Diarrhea
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Diarrhea--loose, watery stools occurring more than three times in
one day--is a common problem that usually lasts a day or two and
goes away on its own without any special treatment. However,
prolonged diarrhea can be a sign of other problems. People with
diarrhea may pass more than a quart of stool a day.
Diarrhea can cause dehydration, which means the body lacks enough
fluid to function properly. Dehydration is particularly dangerous
in
children and the elderly, and it must be treated promptly to avoid
serious health problems.
People of all ages can get diarrhea. The average adult has a bout
of diarrhea about four times a year.
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Diarrhea may be caused by a temporary problem, like an infection,
or a chronic problem, like an intestinal disease. A few of the more
common causes of diarrhea are
- Bacterial infections. Several types of bacteria,
consumed through contaminated food or water, can cause diarrhea.
Common culprits include Campylobacter, Salmonella,
Shigella, and Escherichia coli.
- Viral infections. Many viruses cause diarrhea,
including rotavirus, Norwalk virus, cytomegalovirus, herpes
simplex virus, and viral hepatitis.
- Food intolerances. Some people are unable to digest
some component of food, such as lactose, the sugar found in
milk.
- Parasites. Parasites can enter the body through food or
water and settle in the digestive system. Parasites that cause
diarrhea include Giardia lamblia, Entamoeba histolytica,
and Cryptosporidium.
- Reaction to medicines, such as antibiotics, blood
pressure medications, and antacids containing magnesium.
- Intestinal diseases, like inflammatory bowel disease or
celiac disease.
- Functional bowel disorders, such as irritable bowel
syndrome, in which the intestines do not work
normally.
Some people develop diarrhea after stomach surgery or removal of
the gallbladder. The reason may be a change in how quickly food
moves through the digestive system after stomach surgery or an
increase in bile in the colon that can occur after gallbladder
surgery.
In many cases, the cause of diarrhea cannot be found. As long as
diarrhea goes away on its own, an extensive search for the cause is
not usually necessary.
People who visit foreign countries are at risk for traveler's
diarrhea, which is caused by eating food or drinking water
contaminated with bacteria, viruses, or, sometimes, parasites.
Traveler's diarrhea is a particular problem for people visiting
developing countries. Visitors to the United States, Canada, most
European countries, Japan, Australia, and New Zealand do not face
much risk for traveler's diarrhea.
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Diarrhea may be accompanied by cramping abdominal pain, bloating,
nausea, or an urgent need to use the bathroom. Depending on the
cause, a person may have a fever or bloody stools.
Diarrhea can be either acute (short-term) or chronic (long-term).
The acute form, which lasts less than 4 weeks, is usually related to
a bacterial, viral, or parasitic infection. Chronic diarrhea lasts
more than 4 weeks and is usually related to functional disorders
like irritable bowel syndrome or inflammatory bowel diseases like
celiac disease.
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Children can have acute or chronic forms of diarrhea. Causes
include bacteria, viruses, parasites, medications, functional
disorders, and food sensitivities. Infection with the rotavirus is
the most common cause of acute childhood diarrhea. Rotavirus
diarrhea usually resolves in 3 to 9 days.
Medications to treat diarrhea in adults can be dangerous to
children and should be given only under a doctor's guidance.
Diarrhea can be dangerous in newborns and infants. In small
children, severe diarrhea lasting just a day or two can lead to
dehydration. Because a child can die from dehydration within a few
days, the main treatment for diarrhea in children is rehydration.
Take your child to the doctor if any of the following symptoms
appear:
- stools containing blood or pus, or black stools
- temperature above 101.4 degrees Fahrenheit
- no improvement after 24 hours
- signs of dehydration
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General signs of dehydration include
- thirst
- less frequent urination
- dry skin
- fatigue
- light-headedness
- dark colored urine
Signs of dehydration in children include
- dry mouth and tongue
- no tears when crying
- no wet diapers for 3 hours or more
- sunken abdomen, eyes, or cheeks
- high fever
- listlessness or irritability
- skin that does not flatten when pinched and released
If you suspect that you or your child is dehydrated, call the
doctor immediately. Severe dehydration may require
hospitalization.
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Although usually not harmful, diarrhea can become dangerous or
signal a more serious problem. You should see the doctor if any of
the following is true:
- You have diarrhea for more than 3 days.
- You have severe pain in the abdomen or rectum.
