Diarrhea is the frequent passage of loose, watery stools due to irritation in the intestinal tract. This may be caused by :
- infection – bacterial (ex: toxigenic E. coli, Salmonella), viral (ex: Norwalk virus, rotavirus) or parasitic (ex: Giardia lamblia, Entamoeba histolytica)
- food intolerance – such as towards lactose-containing foods and foods containing artificial sweeteners
- reactions to medications – such as antibiotics, high blood pressure medications, antacids, etc.
- certain chronic diseases (ex: Crohn’s disease, irritable bowel syndrome, diabetic neuropathy)
- nutritional deficiency, such as zinc
- reaction to stress
The principal concern in diarrhea is dehydration, and prompt treatment should be given especially to infants and older people. Oral hydration is recommended; but for moderate to extreme dehydration, an intravenous fluid hydration may be necessary and this requires hospital consultation.
Next important in consideration is to limit the intake of food and avoid foods which contain lactose such as milk and other dairy products, and fatty foods.
Acute and Chronic Diarrhea
In most cases, diarrhea is acute, with sudden onset and usually lasting for 1-2 days.
Diarrhea may also be chronic, that is, generally lasting longer than four weeks. This occurs due to chronic disease, such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis), cancer of the colon, irritable bowel syndrome, or malabsorption.
In most cases, diarrhea will resolve on its own. However, the patient should be checked for dehydration. To avoid this, it is important to drink clear liquids, broth and soft juices.
It is also important to replace the electrolytes lost during diarrhea, particularly sodium and potassium. Electrolyte mixtures like Pedialyte are able to replace these electrolytes. Liquids containing glucose (sugar) may also help increase the absorption in the intestines of water and minerals, thus minimizing their loss.
As to food, it is recommended that the patient take soft, low-fiber foods that do not contain dairy products or too much fat, and foods which are also easier to digest. Examples of these are banana (which is also high in potassium), soda crackers, rice, egg and potato. After the diarrhea has been resolved, the patient may go back to his regular diet and high-fiber foods.
Antidiarrheal medicines are discouraged because they will only trap the organisms that may have caused the diarrhea instead of purging them by allowing movement of stools. As for prescription antibiotics, these are used to treat parasitic or bacterial infections but not diarrhea caused by viruses. Antimotility agents lessen the motility/movement of the intestine and allow more absorption of water in the intestine.
Medications should only be given to children upon consultation with the physician.
Treatment of underlying chronic disease or problems will also help treat chronic diarrhea.
When to Seek Consultation
Any sign of dehydration – which can occur despite drinking more fluids – will require consultation with the physician. Diarrhea lasting for more than 2 days will also require check-up.
Signs of dehydration are :
- less urination
- sunken eyes
- dry mouth
- increased thirst
- wrinkled skin
- in children: other signs are irritability, high fever, and sunken fontanel in infants
Other signs that should be watched are :
- presence of blood or pus in the stools
- presence of black, tarry stools (which are a sign of bleeding in the intestinal tract)
- fever over 101ºF
- severe pain in the abdomen or rectum