Discover how diarrhea can cause dehydration, electrolyte imbalances, pain, and fever. Our team of doctors offers expert guidance on prevention and treatment

Diarrhea

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Iqra Mazhar

Overview

Diarrhea is a condition characterized by the frequent passage of loose, watery stools. 
&nbsp;

Diarrhea is not a disease, but a symptom of an underlying condition. In general, diarrhea occurs when there is an increase in the frequency, volume, and liquidity of bowel movements. The duration of diarrhea is usually less than 14 days, but it can last longer in some cases, with or without fever, vomiting, or abdominal pain.

According to the WHO estimates, there are approximately 1.7 billion cases of diarrhea worldwide every year. It is also a leading cause of malnutrition and death in children under the age of 5, particularly in low- and middle-income countries1<a href="#accordion">[1]</a>. 
&nbsp;

Diarrhea is a significant public health problem in Pakistan, particularly in rural areas.

Although the government has implemented vaccination programs for rotavirus, a leading cause of severe diarrhea in children, and has developed guidelines for the management of diarrheal diseases in health facilities, several factors contribute to the high incidence of diarrhea in the country. 
&nbsp;

This includes poor sanitation and hygiene practices, inadequate access to clean drinking water, malnutrition, and poor health infrastructure. Moreover, the situation is exacerbated during natural disasters, such as floods and earthquakes, which can disrupt water and sanitation systems and increase the risk of diarrheal diseases. 
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<ul>
	<li>Acute Diarrhea: Diarrhea that lasts less than 2 weeks is classified as acute diarrhea. It usually resolves on its own within 2-3 days.</li>
	<li>Chronic Diarrhea: Also known as persistent diarrhea, this type of diarrhea lasts longer than 4 weeks. It is a serious condition and requires intervention. 
	&nbsp;</li>
</ul>

Sometimes, diarrhea is also categorized according to the color or look:

<ul>
	<li>Watery Diarrhea: This refers to watery stools that are common to both acute and chronic cases of diarrhea.</li>
	<li>Bloody Diarrhea: This implies that blood has mixed in with the loose, watery stools. It can be an indication of gastrointestinal bleeding due to trauma or disease. </li>
	<li>Traveler&#39;s Diarrhea: This type of diarrhea is caused by consuming contaminated water or other drinks that haven&rsquo;t been treated. This mostly happens while traveling to areas with poor sanitation.</li>
	<li>Yellow Diarrhea: This is an indication of a problem in the gallbladder or liver, usually in infants.</li>
	<li>Black Diarrhea: This is an indication of bleeding from somewhere high up in the digestive tract. However, it can also be because the person is taking iron supplements or consuming food that is black in color.</li>
	<li>Green Diarrhea: This can be a normal occurrence in infants or toddlers. However, it can also be due to the consumption of leafy greens or food with artificial green color<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

<ul>
	<li>Frequent passage of loose, watery stools</li>
	<li>Abdominal cramps</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Fever</li>
	<li>Tenesmus (the feeling of needing to pass stools, even when the bowel is empty)</li>
	<li>Bloating</li>
	<li>Loss of appetite</li>
	<li>Weight loss 
	&nbsp;</li>
</ul>

Causes

<ul>
	<li>Viral infections, such as rotavirus, norovirus, and adenovirus</li>
	<li>Bacterial infections, such as Escherichia coli, Shigella, Salmonella, Campylobacter, and Vibrio cholerae</li>
	<li>Parasitic infections, such as Giardia, Entamoeba histolytica, and Cryptosporidium</li>
	<li><a href="https://merisehat.pk/disease/food-allergy">Food allergies</a> or intolerances</li>
	<li>Medications, such as antibiotics and nonsteroidal anti-inflammatory drugs</li>
	<li>Contaminated food or water</li>
	<li><a href="https://merisehat.pk/disease/irritable-bowel-syndrome-62">Irritable bowel syndrome (IBS)</a></li>
	<li>Inflammatory bowel disease (IBD), including Crohn&rsquo;s disease and <a href="https://merisehat.pk/disease/ulcerative-colitis">ulcerative colitis</a></li>
	<li><a href="https://merisehat.pk/disease/celiac-disease">Celiac disease</a></li>
	<li>Microscopic colitis</li>
	<li>Endocrine disorders, such as <a href="https://merisehat.pk/disease/hyperthyroidism">hyperthyroidism </a>or <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a></li>
</ul>

