Diarrhea Overview
Diarrhea is a common problem characterized by loose, watery stools or a frequent need to have a bowel movement, the passage of 3 or more loose or liquid stools per day. It usually lasts a few days (1-3 days) and often disappears without any treatment or intervention. When you have diarrhea, you may need to quickly run to the bathroom with urgency and this may happen more frequently than normal. You may also feel bloated, have lower abdominal Pain, cramping and sometimes experience nausea.
Diarrhea is one of the most common health complaints worldwide. It can range from a mild, temporary condition to a potentially life threatening one. Globally, an estimated two billion cases of diarrheal disease occur each year. Also, around 1.9 million children under the age of 5 years, mostly in developing countries, die from diarrhea every year. This makes it the second leading cause of death in this age group. Most cases of diarrhea are due to bacteria, viruses, or parasites. Digestive system disorders can also cause chronic diarrhea. Dehydration is a dangerous side effect of diarrhea.
Although most cases of diarrhea are self-limited (happening for a fixed amount of time and steady level of severity), sometimes diarrhea can lead to serious complications. Diarrhea can cause dehydration (when your body loses large amounts of water), electrolyte imbalance (loss of sodium, potassium and magnesium that play a key role in vital bodily functions) and kidney failure (not enough blood/fluid is supplied to the kidneys). When you have diarrhea, you lose water and electrolytes along with stool. You need to drink plenty of fluids to replace what’s lost. Dehydration can become serious if it fails to resolve (get better), worsens and is not addressed adequately.
Diarrhea can be Acute, Persistent or Chronic:
- Acute Diarrhea- Acute diarrhea occurs when the condition lasts for one to two days and usually goes away on its own. You might experience diarrhea as a result of a viral or bacterial infection, other times, it could be due to food poisoning. Acute diarrhea is more common than persistent or chronic diarrhea. Researchers estimate that about 179 million cases of acute diarrhea occur in the United States each year
- Persistent Diarrhea lasts longer than two weeks and less than four weeks.
- Chronic Diarrhea lasts at least for at least four weeks. Chronic diarrhea symptoms may be continual or may come and go. Chronic diarrhea is usually the result of an intestinal disease or disorder, such as Celiac disease and Crohn’s disease.
- Traveler’s Diarrhea which happens when you have diarrhea after being exposed to bacteria or parasites while on vacation in a developing nation. Acute diarrhea is fairly common.
Causes of Diarrhea
Diarrhea can be a result of a number of conditions or circumstances, potential causes of diarrhea include:
- Food Intolerance, such as lactose intolerance
- Food Allergy
- Adverse Reaction to a medication
- Viral Infection
- Bacterial infection
- Intestinal Disease
- Parasitic Infection
- Gallbladder or Stomach surgery
The cause of most self-limited diarrhea is generally not identified. The most common cause of diarrhea is a virus that infects your bowel (viral gastroenteritis). The infection usually lasts a couple of days and is sometimes called “intestinal flu.”
Other possible causes of diarrhea can include:
- Infection by bacteria.
- Infections by other organisms and pre-formed toxins
- Eating foods that upset the digestive system.
- Allergies and intolerances to certain foods (Celiac disease
or Lactose Intolerance) - Medications.
- Radiation therapy.
- Malabsorption of food (poor absorption)
Diarrhea Signs and Symptoms
The symptoms you can experience when you have diarrhea can vary depending on if it’s mild or severe and what the cause of the diarrhea happens to be. There’s a link between severe cases of diarrhea and a medical condition that needs to be treated. When you have diarrhea, you may experience all of these symptoms or only a few. The main symptom of diarrhea is loose or watery stool.
Other symptoms of mild diarrhea can include:
- Bloating or Abdominal cramps
- Stomach Pain
- A strong and urgent need to have a bowel movement.
- Nausea (upset stomach)
If you have severe diarrhea, you may experience symptoms like:
Dehydration and Diarrhea
Diarrhea can cause the body to lose fluids quickly and put you at risk for dehydration. If you don’t receive treatment for diarrhea, it can have very serious effects.
