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Diarrhea

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, Salmonella, Shigella, and Escherichia coli
    • Viral: rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis
    • Parasitic: Giardia lamblia, Entamoeba histolytica, and Cryptosporidium, tapeworm, roundworm, flukes
    • Fungal: Candida (yeast)
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.
  • 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 (fever, rash, aching joints, etc.)?
  • 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 linining of your colon show up on an x-ray
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 broth, fruit juices, sports drinks, and 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
  • Caffeinated drinks
Follow the BRAT Diet

When you're ready to eat, start with bananas, rice, applesauce, and toast. Progress to simple, bland foods such as crackers, potatoes, plain chicken, and carrots.

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
  • Anticholinergic medications
  • Psyllium or methylcellulose compounds
  • Kaolin or pectin products
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've got 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.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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