Diarrhea

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VOL 111 / NO 1 / JANUARY 2002 / POSTGRADUATE MEDICINE

People of all ages have bouts of loose, watery stools now and then. In fact, according to the National Institutes of Health, the average adult has diarrhea about four times a year. Most of the time, the problem lasts a day or two and goes away without any special treatment. Sometimes, however, diarrhea is more serious and requires prompt medical attention. It tends to cause the most severe problems in the very young, the very old, and people who have other health conditions.

What are the causes?

Diarrhea is most often caused by a bacterial or viral infection. Many times, the exact cause is not found because the disorder subsides quickly. In some cases, food intolerance, parasites, reactions to medications, or intestinal diseases are responsible.

People who visit foreign countries sometimes are at risk for traveler's diarrhea, which is usually caused by eating food or drinking beverages contaminated with bacteria, viruses, or parasites. Nowadays, traveler's diarrhea is less likely to cause severe problems, except perhaps during or after visits to developing countries.

Special concerns for infants

In newborn babies and other infants, diarrhea can be dangerous because it may quickly lead to dehydration. Therefore, a baby should be seen by a doctor if any of the following symptoms appear:

• Black stools or signs of blood or pus in bowel movements
• Temperature above 101°F (38.3°C)
• No improvement after 24 hours
• Signs of dehydration (see box)

What are the usual symptoms?

In adults or older children, diarrhea most often causes an urgent need to rush to the bathroom for relief, but cramping, abdominal pain, bloating, and nausea may occur as well. The simple form, sometimes called acute diarrhea, lasts a short time and is generally caused by infection. Chronic diarrhea lasts longer--3 weeks or more--and tends to occur with intestinal disorders, including irritable bowel syndrome, or diseases such as celiac disease or inflammatory bowel disease.

What is the best treatment?

Replacing lost fluids and electrolytes (potassium and sodium) generally is the most important step in treating diarrhea. Although water is important in preventing dehydration, it does not contain electrolytes. Therefore, the best treatment is often nonfat broth or soup that contains salt (sodium), along with orange juice or sport drinks, soft fruits, or low-fiber vegetables that contain potassium. Babies sometimes need a special rehydration solution; your doctor can recommend one that you can usually find at the grocery store.

Medicines that stop the loose stools may be helpful, but they are not generally recommended. In fact, stopping the diarrhea can trap organisms in the intestines, prolonging the problem. No drugs are available to treat viral infections, which usually run their course. However, antibiotics are sometimes given for bacterial infections that last longer than normal.

Until the diarrhea subsides, it is often a good idea to avoid milk products and foods that are greasy, rich in fiber, or very sweet. As you feel better, you can eat soft, bland foods, such as bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without skin or fat. Doctors sometimes recommend a "BRAT" diet for kids, which consists of bananas, rice, applesauce, and toast.

When to call the doctor

Although diarrhea usually doesn't cause serious problems for otherwise healthy children and adults, be sure to call the doctor right away if you notice any of these problems:

• Diarrhea that continues for more than 3 days
• Severe abdominal or rectal pain
• Temperature of 102°F (38.9°C) or higher
• Bloody or black, tarry-looking stools
• Signs of dehydration (see box)

It's always best to play it safe. If you have questions about diarrhea, call for professional advice.

Signs of dehydration

General signs of dehydration include the following:

• Thirst
• Reduced urine output
• Dry skin
• Fatigue
• Light-headedness
• Dark-colored urine

In young children, special concerns include:

• Dry mouth and tongue
• No tears when crying
• No wet diapers for 3 hours or more
• Fever
• Listlessness or irritability
• Sunken eyes, cheeks, or abdomen
• Skin that does not flatten when pinched and released

This information is not a substitute for medical treatment.

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