Last modified on February 2022
With inputs from Dr.Abhishtita Mudunuri
What is Diarrhea?
Diarrhea is a common ailment characterised by loose or watery stool. It may be accompanied by other symptoms such as fever, vomiting, stomach discomfort and weight loss.
Fortunately, diarrhea is temporary, lasting only a few days. However, if it lasts more than a few days or weeks, it could be a sign of an underlying health condition such as Irritable Bowel Syndrome (IBS), Celiac disease or any other systemic illness like immunocompromised states.
Chapter 1: Symptoms of Diarrhea
The most common sign of diarrhea is loose motion. Other signs and symptoms associated with diarrhea may include one or more of the following conditions:
- Abdominal cramps
- Blood in the stool
Chapter 2: Causes of Diarrhea
Several factors can cause diarrhea. They are
- Viruses: Norovirus, enteric adenovirus, astrovirus, cytomegalovirus, rotavirus and SARS-CoV-2 are some viruses that can cause diarrhea.
- Bacterial infection: Diarrhea can also be caused due to pathogenic bacteria such as Escherichia coli, Salmonella, Shigella, Clostridioides difficile and Campylobacter in contaminated food and water.
- Parasites: Parasites share many features with human cells, including a defined nucleus, but are different from bacteria and viruses. Some parasites that cause diarrhea are Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica, Cyclospora cayetanensis, Isospora belli, Microsporidium, Blastocystis hominis and Strongyloides stercoralis.
- Lactose intolerance: Lactose intolerance can cause diarrhea. It’s a health condition where people cannot digest lactose, a form of sugar found in dairy products.
- Fructose: Fructose can cause diarrhea in people who cannot digest them. It’s another form of natural sugar present in certain fruits and honey and is used as a sweetener in various beverages.
- Artificial sweeteners: Artificial sweeteners such as sorbitol, erythritol, and mannitol, which are non-absorbable sugars used in chewing gum and other sugar-free goods, can cause diarrhea in otherwise healthy people.
- Surgery: Diarrhea can occur after partial intestine or gallbladder removal procedures.
Other gastrointestinal conditions: IBS, Crohn’s disease, ulcerative colitis, celiac disease and microscopic colitis are some health conditions that can cause chronic diarrhea (SIBO).
Chapter 3: When to call the doctors?
Not knowing when to see a doctor can be detrimental to your recovery. Usually, diarrhea isn’t harmful, and the person regains health in a few days. But there are times when it can be severe.
Schedule an appointment with a doctor if you’re experiencing the following symptoms:
- Diarrhea that persists for more than two days with no signs of improvement
- When you’ve been to the loo more than ten times a day. When the fluid loss is significantly higher than fluid intake, it can cause dehydration
- Excessive thirst, a dry tongue or skin, sunken eyes or no appetite are all signs of dehydration
- Severe abdominal or rectal pain
- Stools that are bloody or black
- A fever of greater than 102 degrees Fahrenheit (39 C)
You should seek medical help if your child exhibits the following symptoms:
- Diarrhea that persists for more than 24 hours
- There hasn’t been a wet diaper in three hours or more
- A fever of greater than 102 degrees Fahrenheit (39 C)
- Stools that are bloody or black
- Cries without tears or a dry mouth or tongue
- Sleepy, drowsy, unresponsive, or irritable in an unusual way
- The abdomen, eyes, or cheekbones appear sunken
- Skin that does not flatten when pinched or pushed
Chapter 4: Diagnosis of Diarrhea
Most cases of diarrhea resolve on their own with over the counter medications. However, in severe cases of diarrhea, your doctor may prescribe one or more of the following tests. These tests help diagnose the underlying health conditions causing diarrhea.
- Blood tests: A complete blood count test, electrolyte measurements, and liver function tests can help determine the severity of diarrhea
- Stool test: Your doctor may recommend a stool routine, stool culture sensitivity and stool hanging drop tests to determine the pathogen responsible for diarrhea
- Hydrogen breath test: A hydrogen breath test might help your doctor assess whether or not you have lactose intolerance. Your doctor will measure the amount of hydrogen in your breath at regular intervals after consuming a liquid containing lactose. If you’re exhaling too much hydrogen, it means you’re not adequately digesting and absorbing lactose.
