Diarrhoea

Overview

Diarrhoea is a common condition where an individual has loose, watery stools. It can develop due to various factors including food poisoning, viral or bacterial infections, certain medications, or underlying health conditions. It can cause symptoms such as frequent bowel movements, abdominal cramps, nausea, and sometimes fever. While this condition is mostly mild and goes away on its own, severe diarrhoea can lead to dehydration. To prevent it, practising good hygiene, drinking plenty of fluids, and consulting a doctor if symptoms persist can be helpful.

What is Diarrhoea?

Diarrhoea is a condition where an individual passes watery or loose stool for a few days (usually 1-2 days). It may be unpleasant for some as they experience nausea, vomiting and mental stress along with the pain of passing sickly-looking, sparse poop down the toilet bowl.

While this condition goes away on its cause as the viral or bacterial infection flushes out naturally, some individuals can face severe complications. The severity of diarrhoea can lead to the loss of fluids from the body (dehydration), the body's inability to absorb essential nutrients and bloody stools.

Types of Diarrhoea

The following are 3 major types of diarrhoea:

Acute Diarrhoea: This is the most common type of diarrhoea that lasts for a few days. Oftentimes, it is caused by bacterial or viral infections, which may also resolve on its own within 1-2 days. Individuals may have 3 or more watery, loose stools per day.

Persistent Diarrhoea: It lasts for more than 14 days, often extending up to 4 weeks. It may be caused by other medical conditions, such as inflammatory bowel diseases or bacterial and parasitic infections.

Chronic Diarrhoea: This type of diarrhoea lasts for more than 4 weeks or occurs frequently over a long period. It can be caused by various underlying conditions, including inflammatory bowel diseases, irritable bowel syndrome, or malabsorption disorders, causing complications such as bloody stool, abdominal cramps, weight loss and nausea or vomiting.

The other less common types include:

Inflammatory Diarrhoea: This occurs when intestinal inflammation causes damage to the lining of intestines, causing fever, bloody stools and abdominal cramps.

Secretory Diarrhoea: This diarrhoea type happens when there is an excessive amount of fluid secretion from the intestines, causing watery stools.

Osmotic Diarrhoea: It is caused when water and electrolytes are prevented from normal absorption as the poorly absorbed solutes draw water into the intestines.

Motility Diarrhoea: This occurs when the body is prevented from absorbing enough nutrients and water as the food passes rapidly through the intestines.

Symptoms of Diarrhoea

The main symptom of diarrhoea that an individual experiences is having watery or loose stool. They may also experience an upset stomach along with nausea, excessive thirst, dry skin or mouth, belly cramps and bloating, and a strong and immediate urge to poop. The symptoms may last a few days or turn into severe diarrhoea, which requires an individual to schedule a proper visit to a healthcare provider.

Individuals having severe diarrhoea may experience intense pain in the stomach, fever, vomiting, unexplainable weight loss (resulting from the body's inability to absorb enough nutrients), and mucus or blood in the stool.

This may also cause dehydration, especially in children, exhibiting symptoms such as severe nausea and vomiting, confusion, lightheadedness and dizziness, flushed dry skin, headache, zero wet diapers in toddlers, fatigue, less urge to pee or dark pee, lesser than six wet diapers throughout the day in an infant, and no tears while crying in both toddlers and infants. It is crucial to call a doctor if an individual experiences terrible rectal or abdominal pain, black or bloody stool, fever above 101 degrees Fahrenheit, or insomnia.

Causes of Diarrhoea

Diarrhoea can be caused by numerous reasons, including exposure to Norwalk viruses (or enteric adenoviruses, norovirus, cytomegalovirus, astrovirus and hepatitis-causing virus). These viruses can cause sudden diarrhoea in children. The COVID-19-causing virus is also suspected of causing gastrointestinal symptoms, including diarrhoea, vomiting and nausea.

Bacteria such as Escherichia coli, or coming in exposure to parasites through contaminated water or food is a leading cause of diarrhoea. This can especially occur when an individual is travelling in developing countries, the condition is also known as traveler's diarrhea. Another bacterium that leads to diarrhoea is C. diff or Clostridioides difficile, which can attack the body during a stay at the hospital or after an antibiotics course. This C. diff bacteria found in certain medicines disturb the good bacteria in the body, eventually causing diarrhoea.

