Diarrhea
डिस्क्रिप्सन
Definition of Diarrhea
Diarrhea can be described as an increase in the frequency of bowel movements or loose watery bowel movements. Although both changes in frequency of bowel movements and looseness of stools can occur separately, they are usually seen together. This looseness in stools which can vary from slightly soft to watery occurs due to an increase of water content in the stool, most commonly due to an infection of the digestive tract. This medical condition is a common reason for people to seek emergency medical advice.
Causes and Risk Factors of Diarrhea
A number of factors can cause diarrhoea such as:
1. Viruses: These include Norwalk virus, cytomegalovirus, and hepatitis virus. Rotavirus is the most common cause of diarrhoea in children.
2. Bacteria, protozoa and parasites: These can be spread through contaminated food and water, e.g., typhoid, cholera, etc.
3. Medications: A number of commonly prescribed medications including antibiotics can cause diarrhoea.
4. Lactose intolerance: People who lack enzyme lactase are unable to digest milk protein lactose that is present in dairy products, leading to diarrhoea after eating such foods.
5. Surgery: After an abdominal surgery or gall bladder surgery.
6. Chronic bowel infection: Chronic diarrhoea can occur due to chronic bowel infection e.g., tropical sprue, inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and bowel cancer.
Signs and Symptoms of Diarrhea
These include:
1. Loose watery stools occurring many times in a day
2. Abdominal pain and cramps
3. Fever
4. Blood in stool
5. Bloating
6. Nausea and vomiting
7. Weakness
8. Cold, moist skin
Investigations
To come to a diagnosis, apart from a complete physical examination and history, following tests may also be advised by your physician.
1. Blood tests: Like Widal, Typhidot, CBC (complete blood count) to find out the cause of diarrhoea.
2. Stool test: To determine whether a bacteria or parasite is causing the diarrhoea.
3. Colonoscopy: In cases of persistent diarrhoea your physician may advise colonoscopy to view the internal lining of colon and also conduct biopsies if required.
Treatments of Diarrhea
Mild cases of diarrhea usually subside without any treatment apart from slight modification in diet. Chronic persistent cases will require tests and other treatment according to the cause.
Standard protocol for treatment of diarrhoea:
1. Drink more fluids to prevent dehydration and compensate for water loss. Severe cases will require fluids intravenously.
2. Oral rehydration salts (ORS) which are simple sugars and salts should be given to patients of diarrhoea. ORS sachets are inexpensive and available widely in all pharmacies.
3. Antidiarrhoeal medications
Prognosis and Prevention
Most cases of acute and mild diarrhoea are self-limiting and respond within 5 days of treatment. Infectious diarrhoea responds well to antibiotic therapy; however, most deaths from diarrhoea occur due to dehydration. This is common in small children and elderly due to already compromised immune system and proneness to dehydration.
The best way to prevent diarrhoea is to effectively wash hands especially after using the toilet, changing nappies, and before eating/cooking/serving meals. Drinking water should be boiled or purified using popular methods and stored in hygienic conditions. Food should also be prepared and stored in a neat and hygienic manner.
Home tips to treat and prevent diarrhoea:
1. Consume foods high in fiber such as bananas, rice, and oatmeal to restore nutrition.
2. Restrict foods that aggravate diarrhoea such as sugary and fried foods.
3. Consume high potassium foods such as diluted fruit juices, tomatoes, potatoes, and bananas.
4. Drink more fluid between meals not during.
Did You Know?
Did you know that artificial sweeteners like mannitol or sorbitol can also cause diarrhoea? In fact, one artificial sugar called lactulose induces diarrhoea and is used as a medicine for relieving constipation.
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Last updated on:
02 Apr 2019 | 10:57 AM (IST)
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Diarrhoea if not treated adequately in time can be fatal. The underlying cause for the symptom of diarrhoea should be identified and aggressively treated to prevent death.
No. Diarrhoea is not a sign of any trimester of pregnancy. Diarrhoea is most commonly due to an underlying digestive tract infection or other causes like antibiotic-induced diarrhoea. The cause should be identified and treated immediately.
