Diarrhea: What Are the Causes and How is It Treated?

Diarrhea is a common digestive problem most people experience as often as a couple of times per year. Diarrhea is loose or watery bowel movements that occur more than three times per day. Acute diarrhea is common and generally resolves on its own after a few days. Diarrhea that lasts longer may require treatment or evaluation.

What causes diarrhea?

Diarrhea can be normal, even though it is not a part of your daily life. Acute diarrhea can occur suddenly, is quite common, and does not require treatment other than rest, comfort, and increased fluid intake. It typically lasts only a few days. Persistent diarrhea lasts for two to four weeks. Chronic diarrhea lasts longer than four weeks. Symptoms of chronic diarrhea may also come and go for long periods.

Several factors can prompt diarrhea:

  • Bacteria like Escherichia coli (E. coli) and Salmonella can contaminate food or water and cause diarrhea. This is common with traveler’s diarrhea but also occurs in food preparation, storage, and transport.
  • Many viruses can cause diarrhea, like norovirus, adenovirus, cytomegalovirus, rotavirus, and gastroenteritis.
  • Parasites can also contaminate food and water, resulting in diarrhea.
  • Diarrhea may result as a side effect of a medication. This can happen with antibiotics that eliminate bacteria in the body, including those that fight infections.
  • Intolerance to lactose and other ingredients, as well as allergies to foods such as eggs, grains, wheat, soy, and more, can result in diarrhea.
  • Foods high in fructose or sugar substitutes may cause some people digestive discomfort.
  • Several digestive tract illnesses like celiac disease, Crohn’s disease, irritable bowel syndrome, and ulcerative colitis cause ongoing diarrhea.
  • Surgeries on the gallbladder, intestines, pancreas, stomach, and other abdominal surgeries can lead to chronic diarrhea.

Who can get diarrhea?

Diarrhea can affect anyone. It is a common illness that tends to pass quickly. Be sure to closely monitor young children, the elderly, and chronically ill individuals who experience diarrhea, as its effects can quickly compound and create additional health risks.

Symptoms of diarrhea

The most notable symptoms of diarrhea are loose and watery bowel movements. Other symptoms can be mild to severe and may include:

  • Bloating
  • Cramping or abdominal pain
  • Urgent need to have a bowel movement
  • Nausea

Severe symptoms include:

  • Vomiting
  • Fever
  • Blood in stool
  • Dizziness

Severe or persistent symptoms can lead to dehydration or malabsorption. Dehydration occurs when someone is not taking in enough water and electrolytes to compensate for how much fluid is going out. Malabsorption occurs when the small intestine does not absorb enough nutrients from foods because it passes through too quickly. As a result, the body does not get enough nutrition.

Signs of dehydration:

  • Thirst
  • Dark-colored urine
  • Dry mouth
  • Lightheadedness, dizziness, or fainting
  • No tears when crying (more common in children)
  • Sunken eyes
  • Irritability
  • Less frequent or no urination in 24 hours
  • Confusion

Contact your healthcare provider if you experience severe diarrhea or symptoms for longer than four days. This is particularly important for infants, toddlers, young children, and the elderly. If you experience any of the following, seek emergency care:

  • Fever over 102ºF (39ºC)
  • Six or more loose stools in 24 hours
  • Severe abdominal or rectal pain
  • Black, tarry, or bloody stools
  • Symptoms of dehydration

Diagnosing diarrhea

Discuss your symptoms with your healthcare provider if they continue longer than a few days. Diarrhea can be a sign of other health issues. Acute diarrhea does not require treatment beyond supportive therapy, including rest, a bland diet, and staying hydrated.

With severe, persistent, or chronic diarrhea, your healthcare provider will complete a physical exam and gather information about your medical and family history. This will include:

  • How long have you had diarrhea?
  • How often do you move your bowels on a normal day?
  • How much do you go when you use the bathroom?
  • What does it look like? (color, consistency, etc.)
  • Do you have any other symptoms that accompany the diarrhea?
  • What food and drinks do you regularly have that may contribute to diarrhea?
  • Have you done any recent traveling, taken any new medications, or engaged in other behaviors that are known causes of diarrhea?
  • Do you have a family history of celiac disease, Crohn’s disease, lactose intolerance, colitis, etc.?

Providers may issue a stool test to determine the cause if they suspect the presence of blood, infection, parasites, or other diseases. Blood tests may also help determine if inflammatory conditions play a part. In some cases, elimination diets may rule out whether or not food is the problem. Your healthcare provider can guide you through the process of a diet like this.

At times, additional testing may be necessary. An endoscopy test can examine your digestive tract with a tiny flexible camera to see if internal problems contribute to diarrhea. These tests might include a colonoscopy, flexible sigmoidoscopy, or upper gastrointestinal endoscopy.

Managing diarrhea

As mentioned above, acute diarrhea requires little more than adequate hydration and a bland diet:

  • Plenty of water can keep you hydrated. You can also add broth, natural fruit juice, and electrolyte drinks to replenish your energy.
  • A bland diet means avoiding greasy and fatty foods that aggravate diarrhea symptoms. The BRAT diet will keep things bland: bananas, rice (white), applesauce, and toast. You can also try lean meat, fish, noodles, potatoes, white bread, or bland starches if you tolerate the first four items well.
  • Avoid caffeine, foods that cause gas, and anything else that would typically upset your gut.

For infants and young children with diarrhea:

  • Notify your healthcare provider as soon as possible
  • Do not use any over-the-counter medications
  • Provide adequate hydration with breast milk or formula for infants. You can also offer pediatric electrolyte drinks, but only for older children.

Over-the-counter medications, such as loperamide and bismuth subsalicylate, are available for diarrhea. However, it is essential not to use these medications for diarrhea with blood in the stool or fever. Infections and parasites could cause this type of diarrhea, which requires prompt treatment. Additionally, these medications will stop the symptoms, which is not recommended since the body needs to eliminate the offending germ(s).

Disease-specific medications or antibiotics may be necessary to treat the cause of diarrhea. Probiotics may increase good bacteria in the gut. Discuss this with your healthcare provider.

Preventing diarrhea

Some basic prevention methods can minimize your risk of getting or spreading this uncomfortable illness:

  • Wash your hands frequently with warm water and soap for 30 seconds. Wash your hands before and after preparing food, especially uncooked meat.
  • Vaccinations can prevent certain viruses like rotavirus, which are particularly important for infants.
  • Store foods at the correct temperatures, do not eat expired food, and cook food to recommended temperatures.
  • Avoid traveler’s diarrhea by only drinking treated water. Avoid tap water, ice cubes, brushing your teeth with tap water, and unpasteurized dairy products. Also, use caution when trying local foods, raw fruits and vegetables, and undercooked meats.

Diarrhea is a common illness that affects most people at some point. It usually passes within two to three days without treatment. Consult your healthcare provider if your diarrhea lasts longer than two weeks to determine if there is an underlying health issue. It’s important to avoid dehydration when dealing with diarrhea, especially in very young and older adults, since this can lead to additional complications.

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