Diarrhea

What is Diarrhea?

Diarrhea is the passage of loose or watery stools more than three times in 24 hours. Most of the time, diarrhea is self-limited and resolves itself over 2-3 days or with home remedies, such as activated charcoal. Bacterial, viral, or parasitic infections of the gastrointestinal tract are the usual causes of diarrhea. Severe cases may lead to voluminous fluid and electrolyte losses, a life-threatening situation. If bloody mucus is noted more than once with diarrhea, seek urgent medical attention.

How many types of diarrheas?

Diarrhea can be divided into three types according to the temporal duration of symptoms as follow:

•    Acute diarrhea is the run-of-the-mill variety that occurs often. The diarrheal symptoms usually last for 1-3 days, then gradually resolve without medication.
•    Persistent diarrhea is diarrhea that persists for approximately 2-4 weeks.
•    Chronic diarrhea is the episodic type that lasts more than four weeks, occurring off and on over a long period.

How many types of diarrheal stools are there?

There are two types of diarrheal stools:

• Bloody mucoid stool or loose and watery stool mixed with blood. Patients can experience moderate to severe abdominal and rectal pain, tenesmus, and fever, but stool volume is low.
• Watery, yellowish, or light greenish stool, the patients may pass foul-smelling rice-water, oily, or greasy stools associated with intermittent abdominal pain, cramps, nausea, and vomiting. The volume of stool could be considerable, making patients dehydrated and enervated. 

What causes diarrhea?

A variety of infections can cause diarrhea; the most common are viruses, bacteria, and parasites in contaminated food and beverages, as well as other medical conditions such as:

• Viral gastroenteritis, a significant cause of infections of the stomach and intestines
• Rotavirus is a virus often found in patients with diarrhea.
• Bacteria, or parasites, cause gastrointestinal tract infections or food poisoning through unclean food intake or drinking contaminated water. 
• Spicy foods or foods that irritate the digestive system.
• Celiac disease or gluten intolerance in certain starchy foods, e.g., wheat
• Inflammatory bowel disease
• Malabsorption of food or poor absorption 
• Pancreatic cancer or chronic pancreatitis
• Pancreas produces and secretes digestive enzymes. Chronic inflammation or cancer can reduce or block the secretion of pancreatic enzymes leading to poor digestion and fat absorption, causing diarrhea.
• Intestinal tumors can produce substances that stimulate increased fluid secretion in the intestine.
• Radiation therapy

What are the signs and symptoms of diarrhea?

• Signs and symptoms of diarrhea vary depending on their intensity, ranging from mild to severe. Severe diarrhea may be due to an underlying disease that requires further investigation, diagnosis, and treatment by a medical doctor. The signs and symptoms of diarrhea include:
• Abdominal pain, cramps
• Bloating
• Nausea and vomiting
• Fever, lightheadedness, dizziness
• Flushed, dry skin.
• Bloody stools
• Mucus in the stools
• Frequent bowel movements

Diarrhea in adults: When to see the doctor?

• Persistent diarrhea for two days or more without symptom improvement.
• Dehydration, e.g., dry lips, no urine longer than 6 hours, or lightheadedness when changing position
• Generalized or lower abdominal pain or severe rectal pain
• Black and tarry stools or bloody mucoid stools
• High fever of 39 degrees Celsius and above

 Diarrhea in infants and children: When to see a doctor?

Diarrhea in infants and children can quickly lead to dehydration. If diarrhea does not improve within 24 hours, urgently seek medical attention. 

Complications of diarrhea

Diarrhea can lead to dehydration, a life-threatening condition if left untreated. Dehydration becomes more dangerous, particularly in children, the elderly, and those with weakened immune systems. Therefore, diarrhea patients with possible signs of dehydration should see a medical doctor as soon as possible.

