Diarrhea is one of the most common health complaints.

It can range from a mild, temporary

condition, to a potentially life-threatening one.
Globally, an estimated 2 billion cases of diarrheal disease occur each year, and 1.9
million children under the age of 5 years, mostly in developing countries, die from diarrhea.

Diarrhea is characterized by abnormally loose or watery stools.

Some people frequently pass stools, but they are of normal consistency. This is not diarrhea.
Similarly, breastfed babies often pass loose, pasty stools. This is normal. It is not diarrhea.

Fast facts on diarrhea

Here are some key points about diarrhea. More detail and supporting information is in the
body of this article.

 Most cases of diarrhea are caused by bacteria, viruses, or parasites

 Inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative

colitis can cause chronic diarrhea

 Antidiarrheal medications can reduce diarrheal output and zinc supplement is

effective in children

 Some nutritional and probiotic interventions may help prevent diarrhea

Causes

Correcting dehydration is the priority of diarrhea treatment.

Most cases of diarrhea are caused by 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 Shiga-toxin-producing Escherichia coli.

Some cases of chronic diarrhea are called "functional" because a clear cause cannot be found.
In the developed world, irritable bowel syndrome (IBS) is the most common cause of
functional diarrhea.

IBS is a complex of symptoms. There is cramping abdominal pain and altered bowel habits,
including diarrhea, constipation, or both.

Inflammatory bowel disease (IBD) is another cause of chronic diarrhea. It is a term used to
describe either ulcerative colitis or Crohn's disease. There is often blood in the stool in both
conditions.

Other major causes of chronic diarrhea include:

 Microscopic colitis: This is a persistent diarrhea that usually affects older adults,
often during the night.

 Malabsorptive and maldigestive diarrhea: The first is caused by impaired nutrient

absorption, the second by impaired digestive function. Celiac disease is one example.

 Chronic infections: A history of travel or antibiotic use can be clues to chronic

diarrhea. Various bacteria and parasites can be the cause.

 Drug-induced diarrhea: Laxatives and other drugs, including antibiotics, can trigger
diarrhea.

 Endocrine causes: Sometimes hormonal factors cause diarrhea, for example, in the
case of Addison disease and carcinoid tumors.

 Cancer causes: Neoplastic diarrhea is associated with a number of gut cancers.

 Treatment

Mild cases of acute diarrhea may resolve without treatment. Persistent or chronic diarrhea
will be diagnosed and any underlying causes will be treated in addition to the symptoms of
diarrhea.

Dehydration

For all cases of diarrhea, rehydration is key:

 Fluids can be replaced by simply drinking more fluids, or they can be received
intravenously in severe cases. Children and older people are more vulnerable
to dehydration.

 Oral rehydration solution or salts (ORS) refers to water that contains salt and glucose.
It is absorbed by the small intestine to replace the water and electrolytes lost in the stool. In
developing countries, ORS costs just a few cents. The World Health Organization (WHO)
says ORS can safely and effectively treat over 90 percent of non-severe diarrhea cases.

 Oral rehydration products, such as Oralyte and Rehydralyte, are available

commercially. Zinc supplementation may reduce the severity and duration of diarrhea in
children. Various products are available to purchase online.

Antidiarrheal medication

Over-the-counter (OTC) antidiarrheal medicines are also available:

 Loperamide, or Imodium, is an antimotility drug that reduces stool

passage. Loperamide and Imodium are both available to purchase over-the-counter or
online.

 Bismuth subsalicylate, for example, Pepto-Bismol, reduces diarrheal stool output in

adults and children. It can also be used to prevent traveler's diarrhea. The can be
bought online as well as over-the-counter.
There is some concern that antidiarrheal medications could prolong bacterial infection by
reducing the removal of pathogens through stools.
 Antibiotics

Antibiotics are only used to treat diarrhea caused by a bacterial infection. If the cause is a
certain medication, switching to another drug might be possible.

Diet

Nutritionists from Stanford Health Care offer some nutritional tips for diarrhea:

 Sip on clear, still liquids such as fruit juice without added sugar.

