In this article:
- Diarrhea is an ailment characterized by the passing of loose, watery stools.
- Viral, bacterial, or parasitic infections may cause diarrhea, the severity of which can range from mild to fatal.
- Diarrhea presents many symptoms, and there may be additional symptoms in children.
- Diagnosis is made by identifying symptoms through physical tests, however, severe cases may require some advanced tests.
- Both medical and self-care treatments are available for managing diarrhea.
- Preventive measures can be taken to avoid diarrhea.
- Severe dehydration can be life-threatening in children and the elderly.
The frequent occurrence of watery, loose, and unformed bowels is known as diarrhea. It causes abdominal cramps and an urgent need to pass stool.
The condition is more commonly known as loose motions and often occurs as a symptom of gastroenteritis or stomach flu. Usually, diarrhea is an acute condition that resolves on its own.
Types of Diarrhea
Diarrhea can be classified into different types according to their duration and severity:
- Acute diarrhea: Short-term diarrhea lasts for 1 or 2 days and may be caused by a viral infection. Another common cause of acute diarrhea is bacterial infections, which occur due to the ingestion of contaminated food or water. Diarrhea is considered acute if it lasts 14 days or fewer.
- Chronic diarrhea: Long-term diarrhea lasts over 30 days and generally occurs as a symptom of a medical problem, such as irritable bowel syndrome, celiac disease, and Crohn’s disease.
Chronic diarrhea can also be due to a parasitic infection, and the symptoms may occur continuously or in intervals.
Diarrhea is divided into three classes based on the number of watery bowel movements in a day:
- Mild diarrhea: 2-5 bowel movements a day
- Moderate diarrhea: 6-9 bowel movements a day
- Severe diarrhea: more than 10 bowel movements a day
Causes of Diarrhea
Diarrhea can occur due to various factors, including:
- Viruses: An infection by cytomegalo virus, hepatitis virus, and Norwalk virus can cause diarrhea. Rota virus infection is a common cause of acute diarrhea in children. Other common viruses that cause diarrhea include adeno viruses and astro viruses.
- Bacteria: Ingestion of food contaminated with bacteria may cause food poisoning and is the most common reason for diarrhea in developed countries such as the United States.
Any food that is not stored, cooked, or handled properly may get contaminated by bacteria that release toxins that cause food poisoning. Common bacteria that cause diarrhea include E. coli, salmonella, shigella, and clostridium.
- Parasites: Diarrhea-causing parasites usually spread through water sources or human contact. Drinking water from infected sources or bathing in contaminated lakes or streams can cause an infection with parasites, resulting in diarrhea.
The Giardia parasite is resistant to chlorine treatment and thus spreads in public pools and water parks. Other common parasites include cryptosporidium and entamoeba.
- Food intolerance: In some individuals, the consumption of a particular food may cause digestive problems and may result in diarrhea. This phenomenon is known as food intolerance and may occur due to foods such as:
- Lactose: The inability to digest dairy products is known as lactose intolerance, and the problem worsens with age since the production of lactase (an enzyme responsible for the digestion of lactose) decreases gradually after childhood.
- Fructose: Some people are unable to digest fructose, a natural sugar present in fruits and honey, which is often used to sweeten some beverages.
- Artificial sweeteners: Consumption of products like chewing gum and sugar-free products containing artificial sweeteners, such as sorbitol and mannitol, may cause diarrhea in some people.
- Medications: Diarrhea can be a side effect of antibiotics, antacids containing magnesium, cancer drugs, and other medications.
- Surgery: Diarrhea may occur as a consequence of surgical procedures, such as gallbladder removal and other abdominal surgeries.
- Digestive disorders: Diarrhea may occur as a chronic symptom of digestive problems such as:
- Ulcerative colitis
- Microscopic colitis
- Crohn’s disease
- Celiac disease
- Diet: Consumption of excessive sugar or caffeine can also cause diarrhea. Drinks with a high amount of caffeine may act as laxatives, and thus, the intake of large amounts of coffee or tea (more than 2-3 cups daily) can result in diarrhea.
