Diarrhea: Everything you need to know about symptoms, causes, and treatment

Diarrhea is characterized by loose or watery stools. It is often accompanied by a more frequent need to have a bowel movement. Diarrhea can be acute or chronic.

Acute diarrhea is common and typically lasts two to three days. It is usually the result of a viral or bacterial infection.

Chronic diarrhea is diarrhea that lasts longer than four weeks. The symptoms can be continual or they can come and go. Chronic diarrhea can be the sign of a food intolerance or a more serious intestinal condition, such as IBS, ulcerative colitis or Crohn's disease.

Symptoms of diarrhea

Depending on the cause of your diarrhea you may experience other signs and symptoms. Some of these include:

• Abdominal cramping and pain
• Bloating
• Nausea
• Blood or mucus in the stool
• Fever

Dehydration

Diarrhea can result in a rapid loss of fluids. This can eventually lead to dehydration, which if left untreated can have serious consequences. Children and babies are particularly vulnerable to dehydration.

Signs of dehydration in adults include:

• Fatigue
• Dry mouth or skin
• Excessive thirst
• Little or no urination
• Lightheadedness
• Dark-colored urine

Signs of dehydration in infants and young children include:

• Dry mouth and tongue
• No wet diaper for 3 hours or more
• High fever
• Crying without tears
• Drowsiness, unresponsiveness, or irritability
• Sunken appearance to abdomen, eyes or cheeks

If you suspect diarrhea is causing you or your child to become dehydrated, you should contact your physician as soon as possible.

What causes diarrhea?

The food we eat gets broken down as it passes through the small intestine so that nutrients and water can be absorbed by the body. The remaining waste passes into the colon (large intestine), where more water is absorbed.

Diarrhea occurs when this process is disrupted and less fluid is absorbed by the body. This results in loose or watery stools.

The most common cause for acute diarrhea is infection of the gastrointestinal tract. Infection can be caused by:

• Bacteria from contaminated food or water, including Salmonella, Campylobacter, and E.Coli
• Viruses such as norovirus or rotavirus. Rotavirus is the most common cause of acute diarrhea in children.
• Protozoa including Giardia and Cryptosporidium which are parasites that can be found in contaminated food or water

Other causes of diarrhea can include:

• Medicines such as antibiotics, cancer drugs, and antacids that contain magnesium
• Malabsorption caused by celiac disease or a food intolerance such as lactose intolerance
• Surgery, for example, gallbladder removal surgery
• Other digestive disorders such as inflammatory bowel disease (including Crohn’s disease and ulcerative colitis), microscopic colitis and irritable bowel syndrome

How is the cause of diarrhea diagnosed?

Your physician will perform a physical examination and consider your medical history when determining the cause of your diarrhea.

Your doctor will be interested in:

• When your diarrhea started
• The frequency of your bowel movements
• The characteristics of your stool (whether it’s watery, fatty, or contains blood or mucus)
• Any other symptoms including signs of dehydration or fever
• Any medications you may be taking such as antibiotics
• Your recent travel history

You may want to use a symptom or food diary to keep track of your symptoms. The Cara Care app has free tracking designed specifically for gut health issues.

What if your diarrhea won't go away?

Most cases of diarrhea resolve without treatment. If your symptoms persist your doctor may perform additional tests. These can include:

• A stool test to check for bacteria, parasites, or white blood cells
• A blood test to detect anemia, infection, or an imbalance of electrolytes which may suggest dehydration
• Tests for antibodies which can indicate celiac disease
• Fecal calprotectin or fecal lactoferrin. Raised levels are increased in intestinal inflammation and may indicate inflammatory bowel disease
• Tests for malabsorption. Including levels of vitamin B12, calcium, and magnesium
• In some cases endoscopic evaluation will be performed such as a sigmoidoscopy or colonoscopy

Treatment for diarrhea

Mild cases of acute diarrhea will often resolve in a few days. In these cases, the symptoms of diarrhea can simply be treated.

For persistent or chronic diarrhea, your physician will treat any underlying causes in addition to the symptoms of diarrhea.

Fluid replacement for diarrhea

In most cases of diarrhea, replacing lost fluids and electrolytes to prevent dehydration is all that is necessary. Adults with diarrhea can drink water, diluted fruit juices, and flavored soft drinks. Salty broths and soups may also be helpful.

Children or those with more acute diarrhea should be given oral rehydration salts (ORS), which are solutions that contain water, sugar and salt.

In severe cases, intravenous fluids may be necessary.

There is no particular food group that is recommended for diarrhea. Your physician may suggest boiled starches, such as potatoes and rice or cereals such as oats. Fatty foods should be avoided as they can make diarrhea worse.

Medication for diarrhea

Some over-the-counter medication can be used to relieve the symptoms of diarrhea. These include:

• Loperamide (Imodium). Inhibits bowel movements and reduces stool frequency and quantity (antimotility)
• Bismuth subsalicylate (Pepto-Bismol). Reduces stool quantity by stimulating the absorption of fluids and electrolytes by the intestine (antisecretory)

Loperamide works by slowing the movement of your intestines allowing the bowel to absorb more fluids and nutrients. If your diarrhea is caused by an infection, the use of loperamide may slow your recovery by delaying the clearing of the infection.

Antibiotics for diarrhea

Antibiotics are used to treat infections caused by bacteria. For parasite infections, special antiparasitic agents are used.

Probiotics for diarrhea

There is some evidence to suggest that probiotics can be used as an alternative therapy for diarrhea. The probiotic bacteria may help to maintain or replenish the natural bacteria in the intestine.

Many different probiotics are available, and each probiotic has different activity, so only specific probiotics may be useful in certain circumstances.

Probiotics such as lactic acid bacteria can shorten the duration of acute diarrhea. Lactobacillus and Saccharomyces boulardii may also be helpful in the prevention of antibiotic-associated diarrhea.

Patients suffering from irritable bowel syndrome may also benefit from probiotics.

Probiotics are offered in capsules or in powder form in drugstores. Yogurt is another source of probiotics.

Traveler’s diarrhea

Diarrhea commonly occurs when traveling to countries where there is inadequate sanitation. It is usually caused by consuming food or water contaminated with bacteria, viruses, or parasites.

To reduce your risk when traveling abroad you can take the following precautions:

• Avoid drinking tap water, including when you brush your teeth, ice cubes, and any fresh produce that may have been washed with tap water
• Eat hot well-cooked foods. Also avoid raw or undercooked meats and dairy foods
• Ask your physician about starting a course of antibiotics before your travel, especially if you have a weakened immune system