- Colonoscopy or flexible sigmoidoscopy: Your doctor can examine the insides of your colon by doing a colonoscopy. The device also has a tool that allows your doctor to obtain a small tissue sample from your colon (biopsy) to diagnose the underlying health condition causing diarrhea.
Endoscopy of the upper intestine: Doctors use an endoscope to inspect your stomach and upper small intestine. They may take a tissue sample (biopsy) for laboratory analysis.
Chapter 5: Treatment for Diarrhea
Acute diarrhea usually clears up on its own after a few days without medication. If lifestyle changes and home remedies for diarrhea haven’t worked, your doctor may prescribe drugs or other therapies.
Antibiotics vs antiparasitics
Bacterial or parasitic diarrhea may be treated with antibiotics or antiparasitic medicines. Antibiotics will not help if a virus causes your diarrhea.
Fluid replacement therapy
Your doctor would certainly advise you to replenish your fluids and salt intakes. For most individuals, this implies taking ORS solution, juice, or broth. Your doctor may recommend IV fluids if consuming drinks bothers your stomach or causes vomiting.
Water is an excellent way to replace fluids, but it lacks the salts and electrolytes — minerals like sodium and potassium — that your body requires to function correctly. Drinking potassium-rich fruit juices or eating sodium-rich soups can help keep your electrolyte levels in check. However, some fruit liquids may aggravate diarrhea, such as apple juice.
To avoid dehydration or replace lost fluids in children, consult your doctor about using an oral rehydration solution such as Pedialyte.
Adjusting medicine dosage
If your doctor determines that an antibiotic is to blame for your diarrhea, they may reduce your dose or switch you to another drug.
Taking care of underlying issues
If a more severe ailment such as Inflammatory Bowel Disease is causing diarrhea, you’d be referred to a gastroenterologist who’d help treat your underlying health condition.
Chapter 6: Home Remedies for Diarrhea
Home remedies and medications can help relieve symptoms of diarrhea and avoid dehydration.
- Water, broths, and juices are all excellent sources of liquids. Caffeine and alcohol should be avoided
- Gradually introduce semi-solid and low-fibre foods as your bowel movements return to normal. Soda crackers, toast, eggs, rice, or chicken are good options
- Avoid dairy items, fatty foods, spicy foods, or foods with a lot of seasoning for a few days
- Over-the-counter anti-diarrheal drugs such as loperamide and bismuth subsalicylate may help control severe symptoms and lessen the number of watery bowel movements. However, some of these medicines can exacerbate certain medical conditions and infections. Therefore it’s advisable to consult your doctor before taking these medicines.
- Take probiotics if you haven’t already. These microorganisms may help reestablish a healthy intestinal balance by increasing the number of beneficial bacteria, but it’s unclear whether they can help lessen a spell of diarrhea. More research is needed to determine which bacteria strains are most beneficial and what dosages are required. Probiotics are available in capsule or liquid form, and some foods, such as certain yogurt brands, include them.
Chapter 7: Diarrhea and covid-19
Diarrhea is a common symptom of Covid-19 infection. Covid-19 is thought to induce diarrhea because it can infect gut cells and alter their normal functioning.
Chapter 8: Diarrhea in kids
Diarrhea is the body’s natural way of getting rid of pathogens, and most episodes can last anywhere from a few days to a week. Fever, nausea, vomiting, cramping, dehydration, and even rashes can accompany diarrhea.
- The most prevalent cause of diarrhea in children is viruses. Consult a doctor if the symptoms persist for more than two days. If you’ve recently travelled abroad, talk to your doctor; your child may need to have their faeces examined.
- Medications such as laxatives and antibiotics can cause diarrhea in children and adults.
- Keep your child hydrated if they have mild diarrhea caused by medicines. If a course of antibiotics causes your child’s diarrhea, make sure to keep the treatment going and contact your doctor. Reduce the dose, change your diet, add a probiotic, or switch to a different antibiotic, as recommended by your doctor.
- According to studies, antibiotic-induced diarrhea can be relieved by yoghurt or probiotics. Antibiotics kill beneficial gut bacteria; therefore, probiotics aid to replenish them.
- Older children with diarrhea can drink ORS to stay hydrated. Popsicles can also be used to rehydrate slowly.
- Diarrhea can also be caused by food poisoning; keep your child hydrated, and if you have any questions, call your doctor.
