Diarrhea

Diarrhea occurs when the intestines don't absorb enough water from digested food, or when they secrete excess fluid. This results in loose, watery stools that can quickly lead to dehydration if fluids and electrolytes aren't replaced. The condition can be acute (lasting days) or chronic (lasting weeks or longer).

While uncomfortable and inconvenient, acute diarrhea often serves as the body's way of eliminating harmful substances or pathogens. The rapid transit through the digestive system prevents absorption of toxins but also reduces absorption of water and nutrients.

Chronic diarrhea, lasting more than four weeks, may indicate underlying conditions such as inflammatory bowel disease, malabsorption disorders, or chronic infections. Understanding the pattern, triggers, and associated symptoms helps determine the cause and appropriate treatment.

Infectious Causes

• Viral infections: Norovirus, rotavirus, adenovirus
• Bacterial infections: E. coli, Salmonella, Shigella, Campylobacter
• Parasites: Giardia, Cryptosporidium, Entamoeba
• Food poisoning: Contaminated food or water
• Traveler's diarrhea: Usually bacterial (ETEC)
• C. difficile: After antibiotic use

Chronic Digestive Disorders

• IBS: IBS with diarrhea (IBS-D)
• Inflammatory bowel disease: Crohn's disease, ulcerative colitis
• Celiac disease: Gluten intolerance
• Microscopic colitis: Lymphocytic or collagenous
• Chronic pancreatitis: Enzyme deficiency
• Bile acid malabsorption: After gallbladder removal

Food Intolerances

• Lactose intolerance: Dairy products
• Fructose malabsorption: Fruits, honey, HFCS
• Sugar alcohols: Sorbitol, xylitol in sugar-free products
• FODMAPs: Fermentable carbohydrates
• Caffeine sensitivity: Coffee, tea, energy drinks
• Spicy foods: Capsaicin irritation

Medications

• Antibiotics: Disrupt gut bacteria
• Antacids: Containing magnesium
• Metformin: Diabetes medication
• NSAIDs: Can irritate gut
• Chemotherapy drugs: Common side effect
• Laxative abuse: Chronic use
• Heart medications: Digoxin, quinidine

Other Causes

• Stress and anxiety: Gut-brain connection
• Hyperthyroidism: Speeds up digestion
• Diabetes: Autonomic neuropathy
• Alcohol abuse: Damages intestinal lining
• Running/exercise: Runner's diarrhea
• Surgery: Bowel resection, gallbladder removal

Diarrhea often occurs with other symptoms that help identify the cause:

• Abdominal pain and cramping: Common with most causes
• Nausea and vomiting: Suggests gastroenteritis
• Fever: Indicates infection
• Bloating and gas: Common with IBS, food intolerances
• Urgency: Need to rush to bathroom
• Tenesmus: Feeling of incomplete evacuation
• Weight loss: Chronic diarrhea concern
• Fatigue: From dehydration or malabsorption
• Mucus in stool: IBD or infection
• Night sweats: May indicate serious cause

Medical History

• Duration and frequency of diarrhea
• Stool appearance (watery, bloody, mucus)
• Associated symptoms
• Recent travel history
• Food and water sources
• Medication use
• Contact with ill persons
• Underlying health conditions

Physical Examination

• Vital signs check
• Dehydration assessment
• Abdominal examination
• Rectal examination if indicated
• Skin turgor test
• Weight loss evaluation

Diagnostic Tests

• Stool tests: Culture, ova and parasites, C. diff toxin
• Blood tests: CBC, electrolytes, inflammatory markers
• Colonoscopy: For chronic diarrhea
• Hydrogen breath test: Lactose intolerance, SIBO
• Celiac panel: Blood test for celiac disease
• Imaging: CT scan for complications

• Rice water: Provides electrolytes and reduces frequency
• Bananas: Replace potassium, easy to digest
• Toast and crackers: Absorb excess fluid
• Apple sauce: Pectin helps firm stools
• Chamomile tea: Anti-inflammatory, soothing
• Ginger: Reduces cramping and nausea
• Probiotics: Restore gut bacteria balance
• Psyllium husk: Adds bulk to stools
• Avoid sugar: Can worsen diarrhea
• Rest: Allow body to recover

• Hand hygiene: Wash hands frequently and thoroughly
• Food safety: Proper cooking and storage
• Safe water: Drink purified water when traveling
• Avoid risky foods: Raw/undercooked meat, unpasteurized dairy
• Identify triggers: Keep food diary
• Manage stress: Practice relaxation techniques
• Gradual diet changes: Introduce new foods slowly
• Probiotics: Maintain healthy gut flora
• Vaccination: Rotavirus vaccine for infants
• Medication awareness: Know side effects

Adults Should Seek Care For:

• Diarrhea lasting more than 3 days
• Severe abdominal or rectal pain
• Blood or pus in stools
• Black, tarry stools
• Signs of dehydration
• Fever over 102°F (39°C)
• Persistent vomiting
• Recent antibiotic use
• Chronic diarrhea (over 4 weeks)
• Significant weight loss

Children Need Immediate Care For:

• No wet diaper in 3+ hours
• Dry mouth or tongue
• Crying without tears
• Sunken eyes or cheeks
• Fever over 102°F (39°C)
• Blood in stools
• Unusual drowsiness