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Diarrhea In Adults

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Ismail Munir

Overview

Diarrhea in adults is defined as the passage of three or more loose or watery stools in a day<a href="#accordion">[1]</a>. 
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Diarrhea is a common gastrointestinal symptom characterized by loose, watery stools occurring more frequently than usual. In adults, diarrhea can be caused by a wide range of factors, including infections, dietary choices, medications, and underlying medical conditions. While often a self-limiting condition, persistent or severe diarrhea can lead to <a href="https://merisehat.pk/disease/dehydration">dehydration</a> and other complications if not managed properly.

An estimated 1.5 million deaths in 2019 were attributed to diarrheal diseases<a href="#accordion">[2]</a>. Recent public health interventions have significantly reduced the number of deaths due to diarrhea. However, with several countries lacking access to clean water, adequate sanitation, and oral rehydration treatment, diarrhea continues to be a public health concern worldwide. 
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Causes

Diarrhea is a symptom that can manifest in various ways, and its classification is often based on its underlying causes, duration, and characteristics. The following are some of the different types of diarrhea in adults<a href="#accordion">[3][4]</a>:

<ol>
	<li>Acute Diarrhea - This refers to a sudden onset of loose or watery stools that lasts for a short period, typically less than two weeks. It is commonly caused by infections, such as bacterial, viral, or parasitic infections. Contaminated food, water, or person-to-person contact are common modes of transmission. 
	&nbsp;</li>
	<li>Persistent Diarrhea - Persistent diarrhea lasts between two and four weeks, often extending beyond the typical duration of acute diarrhea. It can be attributed to bacterial infections (e.g., certain strains of E. coli), parasitic infections, medications, underlying gastrointestinal disorders, or certain chronic conditions like celiac disease. 
	&nbsp;</li>
	<li>Chronic Diarrhea - Diarrhea that persists for more than four weeks and can be a sign of an underlying medical condition and is referred to as Chronic Diarrhea. It can be associated with conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), malabsorption disorders (e.g., celiac disease), endocrine disorders (e.g., hyperthyroidism), and certain autoimmune diseases. 
	&nbsp;</li>
	<li>Traveler&#39;s Diarrhea - This refers to the onset of diarrhea during or shortly after travel, especially in areas with poor sanitation. It is typically caused by consuming contaminated food or water, often due to bacterial pathogens or parasites. 
	&nbsp;</li>
	<li>Antibiotic-Associated Diarrhea (AAD) - AAD occurs as a side effect of taking antibiotics and is characterized by diarrhea during or after antibiotic treatment. Antibiotics can disrupt the normal balance of gut bacteria, allowing the overgrowth of bacteria like Clostridium difficile (C. difficile), leading to diarrhea. 
	&nbsp;</li>
	<li>Inflammatory Diarrhea - This is characterized by the presence of blood, pus, or mucus in the stool, along with abdominal pain and fever.&nbsp; Inflammatory bowel diseases (e.g., Crohn&#39;s disease, ulcerative colitis), infections (e.g., certain strains of E. coli), and autoimmune conditions can lead to inflammatory diarrhea. 
	&nbsp;</li>
	<li>Osmotic Diarrhea - Osmotic diarrhea occurs when unabsorbed substances in the intestines draw water into the stool, leading to increased stool volume. Malabsorption disorders (e.g., celiac disease, lactose intolerance), medications, and certain artificial sweeteners (e.g., sorbitol) can cause osmotic diarrhea. 
	&nbsp;</li>
	<li>Secretory Diarrhea - This type of diarrhea results from an increase in fluid secretion into the intestines, leading to watery stools. Infections (e.g., cholera), medications, and certain hormonal imbalances (e.g., hyperthyroidism) can cause secretory diarrhea. 
	&nbsp;</li>
	<li>Functional Diarrhea - Functional diarrhea is diarrhea without an identifiable underlying cause and is often associated with conditions like irritable bowel syndrome (IBS). It is related to abnormal gut motility and sensitivity, often triggered by stress, diet, or other factors. 
	&nbsp;</li>
</ol>

Signs and Symptoms

The signs and symptoms of diarrhea vary depending on the cause and severity. Diarrhea is mainly characterized by loose or watery stool. It can also be accompanied by nausea, vomiting, bloating or abdominal cramps, and an urgency to defecate.

