Diarrhea

DIARRHEA

Going to the bathroom, having a bowel movement, defecating (no matter what one chooses to call it), stooling is a regular part of life. Certain times however, this process of getting waste out of the body changes. When one has loose or watery stool, it is referred to as diarrhea. This is a very common condition and usually resolves without intervention.

Diarrhea can happen for a wide variety of reasons and it usually goes away on its own in one to three days. When a person has diarrhea, he/she may need to quickly run to the bathroom, sometimes with great urgency and this may happen more frequently than normal. The person may also feel bloated, may have lower abdominal cramps and sometimes experience nausea.

Although most cases of diarrhea happens for a fixed amount of time and at a steady level of severity (self limiting), the condition can sometimes lead to serious complications. Diarrhea causes the body to loose large amounts of water (dehydration). It could also cause the loss of sodium, potassium and magnesium that play a key role in vital bodily functions (electrolyte imbalance) and kidney failure (i.e. not enough blood/fluid is supplied to the kidneys). When one has diarrhea, they lose water and electrolytes along with the stool. The individual will need to drink plenty of fluids to replace what was lost. Dehydration can become serious if it is not resolved adequately.

Diarrhea is defined as the passage of three or more loose or liquid stools in a day it could also be diarrhea if there is more frequent passage of stool than is normal for the particular individual.  Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of organisms (bacterial, viral and parasitic). Infection is spread through contaminated food or drinking-water. It could be from person-to-person as a result of poor hygiene.

To prevent diarrhea, several interventions, including safe drinking-water, use of improved sanitation and hand washing with soap can reduce the risk of the condition. Normally, diarrhea is treated with oral rehydration solution (ORS), a solution of clean water, sugar and salt. Additionally, 10 to14 days supplemental treatment course of dispersible 20 mg zinc tablets shortens diarrhea duration and improves outcomes.

TYPES OF DIARRHEA

There are three clinical types of diarrhea:

Acute watery diarrhea : The most common, acute diarrhea is loose watery diarrhea that lasts one to two days. This type doesn't need treatment and it usually goes away after a few days. It includes cholera

Acute bloody diarrhea : Also called dysentery, this type of diarrhea generally persists for two to four weeks

Persistent diarrhea : Chronic diarrhea, this lasts for more than four weeks or comes and goes regularly over a long period of time.

CAUSES OF DIARRHEA

Usually, diarrhea happens because the presence of a virus that gets into the microorganisms living in the intestines (The Gut). Some people call it 'intestinal flu' or 'stomach flu.'

Other causes may include:

Alcohol abuse - Alcohol abuse encompasses a spectrum of unhealthy alcohol drinking behaviors, ranging from binge drinking to alcohol dependence.

Allergies to certain foods - A food allergy is when the body's immune system reacts unusually to specific foods. Although allergic reactions are often mild, they can be very serious.

Diabetes - A metabolic disease that causes high blood sugar.

Diseases of the intestines - Gastrointestinal disorders include such conditions as constipation, irritable bowel syndrome, hemorrhoids, anal fissures, perianal abscesses.

Eating foods that upset the digestive system - Foods that cause digestive problems do not pass through the digestive system as easily as say, oatmeal, or an apple.

Infection by bacteria or other organisms - This causes inflammation in the stomach and intestines. One may also experience symptoms like vomiting, severe abdominal cramps, and diarrhea.

Laxative abuse - When a person attempts to eliminate unwanted calories, lose weight, 'feel thin,' or 'feel empty' through the repeated, frequent use of laxatives.

Medications - A medication is a drug used to diagnose, cure, treat, or prevent disease.

Overactive thyroid (hyperthyroidism) - Occurs when the thyroid gland produces too much of the hormone, Thyroxine.

Radiation therapy - Radiation therapy is a treatment for cancer and, less commonly, for thyroid disease, blood disorders, and noncancerous growths.

Running - Runner's diarrhea, also known as runner's colitis and runner's trots, is a condition that often affects distance runners characterized by an urgent need for a bowel movement mid-run.

Some cancers : A cancer is the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are termed cancer cells, malignant cells, or tumor cells. They can infiltrate normal body tissues.

Surgery on the digestive system - Gastrointestinal surgery is a treatment for diseases of the parts of the body involved in digestion. This includes the esophagus, stomach, small intestine, large intestine, and rectum. It also includes the liver, gallbladder, and pancreas.