 After each loose stool, replace lost fluids with at least one cup of liquid.

 Do most of the drinking between, not during meals.

 Consume high-potassium foods and liquids, such as diluted fruit juices, potatoes
without the skin, and bananas.

 Consume high-sodium foods and liquids, such as broths, soups, sports drinks, and
salted crackers.
Other advice from the nutritionists is to:

 eat foods high in soluble fiber, such as banana, oatmeal and rice, as these help thicken
the stool

 limit foods that may make diarrhea worse, such as creamy, fried, and sugary foods
Foods and drinks that might make the diarrhea worse include:

 sugar-free gum, mints, sweet cherries, and prunes

 caffeinated drinks and medication

 fructose in high amounts, from fruit juices, grapes, honey, dates, nuts, figs, soft
drinks, and prunes

 lactose in dairy products

 magnesium

 olestra, or Olean, a fat substitute

Probiotics

There is mixed evidence for the role of probiotics in diarrhea. They may help prevent
traveler's diarrhea. In children, there is evidence that they might reduce diarrheal illness by 1
day.

Antibiotic-associated diarrhea might be reduced by the use of probiotics, as may diarrhea

related to Clostridium difficile, although the evidence is mixed.

People should ask their doctor for advice, as there are numerous strains. The strain most
studied for antibiotic-associated diarrhea are probiotics based on Lactobacillus
rhamnosus and Saccharomyces boulardii.

Probiotics to help with Clostridium difficile and antibiotic diarrheas were investigated in a

trial published in The Lancet. They found no evidence that a multi-strain preparation of
bacteria was effective in preventing these conditions, calling for a better understanding of the
development of antibiotic-associated diarrhea.

Probiotics are available in capsules, tablets, powders, and liquids, and may be
purchase online.

Symptoms

Symptoms of diarrhea can include bloating, thirst, and weight loss.

Diarrhea refers to watery stools, but it may be accompanied by other symptoms.

These include:

 stomach pain
 abdominal cramps

 bloating

 thirst

 weight loss

 fever
Diarrhea is a symptom of other conditions, some of which can be serious.

Other possible symptoms are:

 blood or pus in the stools

 persistent vomiting

 dehydration
If these accompany diarrhea, or if the diarrhea is chronic, it may indicate a more serious
illness.

Complications

Two potentially serious complications of diarrhea are:

 dehydration, with acute or chronic diarrhea

 malabsorption, with chronic diarrhea

Diarrhea can also be a sign of a wide range of underlying chronic conditions. These
conditions need to be diagnosed treated to prevent further problems.

Tests and diagnosis

Parasites or their eggs can be seen under a microscope.

 The doctor will ask about the symptoms and about any current medications, past medical
history, and other medical conditions.

They will also ask:

 when the problem started

 how frequent the stools are

 whether blood is present in the stool

 whether there has been vomiting

 whether the stools are watery, mucus- or pus-filled, and how much stool there is
The doctor will also look for signs of dehydration.

Severe dehydration can be fatal if treatment with rehydration therapy is not given urgently.

Tests for diarrhea

Most cases of diarrhea resolve without treatment, and a doctor will often be able to diagnose
the problem without tests.

However, in more severe cases, a stool test may be needed, especially if the patient is very
young or old.

Further tests may also be recommended if the patient:

 has signs of fever or dehydration

 has stools with blood or pus

 has severe pain

  has low blood pressure

 has a weakened immune system

 has recently traveled to places outside Western Europe, North America, Australia, and
New Zealand

 has recently received antibiotics or been in hospital

 has diarrhea persisting for more than 1 week

If a person has chronic or persistent diarrhea, the doctor will order tests according to the
suspected underlying cause.

These may include the following investigations:

 Full blood count: Anemia or a raised platelet count will suggest inflammation.

 Liver function tests: This will include testing albumin levels.

 Tests for malabsorption: These will check the absorption of calcium, vitamin B-12,

and folate. They will also assess iron status and thyroid function.

 Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Raised levels
may indicate inflammatory bowel disease (IBD).

 Testing for antibodies: This may detect celiac disease.