Often, diarrhea may be associated with warning signs that need immediate evaluation. These include<a href="#accordion">[3]</a>:

<ul>
	<li><a href="https://merisehat.pk/disease/typhoid-fever">Fever</a></li>
	<li>Blood or pus in the stool</li>
	<li>Weight loss</li>
	<li>Dehydration</li>
	<li>Severe pain</li>
	<li>Chronic or nighttime diarrhea 
	&nbsp;</li>
</ul>

Note: If you or someone you know experiences any of the above warning signs, contact a healthcare professional immediately. 
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There are no screening tests for diarrhea in adults. 
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Diagnosis

Diagnosing the underlying cause of diarrhea in adults involves a combination of medical history assessment, physical examination, and sometimes laboratory tests. The process aims to identify the specific cause and guide appropriate treatment.

<ul>
	<li>Medical History - The doctor will begin by asking detailed questions about the individual&#39;s symptoms, including the frequency, consistency, duration, and any associated symptoms like abdominal pain, fever, or blood in the stool. Information about recent travel, dietary habits, medication use, and any potential exposure to contaminated food or water is important. 
	&nbsp;</li>
	<li>Physical Examination -&nbsp; A physical examination helps the doctor assess the patient&#39;s overall health and look for signs of dehydration, abdominal tenderness, bloating, and other relevant findings. 
	&nbsp;</li>
	<li>Stool Analysis -&nbsp;Stool samples may be collected for laboratory analysis to identify the presence of infectious agents, such as bacteria, viruses, parasites, or blood. Testing may include culture, microscopy, and enzyme immunoassays to detect specific pathogens. 
	&nbsp;</li>
	<li>Blood Tests -&nbsp;Blood tests can help assess for signs of infection, inflammation, electrolyte imbalances, and potential underlying medical conditions. Specific tests may include a complete blood count (CBC), electrolyte panel, and tests for markers of inflammation (e.g., C-reactive protein). 
	&nbsp;</li>
	<li>Colonoscopy Or Endoscopy - In cases of persistent or severe diarrhea, where an underlying gastrointestinal disorder is suspected, a colonoscopy or endoscopy may be performed. These procedures involve inserting a flexible tube with a camera into the colon or upper gastrointestinal tract to visually inspect the lining and collect tissue samples (biopsies) for analysis. 
	&nbsp;</li>
	<li>Breath Tests - Breath tests may be used to diagnose conditions like lactose intolerance or bacterial overgrowth in the small intestine. The patient consumes a specific substance, and the breath is tested for certain gasses that can indicate malabsorption. 
	&nbsp;</li>
	<li>Imaging Studies - In certain cases, imaging studies such as abdominal X-rays, CT scans, or ultrasound may be ordered to assess the gastrointestinal tract and surrounding structures. 
	&nbsp;</li>
	<li>Allergy And Intolerance Testing - If food allergies or intolerances are suspected, allergy testing or elimination diets may be recommended to identify trigger foods. 
	&nbsp;</li>
	<li>Medical And Family History - A thorough medical history, including any family history of gastrointestinal conditions, can provide important clues to the underlying cause of diarrhea. 
	&nbsp;</li>
</ul>

The diagnostic approach will vary based on the patient&#39;s symptoms, history, and clinical presentation. Once a diagnosis is made, treatment can be tailored to address the specific cause of the diarrhea, whether it&#39;s an infection, underlying medical condition, dietary issue, or medication-related concern. 
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Treatment

The treatment for diarrhea in adults depends on the underlying cause and severity of symptoms. In many cases, diarrhea is self-limiting and can be managed with simple measures. However, if the diarrhea is severe, persistent, or accompanied by other concerning symptoms, medical evaluation and intervention are important. Here are some general guidelines for treating diarrhea in adults:

