Diarrhea

Is this your symptom?

  • Sudden increase in the number and looseness of stools
  • Diarrhea means 3 or more watery or very loose stools. Reason: 1 or 2 loose stools can be normal with changes in diet.

Causes of Acute Diarrhea

  • Virus(such as Rotavirus, Norovirus or Adenovirus). An infection of the intestines from a virus is the most common cause. Vomiting is often also present. Cannot be treated with antibiotics.
  • Bacteria(such as Salmonella, E. coli or campylobacter). Less common cause. Diarrhea often contains streaks of blood. This may need treatment with antibiotics.
  • Cholera and Typhoid. Tropical diseases which cause diarrhea, fever and stomach pain.
  • Food Poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad or undercooked food. It is caused by toxins from germs growing in foods left out too long, not stored safely or undercooked. It can also occur if food has been handled by someone who is sick or has not washed their hands. It may occur if you eat food after their ‘use by’ date. Most often, symptoms go away in less than 24 hours. It often can be treated at home, without the need for medical care. But sometimes symptoms can be severe and even cause death.
  • Giardia(a parasite). Along with diarrhea, other symptoms can include stomach cramps, bloating, and nausea. It is often a waterborne disease, since the parasites are found in streams and lakes. They can also be found in wells, swimming pools, and hot tubs. The infection can be spread through person-to-person contact.
  • Traveler's Diarrhea. Caused by germs in food or drink. Suspect this if it follows recent foreign travel.
  • Antibiotic Diarrhea. Many antibiotics cause mild diarrhea. This is not an allergic reaction. It is caused by the antibiotic killing both good and bad bacteria in the gut. Keep taking the antibiotic. Call your doctor if any serious symptoms occur.
  • Medications. Besides antibiotics, many other medicines can cause diarrhea as a side effect, such as antacids which contain magnesium, metformin and cancer drugs.
  • Fructose and Artificial Sweeteners used in food can cause diarrhea in some people.
  • Lactose Intolerance. Lactose is a sugar found in milk and other dairy products. Some people have a hard time digesting it and get diarrhea if they eat dairy products.
  • Celiac Disease. Celiac is a disease where your immune system attacks your own tissues if you eat gluten. This damages the gut and keeps you from absorbing nutrients. Even a small amount of gluten can trigger the response. Gluten is a protein found in wheat, barley and rye. It is in any foods made with those products such as bread, pasta, breakfast cereals, some sauces and ready meals. Symptoms include diarrhea, bloating and abdominal pain. People with celiac disease are also more likely to have lactose intolerance.
  • Overflow diarrhea. Some people who have severe constipation and have been unable to pass stools for a long period, may have diarrhea. This is due to more fluid in stools from higher up in the bowel, moving past the hard stools in the rectum that cannot be passed. Treating the constipation will stop the diarrhea as well.
  • Serious Causes. Most bacterial diarrhea goes away on its own. A few can cause a severe bowel infection (such as Shigella colitis). C. difficile is a serious cause that can occur after being on strong antibiotics or if you are in or have been admitted to the hospital.
  • Bowel Cancer. If a change in your bowel habits (either the the number of times you go or the firmness of your stools) does not go back to normal within a few days and has no obvious cause such as a change in diet, you should see your doctor. This could be a symptom of bowel cancer.
  • Chronic Diarrhea. Some people have ongoing diarrhea as a result of health conditions that are not due to infection or their diet. Examples are: abdominal or gall bladder surgery, Crohn’s disease, ulcerative colitis or other problems. These may cause ongoing loose stools or bouts of diarrhea with flare ups.
  • Serious Problems:
    • Dehydration the body has lost too much fluid. See more about this below.
    • Malnutrition. This can occur in patients with long-term diarrhea. The fast movement of food through the gut causes less nutrients to be absorbed.

Diarrhea Scale

  • Mild: 3-5 watery stools per day
  • Moderate: 6-9 watery stools per day
  • Severe: 10 or more watery stools per day
  • The main risk of diarrhea is dehydration.
  • Loose or runny stools do not cause dehydration.
  • Frequent, watery stools can cause dehydration.

