Diarrhea is a condition characterized by having more than three watery stools per day, often accompanied by abdominal cramps, pain, nausea, and a strong urge to empty the intestines. Diarrhea can occur multiple times a year. In most cases, the cause is unknown, and the symptoms resolve on their own within two to three days. However, when diarrhea lasts much longer, even for weeks, it is considered chronic diarrhea, which typically indicates an underlying condition such as irritable bowel syndrome (IBS) or more serious disorders like celiac disease, food allergies, or inflammatory bowel disease (IBD), or prolonged use of medications.
Prolonged diarrhea can lead to dehydration, a significant loss of fluids and electrolytes like magnesium and potassium, which play a vital role in essential bodily functions. To avoid complications, it is necessary to take fluids.
Diarrhea is commonly managed at home by taking fluids and following a light diet. If necessary, especially in cases of prolonged diarrhea, medications such as oral rehydration solutions, activated charcoal, probiotics, or antibiotics may be used.
Acute, persistent, and chronic diarrhea
Depending on the symptoms and duration, there are several types of diarrhea.
Acute diarrhea: The most common type that lasts one to two days and does not require treatment.
Persistent Diarrhea: This type of diarrhea typically lasts two to four weeks and resolves with appropriate treatment. The most common causes of acute and persistent diarrhea are infections, traveler’s diarrhea, and side effects of medications.
Chronic Diarrhea: Diarrhea that lasts longer than four weeks. Some infections, food allergies and intolerances, gastrointestinal disorders, and prolonged use of medications can cause chronic diarrhea.
Who can get diarrhea?
Anyone can get diarrhea, and it can occur multiple times throughout the year. In most cases, it is not a cause for concern. However, diarrhea can have more severe symptoms in certain groups of people:
- Young children
- Elderly individuals
- People with certain medical conditions
Factors that increase the risk of diarrhea
There are many different factors that can increase the risk of diarrhea, among which the main ones are:
- Consuming contaminated food or water
- Poor hand hygiene
- Side effects of certain medications or supplements
- Recent change in diet
Symptoms of diarrhea
Common symptoms that accompany diarrhea include:
- Cramps or abdominal pain
- Bloating
- Nausea
- Urgent need for bowel movements
More severe forms of diarrhea may be accompanied by symptoms such as:
- Vomiting
- High fever
- Blood in the stool
- Mucus in the stool
Important: If you experience these symptoms, seek medical help immediately.
Causes of diarrhea
Viruses: The most common cause of diarrhea is viral gastroenteritis, commonly known as stomach flu. Viruses that can cause diarrhea include noroviruses, rotaviruses, enteric adenoviruses, astroviruses, cytomegaloviruses, and viral hepatitis.
Bacteria and parasites: Exposure to pathogenic bacteria, such as Escherichia coli, or parasites from contaminated food or water can lead to diarrhea.
Allergies and intolerance to certain foods (celiac disease or lactose intolerance). Allergies to foods such as cow’s milk, soy, cereals, eggs, and seafood can cause chronic diarrhea.
Medications: Many medications, such as antibiotics, can cause diarrhea. Antibiotics alleviate infections by killing off harmful bacteria, but they can also disrupt the natural balance of bacteria in the gut, leading to diarrhea.
Clostridium difficile (C. diff) is a type of bacteria that can cause diarrhea and can occur after antibiotic use or during hospitalization. Other medications that can cause diarrhea include anticancer medications and antacids containing magnesium.
Fructose intolerance: Diarrhea occurs after consuming foods or liquids containing fructose, a sugar found in fruits, fruit juices, and honey. Fructose is added to many foods and non-alcoholic beverages as a sweetener called high-fructose corn syrup.
Artificial sweeteners: Sorbitol, erythritol, and mannitol, artificial sweeteners found in sugar-free gums and other products, can cause diarrhea in some otherwise healthy individuals.
Radiation therapy: Pelvic and abdominal radiation therapy can cause diarrhea. Radiation can irritate the healthy cells lining the intestinal mucosa.
Surgical interventions: Partial removal of the intestine or gallbladder can sometimes cause diarrhea.
Other digestive disorders: irritable bowel syndrome, Crohn’s disease, ulcerative colitis, celiac disease.
What color of the stool is a cause for concern?
The color of stool can vary and is often influenced by the color of the food a person consumes. Generally, it is not a cause for concern. However, if the stool becomes black or if blood, mucus, pus, an extremely foul odor, or greasy consistency appear, it is important to seek medical attention as soon as possible.