- Other causes: Some other reasons that may result in diarrhea include:
- Use of laxatives
Symptoms of Diarrhea
The symptoms of diarrhea may vary according to the cause; however, common symptoms include:
- Frequent bowel movements
- Watery and loose stools
- Abdominal cramps
- Nausea and vomiting (upset stomach)
- Stomach ache
- Bloody stools
- Urgent need to pass stool
- Dehydration due to loss of body fluids, causing fatigue, lightheadedness, and thirst
- Lack of appetite
- Incontinence (inability to control bowel movements, resulting in stool leakage)
Diarrhea may be symptomatic of other health problems. It is recommended to visit your doctor if you experience fever, bleeding, or vomiting, along with diarrhea.
Diarrhea may present additional symptoms in babies:
- Sunken soft spot on the head (depressed fontanelle)
- Crying without tears
- Weight loss
- Decreased urination (less than six diapers used in a day)
Often, parents assume that their baby’s diarrhea is associated with teething. However, pediatricians do not support this claim and suggest that, while irritation is normal, the occurrence of fever or diarrhea during teething should be checked immediately by a doctor.
Determining the cause of acute diarrhea is usually not required. However, if diarrhea lasts for more than 4 days, the doctor may study your medical history and perform physical exams or tests for diagnosis.
- The physical exam consists of the following procedures:
- Measuring blood pressure and pulse
- Body examination for fever or signs of dehydration
- Listening to sounds in the abdomen using a stethoscope
- Tapping the abdomen to check for pain or tenderness
- Digital rectal exam
- Stool culture is performed to assess the bacterial types and parasites present in the digestive tract. For this, a stool sample is collected and forwarded to a laboratory for culturing. The results help to determine if any harmful bacteria or parasites are present in your digestive system and causing diarrhea.
- Endoscopic procedures, such as upper gastrointestinal (GI) endoscopy, flexible sigmoidoscopy, and colonoscopy, are diagnostic tests that are used to detect any structural abnormalities that may be causing diarrhea.
- Other tests may be performed to identify allergies or food intolerance. These tests can include blood tests for food allergies and sensitivities and skin prick tests for food allergies.
Taking the following steps toward maintaining hygiene and sanitation may be helpful in the prevention of diarrhea:
- Keep your hands clean to help avoid diarrhea-causing infections. Wash your hands properly with warm water and soap for 30 seconds every time you use the bathroom, change diapers, or handle food.
- Get vaccinated against viral and bacterial agents that cause diarrhea. Timely vaccination against the rota virus is vital for children. If you plan to travel out of the country, ask your doctor if hepatitis A or typhoid vaccines are needed, depending on where you are traveling.
- Store, clean, and cook food properly to avoid food poisoning or other foodborne illnesses. Make sure that you eat properly cooked food, especially meat. The heat from the cooking process helps eliminate potential contaminants, germs, or pathogens.
- Avoid consuming contaminated food or water.
- Reduce your intake of sweet, spicy, or fatty foods.
- Do not consume alcohol.
- Increase your intake of probiotic foods, such as yogurt, and starchy foods, such as bread, rice, and banana.
- Avoid giving fruit juices to children as these may cause diarrhea due to their high sugar content.
- For the first 6 months to 1 year, feed your child with breastmilk only, and avoid giving formula if possible. Doing so helps in the prevention and treatment of diarrhea in infants.
Treatment of Diarrhea
The treatment of diarrhea depends on the cause and severity of the disease.
- Dehydration is the major problem associated with diarrhea and requires the replacement of lost fluids. This is usually done by increasing fluid intake and drinking oral rehydration solutions (ORS). Severe cases may even need intravenous fluids.
- Antibiotics can be used on prescription if a bacterial or parasitic infection is causing diarrhea. Strictly avoid the use of antibiotics if the diarrhea is caused by a viral infection, which is the most common type in children.
