Diarrhea

What is Diarrhea?

Diarrhea can be a symptom of a wide range of intestinal problems, and can occur in people of all ages. Diarrhea generally means more frequent bowel movements, watery or poorly formed stools and an increase in the volume of stool. The greatest risks from diarrhea are dehydration (loss of water), loss of electrolytes, and possible malnutrition from the loss of nutrients.

Because of the dehydration and malnutrition that can occur, young children, the elderly, and those individuals with other diseases are at highest risk when diarrhea occurs. Most bouts of diarrhea last for a few days and then stop without requiring treatment, and are not associated with fever or intestinal bleeding.

Causes of Diarrhea

• Infection by viruses (such as HIV, rotavirus, Norwalk agent); bacteria (such as Campylobacter, Clostridium difficile, Escherichia coli, Listeria monocytogenes, Salmonella enteritidis, Shigella)

or parasites (such as Cryptosporidium parvum, Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia, microsporidia).

• Drinking bad water or eating spoiled food.

• Food poisoning.

• Allergies.

• Emotional upset.

• Overuse of laxatives.

• Certain medications, including some antibiotics (like tetracycline, clindamycin, and ampicillin).

• Diverticulitis - a disease in the intestines.

• Inflammatory bowel disease (primarily ulcerative colitis and Crohn's disease).

If you have fever, blood in your stools, vomiting, abdominal pain or tenderness with light pressure, frequently recurring diarrhea, or severe weakness or dizziness, you should consult your doctor.

Self-Care Tips

It is advisable not to treat mild diarrhea in the first few hours since the body may be purging itself of an infection or toxins. If your diarrhea persists, you should consult your doctor.

Steps to control diarrhea:

With more fluid than usual being flushed out of your body, dehydration is a potential problem, especially with infants and children, who have less fluid to spare than adults.

• The first course of action is to drink plenty of clear fluids. Even sucking on ice chips helps. Adults should have around 2 cups of fluid per hour (if vomiting isn't present). For children under 2, you should consult their doctor about amount and type of fluid. For children over 2, give up to 2 quarts of fluid per day (consult their doctor when in doubt or if they show any signs of dehydration, i.e., thirst, muscle cramps, delirium and weakness). Ready-made solutions such as Pedialyte and Lytren that restore fluids and minerals, available in most drug stores, are often recommended for children. They can also be used for adults.

• Other clear liquids to give include: Water, Jello (both in liquid and solid form), clear broths, sodas such as ginger ale, flat cola, 7-Up, Sprite, etc., weak tea with sugar, and sport drinks such as Gatorade.

• You can also make your own solution by mixing 4 teaspoons of sugar and 1 teaspoon of salt with 1 quart (4 cups) of water.

• Avoid very hot and very cold liquids, however, since they can stimulate the colon. Also, avoid drinking apple juice and milk. It sometimes worsens diarrhea, especially in children.

• Eat little or no solid food for the first few days. (Jello is okay - it counts as a clear liquid).

• When diarrhea is waning, following a B.R.A.T. diet: bananas (ripe), rice, applesauce, and toast. These foods tend to be constipating, and should be the first things you eat after a bout of diarrhea.

• Once the diarrhea has subsided, eat small amounts of semi-soft foods, like cooked potatoes. Stay away from dairy products and foods that contain a lot of protein such as meat.

• Don't eat high-fiber foods like whole-grain breads and bran cereals.

• Avoid eating raw fruits and vegetables and fried foods or drinking coffee, all of which are hard on your digestive tract.

• Limit physical activity until bowel activity returns to normal.

• Try Kaopectate, Immodium AD or other non-prescription remedies containing bismuth, such as Pepto-Bismol. [Note: Do not give aspirin or any medication containing salicylates to anyone 19 years of age or younger unless directed by a physician, due to its association with Reye's Syndrome, a potentially fatal condition.] Follow package directions to the letter. Don't take these right away, though. Letting the diarrhea run its course for at least 12 hours allows the body to rid itself of whatever is causing the diarrhea.

• Always make sure to wash your hands after going to the toilet and before preparing food, especially when you have diarrhea that results from an infection in the GI tract. Don't share towels with others. Use disposable paper towels to dry your hands.

Questions to Ask

Does the diarrhea occur in an infant or child and is it accompanied by any of the following?

Sunken eyes

• Dry skin
• Dry mouth
• Dry diaper for more than 3 hours in an infant
• Passing no urine for more than 6 hours in a child
• Unusual lethargy, weak cry
• Irritability, very upset or cranky

Does an adult have any of these problems with the diarrhea?

• Blood, mucus or worms in the stool
• Black colored stools
• Severe abdominal or rectal pain
• Dry mouth
• Wrinkled skin
• Excessive thirst and little or no urination

In a child or adult, has the diarrhea lasted 48 hours or more and/or is fever of 39 C or higher present?

Is the diarrhea occurring more than 8 times per day in an infant or chronically ill elderly adult?

IF YOUR ANSWER IS "YES", THEN YOU SHOULD VISIT YOUR DOCTOR.