Irritable bowel syndrome, Crohn’s disease, ulcerative colitis, food allergies, and celiac disease are other causes of diarrhea. Call your doctor if you’re not sure what’s causing diarrhea in your child.
Chapter 9: Diarrhea and anxiety
Anxiety is a mental health disorder and can cause psychosomatic symptoms (psychological conditions causing physical illness) such as an upset stomach or diarrhea. Consult your doctor for more information.
Read more on how anxiety affects your gut.
Chapter 10: Diarrhea and pregnancy
According to the American College of Gastroenterology (ACG), there is no current research on the prevalence of diarrhea in pregnant women. However, hormonal or physical changes during pregnancy can cause diarrhea. It can also be caused by an illness or an underlying gastrointestinal disease unrelated to pregnancy.
During the menstrual cycle, increased prostaglandin levels can cause diarrhea.
Diarrhea can also be caused by synthetic prostaglandin medication such as misoprostol (Cytotec), a drug widely used to induce labour.
Chapter 11: Frequently Asked Questions
Q. What are some natural remedies for diarrhea?
- Staying hydrated
- Taking probiotics. They’re good microorganisms that exist in certain foods such as pickles, yoghurt, dark chocolate and cheese
- Low fibre BRAT foods such as Banana, Rice (white), Applesauce and Toast
Q. What causes black diarrhea?
Black diarrhea should be taken seriously. While certain foods can cause your stool to appear black, a black stool can also be a symptom of bleeding in the gastrointestinal tract.
Q. Can a flu shot cause diarrhea as a side effect?
While flu shots can cause nausea, they don’t cause diarrhea. There are so many other reasons to have diarrhea, and it’s entirely possible to have diarrhea at the same time one gets a flu shot.
Q. Why does not eating cause diarrhea?
Usually, fasting doesn’t cause diarrhea on its own. But diarrhea usually occurs due to the oversecretion of water and salts in the gastrointestinal tract. Several triggers can cause this, such as drinking tea or coffee high in caffeine.
Q. Why do I always get diarrhea after eating?
Diarrhea that happens after eating is called postprandial diarrhea (PD). Temporary PD can be caused due to:
- Infections: viral, bacterial and parasites
- Lactose intolerance
- Food poisoning
- Sugar malabsorption
- Magnesium overdose
Chronic PD can be due to
- Irritable Bowel Syndrome
- Celiac disease
- Microscopic colitis
- Gallbladder removal
- Dumping syndrome
Q. Does diarrhea cause weight loss? Is it cause for concern if it does?
Diarrhea that lasts for a while can cause dehydration and subsequent weight loss. Seek medical help immediately.
Q. Why does stress cause diarrhea in some people?
When a person is anxious, their body releases certain hormones and chemicals that can enter the digestive tract and disrupt the gut flora causing diarrhea.
Q. Why does coffee sometimes cause diarrhea?
The caffeine in coffee is a gastrointestinal stimulant that speeds up the passage of food through the digestive tract resulting in diarrhea and stomach cramping.
Q. Why am I having morning diarrhea?
Morning diarrhea may be due to
- Excessive alcohol consumption the previous night
- Midnight snacking
- Drinking too much coffee
- Smoking cigarettes
Q. Is there a reason why having your period gives you diarrhea?
Prostaglandins, natural chemicals that play a role in reproduction, can cause your intestines to contract, causing a wide range of GI symptoms, including diarrhea.
Q. How do you know when diarrhea is serious?
You need to see a doctor when
- Diarrhea lasts more than two days
- You have diarrhea accompanied by a high fever
- When you have gone to the loo more than six times in 24 hours
- You have black or bloody stools
- You have diarrhea accompanied by vomiting
Q. Is diarrhea a symptom of the Covid Delta variant?
The most common symptoms of Delta and also other variants include sore throat, runny nose, headache and fever. Other less common symptoms include cough, loss of smell, nausea, vomiting and diarrhea. Abdominal symptoms are more common in children in Covid.
Q. What cancers cause diarrhea?
Cancer treatment like chemotherapy and radiotherapy can cause diarrhea.
Q. What should you not eat when you have diarrhea?
- Milk and dairy products
- Fried, fatty and greasy foods
- Raw vegetables
- Spicy foods
Q. Does ginger help with diarrhea?
Ginger has antibacterial properties that can help recover from diarrhea. However, you need to consult your doctor to avoid any health complications due to an underlying health condition.