Diarrhea

Acute Diarrhea


What is diarrhea?
Diarrhea is defined as three or more loose or watery stools per day.

How common is diarrhea?
Most everyone will experience diarrhea at some point during their life, with the average adult experiencing it four times per year.

 

What causes diarrhea?
Diarrhea can be caused by infections, viruses, bacteria, parasites, or a variety of other factors. The exact cause of diarrhea is often not identified, especially in those who improve without treatment.

 

Viruses that can cause diarrhea include rotavirus, norovirus, Norwalk virus, adenovirus, cytomegalovirus, astrovirus, and viral hepatitis (most commonly hepatitis A). Rotavirus is the most common cause of gastroenteritis in children.

Bacteria and parasites can be transmitted through eating or drinking contaminated food or water. Signs and symptoms typically begin 12 hours to four days after exposure and resolve within three to seven days. When traveling in developing countries, diarrhea caused by bacteria and parasites is referred to as Traveler's Diarrhea.

Antibiotics destroy both good and bad bacteria in our digestive tracts. This disturbs the natural balance of bacteria in our bodies and can result in diarrhea. Clostridium difficile (or C. diff) is a specific type of bacteria that can cause diarrhea and serious infection. It usually occurs after a course of antibiotics or during a hospitalization and requires prompt and aggressive medical management to avoid complications.

Certain medications can cause diarrhea including cancer drugs, antacids with magnesium, antidepressants, proton pump inhibitors, laxatives, antibiotics, NSAIDs, medications for high blood pressures, heart arrhythmias, asthma, emphysema, and COPD.

Other causes of diarrhea include food allergies, Inflammatory Bowel Disease (IBD), Crohn’s disease or Ulcerative Colitis, microscopic colitis, celiac disease, irritable bowel syndrome (IBS), stress, lactose intolerance, fructose malabsorption, artificial sweeteners, surgeries (especially abdominal or gallbladder surgeries), disease of the pancreas and gallbladder, and other diseases.

Who is at risk for Acute Diarrhea?
1. Household contacts and co-workers of those infected with an infectious cause
2. People who have children in school or daycare
3. Children
4. The elderly
5. Those traveling to developing countries
6. If you drink well water
7. If you have a reptile or other pets
8. If you are pregnant, have a weakened immune system, or are undergoing cancer therapy
9. If you take certain medications
10. If you’ve recently been treated with antibiotics or have been hospitalized
11. If you’ve eaten out at a restaurant that doesn’t follow safe food handling practices, or if you do not follow safe food handling practices in your home or other setting
12. If you’ve come in contact with contaminated fruits, vegetables, meats, cheeses, milk, or other foods
13. Most all of us, at some point in our lives, will be at risk for acute diarrhea.

What symptoms might accompany diarrhea?
1. Loose, watery stools,
2. Abdominal pain or cramps,
3. Fever (in adults, a temperature greater than 100.4°F or 38°C)
4. Blood in the stool,
5. Mucus in the stool,
6. Gas or Bloating,
7. Nausea or vomiting, and/or
8. The urgent need to have a bowel movement.

 

With mild illness, you may have a few loose bowel movements but feel ok otherwise. With severe illness, you may have 20 or more bowel movements per day. This significantly increases your risk for dehydration and other electrolyte imbalances. Seek prompt medical care.

What can I do at home to treat my diarrhea?
1. Drink plenty of fluids
If you have mild to moderate diarrhea, you may be able to treat your diarrhea at home with supportive care. Drink extra fluids. Fluids should contain water, salt, and sugar. Sports drinks may be sufficient if you are not dehydrated and are otherwise healthy. Fruit juices (diluted), flavored soft drinks, salt crackers, broths, bouillon, or soups may be another option.

One way to judge just how hydrated you are is to examine the color of your urine and to monitor how frequently you’re urinating. If you’re not going often or if your urine is dark yellow, you should drink more fluids. Normally, urine should be light yellow to nearly colorless. If you’re well hydrated, you should pass urine every 3-5 hours.

