Definition

Diarrhea is more than 3 loose, liquid stools in a single day. It depletes the body of fluids and electrolytes. Diarrhea can be:

• Acute—Occurring suddenly and lasting briefly
• Chronic—Long-term
• Recurring—Coming and going

If the body loses too much fluid, it can become dehydrated. Dehydration is especially dangerous for babies, young children, and elderly people.

Causes

Causes may include:

• Food intolerance, such as lactose intolerance
• Medication, including:
  • Antibiotics
  • Magnesium-containing antacids
  • Chemotherapy
  • Laxatives
• Irritable bowel syndrome, which is episodes of diarrhea often alternate with periods of constipation
• Injury to the bowel after radiation treatments for cancer
• Malabsorption syndromes, such as Celiac disease
• Diseases of the pancreas and/or gallbladder
• Inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease
• Chronic diseases, such as:
  • Liver disease
  • Diabetes
  • Hyperthyroidism
  • AIDS
  • Colon cancer
• Intestinal surgery
• Infections such as:
  • Bacterial, such as salmonella
  • Viral, such as rotavirus and norovirus
  • Parasitic
  • Fungal, such as yeast

Risk Factors

Risk factors include:

• Traveling to a developing country where the water and food supply may be contaminated
• Taking certain medications
• Hospitalization
• Having a severely weakened immune system, such as with AIDS or after an organ transplant

Symptoms

Symptoms may include:

• Frequent, loose, liquid stools
• Abdominal pain, cramping
• Urgent need to defecate
• Blood and/or mucus in stool
• Fever
• Dehydration
• Nausea, vomiting
• Muscle aches and pains
• Weight loss

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The doctor may insert a gloved finger into your rectum to examine it. This is called a digital rectal exam.

To determine the cause of your diarrhea, the doctor will ask questions, such as:

• Does anyone else in your family have diarrhea?
• What kinds of food have you eaten recently?
• Do you drink well water?
• Do your children attend daycare?
• Have you traveled recently?
• Do you use laxatives?
• What medications do you take?
• Do you have any symptoms other than diarrhea, such as fever, rash, or aching joints?
• What is your sexual history?
• Have you ever had abdominal surgery?

Your bodily fluids, tissues, and waste products may be tested. This can be done with:

• Laboratory analysis of a stool sample
• Blood tests
• Biopsy

You may need to have your rectum and colon examined. This can be done with:

• Flexible sigmoidoscopy
• Colonoscopy

You may need to have images taken of your colon. This can be done with:

• Upper gastrointestinal (GI) series
• Barium enema

Treatment

Treating the underlying condition may help to relieve the diarrhea.

General recommendations for treating diarrhea include:

Prevention

To reduce your chance of getting diarrhea:

• Practice good handwashing.
• Practice safe food preparation and food storage.
• If you have diarrhea, do not prepare food for others.
• If you are traveling:
  • Drink bottled water.
  • Use bottled water when brushing your teeth.
  • Avoid drinks that contain ice.
  • Do not eat food purchased from street vendors.
  • Do not eat raw vegetables or fruits. All produce should be peeled and/or cooked.
  • Make sure meats and seafood are cooked thoroughly.
  • Eat only pasteurized dairy products.
  • If you eat seafood, make sure it is very hot.

Rotavirus is a common cause of diarrhea in children under 5 years of age. There is a vaccine to prevent rotavirus. The first dose is given at age 2 months. Make sure your infant has received this vaccine.

National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov

Health Canada http://www.hc-sc.gc.ca

Diarrhea. Family Doctor—American Academy of Family Physicians website. Available at:
http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/diarrhea.html/
Accessed December 18, 2014.

Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/index.htm
Updated November 25, 2013. Accessed December 18, 2014.

King CK, Glass R, Bresee JS, Duggan C. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR. 2003 Nov 21;52(RR16):1-16

Rotavirus vaccine. Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/vaccinesafety/Vaccines/RotaVSB.html
Updated February 3, 2014. Accessed December 18, 2014.

1/4/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Allen S, Martinez E, Gregorio G, Dans L. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;(12):CD003048.

4/14/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Magill SS, Edwards JR, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208.