Diarrhea

Diarrhea is a medical term used to describe watery stools that happen 3 or more times in one day. It is a common problem experienced by virtually all people at least once in their lifetimes.

Causes of diarrhea in adults and children

• Viruses
• Bacteria sourced from food or water
• Parasites like worms contracted from some tropical countries
• Side effects of medications
• Indigestion of certain foods
• Disease of the gastrointestinal, or digestive, system

Treating Diarrhea

• Replenishing the water lost in the stools is absolutely vital. Drinking water with certain electrolytes (salts) and some sugar content are good choices as well. Examples of these may be fruit juice or soup broth. Urine that looks dark yellow and concentrated is a sign that the person is not getting enough water.
• Eating small amounts of food to point of tolerance will help them have more energy. Good choices are potatoes, rice, oatmeal, bananas, soup, crackers and steamed vegetables.
• In cases of uncomplicated diarrhea, a medication called loperamide (brand name: Imodium) may help reduce the frequency of passing stool. This should not be taken if the diarrhea has blood or if the person has fever, as these may be signs of a more complicated underlying disease, rather than a simple episode of diarrhea.

When to see a Doctor

• If the diarrhea has been ongoing for more than 48 hours or the person has had more than 6 bowel movements in the past 24 hours – severe dehydration is a worrying complication of diarrhea
• The diarrhea is mixed with blood or mucus
• The diarrhea has a strong smell like tar or appears black in color – this may be a sign of bleeding coming from the stomach or small intestine
• The person has a high fever of more than 38 degrees Celsius
• They are having very bad cramps or abdominal pain
• The patient is at the extremes of age – babies and young children or patients more than 70 years old are more susceptible to dehydration and need to be assessed earlier
• The diarrhea started after finishing a course of antibiotics – this is significant as it can point to a specific type of bacterial infection that tends to be more serious.

Signs of Dehydration

• Urine that is concentrated and dark yellow in color or producing very little urine throughout the day
• Fatigue
• Extreme thirst
• Having a constantly dry mouth and tongue
• Muscle cramps
• Dizziness
• Confusion

Tests to diagnose Diarrhea

No tests are required to diagnose diarrhea as it is mainly based on a person’s symptoms. However, tests may be ordered to find the underlying cause of it.

• Blood tests can show if an infection is taking place and assess electrolytes and kidney function
• Urine tests can assist in assessing dehydration.
• A stool sample may be collected to test for specific organisms that may be causing the diarrhea and ensure the correct treatment is given.

If the underlying cause suspected is more serious, the doctor may order an imaging study such as a CT scan or a procedure known as a colonoscopy. A colonoscopy is a procedure where a long narrow tube with a camera at the end is inserted into the patient’s anus. This device can be used to visualize the intestines and take sample if needed.

Treating Diarrhea

• Antibiotics – this will only be given in cases of diarrhea due to bacteria.
• Medications to reduce the number of diarrhea episodes – for example, loperamide (brand name: Imodium) or diphenoxylate (brand name: Lomotil) or bismuth subsalicylate (brand names: Pepto-Bismol, Kaopectate).
• Patient may be given replacement fluids with electrolytes through a vein (IV) if they are dehydrated.
• Medications and certain foods may be withheld until the diarrhea stops.

Preventing Diarrhea

The main routes of transmission are from dirty hands and contaminated food.  Therefore, diarrhea can be prevented best by:

• Washing hands thoroughly with soap and water or using alcohol rubs or gel each time after changing baby diapers, cooking, eating, taking out the trash, touching animals, blowing the nose or going to the bathroom.
• It is important to pay attention to food safety:
• Do not drink unpasteurized milk or foods made from it
• Wash fruits and vegetables well before eating them
• Making sure the refrigerator and freezer are working well and are cooling at the right temperatures to avoid bacteria growing
• Ensuring meats and seafood are well cooked
• Cooking eggs until the yolk is firm
• Washing hands, knives and chopping boards that have come into contact with raw meats

Diarrhea In Children

The number of normal bowel movements per day depends on the age of the child. In the first week of life, most babies pass 3-4 times per day and they are generally soft or liquid especially if breastfed. Up to 10 times per day may still be considered normal at this age. By 3 months, some babies pass stool 2 times per day while others pass stool once every few days. By age 2 years old, most children have bowel movements once a day. Every child is different and whether a child is having diarrhea or not should be judged by the parents or caregiver since they know what is normal for the child.

A child having diarrhea can still continue to eat their normal diet or breastfeed. Lean meats, rice, potatoes, fruits and vegetables are considered acceptable. However certain foods have been observed to worsen diarrhea so the parent may consider avoiding them to be on the safe side. These include very fatty foods, very sugary drinks, and apple and cherry juice. Making sure the child drinks enough water is imperative. If it is a young baby, they will get their water through breast milk as long as they feed frequently enough.

Diarrhea medications should NOT be given to children. They are not usually needed for children, and they might not be safe.

Children having diarrhea should see a doctor if:

• The diarrhea is bloody
• The child refuses to eat or drink for more than a few hours
• The child is having very bad stomachache
• The child is not themselves and is low in energy
• The child is dehydrated. This means they have a dry mouth or tongue, are always thirsty, do not produce tears when crying or have not had many wet diapers in the day (normally every 4-6 hours in babies and every 6-8 hours in older children)
• Extra caution if child less than 1 year of age