Diarrhea

Let’s face it, everyone experiences diarrhea at some point in their lives. Diarrhea certainly varies in severity, be it one liquid stool per day, multiple soft, semi-formed stools every day, or constant, watery stools multiple times per day (and even per hour in severe cases). These liquid feces are primarily composed of water. The typical daily amount of water in the stools in the Western world is around 200 ml or seven oz. (8 oz. = 1 cup). From a medical standpoint, diarrhea occurs when the amount of water in the stools exceeds this average number [1].

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Causes

A variety of factors can cause diarrhea. Fortunately, this shift in bowel habits is transient and resolves on its own in most cases. Diarrhea is most typically caused by a virus or foodborne illness. When diarrhea persists for more than two or three weeks, it is often advisable to seek medical care. Among the several identified causes are the following:

Food

A great number of cases can be linked to food. For those who enjoy hot peppers (the chemical in them is called capsaicin), diarrhea frequently arises the following morning. Many people are lactose intolerant, which means that even relatively small amounts of the lactose sugar in milk can induce diarrhea. Other folks experience the same problem when they consume excessive fatty meals. The curative approach in these circumstances is to avoid the offending substance.

Laxatives

Many people establish a regular practice of using laxatives early in life. The most common chemical stimulants are magnesium (Epsom salt) and cascara (Nature's Remedy). Phenolphthalein was removed from most commercial laxatives because it is a known carcinogen.

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Magnesium can be inadvertently consumed through various over-the-counter drugs like Maalox or Mylanta. Read labels carefully! Sweeteners like sorbitol and erythritol are sugar substitutes. Sorbitol is also a diuretic.

Prescription Medications

If a change in bowel habits happens after starting a new medication, consult the prescribing physician. Many antibiotics for instance have been associated with an increased risk of GI infection and diarrhea. Diarrhea can occur up to one month after taking and completing antibiotics.

Infection

Over 400 distinct bacteria generally coexist peacefully and beneficially in the large intestine. Additionally, numerous viruses and other infectious agents make their way into our systems constantly. Several of these can infect the gastrointestinal tract, thus causing diarrhea [2]. Certain bacterial infections, such as salmonella, are problematic and should be evaluated by a physician. Some parasites affect the intestines, such as amoeba and giardia. Giardia is a parasite found in wild animals, contaminated streams, and well water. In these cases, close medical monitoring is always necessary. Viral infection is probably the most common cause of brief diarrhea, and thankfully, it usually resolves on its own.

Traveler’s Diarrhea

A pathogenic bacterium, E. Coli, often causes Traveler’s diarrhea. It is especially prevalent in developing nations with inadequate sanitation. Avoiding uncooked fruits and vegetables helps prevent this diarrhea. Fruits with protective skins, such as oranges, are usually safe. Avoid drinking tap water in any form, but especially ice. It is advisable to consume bottled beverages. Before traveling to these countries, travelers should consult a physician or travel clinic for additional details on prevention and cures [3].

Diseases

Some intestinal issues might result in chronic diarrhea. Examples are ulcerative and microscopic colitis, Crohn's disease, and even colon cancer. These conditions often require immediate medical attention and therapy. For this reason, colonoscopy is often an important study for investigating the cause of chronic diarrhea [4].

Irritable Bowel Syndrome and Stress (IBS)

IBS is a condition in which the intestines, particularly the colon, do not contract smoothly and rhythmically. Contractions can be excessive, resulting in diarrhea, or they can be slow, resulting in constipation. Occasionally, constipation and diarrhea alternate. Emotional factors such as stress frequently exacerbates these symptoms.

Diagnosis of Diarrhea

Diarrhea can be diagnosed and treated in several ways, including elimination of dietary etiologies such as sugarless candies or magnesium-containing antacids. Oftentimes, the diagnosis will require bloodwork and stool studies. Additionally, X-rays and ultrasound may also be required. As stated above, colonoscopy is often necessary as well. The providers at Digestive & Liver Health Specialists have all the necessary testing modalities to help ensure an accurate diagnosis.

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Treatment of Diarrhea

To alleviate diarrheal symptoms, simple measures at the onset of a diarrheal episode can help. Taking just liquids by mouth and avoiding foods and milk with a high roughage content may benefit. You can also use over-the-counter medications such as Pepto-Bismol, Kao pectate, or Imodium. Treatment for explosive or persistent diarrhea will, of course, depend on the underlying cause. Fortunately, the cause of diarrhea is nearly always detectable, and efficient treatment can subsequently cure the condition.

Summary

Diarrhea is a relatively common occurrence that is typically not dangerous. If the condition is severe or persistent, it is necessary to seek a particular diagnosis with our team of providers. Effective treatment is almost always available when working closely with your provider.

References

[1]     B. Müllhaupt, “[Diarrhea],” Praxis, vol. 91, no. 42, pp. 1749–1756, Oct. 2002, doi: 10.1024/0369-8394.91.42.1749.

[2]     P. de Truchis and A. de Truchis, “[Acute infectious diarrhea],” Presse Medicale Paris Fr. 1983, vol. 36, no. 4 Pt 2, pp. 695–705, Apr. 2007, doi: 10.1016/j.lpm.2006.11.023.

[3]     M.-F. Durieux, M.-L. Dardé, and J.-F. Faucher, “[Traveller’s diarrhea],” Rev. Prat., vol. 69, no. 10, pp. 1113–1117, Dec. 2019.

[4]     “[Chronic diarrhea] - PubMed.” https://pubmed.ncbi.nlm.nih.gov/25154689/ (accessed Mar. 22, 2022).

[5]     "Pexels," [Online]. Available: https://www.pexels.com/search/diarrhea/.

[6]     "Pexels," [Online]. Available: https://www.pexels.com/search/stomach%20pain/.

[7] ”Pexels," [Online]. Available: https://www.pexels.com/search/diagnosis/

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