Yes. Diarrhoea can be a symptom of a waterborne disease, but not always. Diarrhoea occurring due to infections like typhoid, cholera, etc. is due to intake of contaminated water.
Yes. Diarrhoea is a symptom of an underlying disease. If the diarrhoea is due to an infection like typhoid, cholera then it can easily spread to other persons by contamination of food and water.
Diarrhoea most commonly occurs due to an infection of the digestive tract, e.g., cholera and typhoid. Occasionally, diarrhoea can occur due to medicines like antibiotics, or due to uncontrolled diabetes.
Diarrhoea leads to loss of water along with salts, vitamins, and minerals from the body. This loss of essential nutrients can cause malnutrition, weakness, and fatigue.
Diarrhoea is not a disease, but a symptom of an underlying disease. It can be easily cured by correcting the cause behind it. If it is an infection, then appropriate antibiotic should be given, so on and so forth.
Yes. Diarrhoea can cause dramatic weight loss within a day itself if not treated immediately. Diarrhoea is a symptom of an underlying disease. It leads to weight loss because of loss of water and vital nutrients from the body.
Diarrhoea may affect the action of 'the pill.' The pill contains hormones that act on the uterus and prevent pregnancy. Due to diarrhoea, absorption of contents of the pill might be poor, leading to incomplete or failure of action of 'the pill.'
Diarrhoea is a symptom of some underlying disease. Most commonly, it is due a digestive tract infection. This infection can cause fever. Therefore, diarrhoea is commonly associated with fever as a symptom.
Applesauce is commonly used in diarrhoea. BRAT diet consisting banana, rice, applesauce, toast or tea has been tried in acute diarrhoea. Data regarding exact mechanism and effectiveness of applesauce in treating diarrhoea is lacking.
Yes, we can treat diarrhoea and vomiting at same time using antidiarrhoeal medications (loperamide, Lomotil) and domperidone (medicine use to treat vomiting). If vomiting and diarrhoea is of infectious origin, it requires treatment with appropriate antibiotics along with above medications.
Oatmeal can be taken in diarrhoea. Oatmeal is rich in dietary fiber and has low carbohydrate content. Dietary fibers absorbs water from digestive tract making stool less watery. Initially, diarrhoea is treated with rehydrating solutions and antibiotics. Once the patient is stable and able to take food orally without increase in stool frequency, oatmeal can be added to the diet.
Foamy appearance of diarrhoea is due to presence of excess mucus or fat in stool. Foamy diarrhoea can occur due to infections such as giardiasis, celiac disease (malabsorption disorder), fat malabsorption, or irritable bowel syndrome.
Yes, diarrhoea is a common complaint of both acute and chronic alcohol ingestion. Effect of alcohol on digestive system is common. Alcohol increases movement of digestive system and increases secretion of water and electrolytes in digestive system leading to diarrhoea.
Women may experience increased frequency of bowel movements during menstruation. This can be treated by use of antidiarrhoeal medications such as loperamide and Lomotil. Care must be taken to ensure adequate hydration using oral rehydration solutions.
No, breastfeeding does not cause diarrhoea, rather it has been found that diarrhoea related deaths are common in infants who are not breastfeeding. It is advised to nursing women not to stop breastfeeding if child is experiencing diarrhoea, as breast milk provide nutrition, anti-infective factors, and maintain hydration during diarrhoea.
Gastrointestinal problems like diarrhoea and constipation are common during pregnancy. Diarrhoea during pregnancy might be related to noninfectious causes like hormonal changes, diet, stress, or even infections. The cause of diarrhoea in pregnancy need to be evaluated and managed accordingly. The risk factors for getting diarrhoea at 36 weeks of pregnancy include poor personal hygiene, ingestion of contaminated food and water, and certain medications.
Diarrhoea is a common side effect of antibiotic treatment. Almost all antibiotics can cause diarrhoea, but it is common with certain antibiotics such as ampicillin, amoxicillin plus clavulanic acid combinations, erythromycin, and cephalosporins. Age over 65 years and prolonged hospitalization also increases risk of antibiotic associated diarrhoea. Antibiotic-associated diarrhoea can be attributed to increased motility of intestine caused by these antibiotics.