Dehydration: How to Know

  • Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea and especially if both are present. Mild diarrhea or mild vomiting does not cause this. Neither does a small decrease in fluid intake.
  • Dehydration is the most important problem caused by diarrhea. It is a reason to see your doctor right away.
  • These are signs of dehydration:
    • Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow urine color. If your urine is light straw colored, you are not dehydrated.
    • Dry tongue and inside of the mouth. Dry lips are not a helpful sign.
    • Dry eyes with less or no tears
    • You feel ill, tired or weak. If you are alert, active and can carry out your normal daily activities, you are not dehydrated.
    • If you have severe dehydration, you may become too weak to stand. You may also be very dizzy when standing and become confused.

When to Call for Diarrhea

When to Call for Diarrhea

Call 911 Now

  • Too weak or dizzy to stand
  • You think you have a life-threatening emergency

Call Doctor or Seek Care Now

  • You feel dehydrated (dark urine, very dry mouth, dizzy)
  • Severe diarrhea. 10 or more watery stools in the last 24 hours
  • Bloated (distended) abdomen
  • Fever higher than 103° F (39.4° C)
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Moderate diarrhea. 6 or more watery stools in the last 24 hours.
  • Stomach pain that does not go away after each diarrhea stool
  • Loss of bowel control
  • You are fed through a tube or PEG
  • Fever lasts more than 3 days
  • Close contact with person or animal who has diarrhea
  • Travel to country at risk for diarrhea within past month
  • Blood (small amount) or mucus in stool
  • Weak immune system. Examples are: diabetes, sickle cell disease, HIV, cancer, organ transplant, taking oral steroids, or kidney problems.
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Diarrhea lasts more than 1 week
  • You are taking a new drug which may be the cause
  • You were recently in the hospital or took antibiotics
  • Loose stools are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Mild diarrhea; loose stools with no blood or mucus
  • Diarrhea disease: how to prevent

Call 911 Now

  • Too weak or dizzy to stand
  • You think you have a life-threatening emergency

Call Doctor or Seek Care Now

  • You feel dehydrated (dark urine, very dry mouth, dizzy)
  • Severe diarrhea. 10 or more watery stools in the last 24 hours
  • Bloated (distended) abdomen
  • Fever higher than 103° F (39.4° C)
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Moderate diarrhea. 6 or more watery stools in the last 24 hours.
  • Stomach pain that does not go away after each diarrhea stool
  • Loss of bowel control
  • You are fed through a tube or PEG
  • Fever lasts more than 3 days
  • Close contact with person or animal who has diarrhea
  • Travel to country at risk for diarrhea within past month
  • Blood (small amount) or mucus in stool
  • Weak immune system. Examples are: diabetes, sickle cell disease, HIV, cancer, organ transplant, taking oral steroids, or kidney problems.
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Diarrhea lasts more than 1 week
  • You are taking a new drug which may be the cause
  • You were recently in the hospital or took antibiotics
  • Loose stools are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Mild diarrhea; loose stools with no blood or mucus
  • Diarrhea disease: how to prevent