A healthcare provider can help identify the underlying cause of diarrhea in individual cases. 
&nbsp;

There are no screening tests available for diarrhea. 
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Diagnosis

A healthcare provider may order one or more of the following diagnostic tests based on individual symptoms and circumstances:

<ul>
	<li>Stool Culture to detect bacterial infections</li>
	<li>Stool Antigen Tests to detect viral infections, such as rotavirus or norovirus</li>
	<li>Stool Ova And Parasite Exam to detect parasitic infections</li>
	<li>Electrolyte Tests to check for dehydration and electrolyte imbalances</li>
	<li>Colonoscopy to evaluate for inflammatory bowel disease or microscopic colitis</li>
	<li>Blood Tests to check for celiac disease or endocrine disorders</li>
	<li>Allergy Testing to check for food allergies or intolerances</li>
	<li>Imaging Tests to evaluate for complications, such as bowel perforation or abscess 
	&nbsp;</li>
</ul>

Treatment

Here are some treatment modalities for diarrhea:

<ul>
	<li>Oral Rehydration Therapy (ORT) to replace lost fluids and electrolytes</li>
	<li>Zinc Supplementation to reduce the duration and severity of diarrhea</li>
	<li>Antibiotics in cases of bacterial infections, but only when prescribed by a healthcare provider</li>
	<li>Dietary Modifications, such as avoiding trigger foods and increasing fiber intake</li>
	<li>Medications, including antidiarrheals or anti-inflammatory agents, depending on the underlying cause</li>
	<li>Surgery in severe cases only, such as a patient with inflammatory bowel disease</li>
	<li>Fecal Microbiota Transplantation involves transplanting fecal matter from a healthy donor into the gut of a patient. It is an effective treatment for both children and adults. 
	&nbsp;</li>
</ul>

The Integrated Management of Childhood Illness (IMCI) strategy includes a set of guidelines for the management of diarrhea in children under 5:

<ul>
	<li>Assess For Dehydration: Use the IMCI dehydration assessment chart to assess the level of dehydration (none, some, or severe). Treat with ORT as needed.</li>
	<li>Give Zinc Supplementation: Administer zinc supplements for 10&ndash;14 days to reduce the duration and severity of diarrhea.</li>
	<li>Continue Feeding: Encourage continued breastfeeding or formula feeding, and offer more frequent, smaller feedings.</li>
	<li>Consider Antibiotic Therapy: Antibiotics may be prescribed for dysentery or suspected cholera.</li>
	<li>Monitor Progress: Caretakers should continue to monitor the child&#39;s progress and seek follow-up care if symptoms worsen or do not improve.</li>
	<li>Anti-Diarrheal: Anti-diarrheal medications are used to treat diarrhea by slowing down the movement of the intestines and reducing the frequency and urgency of bowel movements. These medications should only be prescribed by an experienced practitioner, including loperamide, bismuth subsalicylate, codeine, diphenoxylate, and racecadotril<a href="#accordion">[3]</a>. 
	&nbsp;</li>
</ul>

It&#39;s important to note that anti-diarrheal medications should not be used to treat diarrhea caused by bacterial infections. A healthcare provider can help determine the appropriate treatment plan. 
&nbsp;

Diarrhea can cause a variety of complications, depending on the underlying cause and duration of the condition. Here are some possible complications of diarrhea: 
&nbsp;

<ol>
	<li>Dehydration: Diarrhea can cause the body to lose significant amounts of fluid and electrolytes, leading to dehydration. In severe cases, dehydration can be life-threatening, especially in young children, older adults, and people with weakened immune systems. 
	&nbsp;</li>
	<li>Malnutrition: Chronic diarrhea can interfere with the absorption of nutrients, leading to malnutrition. 
	&nbsp;</li>
	<li>Electrolyte Imbalances: Diarrhea can cause imbalances in electrolytes, such as sodium, potassium, and magnesium, which can lead to serious complications such as cardiac arrhythmias. 
	&nbsp;</li>
	<li>Hemolytic Uremic Syndrome (HUS): In rare cases, infection with certain strains of E. coli bacteria can lead to HUS, a condition that can cause kidney failure, anemia, and other serious complications. 
	&nbsp;</li>
	<li>Irritable Bowel Syndrome (IBS): Chronic diarrhea can be a symptom of IBS, a chronic condition that can cause abdominal pain and discomfort. 
	&nbsp;</li>
	<li>Colorectal Cancer: Chronic diarrhea can be a symptom of colorectal cancer, especially if it is accompanied by other symptoms, such as blood in the stool, abdominal pain, or weight loss. 
	&nbsp;</li>
</ol>