- Over-the-counter (OTC) medications like loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate) are anti diarrheal drugs that can be taken for acute diarrhea. Doctors advise avoiding OTCs if you have a fever or bloody stools.
- If a specific medication triggers your diarrhea, speak to your doctor about a more suitable alternative.
- Treat underlying diarrhea-causing conditions, such as inflammatory bowel disease or irritable bowel syndrome, for relief.
Note: Use antidiarrheal medications only after consulting your doctor, and avoid giving them to infants and children.
The following changes in diet and eating habits may help in alleviating the symptoms of diarrhea:
- Increase your fluid intake. Consume 8-10 cups of fluids every day, including water, half-strength juice, broth, electrolyte replacement drinks, and chamomile or peppermint tea.
- Eat fiber-rich foods to help solidify your stool.
- Avoid high-fat, fried, or greasy foods.
- Avoid foods with high sugar content, such as chocolate milk, candy, regular soda, and undiluted fruit juice.
- Get ample amounts of rest.
- Drink OTC rehydration drinks as they replenish your body fluids and also supply optimum amounts of salt and sugar.
- Do not force-feed yourself.
- Consume salty foods, such as soup and pretzels, and electrolyte-rich sports drinks.
- Eat foods rich in potassium, such as skinned potatoes, half-strength fruit juices, and bananas.
- Infants with diarrhea should be given small amounts of water between feeds of formula or solid food, but only after consulting your pediatrician since water may not be advised depending on the infant’s age.
- Consumption of bland BRAT (bananas, rice, applesauce, and toast) foods may help manage the condition at the onset of diarrhea.
However, these foods lack nutrients like fat and protein. Therefore, this diet should not be continued beyond a couple of days.
Home Remedies for Diarrhea
Mild to moderate diarrhea can be managed at home with simple and easy remedies.
Probiotics are healthy bacteria that aid digestion and chiefly consist of lactic acid bacteria, which do not have any adverse effects. Taking probiotics can provide quick relief from diarrhea. The most commonly used probiotic is Lactobacillus.
Probiotics may be taken if you are on antibiotics to prevent diarrhea. If you do have antibiotic-associated diarrhea, then Saccharomyces boulardii may help in resolving it.
A review study published in 2015 stated that probiotics could be used in treating diarrhea as a side effect of antibiotics. However, the optimum dosage required for treatment has not been determined yet. (2)
A 2018 study revealed that probiotic use aids diarrhea treatment and prevention in children. Identifying potential Probiotic candidates and employing their use can help in preventing infectious diarrhea and reducing hospital stay. (3)
Probiotic formulations contain bacteria similar to those present in the gut and, therefore, may help in alleviating diarrheal symptoms. Seek medical help if your symptoms do not subside.
2. Green Bananas
Traditionally, green bananas have been used for treating various digestive disorders. Results of a randomized controlled trial conducted in 2010 showed that green bananas could be used for both clinical and at-home treatment of diarrhea. (4)
One study established the benefits of green banana pulp in managing diarrhea as well as constipation. (5) More studies can help in understanding the role of green bananas in treating diarrhea and establishing its efficacy.
3. Chamomile Tea
Chamomile is rich in tannins and can help in the treatment of various gastrointestinal problems, including diarrhea. It can act as an anti-inflammatory and antispasmodic agent, helping to subside abdominal cramps.
Animal studies have highlighted the antidiarrheal and antioxidant effects of chamomile tea. However, the efficacy of chamomile tea against diarrhea is yet to be proven in human trials. (6)
4. Peppermint Tea
Peppermint tea is found to be effective in alleviating diarrhea associated with irritable bowel syndrome due to its antispasmodic effects. The peppermint oil in the tea is the active agent, but further direct research is needed to prove its usefulness in diarrhea caused by other reasons. (7)(8)
Note: Home remedies should only be used to provide relief from mild to moderate cases of diarrhea. Medical help should be considered if remedies fail to provide sufficient relief or if the diarrhea is severe or associated with blood, mucus, or fever. Consult a doctor before using home remedies if you have chronic diarrhea.