Presence of green colored diarrhoea can be normal during pregnancy. Iron supplements like ferrous gluconate, multivitamins, green leafy vegetables, and excretion of unchanged bile pigment in stools might also be responsible for greenish stool during pregnancy.
Yes, excess thyroid hormone can cause diarrhoea. Thyroid hormone has influence on intestinal motility and intestinal secretion. Increase in thyroid hormone in body causes increase intestinal motility and hypersecretory state of intestine resulting in diarhoea.
Red colored diarrhoea can occur due to bleeding from lower digestive tract like anus, rectum, and colon, consumption of red colored food or drink like wine, jelly-O, or red candy.
Coffee ground colored appearance of stool suggest action of stomach acid on blood in the digestive tract and can been seen in patients with stomach ulcer or bleeding from upper digestive tract.
Onset of diarrhoea depends on underlying cause. Diarrhoea due to food poisoning can start within an hour of ingestion of food with toxins, e.g., staphylococcal food poisoning. Onset of diarrhoea of infectious origin also depends on the causative organism and can vary from 12 hours to 4 days.
In diarrhoea, there is loss of sodium, potassium, and bicarbonate ions in stools. Loss of basic ions (bicarbonate ion) with increase in acidic ions (hydrogen ions) in the body leads to acidosis in patients with diarrhoea.
Travelers’ diarrhoea (TD) is common travel related illness. Poor personal hygiene, ingestion of contaminated food, and water are the contributing factors for development of Travelers’ diarrhoea. Travelers’ diarrhoea can be simply prevented by following simple recommendations when eating food or drinking water: “Boil it, cook it, peel it, or forget it.”
Improvement in diarrhoea usually occurs within 1 to 2 days after treatment. Patient should consult a doctor if diarrhoea or fever persists or it gets worsened despite appropriate treatment. In severe diarrhoea, there may be passage of black or bloody stools and the patient may become unconscious.
Generally, people do not experience diarrhoea after eating eggs. Diarrhoea after eating eggs might be due to contaminated food or poor personal hygiene, and indigestion of egg protein or allergy to egg protein. It is better to consult physician if person is experiencing diarrhoea after eating eggs. Diarrhoea after eating eggs can be prevented by proper cooking of eggs, using clean utensils, and maintaining good personal hygiene.
Generally, patient may either experience diarrhoea or constipation depending upon the cause, but in irritable bowel syndrome, patient can have diarrhoea with constipation together. So, if you are experiencing intermittent diarrhoea and constipation, consult your physician immediately.
Yes, usually long distance runners may experience diarrhoea which is popularly called as runner's diarrhoea. The exact cause of such diarrhoea is still unknown. Nutritional factors such as ingestion of fiber, fat, protein, high concentrated carbohydrate beverages, caffeine along with running induced decreased oxygen supply to tissue might contribute to development of diarrhoea. Runner's diarrhoea can be prevented by avoiding contributing factors and wearing comfortable dresses while running.
Yes, banana is helpful in treatment of diarrhoea. Banana contains dietary fibers which help in reducing frequency and duration of stools, as well as increases absorption of nutrients from digestive tract. Banana contains high amount of potassium which helps in replenishing lost potassium ions in diarrhoea.
Diarrhoea in babies is common. Infections of digestive tract caused by viruses or bacteria, food poisoning, medication use are the common causes of acute diarrhoea (diarrhoea duration less than 2 week) in children. Chronic diarrhoea (diarrhoea duration more than 4 weeks) can result from infections of digestive tract, nutritional deficiencies (zinc deficiency), malabsorption of nutrients or from chronic diseases like Crohn’s disease, and ulcerative colitis.
Diarrhoea of noninfective origin can be managed symptomatically with rehydrating fluids, antidiarrhoeal medications such as loperamide. Antibiotics are used in the treatment of infective diarrhoea. Choice of antibiotic depends upon the causative microorganism and sensitivity of microorganism to available antibiotics.
