Diarrhea

Diarrhea - Yes, you can do something about it

Everybody's familiar with diarrhea: the passage of loose or watery stools during a bowel movement. Many things cause this condition, but most often it's a sure sign of bacterial, viral, or parasitic infection. Sometimes stress can cause it.

Most cases of diarrhea are annoying but not life-threatening. However, some forms of diarrhea signal a serious condition. Call your doctor if it lasts more than three days, if it is bloody, or if it happens in a young child.

Most episodes are minor and temporary. But because diarrhea is a symptom of something gone awry in your system, it's important to determine the underlying cause. Did you recently travel to a foreign country? Could a new restaurant or weekend potato salad be the culprit? Are you perhaps taking antibiotics that could have caused diarrhea as a side effect?

If you have diarrhea, start treatment by avoiding all dairy products. Drink plenty of water, because your body is losing a lot of fluids. See your doctor if the condition persists.

Detailed Description

Diarrhea is divided into two broad categories: noninfectious and infectious (caused by virus, bacteria, or parasite).

The exact nature of the diarrhea is a key factor in determining how to treat it. The most common form lasts one to three days and is caused by a virus. Continuous diarrhea is probably caused by an infection. Bacterial diarrhea usually comes from infected food, while protozoal diarrhea comes from an infected water supply. (You've heard this called "Montezuma's revenge" when it happens after travel to Mexico and Central and South America). Bloody diarrhea can indicate a severe internal infection, especially if you also have a high fever. E. coli poisoning, from raw juices or uncooked hamburger, falls into this category.

Diarrhea can also accompany various well-known, though rare, diseases such as amoebic dysentery and cholera, often associated with foreign travel.

Pronunciation

die-uh-REE-uh

Possible Underlying Causes

Infectious causes include:

  • Infectious agents: such as salmonella (often from the bacteria of raw poultry -- be sure to clean all cutting boards) or a virus, which cause noninflammatory or common diarrhea
  • Tissue damage to the colon: causes inflammatory diarrhea, which is usually accompanied by bloody stools
  • Enteric fever: a severe and uncommon systemic illness

Noninfectious causes include:

  • Stress or emotional upset
  • Food poisoning
  • Food allergies
  • Some antibiotics to uncommon conditions such as a tumor of the pancreas or malabsorption syndrome
  • Irritable bowel syndrome, a common term for a syndrome of alternating diarrhea with constipation, often in women, worse with stress
  • Bowel stimulants such as caffeine, and laxative overuse

Drugs That Can Cause or Aggravate Diarrhea

Diarrhea can be a side effect of many drugs, most commonly antibiotics but also including antihypertensive agents and antidepressants. The possibility and frequency of developing diarrhea from a drug depends on your individual sensitivity to that drug. Based on your past medical history and drug sensitivities, your doctor can prescribe medications to which you will be least sensitive. If you develop diarrhea or other sensitivity reactions to a drug, call your doctor so that he or she can consider an alternative.

Diagnosing the Underlying Cause

While diarrhea is usually nothing to worry about, in some instances it may be a symptom of an underlying disease or disorder. The following conditions may have diarrhea as a symptom:

  • Viral infection
  • Bacterial or parasitic infection
  • Irritable bowel syndrome
  • Pancreatic disorders
  • Laxative use/abuse
  • HIV-associated diarrheas
  • Malabsorption disorders
  • Ulcerative colitis
  • Crohn's disease
  • Colon cancer or tumors
  • Cholera
  • Psychological stress
  • Diuretic use, drug use, alcohol

Diagnostic Procedures

To make a diagnosis, your doctor will want to take your recent medical history and learn about the presence of other symptoms. Your doctor may take a stool sample to test your fecal matter for the presence of blood, bacteria, amoebas, and parasites. In some cases, your doctor will perform a sigmoidoscopy, a procedure that allows him or her to examine the distant end of the colon through a fiber-optic viewing tube, or a colonoscopy, which allows your doctor to view the entire large intestine. In rare cases, your doctor may perform a biopsy -- removal of a section of the rectal lining to view under a microscope.

Goals of Treatment

Don't eat solid foods -- and no cheese, ice cream, or milk. Because diarrhea can cause dehydration, drink more fluids such as water, flat sodas, tea, or clear soup. The replacement of electrolytes is also essential. With diarrhea, you lose potassium, sodium, and chloride, which you can replace by drinking teas, vegetable broth, and sports drinks.

Treatment Options

Using drugs to stop diarrhea (as opposed to treating the underlying cause) may be harmful if you use them too much. Check with your doctor before taking multiple doses.

Drugs most commonly used

Supplements

  • Vitamin C: Large doses of this vitamin can actually cause diarrhea. The triggering dose varies, but if you take more than a 2,000 mg of vitamin C a day, take less or stop taking it until you're better.

Herbs

  • Teas: Those made with raspberry, blackberry, or blueberry leaves can help treat diarrhea. They contain astringent compounds (tannins) that soothe the digestive tract. [1]

Homeopathy

Homeopathic medicine is based on the idea that some conditions can be cured by administering small amounts of drugs or substances that, in a healthy person, would produce symptoms like that of the disease -- thereby working with, not against, the body's natural defense systems.

Purchase commercially prepared homeopathic medicines or visit a professional; do not attempt to mix your own, as many of the substances are dangerous in more than tiny amounts.

