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Diarrhea

is the frequent passing of loose or watery stools. Acute diarrhea, which is a common cause of death in developing countries, appears rapidly and may last from five to ten days. Chronic diarrhea lastsmuch longer and is the second cause of childhood death in the developing world. Diarrhea is sometimesaccompanied by abdominal cramps or fever . It may be caused by infection, allergy, or could be a sign of aserious disorder, such as IBD (inflammatory bowel disease), or Crohn's disease.According to the World Health Organization (WHO) approximately 3.5 million deaths each year areattributable to diarrhea. 80% of those deaths occur in children under the age of 5 years. Children are moresusceptible to the complications of diarrhea because a smaller amount of fluid loss leads todehydration,compared to adults.

•

Secretory diarrhea

Either the gut is secreting more fluids than usual, or it cannot absorb fluids properly. In suchcases structural damage is minimal. This is most commonly caused by a cholera toxin - a proteinsecreted by the bacterium

Vibrio cholera

•

Osmotic diarrhea

Too much water is drawn into the bowels. This may be the result of celiac disease, pancreaticdisease, or laxatives. Too much magnesium, vitamin C, undigested lactose, or undigested fructosecan also trigger osmotic diarrhea.

•

Motility-related diarrhea

Food moves too quickly through the intestines (hypermotility). If the food moves too quicklythere is not enough time to absorb sufficient nutrients and water. Patients who had a vagotomy(removal or severing of the vagus nerve) as well as those with diabeticneuropathyare susceptibleto this type of diarrhea.

•

Inflammatory diarrhea

The lining of the gut becomes inflamed. This is usually caused by bacterial infections, viralinfections, parasitic infections, or autoimmune problems such as IBS (inflammatory boweldisease).Tuberculosis,colon cancer and enteritis can also cause inflammatory diarrhea.

•

Dysentery

The presence of blood in the stools is usually a sign of dysentery, rather than diarrhea. Dysenteryis caused by a release of excess water caused by an antidiuretic hormone from the posterior pituitary gland. Dysentery is one of the symptoms of

Shigella, Entamoeba histolytica

, and

Salmonella

What are the symptoms of diarrhea?

Some sufferers may pass slightly watery stools and have brief episodes of stomachache, while others may pass very watery stools and have more severe stomach cramping. The most common symptoms include:

•

Abdominal cramps

•

Abdominal pain

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An urge to go to the toilet, sometimes this may be sudden

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Vomiting

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Nausea

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Temperature (fever)

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Headache

•

Loss of appetite

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Fatigue

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Loose, watery stools

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Bloating

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Blood in stoolAnybody who has had diarrhea for more than one week should see their doctor. The UK National HealthService advises parents to take their child to the doctor if:

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The child is aged 3 months to 1 year and the diarrhea has lasted over two days

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The child is over 1 year of age and the diarrhea has lasted more than five daysYou should also see your doctor if you experience or witness any of the following:

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You have symptoms of dehydration - excessive thirst, very dry mouth, very little or no urination

•

Your abdominal pain is severe

•

You have severe rectal pain

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There is blood in the stools, the stools are black

•

Your temperature is over 39C (102 F)

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A baby has not wet the diaper (UK: nappy) in over three hours

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A child/baby is very sleepy, irritable, or unresponsive

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A child/baby has a sunken abdomen

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A child/baby has sunken eyes and/or cheeks

•

The child's/baby's skin does not flatten after being pinched

What causes diarrhea?Causes of acute diarrhea (short term diarrhea)

This is usually caused by an infection, and is also a symptom of a bowel infection when the stomach andthe intestines become inflamed (gastroenteritis). This may be caused by:

•

A virus - most commonly a norovirus or a rotavirus. It could also be caused by ahepatitisvirus,or theherpessimplex virus. Viral diarrhea spreads easily.

•

A bacteria - if food or water is contaminated bacteria and parasites can be transmitted into the body. Parasites may include

Giardia lamblia

and

cryptosporidium

. Examples of bacteria are

campylobacter, salmonella, shigella

and

Escherichia coli (E. coli)

. Traveler's diarrhea is usuallycaused by bacteria or parasites.Researchers at Boston University School of Medicineidentifiedthe structure of bacteria responsible for traveler's diarrhea.

•

Anantibiotic- antibiotics can disturb the natural balance of bacteria in our intestines, which canlead to infection, commonly with a bacterium called

Clostridium difficile

.The following may also be causes of acute diarrhea:

•

Anxiety

•

Consuming too much alcohol

•

Consuming too much coffee

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Some other medications, apart from antibiotics

Causes of chronic diarrhea (persistent, longer term diarrhea)

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Bacteria

•

A virus

•

Laxatives

•

Some dietary habits - long term regular alcohol, coffee consumption may cause persistentdiarrhea. Regular eating of candy (sweets) can too.Many sugar-free chewing gums containing asweetener called sorbitol can cause chronic diarrhea,

The British Medical Journal

reported.The following long-term conditions can cause chronic diarrhea

•

Celiac disease

•

Crohn's disease

•

Diabetes

•

Irritable bowel syndrome(IBS)

•

Lactose intolerance

•

Pancreatitis

•

Ulcerative colitis

How is diarrhea diagnosed?

Most cases of acute diarrhea will resolve themselves within a week or so. If the diarrhea lasts longer, or if there is blood in the stools and there are other symptoms, such as dehydration, the GP (general practitioner, primary care physician) will take a stool sample to check for infection.A sigmoidoscopy may also be performed. This involves introducing a thin fiber-optic tube through therectum to look into the intestine. The device has a viewing lens.The doctor will also ask the patient whether he/she is taking any medications, has traveled recently, and possibly some questions about what foods were consumed over the last couple of weeks. The GP mayalso examine the abdomen to determine where the pain is.