Anticancer drugs or antacids with magnesium are some other medicines that can also cause diarrhoea. Individuals who are intolerant to fructose, a natural sugar found in honey and fruits, are prone to developing diarrhoea. Artificial sweeteners found in sugar-free products or chewing gum, including mannitol, erythritol and sorbitol, can also trigger the chances of diarrhoea in physically active and otherwise healthy people.

People with lactose intolerance can also have diarrhoea, especially after having consumed dairy products. In addition, certain surgery methods, such as gallbladder or partial intestine removal surgeries, can sometimes become the root cause of diarrhoea. Other major digestive disorders that lead to diarrhoea include celiac disease, ulcerative colitis, Crohn's disease, IBS, and small intestinal bacterial overgrowth (SIBO).

Hence, exposure to parasites, bacteria or viruses increases the risk of having the disease. Taking coffee, tea or foods with artificial sweeteners also raises the warning alarm. Medicines such as laxatives, antidepressants, magnesium supplements, NSAIDS, antibiotics, immunotherapy and chemotherapy can also trigger the chances of getting diarrhoea.

Diagnosis of Diarrhoea

A healthcare provider may not diagnose or treat diarrhoea in most cases, especially if the symptoms fade away in a few days. However, in severe cases, the doctor may ask the individual about their and family's medical history, any sick contacts they have and travel history.

After a physical examination, the healthcare provider may order certain tests including a hydrogen breath test, blood tests, stool test, or an endoscopy.

The severity of diarrhoea is based on its stages, which include the following:

Mild Diarrhoea: This stage causes an individual to have a few watery stools throughout 24 hours.

Moderate Diarrhoea: An individual may not take more than 10 watery stools during a 24-hour tenure in this stage.

Severe Diarrhoea: This stage causes complications including dehydration and electrolyte imbalance. An individual may also take more than 10 loose, watery stools within 24 hours.

Treatment for Diarrhoea

Diarrhoea can be gotten rid of at home. At-home treatment plans may involve taking over-the-counter medicines such as bismuth subsalicylate (Kaopectate® or Pepto-Bismol®). An individual experiencing the signs of severe diarrhoea may receive a treatment recommendation such as antiparasitics or antibiotics, probiotics and medications that treat diarrhoea-causing underlying conditions (IBS or IBD).

The at-home treatment and medication for diarrhoea also includes drinking lots of water and electrolyte-balanced drinks, keeping white rice, banana, applesauce and toast in their diet, and avoiding gas-inducing foods, alcohol and caffeine.

Prevention of Diarrhoea

The spread of infectious diarrhoea can be prevented by ensuring sufficient hand-washing. This involves washing one's hands after using the washroom and before and after cooking food or eating meals. One must also wash hands after coughing, sneezing or changing diapers. They must rub their hands together while lathering it with soap for 20-30 seconds at least. Using an alcohol-based hand sanitiser is also essential when one cannot use the sink to wash their hands.

Besides following the basic hygiene measures, one must vaccinate their infants against rotavirus, which is the major cause of children's diarrhoea. Additionally, traveller's diarrhoea can be prevented by looking out for what one is consuming or eating. The food must be well-prepared and hot, and one must not consume raw vegetables or fruits or undercooked dairy products or meats. Also, people must avoid drinking tap water, and encourage themselves to drink bottled beer, soda, water or wine.

An individual must ensure that their mouth is closed while taking a shower and that they are using bottled water for brushing their teeth. Boiling water for preparing tea or coffee should also be done with bottled water. This will help to decrease the risk of virus or parasite exposure.

Myths and Facts Related to Diarrhoea

Following are the myths and facts about Diarrhoea:

Myth 1: Diarrhoea is Only Caused by Food Poisoning
Fact: While diarrhoea may majorly be caused due to food poisoning, other risk factors include medical conditions, food intolerances, bacterial or viral infections, and medication side effects.

Myth 2: Diarrhoea is a Sign of a Serious Illness
Fact: While most cases of diarrhoea are mild, resolving on their own within a few days, it is concerning if the diarrhoea is severe, bloody, or accompanied by other symptoms such as fever or abdominal pain.

Myth 3: Dehydration is Not a Serious Complication of Diarrhoea
Fact: Dehydration can be a serious complication of diarrhoea in children and elderly people. It is, therefore, essential to drink plenty of fluids to balance electrolyte levels and replace the lost fluids.