Definition

Diarrhea is more than three loose, liquid stools in a single day. Diarrhea can be:

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

Diarrhea depletes your body of fluids and electrolytes. If you lose too much fluid, you can become dehydrated . Diarrhea is particularly dangerous for babies, young children, and elderly people.

Causes

Causes may include:

• Food intolerance, such as lactose intolerance
• Medications, including:
  • Antibiotics
  • Magnesium-containing antacids
  • High blood pressure medications
  • Quinine
  • Cancer chemotherapy
  • Laxatives
• Irritable bowel syndrome (episodes of diarrhea often alternate with periods of constipation )
• Injury to the bowel after radiation treatments for cancer
• Malabsorption syndromes, such as:
  • Celiac sprue
  • Tropical sprue
  • Short bowel syndrome
  • Whipple's disease
  • Intestinal lymphangiectasia
• Diseases of the pancreas and/or gallbladder
• Inflammatory bowel diseases (ulcerative colitis, Crohn's disease)
• Chronic diseases, such as:
  • Liver disease
  • Diabetes
  • Hyperthyroidism
  • Addison's disease
  • Pellagra
  • Scleroderma
  • Amyloidosis
  • AIDS
  • Colon cancer
• Intestinal surgery
• Infections, including food poisoning, such as:
  • Bacterial: Campylobacter, Clostridium difficile, Salmonella, Shigella, and Escherichia coli
  • Viral: rotavirus , Norwalk virus , cytomegalovirus , herpes simplex virus , and viral hepatitis
  • Parasitic: Giardia lamblia , Entamoeba histolytica , Cryptosporidium,tapeworm , roundworm , flukes
  • Fungal: Candida (yeast)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors 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, and perform a physical exam. 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
	© 2008 Nucleus Medical Art, Inc.

Treatment

If a medical condition is causing your diarrhea, treating it may help relieve your diarrhea.

General recommendations for treating diarrhea include:

Drink Lots of Fluids

Plain water will not replace the electrolytes lost through diarrhea. Consider drinking sports drinks or specially balanced rehydration solutions.

Ask Your Doctor If You Should Eat

Some doctors suggest that you consume only clear fluids during the most severe phase of diarrhea.

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

Depending on why you have diarrhea, 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

If your diarrhea causes severe dehydration or you have other chronic conditions, you may need to be hospitalized to receive fluids through an intravenous line.

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:

American Gastroenterological Association
http://www.gastro.org

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

CANADIAN RESOURCES:

Alberta Health and Wellness
http://www.health.gov.ab.ca/

Communicable Disease Control Unit
http://www.gov.mb.ca/health/publichealth/cdc/index.html

References:

American Gastroenterological Association website. Available at: http://www.gastro.org .

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

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

Primary Care Medicine . 4th ed. Lippincott, Williams, and Wilkins; 2000.

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