If you become dehydrated and are unable to take fluids by mouth, you may need to receive fluids through at IV at a hospital or urgent care center. Seek prompt medical care!

2. Make sure you’re eating enough.
Adequate nutrition is important during an episode of acute diarrhea. Boiled starches (potatoes, noodles, rice) with salt and cereals are recommended if you have watery diarrhea. Crackers, dry bread, bananas, soups, and boiled vegetables may also be eaten if you can tolerate them.

3. Consider anti-diarrheal medications
Medications to reduce diarrhea are available, and are generally safe to use if you do not have a fever (in adults a temperature greater than 100.4°F or 38°C) and if your stool is not bloody. These medications do not cure the cause of your diarrhea, but can help to reduce the frequency of your bowel movements.
ALWAYS CHECK WITH A TRAINED MEDICAL PROVIDER BEFORE TAKING ANY PRESCRIPTION OR OVER THE COUNTER MEDICATIONS. Anti-diarrheal medications can be contraindicated in certain conditions and can make certain conditions worse.

4. Antibiotics may be needed.
Antibiotics are not needed in most cases of acute diarrhea, and they can actually worsen diarrhea or cause further complications if used inappropriately. The decision to use antibiotics must be made carefully after discussing the potential risks and benefits with a trained healthcare provider who is familiar with your current illness and past medical history.

5. Know when to seek medical advice!

When should I call a medical professional?
If you have any concern about your symptoms please call our office for an appointment, or go to your nearest Emergency Department for immediate care!

If your diarrhea is not severe, you may not always need to be seen by a doctor, especially if your diarrhea begins to improve within 48 hours; however, diarrhea can cause dehydration, which can be life threatening if untreated. Dehydration is particularly dangerous in children, older adults, and those with weakened immune systems.

If you have signs of serious dehydration, seek medical help. These include:
1. Excessive thirst,
2. Dry mouth, tongue, or skin,
3. Little or no urination,
4. Weakness, dizziness or lightheadedness after standing or sitting up,
5. Fatigue or sluggishness,
6. Dark-colored urine,
7. More serious symptoms include: abdominal pain, chest pain, confusion, or difficulty remaining alert.

Seek medical care immediately if you have
1. Profuse watery diarrhea with signs of dehydration.
2. Many small stools containing blood and mucus.
3. Bloody or black diarrhea.
4. Temperature ≥101.3°F
5. Greater than 7 unformed stools in 24 hours or illness that lasts more than 48 hours
6. Severe abdominal pain or cramping or painful bowel movements
7. If you have persistent diarrhea following antibiotics, are older than 69 years of age, have other medical illnesses or a weakened immune system seek medical care immediately.

 

How can I prevent infectious diarrhea?

Prevent the spread of infectious causes. Wash you hands!!!

Be cautious to avoid spreading infection to family, friends, co-workers, and other contacts. You are considered infectious as long as your diarrhea continues. Microorganisms that cause diarrhea can easily be spread from hand to mouth so washing your hands, using care with diapering, and using an alcohol-based hand rub, are all extremely important to prevent the spread of infection.

Follow food-safety guidelines.

  • Do not drink raw or unpasteurized milk or foods that contain unpasteurized milk
  • Wash raw fruits and vegetables before eating them.
  • Keep your refrigerator temperature at 40°F or lower and your freezer at 0°F or lower.
  • Use precooked, perishable, or ready-to-eat food as soon as possible.
  • Keep raw meat, fish, and poultry separate from other food.
  • Wash hands, knives, and cutting boards after handling uncooked food, produce, raw meat, fish, or poultry.
  • Thoroughly cook raw food from animal sources to a safe internal temperature: ground beef 160°F (71°C); chicken 170°F (77°C); turkey 180°F (82°C); pork 145°F (63°C) with a three minute rest time.
  • Cook seafood thoroughly.
  • Cook eggs thoroughly until the yolk is firm.
  • Refrigerate foods promptly. Never leave cooked foods at room temperature for more than two hours, including at picnics, potlucks or family gatherings.
  • If you are pregnant or have a weakened immune system talk to your medical provider about special precautions. Consider avoiding lunchmeats, soft cheeses, and pre-prepared salads.