When should you seek medical attention?
- Diarrhea lasts longer than two days without improvement
- Dehydration
- Severe abdominal or rectal pain
- Bloody or black stool
- Temperature above 39 C
When should you urgently take your child to the doctor?
In children, especially infants and toddlers up to three years old, diarrhea can quickly lead to dehydration.
Take your child to the doctor if:
- Diarrhea lasts longer than 24 hours
- Child is dehydrated.
- Child has a temperature above 39C
- Child has a bloody or black stool
Dehydration as a complication of diarrhea
Diarrhea can lead to dehydration, which can be life-threatening if not treated. Dehydration is particularly dangerous in children, older adults, and individuals with weakened immune systems. Symptoms of dehydration include excessive thirst, dry mouth or skin, decreased urine output, dark urine, dizziness, and in children, additional symptoms such as drowsiness, irritability, crying without tears, lack of urination, weak pulse, less elastic and wrinkled skin.
IMPORTANT: Severe symptoms of dehydration, especially in children, should also prompt immediate medical attention!
Diagnosis and tests
For most cases of mild diarrhea, medical intervention is not necessary. Treating it at home with fluid replacement and an appropriate light diet is usually sufficient. However, more severe cases of diarrhea require a doctor’s examination and diagnostic tests to determine the underlying cause.
Physical Examination: The doctor will take a detailed medical history, including information about the patient’s health condition, recent travel history, and potential contact with individuals who have infections. Based on the examination, the doctor will decide on one or more tests for further diagnosis.
Blood Tests: Complete blood count, electrolyte measurement, and kidney function tests can help assess the severity of diarrhea. Blood tests can also indicate thyroid disorders, pancreatic dysfunction, and celiac disease.
Stool Sample Testing: Laboratory analysis can determine whether the cause of diarrhea is bacterial, viral, or parasite infection.
Hydrogen Breath Test: This type of test can help identify lactose and fructose intolerance.
Flexible Sigmoidoscopy or Colonoscopy: Flexible sigmoidoscopy provides a view of the lower part of the large intestine, while colonoscopy allows the doctor to visualize the entire colon.
Upper Endoscopy: It enables the doctor to examine the abdomen and upper part of the small intestine. They may also take a tissue sample (biopsy) for laboratory analysis. Endoscopic evaluations of the upper and lower gastrointestinal tract can reveal potential organic changes (ulcers, infections, neoplastic processes) that may be the cause of diarrhea.
Control of diarrhea and treatment
Acute, short-term diarrhea does not leave any lasting effects and does not harm health. It typically resolves without specific treatment measures. However, chronic diarrhea poses a risk of dehydration and its associated complications. With chronic diarrhea, there is a significant loss of water and electrolytes, which can have serious consequences for the entire body. Their deficiency can affect the functioning of the heart, lungs, brain and nervous system, and kidneys. In these cases, treatment is necessary and may involve medications and fluid replacement.
Common treatment options for diarrhea
Antibiotics or antiparasitic: antibiotics or anti-parasite medications can help treat diarrhea caused by bacteria or parasites. If diarrhea is caused by the virus, antibiotics are not used.
Adjustment of therapy: If a medication, such as an antibiotic, is determined to be the cause of diarrhea, the dosage may be adjusted, or a different medication may be prescribed.
Treatment of underlying conditions: Diarrhea can be a symptom of several medical conditions, such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) – Crohn’s disease and ulcerative colitis. Once the cause of the diarrhea is identified, treatment is directed toward the underlying condition.
Probiotics: Probiotics, which are beneficial bacteria, are sometimes used to restore a healthy gut microbiome and help fight diarrhea. The choice of an appropriate probiotic should be discussed with a healthcare provider.
Fluid replacement: To prevent dehydration, it is important to replace fluids and electrolytes. For most adults, this involves drinking water with electrolytes, fruit juice, or soup. Water is good for hydration but does not contain salts and electrolytes such as sodium and potassium, which are necessary for proper bodily function. Therefore, it is important to consume certain fruit juices for potassium and soups for sodium. However, some fruit juices, such as apple juice, may worsen diarrhea. It is recommended to consult a healthcare provider on the best approach for fluid replacement. In the case of children with diarrhea, the use of oral rehydration solutions is beneficial.
