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Diarrhea: The passage of an increased amount of stool. This is frequently considered to be 3 or more stools per day, or excessively watery and unformed stool. Chronic diarrhea occurs when loose or more frequent stools persist for longer than two weeks.

Alternative Names: Stools - watery; Frequent bowel movements; Loose bowel movements

Considerations: The majority of diarrheal diseases result from infection, and are generally short lived, self-limiting conditions. Common forms of diarrhea are grouped under terms such as "stomach flu" and gastroenteritis. These conditions may include vomiting, and often appear in mini-epidemics in schools, neighborhoods, or families. Quite often parents and local physicians are aware the stomach flu is "going around".

Most diarrhea will stop without treatment in a few days. Certain drugs, such as antibiotics, can cause or worsen diarrhea.

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Common Causes: Diarrheal diseases can be grouped into several general categories.

1. INFECTIOUS - viruses, bacteria, parasites

2. TOXIC - Often referred to as "food poisoning" Toxins may be produced in foods as bacteria grow. These toxins are responsible for the associated vomiting and diarrhea. The most common toxin is an enterotoxin produced by staphylococcus species.

3. MALABSORPTION

There are other less frequently encountered causes of malabsorption.

4. INFLAMMATORY DISEASES OF THE BOWEL

  • Crohn's disease
  • Ulcerative colitis

5. IMMUNE DEFICIENCY

  • severe combined immunodeficiency
  • hypogammaglobulinemia
  • panhypogammaglobulinemia (Bruton)
  • chronic granulomatous disease
  • IgA deficiency

6. MEDICATIONS

  • antibiotics
  • laxatives (especially those containing Magnesium)
  • chemotherapy

7. CERTAIN TREATMENTS

  • gastrectomy
  • gastroenterostomy
  • high-dose radiation therapy

8. OTHER

  • Zollinger-Ellison syndrome
  • autonomic neuropathy (diabetic neuropathy)
  • Carcinoid syndrome
  • Bacterial overgrowth syndrome

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Home Care: The risk of developing diarrhea can be reduced by washing hands and avoiding contaminated food, utensils, or other objects. Children should be taught not to put objects in their mouth. Wash hands before and after using the bathroom and before meals.

Diarrhea that comes on suddenly and ends in a day or two is usually caused by an infection or food poisoning.

In general, don't try to stop diarrhea as soon as it develops. Diarrhea is the body's way of getting rid of whatever food, virus, or bug is causing it.

Adults with diarrhea: In adults with diarrhea, it may help to drink plenty of fluids to avoid becoming dehydrated.

In adults, non-prescription medications such as Pepto-Bismol, Kaopectate, Imodium, and Diasorb can help diarrhea. (Note: Pepto-Bismol can discolor the stools and can cause the tongue to turn black. This is a normal response to the medication and not something to be concerned about).

Enteral (formula tube) feedings often cause diarrhea. If you are experiencing diarrhea related to enteral tube feedings, consult your health care provider or dietician. The rate of the feedings may need to be changed or bulk agents may need to be added to the formula.

Adding bulk to the diet may thicken the stool and decrease the frequency of stools. Certain foods thicken the stools, including rice, bananas, yogurt, and cheese. An increase in fiber from whole-wheat grains and bran add bulk to the diet. Additionally, psyllium containing products such as Metamucil or similar products can be used to add bulk to the stools.

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Children with diarrhea: Children who are placed on antibiotics may experience diarrhea. Recent studies suggest that children on antibiotics are less likely to get diarrhea if they eat yogurt with active live cultures.

In children with diarrhea, it used to be recommended (but is no longer) to have the child drink plenty of clear fluids and avoid milk. Now, doctors recommend that children with mild diarrhea should stay on their normal diet -- children and infants with diarrhea should continue getting their normal amount of milk. It may help to switch these children to soy milk, if they will take it, but that is not necessary.

Pedialyte and similar rehydration fluids do NOT treat diarrhea. They are used for vomiting and cases of serious dehydration.

If a child has nausea or vomiting, the liquids should be given in small amounts but very frequently, often every 15 minutes. (Give liquids as directed by a health care provider). Home mixed electrolyte solutions should be avoided -- mixing mistakes can cause significant problems.

Diarrhea medications, even non-prescription ones, should NOT be used in infants and children unless a doctor has approved it. For example, Pepto-Bismol has aspirin-like compounds that are not safe in children.

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Traveler's diarrhea:

  • The best way to avoid traveler's diarrhea is to be careful about what is consumed.
  • "Boil it, peel it, cook it, or don't eat it," should apply to everything on the menu of even the fanciest restaurant in Latin American, Asian, or African countries. Food eaten there should be prepared just prior to serving.
  • "Traveler's diarrhea" usually stops spontaneously.
  • Drink lots of liquids to replace the lost fluids.

Call your health care provider if: black or bloody stools are present, or if abdominal pain is severe; there are signs of dehydration.

These include dry skin, dry mouth, sunken fontanelles (soft spot) in infants, rapid heart rate, confusion, weakness, abnormal skin turgor (when skin is pinched gently it remains together rather than resuming the normal shape; or the skin feels like bread dough).

Severe dehydration can develop in infants and small children within hours The most important signs to look for include
1) decreased activity level
2) no saliva in the mouth
3) cries without tears
4) decreased number of wet diapers; diarrhea persists for more than 4 days; other symptoms are present that may indicate a more serious problem, including explosive diarrhea, bloody diarrhea (gastrointestinal bleeding), tenesmus (ineffective straining to pass stool), high fever or fever with shaking chills, large amounts of mucus with bowel movement or mucus alone, stools - floating, dehydration, other systemic symptoms not normally seen with simple diarrhea.

What to expect at your health care provider's office: The medical history will be obtained and a physical examination will be performed, including detailed examination of the abdomen.

Medical history questions documenting diarrhea in detail may include:

TIME PATTERN:

  • When did the diarrhea start?
  • Are any other family members sick?
  • Have you recently traveled out of the country?
  • How long have you been experiencing diarrhea?

CHARACTERISTICS:

  • Is there blood in the stool?
  • Are you passing large amounts of mucus with the stool?
  • Are you experiencing abdominal pain and severe cramping with the diarrhea?
  • What is the color and consistency of the stool?

AGGRAVATING FACTORS:

  • Is it worse when you are stressed? Do any specific foods make it worse?

ASSOCIATED FACTORS:

  • What surgeries have you had?
  • What injuries have you had?
  • What medications do you take?
  • Do you drink coffee? How much?
  • Do you drink alcohol? How much? How often?
  • Do you smoke? How much each day?
  • Are you on a special diet? Enteral feedings (formula feedings)?

OTHER:

  • What other symptoms are also present?
  • Are you experiencing fever and chills?

Your doctor will ask you to obtain one or more stool samples for testing and culture. If there are signs of dehydration in addition to the diarrhea, the health care provider may order:

  • chem-20 (to check electrolytes)
  • urine specific gravity
  • BUN
  • creatinine
After seeing your health care provider, you may want to add a diagnosis related to diarrhea to your personal medical record.

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