Additional recommendations to prevent acute diarrhea include:
1. Vaccination. Rotavirus is the most common cause of viral diarrhea in children. Have your children vaccinated.
2. If you drink well water, submit samples for analysis at least annually to make sure your water is safe for drinking.
3. If you have any pets, especially reptiles, take extra precautions to avoid infection.
4. If you require antibiotics, talk to you prescribed about ways to replenish your gut flora. Never take antibiotics not prescribed to you.
5. When traveling:

  • Eat hot, well-cooked foods.
  • Avoid raw fruits and vegetables unless you can peel them yourself.
  • Avoid raw or undercooked meats and dairy products.
  • Do not drink raw milk
  • Drink bottled water, soda, beer or wine served in its original container. Make sure that the lids are sealed and containers have not been refilled.
  • Avoid tap water and ice cubes.
  • Use bottled water even for brushing your teeth.
  • Keep your mouth closed while you shower.
  • Ask your doctor about antibiotics before you go, especially if you have a weakened immune system.
  • Check for travel warnings with the Centers for Disease Control and Prevention before traveling.

Chronic Diarrhea

What is Chronic Diarrhea?
Chronic diarrhea is defined as loose stools that last for at least 4 weeks. This usually means three or more loose bowel movements per day.

How common is chronic diarrhea?
Many people experience diarrhea at some point in their lives. These episodes are often acute and resolve in a few days without complications. Other people, however, live with diarrhea that persists for longer. This is less common but not uncommon.

Who is at risk for chronic diarrhea?
Individuals are risk for chronic diarrhea include:

1. Those with a history of inflammatory bowel disease, like Crohn’s or Ulcerative Colitis.
2. Individuals with pancreatitis or pancreatic disease
3. Individuals who have had their gallbladder removed or who have had other abdominal surgeries
4. Individuals with celiac disease
5. Those who eat artificial sweeteners
6. Individuals who eat a lot of high fructose corn syrup or who eat a diet high in processed foods
7. Individuals who take certain medications like: NSAIDs, antibiotics, antacids
8. Those with diabetes
9. Those who have gluten insensitivity
10. Individuals who abuse alcohol or other drugs like cocaine or marijuana
11. Those with Irritable Bowel Syndrome or IBS
12. Those with SIBO or Small Intestinal Bacterial Overgrowth
13. Individuals who have had gastric bypass surgery
14. Those with a lot of stress
15. Individuals suffering from depression, anxiety or other mental health disorders

What are the associated symptoms?
The main symptom of chronic diarrhea is loose or watery stools that persist for 4 or more weeks. Bowel movements may or may not be accompanied by a sense of urgency. Other symptoms may include abdominal cramping, pain, gas, bloating, nausea, vomiting, fevers, blood, or mucous in the stools.

What are the causes of chronic diarrhea?
There are many causes of chronic diarrhea. Common causes include:

1. Irritable bowel syndrome or IBS. IBS can cause crampy abdominal pain and changes in your bowel habits from what had been previously normal for you (diarrhea, constipation, or both). Symptoms are often relieved with a bowel movement and made worse under stressful conditions. IBS can start after an infection.

2. Inflammatory bowel disease. There are several different types of inflammatory bowel disease. Crohn’s disease and ulcerative colitis are the 2 most common. These conditions occur when our own immune system attacks parts of our digestive tract. Blood may be present in the stool and symptoms may keep you awake at night. Weight loss and other more alarming symptoms may be noticed. Often IBD occurs in individuals between the ages of 20 and 30 and again in the 5th and 6th decades of life.

