Management of Diarrhea
What Is Diarrhea?
Diarrhea is the word used to describe loose, watery stools that occur more than three times in one day. Usually diarrhea is an isolated event lasting one or two days before going away on its own. If it lasts for a longer period of time, or is associated with certain symptoms, one should talk to a health professional.
When Should I See a Doctor?
Adults should consult a doctor if they experience one or more of the following:
- Diarrhea lasts for more than 48 hours
- Signs of dehydration occur (excessive thirst, dry mouth, little or no urination, severe weakness, dizziness, or lightheadedness)
- Severe, persistent abdominal or rectal pain
- Bloody or black stools
- Fever greater than 38.5 C
In addition to the above, children with diarrhoea should be checked by a doctor if:
- They are less than six months old
- They have been vomiting for more than four hours
- They haven't had a wet diaper in eight hours, or have a dry mouth or cry without tears (signs of dehydration)
- They are unusually sleepy or drowsy or unresponsive
What Causes Diarrhea?
Bacterial or viral infections are the most common causes of acute (sudden and temporary) diarrhoea. The rotavirus (most common cause of diarrhoea in young children) and Norwalk virus (causes diarrhoea in older children and adults) are examples of viruses that can be spread from person to person. Food or water contaminated with bacteria (such as Salmonella, Shigella, E. coli) can cause severe diarrhoea.
Food intolerances may cause diarrhoea as a result of a person not being able to digest a component of food, such as lactose (the sugar found in milk).
Certain medicines (antibiotics or antacids containing magnesium) may cause diarrhoea.
Intestinal diseases such as inflammatory bowel disease or celiac disease are associated with chronic diarrhoea, as well as functional bowel disorders like irritable bowel syndrome.
Other causes of diarrhoea include nervousness or anxiety, tumours, and rapid increase of fibre in ones diet.
How Can I Prevent Diarrhea?
- Avoid foods or drugs that have caused Diarrhea in the past.
- Wash hands well after going to toilet, changing a diaper, and before preparing or eating food.
- Cook foods thoroughly and eat foods soon after they have been cooked to prevent bacterial growth.
- Keep hot foods hot and cold foods cold.
- Use separate cutting boards for raw meats.
Treatment of Diarrhoea
It is very important to replace lost fluids to prevent dehydration when suffering from Diarrhea. In most cases, this is all that is required. Liquid formulated to mimic the natural fluid in the intestines (called "oral rehydration therapy") is recommended for use early in the treatment of Diarrhea. This is especially true in the case of children and the elderly. Commercial examples of oral rehydration solutions include Gastrolye® and Pedialyte®. The medical community no longer recommends the use of fruit juices, pop, or tea with sugar as rehydrating fluids because of the high concentration of carbohydrates they contain.
Oral rehydration therapy should not be used under the following circumstances:
- Vomiting despite small frequent feedings
- Worsening Diarrhea and an inability to maintain hydration
- Stupor or coma
- Intestinal blockage causing abdominal pain, bloating and/or vomiting
Any medications used for treatment of Diarrhea (including those not requiring a prescription) should be used only on the advice of a health professional. Your PROfile Pharmacist is always happy to talk with you about your medication concerns.
Children should visit a doctor before using medication to treat Diarrhea. Medication available without a prescription includes:
- Kaolin and pectin
- Bismuth subsalicylate
Children or adolescents should not use bismuth subsalicylate. Prescription medications, such as diphenoxylate and codeine, may be prescribed by your doctor if appropriate.
Traveler's Diarrhea is caused by bacteria, viruses, and parasites, and affects from 20 to 50% of all travelers who spend two weeks or more in developing countries such as Latin America, Asia, and Africa. It usually goes away on its own within three to four days.
- Symptoms of traveler's Diarrhea include three or more loose, unformed stools per day along with one symptom of intestinal infection (e.g., fever, abdominal cramps, nausea, urgency, or dysentery).
- People most likely to get traveler's Diarrhea include those who aren't careful about what they eat, those with a low concentration of stomach acid, people with weak immune systems (e.g., on chemotherapy), and younger individuals.
- Foods associated with traveler's Diarrhea include buffet food at room temperature, fresh soft cheese, food from street vendors, cold salads, unpeeled fruit, ice cubes, shellfish, large reef fish (e.g. barracuda, snapper, grouper), custards, mousses, mayonnaise, and hollandaise sauce.
How Can I Prevent Traveler's Diarrhea?
- "Boil it, cook it, peel it, or forget it."
- Use purified water or water from the hot tap to brush teeth.
- Wash hands frequently while traveling.
- Avoid drinking the water while swimming.
- Avoid drinking local water.
- Drink bottled beverages in their original containers.
- Talk to your doctor or PROfile Pharmacist about prevention of traveler's Diarrhea with the use of bismuth subsalicylate. Bismuth subsalicylate should not be used by people taking blood thinners (anticoagulants such as warfarin), anyone with an ASA allergy, children, or adolescents.
If you are at high risk for traveler's Diarrhea and you will be traveling in a high-risk area, your doctor may prescribe antibiotics for prevention.
More Information About Diarrhea Management
Canadian Paediatric Society
Health Canada -- Travel Medicine Program
National Digestive Diseases Information Clearinghouse
National Center for Infectious Diseases
Your PROfile Pharmacist has many resources for education about Diarrhea and is always available to discuss your health concerns!