Excessive daily consumption of coffee for prolonged period can result in diarrhoea. Coffee contains chemical named caffeine which increases motility of digestive tract resulting in diarrhoea.
Drinking chamomile tea results in relief from intestinal cramps and inflammation of the stomach during diarrhoea. One can have it 3 to 4 times a day for better results.
Complication of diarrhoea if continued for prolonged period includes:
Dehydration: Which is manifested as restlessness, irritability, sunken eyes, abdomen, lethargy, and unconsciousness.
Electrolyte and acid-base imbalance: Acidosis (increased body acid) with loss of sodium, potassium, and bicarbonate ions.
Nutritional consequences: Loss of fluids, nutrients, and proteins lead to development of malnutrition. In extreme case, there is loss of skeletal muscle mass, stunted growth.
Impaired immunity: Chronic diarrhoea can lead to decreased immunity. This might be due to malnutrition caused by diarrhoea.
Yellow colored stools can be seen in patients suffering from liver and gall bladder disorders like hepatitis, jaundice, or gall stone disease. It occurs due to increased excretion of yellow colored bile pigment in stools.
No, diarrhoea is not symptom of malaria, but, medication used in treatment of malaria can sometimes cause diarrhoea, e.g., quinine, doxycycline.
Excessive protein intake (if protein constitutes > 35% of total energy intake) can increase ammonia levels in the blood, increase insulin level, and can even cause diarrhoea. Exact mechanism of diarrhoea with excesive protein is unknown, but it might be due to intestinal irritation. Diarrhoea with excessive protein intake can be prevented by: 1) Reducing protein intake.
2) Add more dietary fiber to meal. 3) Remove manufactured food like processed meat. 4) Add easily digestible protein to meal like whey proteins, fish, and plant based proteins such as nuts or legume.
Yes, diarrhoea can cause weight loss. Diarrhoea, if left untreated can lead to weight loss due to loss of fluids, nutrients, and minerals. Diarrhoea is usually a symptom of an underlying disease. Weight loss in chronic diarrhoea can be due underlying diseases such as fat malabsorption, inflammatory bowel disease, and cancer.
Yes, stress and anxiety can cause diarrhoea. Stress and anxiety can lead to alteration in brain-gut interaction, leading to release of chemicals causing change in gut motility. Stress and anxiety, for prolonged period can also increase risk of intestinal disorder like irritable bowel syndrome and ulcerative colitis.
Diarrhoea is common adverse effect associated with antibiotics treatment. Antibiotics associated diarrhoea can be prevented with use of antibiotics which have less propensity to cause diarrhoea, e.g., ciprofloxacin. Use of probiotics along with antibiotic also prevents diarrhoea. Probiotics are the living mico-organisms which may have provide various health benefits to the host. Probiotics such as Lactobacillus acidophilus, L casei GG, L bulgaricus, Bifidobacterium bifidum proved to be effective in treatment of antibiotic associated with diarrhoea.
Travelers’ diarrhoea (TD) occurs by ingestion of food and water contaminated with micro-organisms like bacteria (E. coli), viruses, and protozoa. These organisms infects the digestive tract leading to diarrhoea. TD can be prevented by avoiding exposure to contaminated food, water, and maintaining good personal hygiene during travel.
No, diarrhoea is not associated with ovulation. Ovulation is process where egg is released by ovaries. Lower abdominal cramps, increase in vaginal discharge, mid month spotting, breast tenderness, and increase in body temperature are the signs and symptoms associated with ovulation. There is no scientific data supporting diarrhoea as symptom of ovulation.
Practice of having regulated and supervised food is popularly known as dieting. Generally dieting does not lead to development of diarrhoea. During dieting people prefer diet rich in dietary fibers and milk. Milk ingestion in lactose intolerant individuals can however lead to diarrhoea.
Teething is associated with various systemic manifestations like fever, vomiting, irritability, drooling, etc. The exact mechanism for diarrhoea during teething is still unknown, but it might be attributed to babies contamination of fingers or mouthing of an object by child. Treatment of diarrhoea during teething is same as that of diarrhoea in non-teething child.
