Diarrhoea

What Is Diarrhea?

is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

The most common cause is an infection of the intestines due to either a virus, bacteria, or parasite—a condition also known as gastroenteritis. These infections are often acquired from food or water that has been contaminated by feces, or directly from another person who is infected.

The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody). The short duration watery diarrhea may be due to cholera, although this is rare in the developed world. If blood is present, it is also known as dysentery. A number of non-infectious causes can result in diarrhea. These include lactose intolerance, irritable bowel syndrome, non-celiac gluten sensitivity, celiac disease, inflammatory bowel disease such as ulcerative colitis, hyperthyroidism, bile acid diarrhea, and a number of medications. In most cases, stool cultures to confirm the exact cause are not required

Symptoms of diarrhoea

In addition to frequent, watery bowel movements, the stool may also contain mucus, pus, blood or excessive amounts of fat.
Diarrhoea can be accompanied by:

• painful abdominal cramps;
• nausea;
• fever;
• bloating; and
• generalised weakness.

Diarrhoea can cause dehydration, especially in young children and older people. Symptoms of dehydration in adults can include:

• thirst;
• lack of energy;
• passing less urine than normal;
• dizziness or light-headedness; and
• the skin on the back of your hand being slow to return to position after being pinched upwards.

Symptoms of mild to moderate dehydration in children can include:

• dry mouth;
• passing less urine than usual (often noticed as fewer wet nappies in babies and toddlers);
• irritability;
• listlessness; and
• less tears when crying.

Signs of severe dehydration in children include sunken eyes, cheeks or belly, or a sunken fontanelle (the soft spot on the top of the head in babies and toddlers).

What are the Causes of diarrhoea

When to see your doctor about diarrhoea

Most people have experienced an episode of diarrhoea at some time in their lives. Generally, this resolves after a few days.

You should seek medical advice if:

• A child or elderly person has severe diarrhoea, as they may become rapidly dehydrated.
• Diarrhoea lasts more than 5 days in an otherwise healthy adult.
• Your diarrhoea has not improved with self-care measures.
• There is bright red blood in the faeces, or stools are dark and tarry.
• You have diarrhoea that contains mucus.
• The faeces have high fat content, which may be seen as pale, greasy, foul smelling stools that are difficult to flush.
• Symptoms include fever, rash or stomach cramps, or a general feeling of being unwell.
• You have vomiting, weakness and dizziness.
• You have associated weight loss.
• You have symptoms of dehydration (thirst, lack of energy, passing less urine than normal, dizziness or the skin on the back of your hand being slow to return to position after being pinched upwards).
• Constipation alternates with the diarrhoea.
• The diarrhoea was acquired while travelling overseas.
• The diarrhoea is associated with use of a medication and is not improving.
• If you have a pre-existing medical condition such as type 1 diabetes, heart failure or kidney failure.

If your child has diarrhoea, take them to a doctor straight away if they have:

• symptoms of dehydration;
• diarrhoea lasting for more than 48 hours;
• vomiting that is stopping them from keeping down fluids;
• blood or pus in their stool;
• an associated rash;
• a fever above 38 degrees Celsius;
• severe pain in their abdomen; or if
• they are lethargic, cool, floppy, pale or unwell looking.

Diagnosis and tests

Your GP (general practitioner) will ask about your symptoms and how long you have had diarrhoea and ask about your diet and any medicines you are taking. They will want to examine you, looking for signs of dehydration and possible causes of diarrhoea.

Your doctor may recommend sending a stool sample to a laboratory for testing. Blood tests may also be recommended.

Depending on your symptoms, your doctor may refer you to a gastroenterologist (specialist in conditions of the digestive tract) for further evaluation and tests.

Diarrhoea treatments

Most adults will experience diarrhoea at some time. Most people do not need any specific treatment for infectious diarrhoea as it usually improves on its own in a couple of days. However, it is important to drink plenty of liquids to keep well hydrated. This is especially important for children and babies.

The treatment for non-infectious diarrhoea will depend on the cause.

Staying hydrated

If you have diarrhoea you should drink plenty of fluids. Suitable fluids include:

• Water. However, if dehydration is sufficiently severe, water alone is inadequate.
• Oral rehydration fluids (available from pharmacies) contain not only the water replacement that is required in diarrhoea or vomiting-induced dehydration, but also important electrolytes that must be replaced. Available products include Gastrolyte, Hydralyte, Pedialyte and Repalyte. These should be mixed exactly to the manufacturer’s directions. It is very important to comply with the expiry dates of the rehydration solutions once they have been opened or made up.
• Diluted cordial (one part cordial concentrate to 20 parts water).
• Diluted soft drink or juice (one part juice or soft drink to 5 parts water).

Do not drink undiluted lemonade or other undiluted soft drinks, as the high glucose content may draw fluid into the gut, causing more diarrhoea. Also, do not use sports rehydration drinks.

If you have nausea, try taking small sips of fluid often. Even if you vomit after drinking, you will likely absorb some fluid. If you don’t drink you will only get more dehydrated.

Severe dehydration needs to be treated in hospital with intravenous fluids (fluids given into a vein, via a drip).

Diet

Restrict your food intake if you have gastroenteritis with vomiting. However, do not limit fluid intake.

While you have diarrhoea, avoid caffeine (tea, coffee, cola drinks), alcohol and foods that are fatty, very sweet or high in fibre. Dairy products may aggravate symptoms, but yoghurt (which contains less lactose than milk) may be tolerated.

Resume eating solid food slowly and choose foods that are bland, low in fat and low in fibre. This includes crackers, boiled potatoes, plain rice, or toast. Restrict consumption of fatty, sweet or spicy foods for 48 hours.