Symptoms of dehydration in adults

• Tiredness, lightheadedness, and dizziness
• Dry mouth or skin
• Weakness, exhaustion
• Excessive thirst
• Little or no urination
• Dark-color urine

Symptoms of dehydration in infants and children

• Dry mouth and tongue
• No urine in the diaper for three hours or more
• Drowsiness, unresponsiveness, or irritability
• Eyes, cheeks, and abdomen are noticeably sunken. 

Diarrhea: What medication should I take?

• Activated charcoal can absorb toxins or chemical substances in the gastrointestinal tract. Take two tablets once diarrhea begins. The medicine helps reduce abdominal tightness and improve stool consistency. Patients can repeat the medication every 3–4 hours if they are still loose or watery, but do not exceed 16 tablets a day.
• ORS (Oral Rehydration Salt) replenishes the lost fluids and electrolytes. Mix one sachet of ORS with drinking water as per the instruction on the label. Drink all at once or periodically takes a sip to replenish the lost fluids from diarrhea or vomiting.
• Antidiarrheal, such as Imodium or Loperamide, can help reduce the frequency and volume of stools. Take them if activated charcoal and ORS are inadequate in relieving the symptoms. Take two tablets of Loperamide the first time and repeat one tablet after each loose and watery stool, but do not exceed eight pills a day. Do not use antibiotics without a doctor's prescription. If the symptoms do not improve, an urgent appointment with a medical professional is necessary.

Treatments of Diarrhea

Acute diarrhea is curable by home remedies such as activated charcoal or ORS mineral powder. However, if diarrhea persists for more than 2-3 days or is associated with a high fever and bloody mucus in the stool, in that case, a doctor will look for a definitive cause of diarrhea and if any underlying medical condition exists. The doctor will also take your medical history and provide a specific treatment based on the source of the diarrhea, which may include

• Antibiotics: The doctor may prescribe antibiotics or anti-parasite to eradicate the bacteria or parasite causing diarrhea.
• Medication for a specific condition: Diarrhea can also be a sign of other underlying medical conditions such as irritable bowel syndrome (IBS) and inflammatory bowel diseases such as Crohn's disease, ulcerative colitis, microscopic colitis, or small intestinal bacteria overgrowth. The doctor will prescribe specific treatment once the cause is determined. 
• Probiotics: Doctors may determine for the patient which products contain beneficial flora to fight against harmful infections that cause diarrhea. However, probiotics should be prescribed only by a medical doctor.

How to prevent diarrhea?

Diarrhea can be prevented by following these preventive measures:

• Commit to a hygiene principle and use best practices daily. For example, wash hands regularly with soap and water. Cleaning kitchen equipment before and after use can prevent diarrhea and other infectious diseases.
• Get vaccinated against rotavirus, one of the leading causes of diarrhea, particularly in infants aged one year and older.
• Preserve food at the proper temperature; do not eat spoiled food; eat cooked food; and store food in closed containers.
• Avoid eating and drinking unclean food and water.

Diarrhea: What can we eat?

Acute and chronic diarrhea patients should not forego eating. Instead, eat soft, clean, well-cooked, and easily digestible foods, such as boiled rice, congee, soup, or fish, to replenish fluid, vitamins, minerals, and essential nutrients necessary for the function of the body. Avoid too spicy, intense flavors and too oily food due to it possibly worsening diarrhea.

Diarrhea: when it’s a matter that you better see a doctor.

Diarrhea is a common condition we all experience at least once in our lifetime. It can become life-threatening if complicated by severe dehydration and electrolyte imbalance, particularly in infants, children, and the elderly. One should promptly replenish the lost fluids and electrolytes with oral electrolyte fluids. Avoid food prepared unhygienically, wash your hands regularly, and maintain good hydration as preventive measures to keep diarrhea at bay.

If you experience intractable diarrhea with complications, you should see a doctor in a hospital equipped with advanced technology and equipment to provide immediate comprehensive diagnostic investigations and treatment efficiently and effectively.