Diarrhea

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Diarrhea or diarrhoea (see spelling differences) is a condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; lit. "to run through"). In the Third World, diarrhea is the most common cause of death among infants, killing more than 1.5 million per year.

Causes

This condition can be a symptom, disease, allergy, food intolerance, foodborne illness or extreme excesses of Vitamin C or magnesium and may be accompanied by abdominal pain, nausea and vomiting. There are other conditions which involve some but not all of the symptoms of diarrhea, and so the formal medical definition of diarrhea involves defecation of more than 200 grams per day (though formal weighing of stools to determine a diagnosis is never actually carried out).

It occurs when insufficient fluid is absorbed by the colon. As part of the digestion process, or due to fluid intake, food is mixed with large amounts of water. Thus, digested food is essentially liquid prior to reaching the colon. The colon absorbs water, leaving the remaining material as a semisolid stool. If the colon is damaged or inflamed, however, absorption is inhibited, and watery stools result.

Diarrhea is most commonly caused by viral infections or bacterial toxins. In sanitary living conditions and with ample food and water available, an otherwise healthy patient typically recovers from the common viral infections in a few days and at most a week. However, for ill or malnourished individuals diarrhea can lead to severe dehydration and can become life-threatening without treatment.

It can also be a symptom of more serious diseases, such as dysentery, cholera, or botulism and can also be indicative of a chronic syndrome such as Crohn's disease. Though appendicitis patients don't generally have diarrhea, it is a common symptom of a ruptured appendix. It is also an effect of severe radiation sickness.

Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary. The following types of diarrhea generally indicate medical supervision is desirable:

  • Diarrhea in infants.
  • Moderate or severe diarrhea in young children.
  • Diarrhea associated with blood.
  • Diarrhea that continues for more than 2 weeks.
  • Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc.
  • Diarrhea in travelers (more likely to have exotic infections such as parasites)
  • Diarrhea in food handlers (potential to infect others)
  • Diarrhea in institutions (Hospitals, child care, mental health institutes, geriatric and convalescent homes etc).

Mechanism

To expell the contents of the lower digestive tract, the fluidity of the contents of the small and large intestines is increased. Active transport of Na+ back into the gut initiates a reverse sodium transport. This causes both Cl- and HCO3 to follow passively, as well as water. Now in the intestines, the water dilutes toxins as well as triggers contractions of the intestine due to increase in intestinal distension. These contractions push the contents of the lower GI tract towards and out of the anal canal. Medications such as loperamide are designed to prevent such contractions in response to the distension, and should not be used to prevent diarrhea. Such inhibition actually prolongs the infection or irritation, and can cause a worsening over time because the evacuation of the bowel contents has been delayed.

Acute diarrhea

This may be defined as diarrhea that lasts less than 4 weeks, and is also called enteritis.

Considerations

Diarrhea in adults is usually mild and resolves quickly without complication. In infants and children (especially under age 3), diarrhea is more concerning. Children can become dehydrated fairly quickly.

Home Care

Drink plenty of fluid to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Milk may prolong loose stools, but also provides needed fluids and nourishment. Drinking milk may be fine for mild diarrhea. For moderate and severe diarrhea, electrolyte solutions available in drugstores are usually best.

Active cultures of beneficial bacteria (probiotics) make diarrhea less severe and shorten its duration. Probiotics can be found in yogurt with active or live cultures and in supplements. Foods like rice, dry toast, and bananas may help some.

Avoid over-the-counter diarrheal medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever food, virus, or other bug is causing it.

If you have a chronic form of diarrhea, like irritable bowel syndrome, try adding bulk to your diet to thicken the stool and regulate bowel movements. Such foods include rice, bananas, and fiber from whole-wheat grains and bran. Psyllium-containing products such as Metamucil or similar products can add bulk to stools.

Call your health care provider if

  • Do you drink alcohol? How much? How often?
  • Do you smoke? How much each day?
  • Are you on a special diet?
  • 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.
  • You have blood or pus in your stools or if your stool is black.
  • You have abdominal pain that is not relieved by a bowel movement.
  • You have symptoms of dehydration -- see article on dehydration.
  • You have a fever above 101°F or your child has a fever above 100.4°F along with diarrhea.
  • You have foul smelling or oily-looking stools.
  • You have recently traveled to a foreign country.
  • You have eaten with other people who also have diarrhea.
  • You have started on a new medication.
  • Your diarrhea does not get better in 5 days (2 days for an infant or child) or worsens before that.
  • Your child has been vomiting for more than 12 hours. In a newborn (under 3 months), you should call as soon as vomiting or diarrhea begins.

What to expect at your health care provider's office

Your doctor will take a complete medical history and do a physical examination, paying careful attention to your abdomen.

Questions that the doctor may ask include:

  • When did your diarrhea start?
  • How long have you had diarrhea?
  • What is the color and consistency of your stool?
  • Do you have blood in your stool?
  • Are you passing large amounts of mucus with your stool?
  • What other symptoms do you have?
  • Do you have abdominal pain or severe cramping with the diarrhea?
  • Do you have fever or chills?
  • Are any other family members sick?
  • Have you recently traveled out of the country?
  • What makes your pain worse? Stress? Specific foods?
  • Have you had abdominal surgery?
  • What medications do you take? Any recent changes to your medications?
  • Do you drink coffee? How much?
  • Do you drink alcohol? How much? How often?
  • Do you smoke? How much each day?
  • Are you on a special diet?

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.


If there are signs of dehydration in addition to the diarrhea, your doctor may order:

  • chem-20 (to check electrolytes)
  • urine specific gravity
  • BUN and creatinine

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.
  • When traveling to underdeveloped areas, follow the steps below to avoid diarrhea:
  • Drink only bottled water and DO NOT use ice.
  • DO NOT eat uncooked vegetables or fruit without a peel.
  • DO NOT eat raw shellfish or undercooked meat.
  • DO NOT consume dairy products.
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