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Diarrhea

Definition

Diarrhea is more than three loose, liquid stools in a single day. It depletes the body of fluids and electrolytes. Diarrhea can be:
  • Acute—Occurring suddenly and lasting briefly
  • Chronic—Long-term
  • Recurring—Coming and going
If the body loses too much fluid, it can become dehydrated. Dehydration is especially dangerous for babies, young children, and elderly people.

Causes

Causes may include:

Risk Factors

Risk factors include:
  • 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 medicines

Symptoms

Symptoms may 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

When Should I Call My Doctor?

Call your doctor if you:
  • Have diarrhea that lasts longer than three days
  • Are not able to eat or drink to stay hydrated
  • Have a fever
Call your doctor if your young child:
  • Has diarrhea lasting longer than a day
  • Has pus in stool
  • Is dehydrated—no wet diapers in three hours, dry mouth, crying without tears, skin that stays up after being pinched
  • Is sleepy or irritable
  • Has a fever

When Should I Call for Medical Help Immediately?

Call for medical help or go to the emergency room right away if you or your child has:
  • Severe abdominal pain and cramping
  • Bloody or black stool

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may insert a gloved finger into your rectum to examine it. This is called a digital rectal 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 medicines do you take?
  • Do you have any symptoms other than diarrhea, such as fever, rash, or aching joints?
  • What is your sexual history?
  • Have you ever had abdominal surgery?
Tests may include:
  • Your bodily fluids, tissues, and waste products may be tested. This can be done with:
    • Laboratory analysis of a stool sample
    • Blood tests
    • Biopsy
  • You may need to have your rectum and colon examined. This can be done with:
  • You may need to have images taken of your colon. This can be done with:
  • You may need to have fasting or food elimination tests.
Barium Enema
Radiology colon
Copyright © Nucleus Medical Media, Inc.

Treatment

Treating the underlying condition may help to relieve the diarrhea.
General recommendations for treating diarrhea include:

Drink Lots of Fluids

Plain water will not replace the electrolytes lost through diarrhea. For adults and children, look for age-specific oral rehydration solutions. Avoid fruit juices and soda. For young children, continue with breastfeeding or formula feeding.

Ask Your Doctor What You Should Eat

Doctors differ in their approach to treating diarrhea. For example, your doctor may recommend that you:
  • Drink only clear fluids during severe phases of diarrhea.
  • Avoid certain foods, such as: very spicy foods, fatty foods, greasy foods, high-fiber foods, dairy products in large amounts, and caffeinated drinks.
  • Eat certain foods, such as: complex carbohydrates like pasta and rice, yogurt, fruits and vegetables, and lean meats
Ask your doctor which dietary guidelines you should follow. As your diarrhea subsides, your usual healthy foods can be reintroduced.

Treat Abdominal Pain With Heat

Use a hot water bottle or heating pad on your abdomen to relieve cramps and pain.

Medications

Your doctor may recommend medicines, such as:
  • Antidiarrheal medicine
  • Antibiotics—May be needed if a bacterial infection is causing diarrhea
  • Probiotics, such as Lactobacillus casei, Enterococcus faecium, and Saccharomyces boulardii—May be beneficial in some cases
  • Zinc supplementation—May be advised in some cases
Children should not be given medicine unless specifically recommended by the doctor.

Hospitalization

Diarrhea can cause severe dehydration. You may need to be hospitalized. Fluids will be delivered through an IV.

Prevention

To reduce your chance of getting diarrhea:
  • Practice good handwashing.
  • Practice safe food preparation and food storage.
  • If you have diarrhea, do not prepare food for others.
  • If you are traveling:
    • Drink bottled water.
    • Use bottled water when brushing your teeth.
    • Avoid drinks that contain ice.
    • Do not eat food purchased from street vendors.
    • Do not 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 is very hot.
Rotavirus is a common cause of diarrhea in children under five years of age. There is a vaccine to prevent rotavirus. The first dose is given at age two months. Make sure your infant has received this vaccine.

RESOURCES

American Academy of Family Physicians http://familydoctor.org

National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/

CANADIAN RESOURCES

The College of Family Physicians of Canada http://www.cfpc.ca

Health Canada http://www.hc-sc.gc.ca

References

Celiac disease. American Gastroenterological Association website. Available at: http://www.gastro.org/practice/resource-library/hot-topics/celiac-disease. Accessed March 4, 2013.

Diarrhea. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/diarrhea.html/. Accessed March 4, 2013.

Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/index.htm. Updated September 24, 2012. Accessed March 4, 2013.

King CK, Glass R, Bresee JS, Duggan C. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR. 2003 Nov 21;52(RR16):1-16

Kleigman RM, Jensen HB, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007.

Robinson DL, McKenzie C. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins;2000.

Rotavirus vaccine. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccinesafety/Vaccines/RotaVSB.html. Updated November 9, 2012. Accessed March 4, 2013.

1/4/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Allen S, Martinez E, Gregorio G, Dans L. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;(12):CD003048.

Revision Information

  • Reviewer: Daus Mahnke, MD
  • Review Date: 09/2012 -
  • Update Date: 03/04/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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