Definition

Diarrhea is more than three loose, liquid stools in a single day. It depletes the body of fluids and electrolytes. Diarrhea can be:

• Acute—Occurring suddenly and lasting briefly
• Chronic—Long-term
• Recurring—Coming and going

If the body loses too much fluid, it can become dehydrated. Dehydration is especially dangerous for babies, young children, and elderly people.

Causes

Causes may include:

• Food intolerance, such as lactose intolerance
• Medicines, including:
  • Antibiotics
  • Magnesium-containing antacids
  • High blood pressure medications
  • Quinine
  • Chemotherapy
  • Laxatives
• Irritable bowel syndrome, which is episodes of diarrhea often alternate with periods of constipation
• Injury to the bowel after radiation treatments for cancer
• Malabsorption syndromes, such as:
  • Celiac disease
  • Tropical sprue
  • Short bowel syndrome
  • Whipple's disease
  • Intestinal lymphangiectasia
• Diseases of the pancreas and/or gallbladder
• Inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease
• Chronic diseases, such as:
  • Liver disease
  • Diabetes
  • Hyperthyroidism
  • Addison's disease
  • Pellagra
  • Scleroderma
  • Amyloidosis
  • Acquired Immune Deficiency Syndrome (AIDS)
  • Colon cancer
• Intestinal surgery
• Infections, including food poisoning, such as:
  • Bacterial: Campylobacter, Clostridium difficile, Salmonella, Shigella, and Escherichia coli
  • Viral: rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis
  • Parasitic: Giardia lamblia, Entamoeba histolytica, Cryptosporidium, tapeworm, roundworm, flukes
  • Fungal: Candida—yeast

Risk Factors

Risk factors include:

• Traveling to a developing country where the water and food supply may be contaminated
• Having a severely weakened immune system, such as with AIDS or after an organ transplant
• Taking certain medicines

Symptoms

Symptoms may include:

• Frequent, loose, liquid stools
• Abdominal pain, cramping
• Urgent need to defecate
• Blood and/or mucus in stool
• Fever
• Dehydration
• Nausea, vomiting
• Muscle aches and pains
• Weight loss
• Malnutrition

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may insert a gloved finger into your rectum to examine it. This is called a digital rectal exam.

To determine the cause of your diarrhea, the doctor will ask questions, such as:

• Does anyone else in your family have diarrhea?
• What kinds of food have you eaten recently?
• Do you drink well water?
• Do your children attend daycare?
• Have you traveled recently?
• Do you use laxatives?
• What medicines do you take?
• Do you have any symptoms other than diarrhea, such as fever, rash, or aching joints?
• What is your sexual history?
• Have you ever had abdominal surgery?

Tests may include:

• Your bodily fluids, tissues, and waste products may be tested. This can be done with:
  • Laboratory analysis of a stool sample
  • Blood tests
  • Biopsy
• You may need to have your rectum and colon examined. This can be done with:
  • Flexible sigmoidoscopy
  • Colonoscopy
• You may need to have images taken of your colon. This can be done with:
  • Upper Gastrointestinal (GI) Series
  • Barium enema
• You may need to have fasting or food elimination tests.

Barium Enema

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Treatment

Treating the underlying condition may help to relieve the diarrhea.

General recommendations for treating diarrhea include:

Prevention

To reduce your chance of getting diarrhea:

• Practice good handwashing.
• Practice safe food preparation and food storage.
• If you have diarrhea, do not prepare food for others.
• If you are traveling:
  • Drink bottled water.
  • Use bottled water when brushing your teeth.
  • Avoid drinks that contain ice.
  • Do not eat food purchased from street vendors.
  • Do not eat raw vegetables or fruits. All produce should be peeled and/or cooked.
  • Make sure meats are cooked thoroughly.
  • Eat only pasteurized dairy products.
  • If you eat seafood, make sure it is very hot.

Rotavirus is a common cause of diarrhea in children under five years of age. There is a vaccine to prevent rotavirus. The first dose is given at age two months. Make sure your infant has received this vaccine.