Diarrhoea is defined as passage of three or more loose stools per day or frequent passage of stools more than normal for that individual. Noninfective diarrhoea usually resolves within 4 to 5 days when treated symptomatically with rehydrating fluids. Acute diarrhoea of infectious origin get resolved within 7 to 14 days with appropriate use of antibiotics. If diarrhoea persists beyond 14 days, it needs to be evaluated for any underlying pathology.
Patients with foul smelling diarrhoea has very intense bad odor of stools. It can occur due to change in diet or due to various medical conditions like:
1) Infectious diarrhoea, e.g., amoebiasis, giardiasis, enteric fever, etc. 2) Malabsorption 3) Coeliac disease 4) Ulcerative colitis 5) Chronic pancreatitis.
Black diarrhoea is a sign of presence of blood in diarrhoea. Source of blood in diarrhoea could be bleeding from upper digestive tract, i.e., oesophagus, stomach, duodenum, and ileum. In infants and children, infection of digestive tract, certain diseases like Crohn’s disease, ulcerative colitis can lead to black diarrhoea. Intestinal infection, gastric, or duodenal ulcer, cancer of digestive tract can result in black diarrhoea in adults. Some medications can also make stool color black like bismuth based medications.
Foods which aggravate or cause diarrhoea and hence better avoided during diarrhoea include: cauliflower, cabbage, broccoli, beans, peas, milk, coffee, alcohol, and spicy food.
Nausea, vomiting, and diarrhoea are the common symptoms of typical food poisoning. Food poisoning without vomiting and diarrhoea is rare. Food borne botulism (poisoning with botulinum toxin) can manifests as vomiting without diarrhoea.
Watery diarrhoea of noninfective origin can be managed at home by following methods, 1) Maintain hydration: Dehydration is common consequence of diarrhoea. Hydration is maintained by drink fluids as much as patient can. Oral rehydration solutions or Solution prepared at home with teaspoonful of sugar, pinch of salt in 1 liter of water prevent dehydration.
2) High fiber diet: Once patient is able to take food, light meal like banana, applesauce, yogurt and rice which contains high amount of dietary fibers can be started. Avoid spicy food, milk, coffee, tea, cabbage, etc.
3) Over-the-counter antidiarrhoeal medications: If patient is having diarrhoea without fever, antidiarrhoeal drugs like loperamide, Lomotil can be given to patient.
Yes, prolonged diarrhoea can itself lead to malnutrition. Malnutrition in diarrhoea is due to loss of nutrients, minerals in stools, and may be due to underlying diseases like ulcerative colitis, and celiac disease.
Presence of mucus gives jelly-like appearance to stools. Mucus lubricates digestive tract to protect its lining from the damage. Normally stools consists little mucus which is difficult to notice, but, certain inflammatory conditions like ulcerative colitis, Crohn's disease, irritable bowel syndrome, malabsorption, and infections can lead to excessive secretion of mucus in stools giving it jelly-like appearance.
Diarrhoea is symptom, not a disease. Many diseases which causes infective diarrhoea are contagious, e.g., typhoid, cholera, amoebiasis, rotavirus, etc. Transfer of infective agent from one person to another person occur due to poor personal hygiene via contaminated hands, food, and water which lead to development of diarrhoea.
Diarrhoea is one of the common adverse effect of medications such as antibiotics, pain-killers like aspirin, laxatives, and anticancer drugs.
Heroin is substance of abuse which belongs to opioid class of drugs. When people stop using heroin they experience opioid withdrawal symptoms which includes nausea, vomiting, and diarrhoea. These withdrawal symptoms are due to increased activity of nervous system which occurs due to sudden stoppage of the opioid drug.
Few females experience diarrhoea during or before menses. During menstruation, there is rise of chemical in the body such as prostaglandins which causes increased contraction of digestive tract leading to diarrhoea.
Coconut water is rich in potassium, sodium, and sugar. All of these replenish the minerals that are lost during diarrhoea and provide much needed energy.