Diarrhea During Pregnancy
During pregnancy, women may develop sensitivity toward some foods that they could easily consume before, which may cause diarrhea. It may also be a result of the hormonal changes associated with pregnancy.
It is highly advisable to consult a doctor if you are pregnant and have diarrhea for more than 2 days. The condition can be discomforting and may cause dehydration, which can trigger contractions and lead to premature labor.
Therefore, rehydration is necessary to avoid complications associated with diarrhea and dehydration. The chances of diarrhea may increase as you approach your due date.
Risk Factors for Diarrhea
Certain factors may predispose you to diarrhea, including:
- Use of some medications
- Traveling to developing countries where the water or food may be contaminated
- A food allergy or hypersensitivity. Examples include:
- Consumption of gluten by people with celiac diseases
- Consumption of milk by people with lactose intolerance
- Endocrine disorders, such as:
- Hyperthyroidism (overactive thyroid), which may result in weight loss and chronic diarrhea
- Diabetes, which may cause damage in the nerves that supply the digestive system, causing neuropathy and triggering chronic diarrhea
- Irritable bowel syndrome, which can also result in abdominal pain
- Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn’s disease, which are autoimmune disorders that occur when the body’s immune cells attack self-cells of the digestive system, resulting in diarrhea that tends to be episodic, recurrent, and frequently associated with pain, blood, and fever
- Age above 65 years, especially when suffering from digestive disorders
- HIV/AIDS, organ transplant, and intestinal cancers (11)
Complications Associated with Diarrhea
A prevalent condition, diarrhea affects almost every person once, and severe cases may lead to complications, including:
- Dehydration: An excessive loss of fluids and electrolytes is known as dehydration. It can be characterized by thirst, lack of urination, dry mouth, and fatigue. Dehydration can be life-threatening, especially in children, the elderly, and individuals with a weak immune system.
- Malnutrition: Frequent bowel movements inhibit the absorption of nutrients by the intestinal tract, leading to malnutrition, even when sufficient amounts of food are consumed.
Some General Queries
Can diabetes lead to diarrhea?
Diarrhea may occur in patients with diabetes as a side effect of medications, such as metformin, or the use of sugar-free sweeteners in some individuals. The diarrhea is watery and painless, usually occurs at night, and may lead to fecal incontinence.
Diabetic diarrhea may be intermittent with regular bowel movements or even constipation. It can also occur due to damage to the nerves in your intestines, called autonomic neuropathy.
Is diarrhea fatal?
Diarrhea is responsible for 2,195 child deaths every day, which is more than the number of deaths caused by malaria, AIDS, and measles combined. It is the second most significant factor for the death of children below 5 years and accounts for 1 in 9 child deaths worldwide. (1)
However, rota virus vaccination, breastfeeding, improved water hygiene and sanitation, and the use of safe drinking water have been cost-effective measures toward preventing diarrhea. (1)
Rota virus vaccines have led to a decrease in the rate of hospitalization of children due to severe diarrhea.
What is the relationship between autonomic neuropathy and diarrhea?
Autonomic neuropathy refers to symptoms resulting from nerve damage. It may cause diarrhea if the nerves that control the small intestine are damaged.
What do yellow and green stools during diarrhea indicate?
Generally, stools associated with diarrhea are brown due to the presence of bilirubin, a by-product of red blood cells that is formed in the liver. Stools of any other color, especially yellow, may indicate a severe complication.
Green stools may be due to the rapid movement of food through the large intestine, causing incomplete action on the bile pigments. Dietary reasons for green stools may include the consumption of green leafy vegetables, iron supplements, or foods with green food coloring, such as ice pops or drinks.
Yellow or bright-yellow stools may be symptomatic of a Giardiasis infection. A pale-yellow stool may occur due to decreased production of bile salts or may indicate a liver or gallbladder problem. Thus, seek medical help if your bowel movements are persistently light-colored.
What causes black diarrhea?
