Gastroenterology & Hepatology

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Division of Gastroenterology & Hepatology

Diarrhea

What is Diarrhea?
Diarrhea is a common problem most frequently defined as more frequent or water bowel movements. “Acute” episodes of diarrhea usually improve spontaneously after a few days. “Chronic” diarrhea lasts for more than 3 weeks and is usually considered as more serious.

 

Symptoms of Diarrhea
Common symptoms of diarrhea are:

  • Loose or watery stools
  • Urgency  with passage of stools
  • More frequent stools than usual
  • Crampy pain or rectal spasms
  • Aggravation following meals

 

Normal Bowel Function
Following eating fluids are added to the food as it passes thru the digestive tract. Nutrients are absorbed during food transit (thru the small intestine 18 feet) and undigested debris empties into the color (3 feet of large intestine). The primary function of the colon is absorption of excess fluid from the debris as it passes out as stool, usually in 1 to 3 days.

 

Diarrhea
Diarrhea is the intestinal tract’s response to an infection, irritation or inflammation frequently resulting in secretion of excessive secretion into the digestive system. The colon is unable to absorb this over load and continuing excess of fluid results in frequent loose or watery stools. The stooling may occur both day and night and in the presence of an inflammatory process may contain blood. The loss of excessive fluid may lead to dehydration and/or electrolyte depletion in severe cases of diarrhea. Abdominal cramping is experienced often prior to defection.

 

Common causes of diarrhea
The most common causes of acute limited episodes of diarrhea are viral and bacterial sources and medications (especially antibiotics). Certain foods (seafoods) and spices may prompt an episode of diarrhea too. Other food products such as lactose, fructose, and gluten may cause recurrent diarrhea. Inflammation of the small bowel (“enteritis”) and the colon (“colonitis”) may result in chronic diarrhea and other systemic complications.

 

Assessment of the problem
The majority of cases of diarrhea are short lived. If the diarrhea is protracted, incapacitating or associated with blood in the stool you should consult your doctor promptly. An appropriate evaluation by your physician will direct you towards appropriate treatment and resolution of the diarrhea.

 

Clinical Evaluation
During assessment of your situation an accurate and hopefully detailed history is most important. The following questions are often asked by your physician.

  • How long have you had the diarrhea?
  • What is the pattern of the diarrhea?
  • Is there associated cramping, bleeding?
  • Did you eat out at a restaurant; food type?
  • Have you taken antibiotics in the last few weeks?
  • Have you had a fever, headaches, or muscle soreness?
  • Have you traveled recently? Outside the USA?
  • Is there a history of IBD in the family?
  • Have you experienced similar episodes in the past?
  • Have you lost weight, been anemic recently?

The physical exam will evaluate your overall condition including vital signs and temperature. A blood count, electrolyte panel, and often times, a stool culture will be obtained.  Additional diagnostic testing depends upon the clinical situation e.g. colonoscopy, abdominal x-ray imaging and tissue sampling of the small intestine may be helpful.

 

Diarrhea Treatment
Acute episodes of diarrhea usually respond to a combination of rest, fluid replacement and restriction of food intake for a few days. Viral gastroenteritis, food “poisoning” and intolerance are the most frequent non-bacterial causes. However , the notorious bacteria, C. Difficile is the most common cause of community diarrhea now and this organism is capable of causing severe diarrhea and requires specific antibiotic treatment and possibly hospitalization.

The question of using anti-diarrhea medication to reduce the diarrhea has not been resolved. Some authorities caution that these medications are contraindicated because they permit prolonged exposure to the offending agents. However, the judicious use of Pepto Bismal or Imodium may be helpful in certain instances. Replenishment of fluid loss with clear fluids or Gatorade is often useful. Bed rest can be helpful.  Other treatment modalities may be necessary depending on the nature of diarrhea. Your physicians will determine this.

 

When to contact your physician
Contact your physician if you experience:

  • Extreme, protracted diarrhea
  • Diarrhea lasting longer than 1 week
  • Severe abdominal cramping
  • High fever or bloody stools
  • Severe dehydration (dizziness, dry mouth, rapid pulse, dark urine)

 

 

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Page Updated 10/02/2014