The symptoms of dehydration include:
- Fatigue
- Dry mucous membranes
- Increased heart rate
- Headache
- Lightheadedness
- Increased thirst
- Decreased urination
- Dry mouth
Most cases of diarrhea occur due to an infection in the gastrointestinal tract. The microbes responsible for this infection include:
- Bacteria
- Viruses
- Parasitic Organisms
The most commonly identified causes of acute diarrhea in the United States are the bacteria Salmonella, Campylobacter, Shigella, and Escherichia coli according to the aafp.org.
Some cases of chronic diarrhea are called “functional” because although all the digestive organs appear normal, they are not functioning as they ideally should. In the developed world, Irritable Bowel Disease (IBS) is the most common cause of functional diarrhea. IBS causes many symptoms, including cramping, abdominal pain, and altered bowel habits, which can include diarrhea, constipation, or both.
Inflammatory Bowel Disease (IBD) is another cause of chronic diarrhea. IBD describes either Ulcerative Colitis or Crohn’s disease. Both conditions can also cause blood in the stool.
Some other major causes of chronic diarrhea include:
- Microscopic colitis: This is a persistent type of diarrhea that usually affects older adults. It develops due to inflammation and occurs often during the night.
- Malabsorptive and Maldigestive Diarrhea: The first is due to impaired nutrient absorption, and the second is due to impaired digestive function. Celiac disease is one example.
- Chronic Infections: A history of travel or antibiotic use can be clues in chronic diarrhea. Various bacteria and parasites can also be the cause.
- Drug-Induced Diarrhea: Laxatives and other drugs, including antibiotics, can trigger diarrhea.
- Endocrine-Related Causes: Sometimes, hormonal factors cause diarrhea. This is the case in Addison’s disease and carcinoid tumors.
- Cancer-related causes: Neoplastic diarrhea is associated with a number of gut cancer.
- Radiation Therapy
- Eating foods that upset digestive system
- Allergies and intolerance of certain foods (Celiac disease or lactose intolerance)
- Malabsorption of food (poor absorption)
Antibiotics can Cause Diarrhea
Most antibiotics (clindamycin, erythromycins and broad spectrum antibiotics) can cause diarrhea. Antibiotics can change the balance of bacteria normally found in the intestines (Gut bacteria), allowing certain types of bacteria like C. difficile to thrive. When this happens, your colon can become overrun by bad (pathologic) bacteria that causes colitis (inflammation of your colon lining). Antibiotic-associated diarrhea can begin any time while you’re taking the antibiotic or shortly thereafter.
Diagnosis of Diarrhea
For the majority of mild diarrhea cases, you don’t need medical attention, the diarrhea goes away by itself or by taking OTC medicine. These cases are self-limited (only lasts for a fixed amount of time) and get better without medical intervention. The key to mild diarrhea is supportive therapy, staying hydrated and eating a bland diet.
More serious cases of diarrhea may require medical attention. In these situations, there are a few diagnostic tests that your doctor may order. These tests can include:
- Discussing a detailed family history, as well as physical and medical conditions, your travel history, and any sick contacts you may have.
- Doing a stool test on a collected stool sample to check for blood, bacterial infections, parasite, inflammatory markers. or signs of diseases and disorders.
- Doing a breath test to check for lactose or fructose intolerance, and bacterial overgrowth.
- Doing blood work to rule out medical causes of diarrhea such as a thyroid disorder, celiac sprue and pancreatic disorders.
- Doing endoscopic evaluations, your doctor may use endoscopy to look inside your body to help fin the cause of the diarrhea, evaluations of your upper and colonoscopy for the lower digestive tract to rule out organic abnormalities (ulcers, infections, neoplastic process and other diseases). Endoscopic procedures include colonoscopy, flexible sigmoidoscopy and upper gastrointestinal (GI) endoscopy.
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