Care Advice

Treatment for Mild Diarrhea

  1. What You Should Know About Diarrhea:
    • Most diarrhea is caused by a virus.
    • Bacterial infections as a cause of diarrhea are not common.
    • Parasites from contaminated water can also cause diarrhea.
    • Diarrhea is the body's way of getting rid of the germs.
    • You may also have fever, nausea or vomiting and abdominal cramps.
    • You may find you need to empty your bowels urgently and that you pass mucus in the stool as well.
    • The main risk of diarrhea is dehydration. Dehydration means the body has lost too much fluid.
    • Most people with diarrhea don't need to see their doctor.
    • Here are some tips on how to keep ahead of the fluid losses.
  2. Mild Diarrhea:
    • Most people with diarrhea can continue to drink and eat solid foods.
    • Drink plenty of fluids to prevent dehydration. If you are also vomiting, try drinking small amounts of fluids more often. Water and broth are good choices. Avoid alcohol and caffeine.
    • Do not drink fruit juices or full-strength sports drinks. Reason: they can make diarrhea worse.
    • Solid foods: eat more starchy foods (such as cereal, crackers, rice, pasta). Eggs and chicken are also good choices. Pretzels or salty crackers will help add some salt to meals. Some salt is good.
    • Avoid dairy products, fatty foods and spicy foods for a few days.
  3. Oral Rehydration Solutions (ORS):
    • ORS is also called electrolyte replacement fluids. It contains water, salt and sugar.
    • ORS is a special fluid that can help you stay hydrated and replace some of the salts you lose when you have diarrhea. It can be bought in grocery stores or drugstores, usually as a powder that you mix with water. However, drinking broth is also a good choice.
    • When to use: start rehydration for frequent, watery diarrhea if you think you are getting dehydrated. That means if you're feeling thirsty or passing less urine than normal.
  4. Probiotics:
    • Probiotics are healthy bacteria (such as Lactobacilli). They can replace harmful bacteria in the gut (stomach).
    • Probiotics may be helpful in reducing the number of diarrhea stools.
    • Yogurt is the easiest source of probiotics. Note: today, almost all yogurts have "active cultures."
    • Probiotic supplements can be bought in liquid and capsule forms from health food stores.
  5. Pain and Fever Medicine:
    • To help with pain and/or fever, take an acetaminophen product (such as Tylenol).
    • Use as needed, but do not take more than the maximum recommended dosage as listed on the package.
    • If you are not sure what to take, ask a pharmacist.
  6. Antidiarrheal Medicines:
    • Can be bought over-the-counter from a drugstore without a prescription.
    • The medicines can help slow down or stop diarrhea for a few hours.
    • But, it is best not to take any medicine for diarrhea, if possible.
    • Remember: diarrhea is the body’s way of getting rid of a toxin or infection. Antidiarrheal medicines may not reduce the length of time you have diarrhea. Fluids are still the best treatment, but antidiarrhea meds may be helpful if you are travelling. They slow down the passage of fluids and food in the gut. They may help your body absorb fluids to reduce the chance of dehydration.
  7. Return to Work:
    • Stay off work until you have not had diarrhea or been sick for at least 2 days. This is especially important if you work in the food industry.
    • Your fever and any abdominal pain should also be gone.
  8. What to Expect:
    • Viral diarrhea lasts 5-14 days. Vomiting usually settles within 1 or 2 days.
    • Severe diarrhea only occurs on the first 1 or 2 days. But, loose stools can last for 1 to 2 weeks.
  9. Call Your Doctor If:
    • Blood in the diarrhea
    • Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth)
    • Diarrhea lasts more than 2 weeks
    • You think you need to be seen
    • Your symptoms get worse

Preventing Diarrhea Disease

  1. Safety Tips in All Countries:
    • Hand washing is the key to preventing the spread of infections.
    • Always wash the hands before eating, feeding or handling young children or cooking.
    • Always wash the hands after any contact with vomit or stools.
    • Wash the hands after using the toilet.
    • Avoid sharing towels with others.
    • Avoid cooking food for others.
    • Cook all poultry (chicken, turkey) fully. Never serve chicken that is still pink inside. Reason: undercooked poultry is a common cause of diarrhea.
  2. Extra Safety Tips in Developing Countries:
    • Drink bottled water or boiled water. Avoid tap water, ice cubes and flavored ices.
    • Eat foods that have been fully cooked and that are still hot.
    • Dry foods such as bread are usually safe.
    • Avoid salads and raw vegetables. They may have been washed in contaminated water or not washed at all. Avoid fruits that cannot be peeled. Bananas, oranges and apples are safe. Wash your hands before peeling fruit.
    • Avoid all undercooked meat and fish.
    • Avoid buying foods and drinks from street vendors. Reason: this is a common cause of traveler's diarrhea.
    • Brush your teeth with bottled or boiled water.
  3. Call Your Doctor If:
    • You have other questions or concerns

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2023 Schmitt Decision Logic, LLC

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