3. Infections. Intestinal infections that cause chronic diarrhea can be seen in people who travel to or live in tropical or developing countries. They can also develop after eating contaminated foods, drinking contaminated water, or consuming unpasteurized milk, cheeses, or other dairy products.

4. Endocrine disorders. An overactive thyroid can cause chronic diarrhea, weight loss, thin hair and changes in the menstrual cycle. Diabetes can cause chronic diarrhea if the nerves that supply the digestive tract are injured, such as in the case of gastroparesis. Other hormonal imbalances can lead to chronic diarrhea. Often women will notice worsening symptoms are the time of their periods.

5. Food allergy and sensitivity.
6. Celiac Disease
7. Lactose Intolerance
8. Fructose Intolerance
9. Artificial sweeteners: our bodies cannot digest artificial sweeteners. While low in calories, they can cause gas, bloating, diarrhea and other symptoms of GI distress.
10. A number of different prescription and over the counter medications, herbs, and dietary supplements can cause diarrhea as a side effect. Always discuss potential side effects of any medication prescribed to you with your doctor or pharmacist prior to taking them.
11. SIBO
12. Stress, Anxiety, Depression, and other mental health conditions
13. Having had your gallbladder removed
14. Having had a section of your colon or small intestine removed
15. Having had gastric bypass surgery
16. Having chronic pancreatitis or other diseases of the pancreas
17. Cancer and cancer therapies

 

How is chronic diarrhea diagnosed?
If you have any "alarm symptoms" seek medical care immediately. Alarm symptoms include: bloody diarrhea, fever, dehydration, weight loss or abdominal pain that interferes with your activities or prevents you from eating, symptoms that keep you up at night, back pain, night sweats, recent antibiotic use.

A trained medical professional like Dr. Sinha will make the diagnosis of chronic diarrhea by obtaining a thorough and comprehensive history and physical exam, ordering blood, stool, and urine tests if indicated, and ordering other appropriate studies. These tests might include: breath tests, CT scan, MRI, colonoscopy, sigmoidoscopy, anoscopy, ultrasound, and/or Prometheus lab testing.

What is the treatment for chronic diarrhea?
Treatment is aimed at correcting the underlying cause of your diarrhea, firming up loose stools, and preventing and addressing any associated complications.

Infections may be treated with antibiotics. Individuals with Inflammatory Bowel Disease (IBD) such as Crohn’s disease or ulcerative colitis, will likely require long-term treatment and follow-up care. Celiac disease is treated with a gluten free diet to decrease symptoms and to reduce the risk for lymphoma. In some cases, treatment may be as simple as eliminating food triggers or a causative medication. In the case of lactose intolerance, avoiding dairy products is advised. Sometimes the treatment is as simple as removing artificial sweeteners from one’s diet.

Sometimes medications are required. OTC and prescription options are available and should be discussed with a trained medical provider like Dr. Sinha and our team here at Hunterdon Digestive Health Specialists once a diagnosis is made and any underlying conditions are addressed.

What lifestyle and diet modifications can I make?
Keep a food and symptom diary to help determine whether diet is an underlying factor contributing to your chronic diarrhea. This may help you to identify potential food triggers. Other lifestyle changes to help resolve chronic diarrhea include:

1. Avoid caffeine and alcoholic beverages
2. Stop smoking
3. Decrease stress
4. Avoid high fiber foods (if these are problematic for you)
5. Keep hydrated
6. Avoid overeating

What are the complications associated with chronic diarrhea?

Chronic or severe diarrhea can lead to serious complications, including dehydration and malnutrition. Keep a close eye on your hydration and be sure to drink plenty of fluids. Watch for signs and symptoms of dehydration.

If you are not able to drink enough fluids and you become dehydrated, you may need to be given fluids through a vein to replace the fluids and electrolytes lost in your diarrhea. This will not cure your diarrhea, but it can help to prevent more serious complications including cardiac arrhythmias caused by electrolyte imbalances, lightheadedness, dizziness, weakness, fatigue, syncope, and other more serious life-threatening complications.

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