Diarrhea occurs when too much fluid is passed along with the stool during a bowel movement. Normally, fluids in the digestive tract are reabsorbed through the intestinal walls, so that fecal matter solidifies as it travels through the digestive tract. If something interferes with the effectiveness of this process, you’ll pass excess fluid as you defecate.
It’s important to distinguish between two basic types of diarrhea. Non-inflammatory diarrhea is characterized by unformed, watery, and frequent bowel movements, often accompanied by abdominal cramps, gas, and nausea. This type of diarrhea is common, and an acute bout that is mild to moderate is often unpleasant and inconvenient (though it can be serious, particularly for children and the elderly, because of the risk of dehydration).
Inflammatory diarrhea is another matter. This is signaled by small stools, blood and/or pus in the stool, fever, and abdominal pain. These symptoms are indicative of a more serious bowel disease and should not be self-treated with an anti-diarrheal remedy or any other over-the-counter product. Anyone with these symptoms needs to be diagnosed by a physician before beginning treatment.
Symptoms of Diarrhea
- A change in bowel habits with unformed, watery and/or frequent bowel movements
- Loss of appetite
- Abdominal pain and cramping
- Excessive gas
- Weight loss
What Causes Diarrhea?
Simple non-inflammatory diarrhea has many causes. The leading cause is bacterial or viral infection from ingesting contaminated food or water.
In addition, specific types of diarrhea can occur after taking antibiotics as well as from excessive use of certain over-the-counter antacids that contain magnesium. People with lactose intolerance (who have trouble digesting milk products) may also suffer from recurrent diarrhea if they eat dairy products. Diarrhea may also be triggered by emotional stress.
Chronic diarrhea that persists for days or weeks can result from an excessive use of laxatives. Another cause of persistent diarrhea, often alternating with bouts of constipation, is called irritable bowel syndrome. (In these cases, or whenever diarrhea lasts for more than 48 hours, medical evaluation is recommended for determining the cause and applying the appropriate treatment.
What If You Do Nothing?
Fortunately, simple diarrhea is usually self-limiting—it gets better without treatment in a day or two as long as you drink plenty of fluids. However, diarrhea can have serious consequences when it causes dehydration.
Diarrhea in Children
Only illnesses such as colds occur more frequently during childhood than diarrhea. Often a child will develop diarrhea at the same time as, or immediately following, the start of an infection of the upper respiratory tract. Most diarrheas are short-term and usually run their course and improve without medication. Home treatment of children with short-term diarrhea is usually successful in a few days; severe cases may require a week or more until all signs and symptoms disappear.
For many mild cases of diarrhea, effective home treatment is usually sufficient to comfort your child. However, children require or can benefit from certain measures that aren’t necessary for adults.
Make sure the child drinks plenty of fluids. Fluids are most important, even if no solid food is eaten during the several days of an episode. As the frequency of stools increases, so does the need for fluids to keep up with losses. When a child is having frequent stools, a liquids-only diet is recommended. Once diarrhea begins to diminish, soft solid foods may be introduced, followed eventually by a normal diet.
Simple, clear liquids are most helpful. However, liquids like apple juice, cola drinks, and sports drinks contain too much sugar, which can exacerbate a child’s diarrhea. Plain water doesn’t replace lost minerals. Therefore, in infants and children up to 12, replace lost fluid with specially made rehydration drinks such as Infalyte, Naturalyte, Pedialyte and Rehydrate. These products contain the right amount of fluid, salts, and carbohydrates to prevent dehydration.
Children older than 12 can also consume sports drinks or the home rehydration mix described on page 242. Decaffeinated flat (defizzed) soda such as ginger ale,tea with sugar or diluted fruit-flavored gelatin are other acceptable choices.
For babies who are breast-feeding, continue regular feedings. Although breast milk contains lactose, it doesn’t appear to worsen diarrhea; some substance in the milk may actually enhance the digestion of lactose. For infants on baby milk formula, diluted versions of the formula they are taking is satisfactory.
Here is a suggested drinking schedule indicating the minimum amounts of fluid a child should consume. (If a child balks at drinking, encourage the child to take small sips. Sucking on ice chips or licking ice that has been frozen in a paper cup may be a welcome variation.)
- Infants: 2 ounces every hour (12 ounces, or one and a half cups, every 6 hours).
- Preschool children: 4 ounces every hour (24 ounces—3 cups—every 6 hours).
- School-age children: 5 ounces every hour (30 ounces—almost 4 cups—every 6 hours).
Follow the Regular Diet
If diarrhea occurs no more than twice in 24 hours, continue the same eating patterns. Contact your physician if stools are still loose after 36 hours.
Start the BRAT Diet
If diarrhea occurs as often as once every four hours, clear liquids and the BRAT diet (bananas, rice, applesauce, toast) can be started. These bland, easily digested foods will help speed recovery. If no change in diarrhea occurs within 24 hours, consult your physician.
Avoid fats, at least for several days. Fats won’t remain long enough in the intestines to be digested. While not harmful, this undigested food leads to foul-smelling bowel movements.
Protect the Sensitive Areas
Once an infant develops diarrhea, protect the diaper area with zinc oxide paste or petroleum jelly to prevent painful skin irritation. Change diapers more often, and with each change wash the child’s bottom with plain water and then rinse and pat dry with a clean towel.
Home Remedies for Diarrhea
You can obtain symptomatic relief with the following steps.
