Diarrhoea means having more frequent loose watery stools. Diarrhoea that comes suddenly and lasts no longer than a couple of days is referred to as acute diarrhoea. Most people with acute diarrhoea will recover on their own without any medical intervention. Diarrhoea that lasts for more than 2 weeks is termed chronic diarrhoea and this usually requires medical care to find out the cause of the diarrhoea and treat complications like dehydration. When people travel abroad especially to areas with poor standard of public hygiene, they may develop diarrhoea and this type is called traveller’s diarrhoea.
Diarrhoea is clinically defined as having loose watery stools more than 3 times in a day or volume of loose watery stools greater than 200mls in a day.
Diarrhoea can affect both men and women, children and adults. Loose but non-watery stools in babies who are exclusively breastfed is considered as normal. Some infants can also go to toilet about 3 or 4 times in a day which may be considered normal for them. Diarrhoea is actually more about how watery the stools are than how frequent one goes to toilet.
You can get diarrhoea through direct contact with others who have diarrhoea or from ingesting contaminated food or water (food poisoning). About 1.7 – 5 billion cases of diarrhoea occur per year worldwide, with the highest prevalence in developing countries where young children get diarrhoea averagely 3 times in a year. In 2012, diarrhoea was announced to be the second most common cause of death in children younger than 5 years.
COMMON CAUSES OF DIARRHOEA
Infection of the gastrointestinal tract (gastroenteritis) is the most common cause of diarrhoea. The infections can come from different infectious agents such as :
- Viruses : Rotavirus is the most common cause of diarrhoea in children. Other viruses that can cause diarrhoea include norovirus, enterovirus and hepatitis virus.
- Bacteria : Such as E. Coli, Salmonella, Shigella, Campylobacter, Clostridium Difficele and Vibrio Cholerae are among the most common causes of bacterial diarrhoea.
- Parasites : Parasitic organisms like Giardia Lamblia which cause giardiasis and amoebiasis as well as other parasites like cryptosporidium spp., E. Histolytica, Blastocystis spp., and Contemporary cayetaneisis are responsible for certain incidences of diarrhoea.
The duration of the diarrhoea often depends on the causative organisms. Diarrhoea from norovirus lasts up to 2 days, rotavirus lasts 3 – 8 days, Campylobacter and Salmonella lasts 2 – 7 days, and diarrhoea from giardia parasite can last for several weeks.
Some medical conditions may come with diarrhoea as a symptom. They include coeliac disease, cystic fibrosis, thyroid disease, diabetes, adrenal diseases, zollinger-Ellison syndrome, short bowel syndrome, inflammatory bowel disease (ulcerative colitis), diverticulitis, inflammatory bowel syndrome, bowel cancer and other tumours like carcinoid tumours and pheochromocytoma.
Food allergies especially milk can contribute to diarrhoea in certain individuals. Those with lactose intolerance will always develop diarrhoea after consuming milk above their threshold.
Foods that are very rich in fibre like fruits and vegetables and whole grains (including beans) can cause diarrhoea when consumed beyond moderation.
There are several medications whose side effects include diarrhoea. People taking such drugs will experience episodes of diarrhoea when placed on such medications which usually stops as soon as the medication is discontinued. It is advisable to report to your doctor if you are experiencing such during any current treatment you are on.
Psycho-physical factors like anxiety can predispose an individual to develop diarrhoea. This however vary from person to person and cannot be generalised. The exact mechanism of how anxiety causes diarrhoea in some people is still not very clearly understood but it’s important to note it as one of the possible predisposing factors for diarrhoea.
MANAGEMENT OF DIARRHOEA
The management of diarrhoea is step wise and depends on the failure of a simpler intervention to correct the complications of diarrhoea like dehydration and electrolyte imbalance.
Most cases of diarrhoea resolve on their own without any medical intervention. If diarrhoea is prolonged and fluid loss is minimal, fluid replacement by drinking lots of fluids especially water is advocated.
If fluid replacement by drinking plenty water is insufficient to manage the complications of the diarrhoea (electrolytes imbalance), oral rehydration salts (ORS) may be necessary to manage such diarrhoea.
In more severe diarrhoea where ORS can not sufficiently correct fluid and electrolyte loss (such as severe acute diarrhoea and cholera), intravenous fluids (drip) will be needed to effectively manage the diarrhoea with admission to the hospital.
Antidiarrhoeal medications like loperamide, bismuth subsalicyclate and antibiotics are only used when indicated. Antibiotics are used when diarrhoea comes with associated high fever.
Eating healthy foods should continue even during treatment of diarrhoea and babies should also continue to be breastfed during treatment of diarrhoea. Zinc and vitamin A supplementation have been shown to be very useful in managing diarrhoea.
When to See a Doctor
Report to the hospital when
- There is blood or mucus in your stool or your child’s stool
- Diarrhoea refuse to stop
- There is associated persistent vomiting
- There is severe continuous stomach ache
- You or your child have weight loss
- Stool is dark or black
- There are signs of dehydration (drowsiness, passing infrequent urine, loss of normal skin stretchiness, irritable behaviour, fast heart beat, decrease in consciousness).
Prevention of Diarrhoea
Diarrhoea can be prevented through improved personal and public hygiene like sanitation, water treatment and hand washing practice.
There are vaccination against diarrhoea causes by rotavirus for children under 5 years. Cholera vaccination is also available to protect against the deadly diarrhoea from cholera epidemics.
Breastfeeding a child helps to protect the child against several infections that can cause disease and diarrhoea in the babies fragile immune system. The WHO recommendation is 6 months compulsory exclusive breastfeeding for all babies before adding other tolerable foods. Breastfeeding should last up to 2 years ideally.