Diarrhea

What is diarrhea?

Acute diarrhea is an unpleasant digestive disorder that virtually everyone experiences at one time or another. The loose-stool consistency usually lasts a few days at most. Diarrhea often means more frequent trips to the bathroom and may mean your stool is greater in volume. The most common causes of loose, watery stools and abdominal cramps are infections from viruses, bacteria or parasites. Other causes include medications — particularly antibiotics — and artificial sweeteners.

Chronic diarrhea lasts much longer than acute diarrhea. It can be a sign of a serious disorder, or may be due to a less serious condition such as irritable bowel syndrome.

Diarrhea may cause your bowel to lose significant amounts of water and salts. Also, chronic or recurrent diarrhea may signal a more serious underlying medical problem, such as chronic infection, inflammatory bowel disease or poor absorption of nutrients (malabsorption).

Most cases of diarrhea clear on their own without treatment. But if diarrhea persists or you become dehydrated, see your doctor.

Inflammatory bowel disease Digestive Center

Signs and symptoms

Signs and symptoms associated with diarrhea may include:

• Frequent loose, watery stools
  
  
• Abdominal cramps
  
  
• Abdominal pain
  
  
• Fever
  
  
• Bleeding

Nausea and vomiting may precede diarrhea that's caused by an infection. Bacterial or parasitic infections sometimes cause bloody stools. Fever may accompany these infections as well. Persistent abdominal pain is a symptom of potentially even more serious causes of diarrhea.

Fever

Causes

Normally, the food you eat remains in liquid form during most of the digestive process. When food passes through your colon, most of the fluids are absorbed and what remains is a semisolid stool. In diarrhea, food and fluids you've ingested and secreted pass too quickly or in too large an amount — or both — through your colon. The fluids aren't sufficiently absorbed and the result is a watery bowel movement. Also, the lining of your colon may be inflamed or diseased, making it less able to absorb fluids.

The most common causes of diarrhea include:

• Viruses. Rotavirus and adenovirus are common examples in young children. Direct contact easily spreads viral diarrhea.
  
  
• Bacteria and parasites. Parasites such as Giardia lamblia and cryptosporidium can cause diarrhea. Certain bacteria can make a toxin that triggers intestinal cells to secrete rather than to absorb salt and water. Common bacterial causes of diarrhea include campylobacter, salmonella, shigella and Escherichia coli. These infections overwhelm the capacity of your lower small bowel or your colon — or both — to absorb fluid. The result is diarrhea. Contaminated food or water can transmit bacteria and parasites to your body. Lactose, a sugar found in milk and milk products, also is a common cause of diarrhea in some people.

Diarrhea can be a side effect of many medications, particularly antibiotics. Antibiotics can disturb the natural balance of bacteria in your intestines.

In addition, the artificial sweeteners sorbitol and mannitol found in chewing gum and other sugar-free products can cause diarrhea. Many otherwise healthy people may have some difficulty with these sweeteners.

Antibiotic-associated diarrhea

When to seek medical advice

If diarrhea persists beyond 1 week or if you become dehydrated — as suggested by excessive thirst, dry mouth, little or no urination, severe weakness, dizziness or lightheadedness — see your doctor. Also get medical help if you have severe, persistent abdominal or rectal pain, bloody stools, a temperature of more than 101 F or signs of dehydration despite drinking plenty of liquids.

In young children, diarrhea can quickly lead to dehydration. Call your doctor if diarrhea persists for more than 12 hours or if your baby:

• Hasn't had a wet diaper in 8 hours
  
  
• Has a high fever
  
  
• Has bloody stools
  
  
• Has a dry mouth or cries without tears
  
  
• Is unusually sleepy or drowsy or unresponsive

Screening and diagnosis

If you have diarrhea that's bad enough to require medical attention, your doctor will ask about your symptoms and will want to determine if you're dehydrated. Let your doctor know about any medications you're taking, including over-the-counter medications, that may have caused the diarrhea.

Your doctor may examine your abdomen to determine the location of your pain, may listen to your abdomen with a stethoscope and may give you a rectal exam. If you have severe diarrhea, your doctor may suggest blood or stool tests to check for signs of infection or other abnormalities.

Treatment

Most cases of diarrhea clear on their own in 2 or 3 days without treatment. If you've sought medical attention, your doctor likely will advise you to be sure to drink enough replacement fluids and an electrolyte mixture because of the fluids and body chemicals lost during diarrhea. Your body needs adequate levels of minerals — sodium, magnesium, calcium and especially potassium — in order to maintain the electric currents that keep your heart beating. Disruption of your body's levels of fluids and minerals creates an electrolyte imbalance. Unless restored, this imbalance can be serious.

If your doctor determines that an antibiotic medication caused your diarrhea, you'll need to stop taking that medication.

If a parasitic infection caused your diarrhea, prescription antibiotics may ease your symptoms. Antibiotics sometimes, but not always, help ease symptoms of bacterial diarrhea. However, antibiotics won't help viral diarrhea, which is the most common kind of infectious diarrhea.

Prevention

You can help prevent the spread of viral diarrhea by washing your hands and encouraging your children to wash their hands. Because viral diarrhea spreads easily, it's a good idea to keep your child home from school or child care if he or she has diarrhea.

To guard against diarrhea caused by contaminated food:

• Use dairy products that have been pasteurized. Pasteurization involves heating dairy products for a period of time to kill bacteria.
  
  
• Serve food right away or refrigerate it after it has been cooked or reheated. Leaving food out at room temperature encourages growth of bacteria.

Diarrhea commonly affects people who travel to developing countries, sometimes due to inadequate sanitation and contaminated food and water. To reduce your risk:

• Eat hot, well-cooked foods.
  
  
• Drink bottled water, soda, beer or wine served in its original container. Beverages from boiled water, such as coffee and tea, also are usually safe. Remember that alcohol and caffeine can aggravate diarrhea and dehydration.
  
  
• Use bottled water even for brushing your teeth. Keep your mouth closed while you shower.
  
  
• Avoid salads, buffet foods, raw or undercooked meats, raw vegetables, grapes, berries, dairy foods, tap water and ice cubes.
  
  
• Ask your doctor whether you should take diarrhea medication with you.

Traveler's diarrhea Global travel: Advance planning can prevent illness Hand washing: The simplest way to avoid infection

Self-care

Diarrhea caused by viral infections typically clears on its own without antibiotics. Over-the-counter medications such as Imodium, Pepto-Bismol and Kaopectate may slow diarrhea, but they won't speed your recovery.

Take these measures to prevent dehydration and reduce symptoms while you recover:

• Drink at least 8 to 10 glasses (2 to 2 1/2 quarts) of clear liquids, including water, clear sodas and broths, gelatin and juices every day.
  
  
• Add semisolid and low-fiber foods gradually as your bowel movements return to normal. Try soda crackers, toast, eggs, rice or chicken.
  
  
• Avoid dairy products, fatty foods or highly seasoned foods for a few days.
  
  
• Avoid caffeine and alcohol.

Food & Nutrition Center Water: A drink to your health

— October 4, 2002 —