- 1 Diarrhea treatment
- 1.1 What is diarrhea?
- 1.2 How many times do you have to go to the bathroom to be considered diarrhea?
- 1.3 Types of diarrhea
- 1.4 Symptoms of diarrhea
- 1.5 Causes of diarrhea
- 1.6 Diarrhea as a symptom of physical diseases
- 1.7 Diarrhea prevention. How to prevent diarrhea?
- 1.8 Diarrhea treatment
- 1.9 When to go to the doctor?
- 1.10 Admit the patient if:
What is diarrhea?
Diarrhea is defined as an increase in stool mass, frequency, or fluidity, typically to amounts greater than 200 grams per day. Worldwide diarrheal diseases account for greater than 700,000 deaths of children under 5 years of age, making them the second leading cause of death in this age group. Diarrhea or diarrhoea is considered an abnormal condition of the intestines in which abnormally frequent and fluid feces occur, generally accompanied with bowel movements and with little presence of solids.
You should go to the toilet daily to maintain proper intestinal health. When defecation is too frequent, with soft or completely liquid consistency, it is because we have diarrhea. Diarrhea is a symptom that something is wrong with our intestines.
How many times do you have to go to the bathroom to be considered diarrhea?
The number of depositions of a person with diarrhea can vary a lot and become higher than 20 a day. In severe cases, stool volume can exceed 14 L per day and, without fluid resuscitation, result in death.
Rather than the number of bowel movements, it is considered that diarrhea can be defined by the percentage of water in the stool or feces. A person is considered to have diarrhea when their stools have more than 85% water, with 60-85% being the percentage of normal stool.
Types of diarrhea
Clinically, there are three types of diarrhea:
- Acute diarrhea: It is that which affects the individual as a result of a momentary reason. It doesn’t last more than 15 or 20 days. This type of diarrhea, which, in most cases, usually responds to a bacterial or viral cause, is responsible in developing countries for the death of many people, especially girls and children under 5 years.
- Chronic diarrhea: A condition in which the individual has episodes of constant diarrhea. In this case it is a response to some kind of bodily disease. Medically it is said to be that type lasting more than 8 months. This type of diarrhea is a major personal problem for people who suffer it either in their relationship with other people or in their workplace.
- Bloody diarrhea: Painful, bloody, small-volume diarrhea is known as dysentery or bloody diarrhea.
Diarrhea is a common symptom of many intestinal diseases, including those due to infection, inflammation, ischemia, malabsorption, and nutritional deficiency.It can be classified into four major categories:
Secretory diarrhea is characterized by isotonic stool and persists during fasting.
- Osmotic diarrhea, such as that occurring with lactase deficiency, is due to osmotic forces exerted by unabsorbed luminal solutes. The diarrheal fluid is at least 50 mOsm more concentrated than plasma, and the condition abates with fasting.
- Malabsorptive diarrhea caused by inadequate nutrient absorption is associated with steatorrhea and is relieved by fasting.
- Exudative diarrhea is due to inflammatory disease and characterized by purulent, bloody stools that continue during fasting.
Symptoms of diarrhea
Diarrhea is usually a symptom of an infection in the intestinal track, which can be caused by a variety of bacterial, viral and parasitic organisms
Clinical sign and symptoms of diarrhea are following:
- Loose, watery stools
- Abdominal cramps
- Abdominal pain
- Blood in the stool
- Mucus in the stool
- Urgent need to have a bowel movement
Causes of diarrhea
The main causes of diarrhea are:
- Eating spoiled food that leads to food poisoning.
- Drinking contaminated water, which usually occurs especially when the person is in foreign countries.
- Eating poisonous or toxic products, including poisonous plants.
- Food allergies or absorption problems, such as lactose or gluten intolerance. For example, many people who do not tolerate milk well suffer from severe diarrhea after drinking milk or eating cheese.
- Sweeteners: Ingesting many products with artificial sweeteners. It is easy to produce with the consumption of many chewing gums that contain xylitol and other polyols, which are laxatives. It is also produced by consuming sugar substitutes such as birch, which is pure xylitol.
Diarrhea as a symptom of physical diseases
Diarrhea can be a symptom of physical disease. Following are some examples:
- Gastroenteritis: one of the most common diarrhea causes is gastroenteritis caused by intestinal influenza virus that usually affects people living together such as schoolchildren, workers of the same company, members of the same family, etc.
- Irritable bowel syndrome: Episodes of diarrhea along with episodes of constipation alternate in this syndrome.
- Crohn’s Disease: A type of autoimmune chronic intestinal inflammation with the appearance of blood in stool, intestinal pain, fever, painful evacuation, etc.
- Ulcerative Colitis: Type of chronic intestinal inflammation of unknown cause with onset of blood in evacuation.
- Intestinal Surgery
- Thyroid disease
- Some medications or vitamins. Among the former antibiotics and antacids are responsible for the occurrence of diarrhea. B vitamin, vitamin C or magnesium, for example, when taken in excess or are ingested by susceptible individuals, produce diarrhea.
Diarrhea prevention. How to prevent diarrhea?
To avoid the occurrence of diarrhea you should follow the following tips:
- Wash your hands thoroughly with soap and water before eating.
- Wash your hands thoroughly after handling food, especially raw meat.
- Do not leave your cooked food out of the fridge for too long.
- Thaw your food in the microwave.
- Wash dishes with soap and water especially if raw meat has been placed on them.
- Wash your dishes well right after eating.
- On trips abroad or in areas of low confidence drink only bottled water. Use this water for brushing your teeth.
- In foreign travels or at places of low confidence do not eat anything raw.