The presence of digested blood causes your stool to appear black and may occur as a result of internal bleeding in your upper digestive tract (stomach or food pipe). You may vomit the blood, or it may travel down your intestine for 25 feet toward the rectum.
As the blood passes through the intestine, it gradually gets digested and turns darker, ultimately appearing black on reaching the colon.
Black diarrhea can only occur if you bleed a minimum of 2 ounces of blood. Keep in mind that black stools may also be the result of medicines such as Pepto-Bismol, which can be helpful when you have diarrhea.
Can diarrhea and constipation occur at the same time?
Diarrhea and constipation are common problems; however, if both disorders co-occur, it may be indicative of irritable bowel syndrome (IBS).
The quick fluctuation in symptoms from diarrhea to constipation, and vice versa, is characteristic of IBS-M (mixed type) and may occur due to various reasons, differing among individuals. (10)
How can a traveler’s diarrhea be prevented?
Traveling internationally, especially to developing countries, can expose you to different diarrhea-causing bacteria. The most common cause of traveler’s diarrhea is an infection with E. coli, which can quickly spread through contaminated water.
The following steps may help in preventing traveler’s diarrhea:
- Drink only bottled water and beverages, and avoid intake of tap water.
- Do not use ice made from unfiltered water.
- Try to consume tea or coffee made from bottled or boiled water only.
- Do not eat pre-cut fruits.
- Avoid buying eatables from street vendors.
- Consult your doctor for steps to be taken, according to your place of travel and the period of stay.
Note: Washing your hands with antibacterial soap helps in removing harmful E. coli from your hands. However, it will not have a significant effect on reducing the risk of infection if you do not take other preventive measures.
Are diarrhea and dysentery different?
Diarrhea is the frequent passing of loose and watery stools. Dysentery, on the other hand, is an inflammatory condition in the intestines that may lead to severe diarrhea associated with mucus and blood in the stool.
Dysentery is commonly caused by an infection with Shigella species (bacillary dysentery) or Entamoeba histolytica (amebic dysentery). Symptoms include cramps and fever, and the condition can lead to severe dehydration and death.
When to See a Doctor
It is advised to get medical attention if your diarrhea is persistent for more than 3 days or is accompanied by any of the following symptoms:
- Inability to consume foods or liquids
- Bloody stools
- Mucus in the stools
- Abdominal cramps and pains
- Nausea and vomiting
- Lack of urination
- Dry mouth or dry skin
- If you are pregnant or immunocompromised
For children, medical help should be sought if diarrhea lasts for more than a day or presents with any of the following signs:
- Pus in the stools
- Black stools
- Dehydration characterized by dry mouth, tearless crying, no wet diaper in 3 hours, or skin not taking its original shape instantly after being pinched
- Excessive sleeping
Persistent diarrhea should be clinically treated as it can affect your daily routine and can lead to dehydration and electrolyte imbalance.
What you may ask your doctor:
- What may be the reason behind my diarrhea?
- Do I need to undergo tests?
- Is my diarrhea a result of medication?
- Am I allergic to any food?
- Is my diarrhea acute or chronic?
- Should I visit a specialist?
- Is my diarrhea contagious to others?
- Do I need an antibiotic?
- Is it safe for me to take Imodium or other antidiarrheal medicines?
What your doctor may ask you:
- Since when were you experiencing these symptoms?
- Does any factor worsen the condition?
- Is your diarrhea intermittent or consistent?
- Have you undergone any tests or treatments?
- Have you taken any new medication or vitamins/supplements?
- Are your symptoms severe?
- Have you been in recent contact with a person suffering from diarrhea?
- Have you recently traveled?
- Have you recently eaten food not made at home?
Diarrhea is a common problem that is usually acute and resolves on its own in a few weeks. However, a few cases may be persistent for over a month and cause complications.
Thus, chronic diarrhea requires immediate medical attention. Diarrhea can be fatal in young children and the elderly, especially if they have a weak immune system or are malnourished.