Trouble absorbing certain nutrients, (malabsorption) - Malabsorption is a disorder that occurs when people are unable to absorb nutrients from their diets, such as carbohydrates, fats, minerals, proteins, or vitamins. Common among the examples are lactose intolerance and celiac disease.

SYMPTOMS OF DIARRHEA

A person may have:

Bloating in the belly - Bloating is when the belly feels swollen after eating. It is usually caused by excess gas production or disturbances in the movement of the muscles of the digestive system

Cramps - A muscle cramp is a sudden and involuntary contraction of one or more muscles.

Thin or loose stools - In some cases, narrow stools (especially if it is pencil thin) may be a sign of narrowing or obstruction of the colon due to colon cancer.

Watery stools - A loose stool is a term used to describe stools that are more watery and softer than usual.

An urgent feeling of the need to have a bowel movement - The feeling of urgent need to defecate, even if one has already defecated not long before then.

Nausea and throwing up : Nausea (the feeling to vomit) and vomiting are not diseases in themselves, rather, they are symptoms of many different conditions, such as infection, food poisoning, motion sickness, overeating.

More serious symptoms of diarrhea include:

• Fever
• Blood or mucus in the stool
• Weight loss

If an individual has watery stools more than three times in one day and they do not drink enough fluids, he/she could become dehydrated. That can be a serious problem if not treated.

COMPLICATIONS

Diarrhea can cause dehydration, dehydration is particularly dangerous in children, older adults and those with weakened immune systems.

If anyone has signs of serious dehydration, seek immediate medical help.

Indications of dehydration in adults will include:

• Excessive thirst
• Dry mouth or skin
• Little or no urination
• Weakness, dizziness or lightheadedness
• Fatigue
• Dark-colored urine

Indications of dehydration in infants and young children will include:

• Crying without tears
• Sunken appearance to the abdomen, eyes or cheeks
• Not having a wet diaper in three or more hours
• Dry mouth and tongue
• Fever above 102 F (39 C)
• Drowsiness, unresponsiveness or irritability

WHEN TO SEE A DOCTOR

Adults should see their doctor if:

The diarrhea persists beyond a few days

They become dehydrated

They have severe abdominal or rectal pain

They have bloody or black stools

They have a fever above 102 F (39 C)

In particularly young children, diarrhea can quickly lead to dehydration. Call a doctor if the child's diarrhea does not improve within 24 hours or if the baby:

• Becomes dehydrated
• Has a fever above 102 F (39 C)
• Has bloody or black stools

LIFESTYLE RISK FACTORS

Immediate changes to diet, such as going on a mostly liquid diet, eating too much fiber, or eating spicy foods may lead to diarrhea.

Beyond examining and, perhaps, adjusting what to eat and drink, other habits and exposures can put a person at greater risk for diarrhea.

Personal Hygiene

The bacteria, viruses, and parasites that cause traveler's diarrhea and stomach flu are spread by contact with contaminated surfaces, food, and water. To reduce risks, wash hands well after using the bathroom, after changing children's diapers, and before eating. Use an alcohol-based hand gel in case there is no soap and/or water.

Refrain from drinking untreated water from a natural source, such as streams. They can be contaminated with diarrhea-causing parasites that are spread by microscopic parasites such as Giardia.

If a person has to travel to areas that have a higher risk of contaminated water and food, he/she has to drink only bottled water and must not use ice unless it is from bottled or purified water. Uncooked vegetables and fruits (unless they can be peeled), undercooked meat, and dairy products must be avoided.

Improper Handling of Food

Food poisoning is often caused by improper food handling, it will therefore be wise to follow these tips;

Clean : Kitchens must be kept clean; utensils and cutting boards washed with hot, soapy water.

Separate - Raw meat, seafood, poultry, and eggs must be kept separate from other foods. It may be prudent to use a separate cutting board for these items.

Cook : Make use of a food thermometer to ensure that meat is cooked to a temperature that will kill the food poisoning bacteria.

Chill - Ensure that the refrigerator is kept below 40 degrees. Frozen foods thawed in the refrigerator or microwave, not out on the counter.

DIAGNOSING DIARRHEA

The doctor will complete a physical examination and consider the patient's medical history to determining the cause of the diarrhea. The doctor may also request laboratory tests to examine urine and blood samples.

Additional tests that the doctor may order to determine the cause of diarrhea and other related conditions can include:

• Fasting as tests to determine whether the cause is a food intolerance or allergy
• Imaging tests to check for inflammation and structural abnormalities of the intestine
• Stool culture to check for bacteria, parasites, or signs of disease
• A colonoscopy to check the entire colon for signs of intestinal disease
• A sigmoidoscopy to check the rectum and lower colon for signs of intestinal disease

A colonoscopy or sigmoidoscopy would especially be helpful in determining if there is an intestinal disease or if it is severe or chronic diarrhea.