Some people may experience lactose intolerance (inability to digest milk sugars) for some time after the diarrhoea has settled. If this persists beyond a week or 2 you should seek medical assistance.

Anti-diarrhoeal medicines

Anti-motility medicines (sometimes called anti-diarrhoeal medicines) can help slow down the diarrhoea. These medicines may be useful in relieving symptoms of mild or moderate diarrhoea if short term control is needed, for example during travel. These medicines can be obtained from pharmacies.

Anti-motility medicines should not be used if you have severe or bloody diarrhoea and may be dangerous in this instance. They should never be used to treat diarrhoea in infants and children.

Available products include:

• loperamide (e.g. Gastro-Stop, Imodium, Stop-It); and
• diphenoxylate and atropine (e.g. Lomotil, Lofenoxal).

These medicines may worsen bacteria-induced diarrhoea, and may cause drowsiness. Alcohol should be avoided.

Antibiotics

Antibiotics are prescribed only in some cases of diarrhoea that is caused by bacteria or parasites. Your doctor may request a stool sample to test for bacteria or parasites before starting antibiotic treatment.

Supplements

If you’ve had an episode of gastroenteritis, you may benefit from taking probiotics.

Diarrhoea and your medicines

Diarrhoea can affect the way that some medicines (such as the contraceptive pill) are absorbed. If you take the contraceptive pill and develop diarrhoea, you should use a back-up method of contraception, such as condoms, until your next menstrual period because the diarrhoea may make the pill less effective.

If you are taking any other regular medicine, talk to your doctor about the effects that diarrhoea may have had on its effectiveness.

Prevention

Some types of diarrhoea can very easily be passed on. It is important that children do not go to school or childcare when they have diarrhoea.

Likewise do not prepare food for people if you are suffering from diarrhoea. You may go on being infectious for a time after you feel better, so keep strict food hygiene precautions for a week after any diarrhoeal illness.

Wash your hands thoroughly with warm water and soap after going to the toilet and before food preparation — teach your children to do the same. Hand sanitisers are useful when you are not near a sink.

There is a vaccine available that can prevent gastroenteritis (or reduce the risk of severe gastroenteritis) caused by rotavirus infection. Rotavirus vaccine is given as part of the routine childhood immunisation schedule.

Frequently Asked Questions

What is diarrhoea?

Diarrhoea is an intestinal disorder characterized by abnormal fluidity and frequency of fecal evacuations, generally the result of increased motility in the colon; may be an important symptom of such underlying disorders as dysenteric diseases, lactose intolerance, GI tumors, and inflammatory bowel disease. Diarrhoea is the passage of watery stools. This means body fluids and salts can be quickly lost from the body. The child becomes dry (dehydrated) and this is very dangerous and may kill the child.
Why is diarrhoea dangerous?

When a person gets diarrhoea, the body begins to lose a lot of water and salts – both of which are necessary for life. If the water and salts are not replaced fast, the body starts to “dry up” or get dehydrated. Severe dehydration can cause death.

What is dehydration?

Dehydration is the loss of water and body salts through diarrhoea. The human body needs water to maintain enough blood and other fluids to function properly. If your body loses substantially more fluids than you are drinking, you become dehydrated. You may lose fluids in a variety of ways:

• when urinating
• when you vomit or have diarrhoea
• when sweating
• from the lungs during normal breathing.

Along with the fluids, your body also loses electrolytes, which are salts normally found in blood, other fluids, and cells.

How does dehydration occur?

The usual causes of dehydration are a lot of diarrhoea and vomiting. Dehydration can also occur if you do not eat or drink much during an illness or if you do not drink enough during or after strenuous exercise. Medications that cause fluid loss to control excess body fluid (diuretics) are a common long-term cause. Although anyone can become dehydrated, those who become dehydrated the most easily are:

• babies under 1 year old
• the elderly
• anyone who has a fever
• people in hot climates.

How is dehydration treated?

If you are mildly dehydrated, you need to drink enough liquid to replace the fluids you have lost. Also, you need to replace the electrolytes (salts) you have lost. Drinking sips of water slowly, along with eating the typical American diet, which is high in salt, will replace fluids and salts you have lost. Nonprescription medicines are available that help replenish fluids and electrolytes. You can also replace both fluids and electrolytes by drinking sports drinks or an oral rehydration solution (ORS).

Can the solution be made with dirty water?

The benefits of fluid replacement in diarrhoea far outweigh the risks of using contaminated water to make oral rehydration solution. In situations where it is difficult to boil water, mothers are advised to use the cleanest water possible.

What sort of foods are good during diarrhoea?

High energy foods such as fats, yogurt and cereals are quite well absorbed during diarrhoea. Small, frequent feeds of energy-rich local foods familiar to the child should be given. A little vegetable oil can be added to foods such as millet or rice to increase the energy content.

• Foods high in potassium are important to restore the body’s essential stores depleted during diarrhoea. Such foods include lentils, bananas, mangoes, pineapples, pawpaw, coconut milk and citrus fruits.
• Certain foods should be avoided during diarrhoea, for example those containing a lot of fibre such as coarse fruits and vegetables, whole grain cereals and spicy foods.

It is very important to continue feeding a person with diarrhoea. Give soft, easy-to-digest foods, like khichri, watery dal, idlis, curd, bananas etc. You should also give plenty of other fluids, like nimbu pani, rice kanji, lassi, coconut water, weak tea etc. If the baby is being breast-fed, continue to give her mother’s milk. Give an extra meal a day, after the diarrhoea stops, to help the body get strong again.