- You have a fever of 102 degrees Fahrenheit or higher.
- You see blood in your stool or have black, tarry stools.
- You have signs of dehydration.
If your child has diarrhea, do not hesitate to call the doctor
for advice. Diarrhea can be dangerous in children if too much fluid
is lost and not replaced quickly.
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Diagnostic tests to find the cause of diarrhea include the
following:
- Medical history and physical examination. The doctor
will need to know about your eating habits and medication use and
will examine you for signs of illness.
- Stool culture. Lab technicians analyze a sample of
stool to check for bacteria, parasites, or other signs of disease
or infection.
- Blood tests. Blood tests can be helpful in ruling out
certain diseases.
- Fasting tests. To find out if a food intolerance or
allergy is causing the diarrhea, the doctor may ask you to avoid
lactose (found in milk products), carbohydrates, wheat, or other
foods to see whether the diarrhea responds to a change in diet.
- Sigmoidoscopy. For this test, the doctor uses a special
instrument to look at the inside of the rectum and lower part of
the colon.
- Colonoscopy. This test is similar to sigmoidoscopy, but
the doctor looks at the entire colon.
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In most cases, replacing lost fluid to prevent dehydration is
the only treatment necessary. Medicines that stop diarrhea may
be helpful
in some cases, but they are not recommended for people whose
diarrhea is caused by a bacterial infection or parasite--stopping
the diarrhea traps the organism in the intestines, prolonging the
problem. Instead, doctors usually prescribe antibiotics. Viral
causes are either treated with medication or left to run their
course, depending on the severity and type of the virus.
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Dehydration occurs when the body has lost too much fluid and
electrolytes (the salts potassium and sodium). The fluid and
electrolytes lost during diarrhea need to be replaced promptly--the
body cannot function properly without them. Dehydration is
particularly dangerous for children, who can die from it within a
matter of days.
Although water is extremely important in preventing dehydration,
it does not contain electrolytes. To maintain electrolyte levels,
you could have broth or soups, which contain sodium, and fruit
juices, soft fruits, or vegetables, which contain potassium.
For children, doctors often recommend a special rehydration
solution that contains the nutrients they need. You can buy this
solution in the grocery store without a prescription. Examples
include Pedialyte, Ceralyte, and Infalyte.
Until diarrhea subsides, try to avoid milk products and foods
that are greasy, high-fiber, or very sweet. These foods tend to
aggravate diarrhea.
As you improve, you can add soft, bland foods to your diet,
including bananas, plain rice, boiled potatoes, toast, crackers,
cooked carrots, and baked chicken without the skin or fat. For
children, the pediatrician may recommend what is called the BRAT
diet: bananas, rice, applesauce, and toast.
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Traveler's diarrhea happens when you consume food or water
contaminated with bacteria, viruses, or parasites. You can take the
following precautions to prevent traveler's diarrhea when you go
abroad:
- Do not drink any tap water, not even when brushing your
teeth.
- Do not drink unpasteurized milk or dairy products.
- Do not use ice made from tap water.
- Avoid all raw fruits and vegetables (including lettuce and
fruit salad) unless they can be peeled and you peel them
yourself.
- Do not eat raw or rare meat and fish.
- Do not eat meat or shellfish that is not hot when served to
you.
- Do not eat food from street vendors.
You can
safely drink bottled water (if you are the one to break the seal),
carbonated soft drinks, and hot drinks like coffee or tea.
Depending on where you are going and how long you are staying,
your doctor may recommend that you take antibiotics before leaving
to protect you from possible infection.
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- Diarrhea is a common problem that usually resolves on its own.
- Diarrhea is dangerous if a person becomes dehydrated.
- Causes include viral, bacterial, or parasitic infections; food
intolerance; reactions to medicine; intestinal diseases; and
functional bowel disorders.
- Treatment involves replacing lost fluids and electrolytes.
Depending on the cause of the problem, a person might also need
medication to stop the diarrhea or treat an infection. Children
may need an oral rehydration solution to replace lost fluids and
electrolytes.
- Call the doctor if a person with diarrhea has severe pain in
the abdomen or rectum, a fever of 102 degrees Fahrenheit or
higher, blood in the stool, signs of dehydration, or diarrhea for
more than 3 days.
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American Gastroenterological Association
International Foundation for Functional Gastrointestinal
Disorders Inc.
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