DIARRHEA

 

By Kemboi Kibet.  Eldoret August 11, 2012

Diarrhea describes loose watery bowel movement that usually last 2 or 3 days. This often means more frequent trips and a greater stool volume. It may be accompanied by nausea, bloating and urgent need to use the toilet. This is a very common condition and it’s usually not serious except in rare cases and may be treated with Over The Counter medication or may be even go away without treatment. Diarrhea  may be caused by a bacteria, virus or parasites. It may also be caused by food intolerance, certain medication or certain conditions like diseases of the stomach and intestines. It may also be a sign of serious trouble especially if there is blood in the stool or strong rectum and abdominal pain.  You should see a doctor if you get signs of severe dehydration or if diarrhea lasts for weeks.

TYPES OF DIARRHEA

Diarrhea may be classified as secretory, osmotic and exudative.

Secretory diarrhea – This may be caused by certain medical condition, drugs and a lot of infections. With this type of diarrhea, the body releases water into the bowel when it’s not suppose to.

Osmotic diarrhea – This is when something in your bowel draws water from your body into the bowel. This could be a sugar substitute like sorbitol that does not get absorbed by the body but gets into the bowel and draws water from the body.

Exudative diarrhea – This occurs with conditions like inflammatory bowel disease (ulcerative colitis and crohn’s disease

CAUSES

A number of disease and conditions can cause diarrhea. But most likely it may be common causes like :

  • viruses
  • bacteria
  • medication
  • food allergy
  • radiation therapy
  • lactose intolerance
  • fructose
  • artificial sweeteners
  • some cancers
  • diabetes
  • hyperthyroidism
  • disease of the intestine (crohn’s disease, celiac disease and ulcerative colitis)
  • alcohol abuse
  • laxative abuse
  • eating foods that upset your stomach

SYMPTOMS

There are both complicated  and uncomplicated symptoms of diarrhea. Uncomplicated symptoms of diarrhea may include:

  • Frequent, loosewatery stools
  • vomiting
  • nausea
  • abdominal pain
  • abdominal cramp
  • headache
  • bloating
  • loss of appetite

However in serious cases, there may be more complicated symptoms like

  • blood in the stool
  • mucus in the stool
  • fever – 102 F (39 C)
  • loss of weight

You must see a doctor if the diarrhea persist for more than 3 days or if you get any of these  complicated symptoms. Also if you show sign of dehydration – very dry mouth, extreme thirst, little or no urine.

In children diarrhea could be more severe and lead to dehydration. Call a doctor if the child’s diarrhea does not improve in 24 hours or if the child is very sleepy, irritable and unresponsive. Also if the child has not had a wet diaper for over 3 hours and has sunken eyes and stomach  and dry tears you should call a doctor. If the child’s skin does not flatten after being pinched  or child has a fever of 102 F (39C) and black or bloody stools you must call a doctor immediately

TEST AND DIAGNOSIS

Test and diagnosis for diarrhea may include :

PHYSICAL  EXAMINATION – A physical examination will be done to check for abdominal pain. Your doctor will also use a stethoscope to  listen to your stomach.

MEDICATION REVIEW – Your doctor may ask about any medications you’re taking, including over-the-counter drugs and any supplements you take.

STOOL TEST – A stool test will be done to determine the cause of the diarrhea – bacterium or parasite

BLOOD TEST – A complete blood count may also be done to check for the cause of the diarrhea.

SIGMOIDOSCOPY – A sigmoidoscopy may also be performed. This involves introducing a thin fiber-optic tube that has a viewing lens through the rectum to look into the intestine.

TREATMENT

Most cases of diarrhea resolve themselves within a couple of days without medication however if the diarrhea persist for more than 3 days consult your doctor for treatment.

Treatment of mild cases of diarrhea:

Absorbents – These are compounds that absorb water. They bind to water in the small intestines and colon and make stools less watery. These are over the – counter medication and can be grouped into 2 categories

Attapulgite – Examples of these are Kaopectate Advanced Formula, Donnagel, Diasorb etc

Polycarbophil – Examples include Polycarb,  Mitrolan, Equalactin etc

Anti-motility medication – These are drugs that relax the muscles of the small intestines and colon which results in slowing the flow intestinal content. This allows more time for water to be absorbed from the intestine and colon and hence decreases the water content in the stool. Two main anti-motilty medication are loperamide (Imodium), which is available without a prescription, and diphenoxylate (Lomotil), which requires a prescription.Anti-motility medication should not be given to children younger than 2 years and it should always be used under a doctor’s guidance.

Bismuth compounds – These are available worldwide. They contains bismuth and salicylate (aspirin), hence people allergic to aspirin should not take it. In general it is very well tolerated. It should not be taken with other aspirin containing medication as this can lead to aspirin toxicity. Do not give this medication to children younger than 2 years. Examples include Pepto-Bismol

Treatment to replace fluid – It is important to replace fluid and salt lost during diarrhea. You must drink enough water, juice or both to replace the fluid. You may replace the fluid intravenously through a vein in your arm if drinking liquid upsets your stomach. Water is good for replacing the fluid but because it has no salt and electrolyte, you may be required to drink fruit juices for potassium and soup  for sodium.

Adjusting medication – Diarrhea may be caused by a medication you are taking. In this case your doctor may lower the dosage or switch you to another medication.

Treatment for severe diarrhea

Antibiotics – These are often needed for people with severe or persistent diarrhea and also for people with additional debilitating disease like AIDS, heart disease etc. Also if your stool examination showed parasites, more serious bacterial infections (Shigella), or C.difficile and traveler’s diarrhea you will need antibiotics. Antibiotics may help treat diarrhea caused by bacteria or parasites. If a virus is causing your diarrhea, antibiotics will not  help.

Treatment of underlying condition – If your diarrhea is caused by a more serious condition, such as inflammatory bowel disease, your doctor will work to control that condition.

PREVENTION

Wash hands frequently to prevent viral diarrhea. Wash hands after using the toilet, handling uncooked meat, sneezing, coughing, blowing your nose and changing diapers. Lather with soap for at least 20 seconds and use hand sanitizer where necessary. Do not eat contaminated food. Serve cooked food immediately or refrigerate. Thaw frozen food in a refrigerator and wash work surfaces frequently. Also when you travel watch what you eat or drink.

 

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