It is important to seek medical attention if diarrhea is persistent, severe, or accompanied by other symptoms, as prompt treatment can help prevent complications. 
&nbsp;

<ul>
	<li>Poor hygiene practices, including inadequate hand washing (by the child or caregivers) and exposure to contaminated objects or surfaces (e.g., at daycare or preschool)</li>
	<li>Malnutrition</li>
	<li>Weakened immune system, due to underlying medical conditions, such as HIV or cancer</li>
	<li>Lack of access to clean drinking water and proper sanitation facilities</li>
	<li>Travel history</li>
	<li>Medical conditions, such as celiac disease and food intolerance (lactose, soy, or gluten) or a family history of IBD </li>
	<li>Diet high in fiber or artificial sweeteners </li>
	<li>Travel history</li>
	<li>Stress</li>
	<li>Age, with young children and elderly at an increased risk</li>
	<li>Smoking 
	&nbsp;</li>
</ul>

<ul>
	<li>Vaccination: Vaccination against rotavirus, a common cause of diarrhea in children, can reduce the risk of infection and associated diarrhea. 
	&nbsp;</li>
	<li>Hand Hygiene: Frequent hand washing with soap and water can help prevent the spread of infectious agents that cause diarrhea. 
	&nbsp;</li>
	<li>Safe Water And Sanitation: Access to safe drinking water and proper sanitation facilities can reduce the risk of diarrhea caused by waterborne pathogens. 
	&nbsp;</li>
	<li>Exclusive Breastfeeding For The First 6 Months Of Life: Breastfeeding provides infants with antibodies and other protective factors that can help prevent diarrhea and other infections. 
	&nbsp;</li>
	<li>Good Food Hygiene: Proper food preparation, storage, and handling can reduce the risk of foodborne illness and associated diarrhea. 
	&nbsp;</li>
	<li>Medication: Proper management of medications, such as taking antibiotics only as prescribed and avoiding unnecessary use of over-the-counter medications, can reduce the risk of medication-induced diarrhea. 
	&nbsp;</li>
	<li>Stress Management: Managing stress through techniques such as meditation, exercise, and counseling can help prevent stress-induced diarrhea.&nbsp; 
	&nbsp;</li>
</ul>

NOTE: These preventive factors may not eliminate the risk of diarrhea and medical attention should be sought if diarrhea persists or is severe. 
&nbsp;
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Key Points

<ul>
	<li>Diarrhea is a condition characterized by the frequent passage of loose, watery stools.</li>
	<li>Diarrhea is not a disease, but a symptom of an underlying condition.</li>
	<li>&nbsp;According to the WHO estimates, there are approximately 1.7 billion cases of diarrhea worldwide every year</li>
	<li>&nbsp;Several factors contribute to the high incidence of diarrhea in Pakistan, including poor sanitation and hygiene practices, inadequate access to clean drinking water, malnutrition, and poor health infrastructure</li>
	<li>Diarrhea in children can have many different causes, including viral or bacterial infections, food allergies or intolerances, medication side effects, and medical conditions such as inflammatory bowel disease or celiac disease.</li>
	<li>Diarrhea can cause the body to lose significant amounts of fluid and electrolytes, leading to dehydration. In severe cases, dehydration can be life-threatening</li>
</ul>
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[1] Diarrhoeal disease. World Health Organization.

[2] Terez Malka MD. Diarrhea: Types, causes, and treatment: K health app. K Health.

[3] Trevor R. Pour, Alex Koyfman, Michael S. Runyon. Emergency centre management of paediatric diarrhoea: An overview. African Journal of Emergency Medicine.