In a study of infectious diarrhea in children in Leon, Nicaragua, University of Washington researchers compared the effects of rehydration fluid with the effects of rehydration fluid plus homeopathic medicine. The combination treatment worked better. The homeopathic medicines used included Arsenicum (arsenic), Chamomilla (chamomile), Mercurius (mercury), Sulphur (sulphur), or Podophyllum (mayapple). [2]

Acupressure

This shiatsu technique is sometimes used to help relieve diarrhea: apply pressure on your index finger a little below the nail.


Sources

1 Tyler, Varro. Herbs of Choice. New York: Pharmaceutical Products Press, 1994.

2 Jacobs, J., et al. "Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Trial in Nicaragua," Pediatrics 93:719, 1994.

Preventive Measures

You may prevent some bouts of diarrhea if you avoid undercooked meats, potentially contaminated foods, or foods prepared under nonhygienic conditions.

Self-Care Measures

  • Drink more fluids. Diarrhea depletes the body of fluids and electrolytes (sodium and potassium). Water is a start, but to replace lost electrolytes, it's better to drink bouillon, sports drinks, or vegetable juices, which contain sodium and potassium. For infants, use special rehydration fluids such as Pedialyte or KaoLectrolyte.
  • Eat "BRAT" foods. BRAT is an easy-to-remember acronym for bananas, rice, applesauce, and toast. These foods are binding and help treat diarrhea.
  • Steer clear of caffeine. For some people, coffee, tea, and sodas make matters worse.
  • If you take antibiotics, try eating some live-culture yogurt. Antibiotics kill the good bacteria along with the bad in your digestive tract and can contribute to diarrhea. Yogurt re-establishes these good bacteria and helps restore your natural balance.

When to Call the Doctor

Consult your doctor if:

  • Diarrhea lasts more than one day in a child under age two.
  • Diarrhea lasts more than two days in an older child or an adult.
  • Diarrhea is accompanied by severe abdominal pain, vomiting, fever, weight loss, or the appearance of blood, mucus, or worms in the stool. This could be an emergency-- get immediate medical help.

Websites & Organizations

American Diabetes Association
National Office
1660 Duke Street
Alexandria, VA 22314
Phone: 703-549-1500 or 800-342-2383

American Digestive Health Foundations
7910 Woodmont Avenue, 7th Floor
Bethesda, MD 20814-3015
Phone: 301-654-2635
Fax: 301-654-1140
Email: dlee@gastro.org

Arnot Ogden Medical Center

Celiac Disease Foundation
3251 Ventura Boulevard. # 3
Studio City, CA 91604
Phone: 818-990-2354.

Crohn's & Colitis Foundation of America, Inc.
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Phone: 212-685-3440 or 800-932-2423
Fax 212-779-4098
Email info@ccfa.org

Endocrineweb.com

HealthAnswers: Diarrhea in Infants

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Email: nddic@info.niddk.nih.gov

Sources & Further Reading

Books

Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.

Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.

Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.

Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw-Hill, 1996.

Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.

Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.

Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.

Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.

Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.

Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.

Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.



Articles

Bentley, ME. "Household Behaviors in the Management of Diarrhea and Their Relevance for Persistent Diarrhea." Acta Paediatr Suppl. 381():49-54. Sep 1992.

Carpenter, CC. "The Pathophysiology of Secretory Diarrheas." Med Clin North Am. 66(3):597-610. May 1982.

DeWitt, TG. "Acute Diarrhea in Children." [Published erratum appears in Pediatr Rev. Oct 1989. 11(4):124.] Pediatr Rev. 11(1):6-13. Jul 1989.

Giannella, RA. "Chronic Diarrhea in Travelers: Diagnostic and Therapeutic Considerations." Rev Infect Dis, 8 Suppl 2():S223-6. May-Jun 1986.

Guerrant, RL, Schorling, JB, McAuliffe, JF, de Souza, MA. "Diarrhea as a Cause and an Effect of Malnutrition: Diarrhea Prevents Catch-up Growth and Malnutrition Increases Diarrhea Frequency and Duration." Am J Trop Med Hyg. 47(1 Pt 2):28-35. Jul 1992.

Hogan, CM. "The Nurse's Role in Diarrhea Management." Oncol Nurs Forum. 25(5):879-86. Jun 1998.

Jacobs, J. et al. "Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Trial in Nicaragua," Pediatrics, 93:719, 1994.

Leung, AK, Robson, WL. "Evaluating the Child with Chronic Diarrhea." Am Fam Physician. 53(2):635-43. Feb 1, 1996.

Mertz, HR, Beck, CK, Dixon, W, Esquivel, MA, Hays, RD, Shapiro, MF. "Validation of a New Measure of Diarrhea." Dig Dis Sci. 40(9):1873-82. Sep 1995.

Pietrusko, RG. "Drug Therapy Reviews: Pharmacotherapy of Diarrhea." Am J Hosp Pharm. 36(6):757-67. Jun 1979.

Talley, NJ, Weaver, AL, Zinsmeister, AR, Melton, LJ 3rd. "Self-Reported Diarrhea: What Does It Mean?" Am J Gastroenterol. 89(8):1160-4. Aug 1994.

Tyler, Varro. Herbs of Choice. Pharmaceutical Products Press, NY, 1994.
 

 

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