Treating diarrhea without medication
In the case of acute diarrhea, it is often sufficient to focus on fluid replacement and adjust your diet. Here are some important steps:
-Drink water and other fluids with electrolytes (diluted fruit juices without pulp, broth). By consuming fluids, you help protect your body from dehydration.
-Modify your diet: Instead of consuming fatty, greasy, or fried foods, opt for foods like bananas, rice, applesauce, and toast (BRAT diet). Avoid coffee, as the caffeine it contains has a mild laxative effect that can worsen diarrhea.
-Avoid foods and drinks that can cause gas (beans, cabbage, carbonated drinks). If the diarrhea is due to lactose intolerance, it is necessary to avoid lactose-containing products (dairy products) until the diarrhea subsides.
Tips for treating diarrhea in babies and young children
Children can easily become dehydrated when they have diarrhea. Therefore, it is important to ensure they drink plenty of fluids. If your child is dehydrated, make sure to:
Offer oral rehydration solutions that contain glucose and electrolytes. These fluids have the right balance of water, sugar, and salts. Oral rehydration solutions are highly recommended for infants and young children with diarrhea, as well as for any child experiencing frequent diarrhea or vomiting.
Avoid giving your child fruit juice or carbonated beverages, as they can worsen diarrhea.
Do not give plain water to your baby.
Avoid giving excessive amounts of plain water to children of any age.
Continue breastfeeding your baby or feeding them with formula.
Do not give anti-diarrheal medications to babies and young children.
Prepare light and easily digestible foods in smaller, more frequent portions. For older babies and young children, these can include bananas, plain pasta, toast, rice cereal, or plain crackers – foods that are gentle on the stomach.
Change diapers frequently and keep the diaper area clean. Use plain lukewarm water for cleaning and dry your baby’s skin before putting on the next diaper.
In case of signs of dehydration and high fever, it is important to seek immediate medical attention for your child.
Prevention of diarrhea
To prevent diarrhea, you need to:
Wash your hands with soap and water for at least 20 seconds. Wash your hands before and after food preparation, after using the toilet, changing diapers, sneezing, coughing, and blowing your nose. Use an alcohol-based hand sanitizer when handwashing is not possible.
– Properly store food: Store food at the appropriate temperature, do not eat foods that are suspicious (spoiled). Cook food at the recommended temperature.
-Prevent diarrhea while traveling: Diarrhea often affects people traveling to countries with inadequate sanitation conditions. Therefore, it is important to:
– Eat thermally processed foods. Avoid raw fruits and vegetables that you’re unsure if have been washed or that you are unable to peel.
-Avoid raw or undercooked meat and dairy foods.
– Drink bottled water and other drinks in their original packaging.
-Avoid tap water and ice cubes.
-Avoid alcohol and caffeine as day can worsen diarrhea and dehydration.
– Consult with your doctor about medications you can take on the road in case of diarrhea (probiotics, antibiotics, oral rehydration roasters).
– Use bottled water for brushing your teeth.
Prognosis in case of occasional or chronic diarrhea
Diarrhea affects most people from time to time, and there is usually no cause for concern. The symptoms are unpleasant but typically resolve within less than a week. Vomiting usually stops within one or two days. In children, diarrhea symptoms usually disappear within a day or two.
In the case of chronic diarrhea, the treatment and outcome depend on the underlying disease or condition.
Can diarrhea be fatal?
Diarrhea can lead to dehydration, and severe dehydration can be life-threatening due to the loss of fluids and electrolytes. Death from dehydration typically occurs when 10 to 15% of the total body weight is lost. Infants and young children are particularly at risk of dehydration.
When to consult a doctor in case of diarrhea?
It is always advisable to seek medical attention if you are concerned about symptoms of diarrhea, especially if it lasts for more than a week. If diarrhea persists for an extended period, there is a risk of additional complications that may require treatment. You should seek immediate medical help if you experience symptoms such as:
- Abdominal pain
- Bleeding
- Unintentional weight loss
- Weakness and fatigue
Tips for recovery and maintaining health after diarrhea
Stay hydrated: Maintaining hydration is crucial for patients recovering from diarrhea. In addition to water, clear soups such as chicken or beef broth without fat are recommended.
-Take small, light meals: Start with simple meals and foods that are recommended, such as bananas, rice, and toast. Avoid fatty and spicy foods.
- Gradually reintroduce other foods into your diet.
- Maintain proper hand and body hygiene.
- Store and prepare food properly to prevent contamination.