TREATING DIARRHEA

Mild and uncomplicated diarrhea can be treated at home in most cases, by using an over-the-counter products.

However, these 'over the counter' medications do not always solve the problem. If for instance the diarrhea is caused by an infection or parasite, a healthcare provider must be consulted for treatment. 'Over the counter' medications should not be used for diarrhea if the individual has a fever or blood in the stool.

If the diarrhea lasts for a long period, the healthcare provider will determine the treatment on the cause of the diarrhea.

This could involve a few different treatment options, including:

Antibiotics - The healthcare provider might prescribe an antibiotic or other medication to treat an infection or parasite that is found to be causing the diarrhea.

Medication for a specific condition : Having diarrhea can be a sign of having several other medical conditions, including;

Irritable bowel syndrome (IBS)

Inflammatory bowel disease (IBD) - (e.g. Crohn's disease and ulcerative colitis, microscopic colitis, or bacterial overgrowth). The diarrhea can usually be controlled once the cause of the diarrhea is identified.

Probiotics : The groupings of good bacteria, sometimes probiotics are used to re-establish a healthy biome to combat diarrhea.

Taking 'over the counter' medications for diarrhea

It is crucial to always follow the instructions on the packaging of 'over-the-counter' medication for diarrhea if one decides to use them. Note that the rules for managing diarrhea in an adult are entirely different from than of children.  

With an acute case of diarrhea, one can often take care of it without needing any medication. Some of the things that can be done to care for diarrhea include:

Drinking plenty of water and other electrolyte balanced fluids (e.g. diluted and pulp-free fruit juices, broths, sports drinks and caffeine-free soft drinks). Make sure to hydrate throughout day because the body loses water each time one has diarrhea. By drinking plenty of extra fluids, the body is protected from dehydration.

Changing one's diet - Instead of fatty, greasy or fried foods, the BRAT diet is advised:

B: Bread (white bread).

R: Rice (white rice).

A: Applesauce.

T: Toast (white bread).

Reducing caffeine intake : Caffeine can have a mild laxative effect, which can make the diarrhea worse. Foods and drinks with caffeine include coffee, diet sodas, strong tea/green tea, and even some chocolate.

Avoiding foods and drinks that give gas - it would help to cut back on things that cause gas, especially if cramping in the stomach is experienced with the diarrhea. Included in this would be beans, cabbage, Brussels sprouts, beer and carbonated beverages.

Sometimes, diarrhea can also make a person lactose intolerant, however this is usually temporary and it means that one needs to avoid items with lactose (e. g. dairy products) until the diarrhea has been treated successfully.

PREVENTION OF DIARRHEA

There are a few ways that a person can decrease his/her chances of having diarrhea. This will include;

Avoiding infections by adopting good hygiene habits - Cooking, handling, and eating, is an important way to prevent diarrhea. Remember to wash hands with soap and water after using the bathroom. Washing hands thoroughly can really help keep an individual and those around remain healthy.

Getting the needed vaccinations - One of the causes of diarrhea, Rotavirus can be prevented with the rotavirus vaccine. This vaccination is given to infants in several stages during the first year of life.

Storing food properly - By keeping stored food at the right temperature and not eating things that have gone bad, cooking food to the recommended temperature and handling all foods safely, diarrhea can be prevented.

Watching what one drinks when traveling - Traveler's diarrhea can happen when one drinks water or other drinks that were not treated correctly. This is most likely to happen in developing countries.

To avoid getting diarrhea there are a few tips to follow.

• Watch that drink.
• Do not drink tap water,
• Use ice cubes,
• Brush the teeth with tap water, or
• Consume unpasteurized milk, milk products or unpasteurized juices.

Care must be exercised when;

• Trying local foods from street vendors,
• Eating raw or undercooked meats (and shellfish),
• Eating raw fruits and vegetables. When in doubt, drink bottled water or something that's been boiled first (e.g. coffee or tea).

OUTLOOK

That diarrhea is common does not mean it cannot be dangerous. In extreme cases of diarrhea, the resultant severe dehydrated can lead to serious complications. Dehydration happens to be one of the most dangerous side effects of diarrhea. It is important to drink plenty of fluids with electrolytes when one has diarrhea. This allows the body to replace the fluid and electrolytes that are lost with the diarrhea.