<ul>
	<li>Hydration - The patient is advised to drink plenty of clear fluids, such as water, clear broths, oral rehydration solutions (ORS), and diluted fruit juices, to prevent dehydration caused by fluid loss. 
	&nbsp;</li>
	<li>Dietary Modifications - The patient must consume a bland diet, including foods like plain rice, bananas, applesauce, and toast (BRAT diet), which can help soothe the stomach and provide easy-to-digest nutrients. It is advised to avoid fatty, greasy, spicy, high-fiber, and dairy-rich foods, as they may exacerbate diarrhea. 
	&nbsp;</li>
	<li>Oral Rehydration Solutions (ORS) - ORS solutions contain the right balance of electrolytes (sodium, potassium, chloride) and glucose to replace lost fluids and electrolytes due to diarrhea. They are especially important in cases of moderate to severe diarrhea. 
	&nbsp;</li>
	<li>Medications - Over-the-counter anti-diarrheal medications, such as loperamide (Imodium), can help reduce the frequency of bowel movements. However, these should be used cautiously and under a doctor&#39;s guidance, as they may not be suitable for all types of diarrhea. Antibiotics may be prescribed if bacterial infections are identified as the cause of diarrhea. However, antibiotics are not effective against viral infections and should only be used under medical supervision. 
	&nbsp;</li>
	<li>Manage Underlying Conditions - If diarrhea is a symptom of an underlying medical condition (e.g., irritable bowel syndrome, inflammatory bowel disease), proper management of the underlying condition is crucial. 
	&nbsp;</li>
	<li>Rest - Doctors typically advise patients to rest and avoid strenuous activities to allow their bodies to recover and conserve energy. 
	&nbsp;</li>
	<li>Probiotics -&nbsp; Probiotics, which contain beneficial bacteria, may help restore the balance of gut flora and alleviate some types of diarrhea. However, their effectiveness can vary, and it&#39;s best to consult a healthcare professional before using them. 
	&nbsp;</li>
</ul>

It&#39;s important to note that while some cases of diarrhea can be managed at home, others require medical intervention.

Note: If you&#39;re unsure about the cause or appropriate treatment for your diarrhea, or if your symptoms worsen or do not improve, it&#39;s recommended to seek medical advice to ensure proper care and prevent complications. Moreover, keep an eye on signs of dehydration, such as dark urine, dry mouth, excessive thirst, dizziness, and rapid heart rate. Seek medical attention if these symptoms are present. 
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Dehydration is the most common and one of the most dangerous complications of diarrhea. Severe dehydration can be life-threatening, especially in vulnerable populations like the elderly and young children. Other complications include:

<ul>
	<li>Electrolyte disturbances</li>
	<li>Weight loss</li>
	<li>Malnutrition</li>
	<li>Secondary infections 
	&nbsp;</li>
</ul>

The following factors can increase the risk of diarrhea in adults:

<ul>
	<li>Contaminated food and water</li>
	<li>Poor hygiene</li>
	<li>Weakened immune system (e.g., due to AIDS, organ transplant, etc)</li>
	<li>Medications</li>
	<li>Food allergies 
	&nbsp;</li>
</ul>

The following measures can help prevent diarrhea in adults:

<ul>
	<li>Wash hands thoroughly with soap and water after using the restroom, before handling food, and after touching potentially contaminated surfaces.</li>
	<li>Properly cooking and storing food.</li>
	<li>Washing fruits and vegetables before consuming them.</li>
	<li>Staying up to date with recommended vaccinations, e.g., for hepatitis and rotavirus.</li>
	<li>Eating a balanced and nutritious diet.</li>
	<li>Using antibiotics as per doctor&rsquo;s instructions. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Diarrhea is characterized by frequent loose or watery stools, often accompanied by abdominal discomfort.</li>
	<li>Common causes include infections (bacterial, viral, parasitic), dietary factors, medications, and underlying conditions.</li>
	<li>Acute (short-term), persistent (2-4 weeks), chronic (over 4 weeks), traveler&#39;s diarrhea, antibiotic-associated, inflammatory, osmotic, and functional diarrhea are some common types of diarrhea in adults.</li>
	<li>Diarrhea can lead to dehydration, electrolyte imbalances, malnutrition, secondary infections, and impact the quality of life.</li>
	<li>Medical history, physical examination, stool analysis, blood tests, colonoscopy/endoscopy, imaging, and allergy/intolerance testing may be used to detect the underlying cause of diarrhea.</li>
	<li>Treatment includes hydration, BRAT diet, oral rehydration solutions (ORS), medications (antidiarrheals, antibiotics if needed), and addressing underlying causes.</li>
	<li>Dehydration, electrolyte imbalances, malnutrition, secondary infections, gastrointestinal disorders, and other health issues can arise if diarrhea is left untreated.</li>
	<li>Contaminated food/water, poor hygiene, medications, underlying conditions, age, weakened immune system, travel, and certain foods increase the risk of diarrhea.</li>
	<li>Practice proper hand hygiene, safe food handling, and water consumption, maintain personal hygiene, get vaccinated, practice safe sex, manage stress, and be cautious with medications to prevent diarrhea.</li>
	<li>Consult a doctor for severe or persistent diarrhea, especially if accompanied by dehydration, blood in stool, fever, or other concerning symptoms.</li>
</ul>