For Acute diarrhea:
Most mild diarrhea will not lead to dehydration provided the patient takes adequate oral fluids containing carbohydrates and electrolytes. Patients find it more comfortable to rest the bowel by avoiding high-fiber foods, fats, milk products, caffeine, and alcohol. Frequent feedings of tea, “flat” carbonated beverages, and soft, easily digested foods (eg, soups, crackers, bananas, applesauce, rice, toast) are encouraged.
In more severe diarrhea, dehydration can occur quickly, especially in children and frail older adults. Oral rehydration with fluids containing glucose, Na+, K+, Cl–, and bicarbonate or citrate is preferred when feasible. A convenient mixture is 1⁄2 tsp salt (3.5 g), 1 tsp baking soda (2.5 g NaHCO3), 8 tsp sugar (40 g), and 8 oz orange juice (1.5 g KCl), diluted to 1 L with water. Alternatively, oral electrolyte solutions (eg, Pedialyte, Gatorade) are readily available. Fluids should be given at rates of 50–200 mL/kg/24 h depending on the hydration status. Intravenous fluids (lactated Ringer injection) are preferred in patients with severe dehydrat.
- Antidiarrheal Agents
Antidiarrheal agents may be used safely in patients with mild to moderate diarrheal illnesses to improve patient comfort. Opioid agents help decrease the stool number and liquidity and control fecal urgency. However, they should not be used in patients with bloody diarrhea, high fever, or systemic toxicity and should be discontinued in patients whose diarrhea is worsening despite therapy. With these provisos, such drugs provide excellent symptomatic relief. Loperamide is preferred, in a dosage of 4 mg orally initially, followed by 2 mg after each loose stool (maximum: 8 mg/24 h). Bismuth subsalicylate (Pepto-Bismol), two tablets or 30 mL orally four times daily, reduces symptoms in patients with traveler’s diarrhea by virtue of its anti-inflammatory and antibacterial properties. It also reduces vomiting associated with viral enteritis. Anticholinergic agents (eg, diphenoxylate with atropine) are contraindicated in acute diarrhea because of the rare precipitation of toxic megacolon.
For Chronic diarrhea:
A number of antidiarrheal agents may be used in certain patients with chronic diarrheal conditions and are listed below. Opioids are safe in most patients with chronic, stable symptoms.
Loperamide: 4 mg orally initially, then 2 mg after each loose stool (maximum: 16mg/day).
Diphenoxylate with atropine: One tablet orally three or four times daily as needed. Codeine and deodorized tincture of opium: Because of potential habituation, these drugs are avoided except in cases of chronic, intractable diarrhea. Codeine may be given in a dosage of 15–60 mg orally every 4 hours; tincture of opium, 0.3–1.2 mL orally every 6 hours as needed.
Clonidine: Alpha-2-adrenergic agonists inhibit intestinal electrolyte secretion. Clonidine, 0.1–0.3 mg orally twice daily, or a clonidine patch, 0.1–0.2 mg/day, may help in some patients with secretory diarrheas, diabetic diarrhea, or cryptosporidiosis.
Octreotide: This somatostatin analog stimulates intestinal fluid and electrolyte absorption and inhibits intestinal fluid secretion and the release of gastrointestinal peptides. It is given for secretory diarrheas due to neuroendocrine tumors (VIPomas, carcinoid). Effective doses range from 50 mcg to 250 mcg subcutaneously three times daily.
Bile salt binders: Cholestyramine or colestipol (2–4 g once to three times daily) or colesevelam (625 mg, 1–3 tablets once or twice daily) may be useful in patients with bile salt-induced diarrhea, which may be idiopathic or secondary to intestinal resection or ileal disease.
Usually the diarrhea problem is solved with a proper diet after a few days. Special emphasis should be put on drinking plenty of fluids to avoid dehydration, especially in infants or young children are affected.
Chronic diarrhea require special treatment by the doctor who must diagnose their cause and apply the proper treatment.
Among the clearest signs to know whether this is a chronic diarrhea is to determine whether there is blood in the feces or whether there is a loss of more than 4.5 kilos of body weight in a short time and without apparent reason. Another clear sign is the need to get up to defecate at night.
When to go to the doctor?
In addition to chronic diarrhea, you also have to search for medical care when, together with acute diarrhea, some symptoms as the following appear:
– Traces of blood in the feces.
– When fever is above 38 º C in babies or above 39 º C in adults.
– When heart problems appear.
– Where there is no improvement after 3 days in young children or babies older than 3 months or after 5 days in adults. Newborns and babies up to 3 months must visit the doctor when they get diarrhea.
– Under the suspicion of possible dehydration
– When you suspect a possible food poisoning has caused this diarrhea, specially if it affects other people who ate the same thing.
– When diarrhea began after traveling to another country.
– If you think that the deposition with diarrhea have an abnormal aspect or they smell strangely.
Admit the patient if:
• Severe dehydration for intravenous fluids, especially if vomiting or unable to maintain sufficient oral fluid intake.
• Bloody diarrhea that is severe or worsening in order to distinguish infectious versus noninfectious cause.
• Severe abdominal pain, worrisome for toxic colitis, inflammatory bowel disease, intestinal ischemia, or surgical abdomen.
• Signs of severe infection or sepsis (temperature higher than 39.5°C, leukocytosis, rash).
• Severe or worsening diarrhea in patients who are older than 70 years or immunocompromised.
• Signs of hemolytic-uremic syndrome (acute kidney injury, thrombocytopenia, hemolytic anemia).
More information on diarrhea
15 June, 2020