive system taken after drinking a barium solution (also called barium swallow)
  • Barium enema—insertion of fluid into the rectum that makes the lining of your colon show up on an x-ray

Barium Enema

Radiology colon

© 2008 Nucleus Medical Art, Inc.

Treatment

A medical condition may cause diarrhea. Treating the condition may help to relieve the diarrhea.

General recommendations for treating diarrhea include:

Drink Lots of Fluids

Plain water will not replace the electrolytes lost through diarrhea. Look for sports drinks or special solutions.

Ask Your Doctor If You Should Eat

Some doctors suggest that you drink only clear fluids during severe phases.

Avoid Certain Foods

Avoid the following foods:

  • Very spicy foods
  • Fatty foods
  • Greasy foods
  • High-fiber foods
  • Dairy products in large amounts
  • Caffeinated drinks

Encourage Certain Foods

  • Complex carbohydrates
  • Yogurt
  • Fruits and vegetables
  • Lean meats

Treat Abdominal Pain With Heat

Use a hot water bottle or heating pad on your abdomen to relieve cramps and pain.

Medications

Your doctor may recommend medications, such as:

  • Bismuth subsalicylate
  • Codeine phosphate
  • Loperamide hydrochloride
  • Paregoric
  • Psyllium or methylcellulose compounds
  • Kaolin or pectin products
  • Antibiotics may be indicated for certain bacterial causes of diarrhea.
  • Probiotics (eg, lactobacillus, bifidobacterium) may be beneficial.
  • Zinc supplementation may be recommended in certain cases.

Hospitalization

Diarrhea can cause severe dehydration. You may need to be hospitalized. Fluids will be delivered through an IV.

Prevention

To reduce your chance of getting diarrhea:

  • Practice good handwashing
  • Practice safe food preparation and food storage
  • If you have diarrhea, don't prepare food for others
  • If you're traveling:
    • Drink bottled water
    • Use bottled water when brushing your teeth
    • Avoid drinks that contain ice
    • Don't eat food purchased from street vendors
    • Don't eat raw vegetables or fruits (all produce should be peeled and/or cooked)
    • Make sure meats are cooked thoroughly
    • Eat only pasteurized dairy products
    • If you eat seafood, make sure it's very hot

RESOURCES:

Familydoctor.org
http://familydoctor.org/

National Institute of Diabetes and Digestive and Kidney Diseases
http://digestive.niddk.nih.gov/

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca/

Health Canada
http://www.hc-sc.gc.ca/

References:

Celiac Disease. American Gastroenterological Association website. Available at: http://www.gastro.org. Accessed July 28, 2008.

Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/index.htm. Accessed July 28, 2008.

Kleigman RM, Jensen HB, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007.

Robinson DL, McKenzie C. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins;2000.



Last reviewed November 2007 by Kari L. Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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