- First and foremost, drink fluids. You need to replace the water you’ve lost and—in more severe cases—restore the proper balance of electrolytes (sodium, potassium and chloride salts) that your body requires for the proper functioning of many organs, including the heart. Glucose or some other carbohydrate should also be consumed, to aid the absorption of electrolytes. For adults with little or no dehydration, drinking several types of clear liquids—fruit juices, clear broths, flat (de-fizzed) soft drinks—provides adequate rehydration. Sip small amounts for the first few hours, increasing your intake to as much as your stomach can handle. Try to drink at least one pint of fluid (16 ounces) every hour.
- For a severe attack of diarrhea, or when a child has diarrhea, it is more effective to consume an oral rehydration solution. You can buy a solution or make it yourself. These solutions don’t taste very good, however, and some people will balk at drinking them. An acceptable second choice is a sports drink like Gatorade. Sports drinks typically don’t contain enough sodium or potassium, and their high sugar content can sometimes aggravate the diarrhea. But they are better than plain water, caffeine-free soda or apple juice. To make up your own oral rehydration solution, dissolve a half teaspoon of salt and four teaspoons of sugar in one quart of water. (Be accurate—too much salt or sugar can cause further dehydration.) Younger children should drink a commercial solution.
- Avoid alcohol, caffeine, milk and dairy products, and any products containing the sweeteners sorbitol, xylitol and mannitol. The latter are most commonly found in sugarless gums, vitamins and diet foods.
- If you suspect food poisoning, you are probably better off letting the diarrhea run its course. This allows you to get the harmful bacteria and/or toxins out of your system. But also consult your doctor just to be sure that your diarrhea isn’t serious. (Traveler’s diarrhea may require different treatment strategies).
- If you suspect diarrhea is caused by a drug you are taking, call your doctor. This is especially true if you are taking an antibiotic. Also, stop using any over-the-counter antacids or laxatives until you’ve spoken to your doctor.
- Be careful with antidiarrheal medications. Wait a few hours after the onset of diarrhea before using one of these medications: you want to give your system a chance to get rid of whatever irritant is causing the problem. Once that occurs, some of the medications designed to alleviate diarrhea can be useful in certain cases. However, don’t use these medications if you have a fever or if there is blood or pus present in your stool. Over-the-counter products helpful for simple diarrhea include those containing loperamide (Imodium AD) and bismuth subsalicylate (Pepto-Bismol). Both are available in generic formulations that are just as effective as the name brands. Diphenoxylate hydrochloride (Lomotil) is an effective prescription medication. None of these products should be used, however, for diarrhea caused by taking an antibiotic. Products containing attapulgite or kaolin and pectin are generally not effective.
- Don’t stop eating. Cutting back on food aggravates dehydration and limits the nourishment necessary for the body to overcome dehydration. Follow the BRAT diet (bananas, rice, applesauce, toast). If you can’t hold down any food, continue to drink rehydration solutions, de-fizzed soda or an eight-ounce glass of fruit juice to which a pinch of table salt and a half teaspoon of table sugar have been added.
Alert: Signs of Dehydration
Contact your physician for any child who cannot retain fluids because of diarrhea. Dehydration, the severe loss of essential body fluids and salts, can occur rapidly and be life-threatening, especially for infants under six months of age. Signs of dehydration include
- fewer wet diapers
- cool, dry, pale skin
- dry tongue and no drooling
- rapid pulse
- sunken eyes
- no tears when crying, and
- sunken fontanelle, the soft spot on the top of an infant’s head
The most easily prevented cause of diarrhea is food poisoning. You simply need to take precautions when preparing, cooking and storing food. Above all, don’t consume any unpasteurized foods or beverages.
Also, avoid foods you know your body can’t tolerate well. People who are lactose-intolerant should avoid the dairy products that seem to trigger symptoms or should drink milk treated with lactase. Avoid taking large doses of vitamin C; too much vitamin C can cause diarrhea. Always observe proper and good hygiene. Washing hands before and after eating helps eliminate bacteria.
Beyond Home Remedies: When To Call Your Doctor
If you started taking—or have recently taken—a prescription drug, contact your physician. Antibiotics in particular can sometimes cause diarrhea by allowing a resistant organism normally present in your gastrointestinal tract (called Clostridium difficile) to grow excessively and produce enough toxin to cause a serious bout of diarrhea. Be sure to tell your doctor if you have been on a course of antibiotics.
At any age, diarrhea requires prompt medical attention if it lasts more than 48 hours or is accompanied by any of these symptoms.
- Severe abdominal cramping.
- Blood or pus in your stool.
- Lightheadedness or dizziness (indicating dehydration).
You should also consult a physician if you get frequent bouts of diarrhea or if you have alternate bouts of diarrhea and constipation, since this may be a sign of an underlying disorder.
For children: Call your doctor right away if diarrhea is accompanied by other symptoms such as severe abdominal pain or vomiting or if diarrhea lasts for more than one day in a child under the age of two, or two days in an older child. Call sooner if diarrhea worsens or if the child has a fever or bloody stools, or the number of bowel movements has not decreased in two days.
What Your Doctor Will Do
For acute diarrhea your doctor will examine your abdomen and often will have the stools examined in a laboratory. If a bacterial infection is present, antibiotics may need to be prescribed. Although the course of the diarrhea may not be shortened, the number of bowel movements will be reduced sharply and promptly in many cases. Chronic diarrhea will require more extensive evaluation of the stools, as well as blood tests and other examinations of the intestinal tract.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media