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more about Diarrhea

  • Diarrhea is a condition in which the bowel movements become loose or watery and more frequent.  When severe, it can result in 10 or more watery bowel movements per day.  Diarrhea can be divided into several types: acute diarrhea, chronic diarrhea, and recurrent diarrhea; Infectious Diarrhea and nonInfectious Diarrhea; inflammatory diarrhea that inflames the colon, and noninflamatory diarrhea that does not inflame the colon.

  • Noninflammatory:
    1. Watery diarrhea
    2. Nausea/vomiting
    3. Abdominal cramps
  • Inflammatory:
    1. Bloody diarrhea
    2. Fever
    3. Abdominal cramps
    4. Pain in rectum after a bowel movement

  • Causes include viruses (rotavirus, enterovirus, adenovirus), bacteria (shigella, salmonella, E.coli), toxins produced by bacteria (as opposed to infection by the bacteria), or medications.
  • Acute diarrhea (noninfectious causes):
    1. Food poisoning -- from heavy metals, scombroid (toxins from certain fish), mushrooms
    2. Antibiotic-induced (Ampicillin)
    3. Hemolytic uremic syndrome
  • Acute diarrhea (infectious causes):
    1. Gastroenteritis (infection from viruses or bacteria)
    2. Systemic infection
  • Chronic diarrhea (noninfectious causes):
    1. Malabsorption (Disaccharidase deficiencies, Cystic Fibrosis, Celiac Disease)
    2. Milk protein or Lactose Intolerance
    3. Irritable colon syndrome
    4. Inflammatory Bowel Disease
    5. LaxativeAbuse
  •  Chronic diarrhea (infectious causes)
    1. Amebiasis
    2. Giardiasis
  • Noninflammatory diarrhea:
    1. Toxin producing bacteria
    2. Enterotoxigenic E. Coli
    3. Staphylococcus aureus -- toxin is released in unrefrigerated food
    4. Bacillus cereus -- bacteria found in unrefrigerated rice
    5. Clostridium perfringens
    6. Cryptosporidium -- common in persons with AIDS
    7. Viruses (rotavirus is common in children)
    8. Giardia (a parasite)
  • Inflammatory diarrhea:
    1. Shigella
    2. Salmonella
    3. Campylobacter
    4. Yersinia
    5. E. coli 0157:H7 -- severe infection found in undercooked meat, unpasteurized milk and cheese
    6. Clostridium difficile -- bacteria overgrowth in colon that occurs when antibiotics kill off good bacteria
    7. Amebae (parasites)

  • Stool checked for white blood cells
  • Stool checked for culture or toxins
  • White blood cell count in blood may be elevated
  • Blood chemistries may show depletion of electrolytes or Dehydration
  • Sigmoidoscopy (scope passed into colon) if diagnosis is unclear

  • Mild cases:
    1. Discontinuing lactose-containing formulas and milk
    2. Restart breastfeeding or regular feeding as soon as possible
    3. Adequate fluid intake should include water and fluids containing electrolytes (such as Gatorade)
    4. Avoid high fiber food such as fruits and vegetables
    5. "BRAT" diet is commonly prescribed, consisting of bananas, rice, applesauce, and toast.
    1. Oral rehydration with solutions such as Pedialyte
    2. Intravenous fluids may be necessary
  • For underlying cause of diarrhea:
    1. Antibiotics in bacterial causes 
    2. Discontinuing the antibiotics for antibiotic induced diarrhea
  • Note: it is generally recommended not to treat Salmonella infections with antibiotics unless they are very severe.
  • Clostridium difficile is treated with metronidazole or vancomycin (see section on Clostridium difficile Colitis)

  • Hand washing
  • Patients should be excluded from day-care centers
  • Bismuth or antibiotics are sometimes recommended to prevent traveler's diarrhea, especially travel to foreign countries.  Depending on where they are traveling, individuals need to check with their physician for themselves, and for their children.  In underdeveloped countries, it is generally recommended to drink only bottled brand-name water, and eat only at establishments (such as hotels) with high sanitary standards.
  • Be especially careful with your children's hygiene -- make sure they wash their hands before handling food, and discourage unsupervised eating from street vendors.  Check with your physician or the Center for Disease Control (CDC) for specific recommendations based on travel destination.

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