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Diarrhea
Always a bother, sometimes serious

In Canada, the United States and Europe, diarrhea is an important cause of death in young children. In less developed countries, diarrhea accounts for more infant deaths than any other ailment. Most cases of diarrhea are mild and cause no long-term ill effects. However, severe cases can cause many complications, including brain damage.

What is diarrhea?

Most people think diarrhea is just watery bowel movements. In fact, any change in the usual bowel pattern which causes more frequent stools (bowel movements), more size or weight of stool, or more soft or liquid stool is diarrhea. Other factors which may go along with diarrhea include nausea or vomiting, fever, stomach cramps, mucous or blood in the stool. Diarrhea may be caused by an infection (virus, bacteria or parasite), certain medications or inflammatory bowel disease. Diarrhea can also be caused by lactose deficiency. This is a condition where milk sugar, lactose, cannot be digested.

Infections elsewhere in the body such as the middle ear, kidney or lungs may cause a bout of diarrhea. Parasites are sometimes the reason. Loose stool which is not caused by infection may be a reaction to foods or drink and certain medications. For instance, a child who is given large amounts of sugar or fruit juice that is not diluted properly may develop diarrhea. Some antibiotics destroy ‘good’ harmless bacteria allowing diarrhea-causing bacteria grow and cause illness.

An infection from a virus can cause damage to the small bowel lining. This may lessen the body’s ability to digest and absorb the nourishment from food. Incompletely digested protein and carbohydrate can remain in the intestine, trapping water and causing diarrhea.

The biggest problem related to diarrhea is dehydration. This is when the body has lost a lot of water and important salts (electrolytes). When this occurs the blood circulation is not good and important organs such as the kidney and brain begin to function poorly. This is more likely to happen if there is frequent diarrhea and vomiting.

Why is treatment important?

When diarrhea does occur, important body fluids and salts (electrolytes) are lost. Patients may eat less food because they associate taking food in with increased diarrhea.

Eating less is not a good idea because the body does not get the foods and fluids it needs to heal. Even when a person has diarrhea, the body can still absorb some of the nutrition it needs such as glucose, water and salt. Starvation can actually make matters worse! It is important to continue to take food and fluids during the illness.

Most bouts of diarrhea will last one to two weeks and then will get better. The early treatment usually means just taking the correct food and fluids. Sometimes people get relief of their symptoms (diarrhea) by taking Imodium, an anti-motility agent. This agent should not be used if a fever is present or if there is blood in the stool. Antibiotics are rarely needed but may be ordered by a doctor if certain specific germs are known to be present.

The best treatment for diarrhea is prevention

The germs which cause diarrhea may be passed easily within a family. Try to keep family members with loose stools away from those who are not ill. Encourage everyone from an early age to wash their hands after using the toilet and before meals. Anyone caring for an infant should wash carefully after changing diapers. Try to avoid other people being exposed to dirty diapers.

Breastfeeding helps prevent diarrhea in infants because it produces stools of slightly acidic nature. This in turn helps ‘good’ bacteria to grow. Breast milk also contains special proteins, called immunoglobulins, which resist infection.

If your baby is bottle-fed, bottles and nipples must be sterile and the water used to make formula must be boiled (up to ten minutes to kill hardy germs such giardiasis). Once the infant is well established on solids you no longer need to sterilize and boil, but still keep everything very clean.

Diarrhea is an unpleasant condition that most of us will have at some time. With proper care, the condition is usually a short-term bother. Severe cases, especially in the very young or elderly, will need close and continued observation to be sure that more intensive medical care is obtained when needed.

Adults should see a doctor if any of the following occur:

• Severe pain in the abdomen or rectum
• Blood or worms in the stool
• Fever greater than 38.5°C/102°F
• Diarrhea continuing longer than 48 hours
• Signs of dehydration such as dry mouth, excessive thirst, wrinkled skin, little or no urine passed, dizziness or lightheadedness

Children should see a doctor if any of the following occur:

• Severe diarrhea and/or vomiting for more than 24 hours
• Blood or worms in the stool.
• Fever greater than 38.5°C/100.5°F (if less than six months old)
• Fever greater than 38.5°C/102°F (for those older than six months)
• Signs of dehydration as above for adults, plus no tears, rapid pulse or breathing, sunken eyes and soft spot (fontanelle), poor colour (pale) or lethargic (sleepy)

What to do for diarrhea in adults

For adults with acute diarrhea, replacing fluids is essential.

For the first day: clear fluids

• Cola or tea without caffeine, non-fat broth, non-diet ginger-ale, cream soda, orange soda, gelatin, Gastrolyte
• About 2 litres per day (3 litres if fever is present)
• Avoid apple and prune juices because of their laxative action

For the next 24 hours: bland foods

• Cooked cereals, rice, soup, bread, crackers
• Bananas, baked potatoes, applesauce
• Avoid fresh fruits, vegetables, fried or spicy foods, bran, candy, drinks with alcohol or caffeine. Avoid milk because some bacterial infections can cause short-term lactase deficiency.

If nausea and/or vomiting are present, keep fluid intake high by taking small sips of liquids. Chilled liquids may be more pleasant to take, but should not be too cold. Take small amounts of fluid rather than large amounts, which may be hard to handle.

Patients require fluids and electrolytes. Solutions containing these are commercially available and they can be made at home. The commercially available products are Gastrolyte, Pedialyte and Lytren. A recipe follows for a home-made mixture to be used to replace fluids lost (oral rehydration). Normal solids can be restarted gradually as they will give food and energy to help the bowel recover and to prevent weight loss. To help the digestive system absorb food and water, continue to eat and drink during the diarrhea.

Special attention must be paid to the elderly. They may need medical care sooner to help with their illness.

How should you treat a child suffering from diarrhea?

Check rectal or oral temperature several times a day. Be careful to observe good hygiene to prevent other family members developing the illness. Watch for signs of dehydration and replace fluids lost for the first 24 hours.

For infants less than six months

If the infant is breast-feeding, replace fluids by continuing to nurse and offering clear liquids between feedings. If an infant is on formula only, offer clear fluids for the first 24 – 48 hours then restart either half-strength formula or half-strength soy formula. Move onto full strength for the next day to two days if diarrhea does not return.