Diarrhea

There is a range of bowel habit patterns that can be considered normal. For some, "normal" may be going to the bathroom once per week. For others, "normal" is several times per day. What one considers their regular bowel habit is based on their usual historic bowel habit and frequency. A change in bowel habits with increasing frequency and/or liquid stools is often described as diarrhea.

What is Diarrhea?

Medically, the definition of diarrhea is based on the actual amount of stool passed in a day, rather than a number of trips to the toilet. On a typical diet, normal is usually less than 200 ml. or grams (approximately 7 ounces) per day.

Diarrhea may be categorized as either acute or chronic. Acute diarrhea may begin suddenly and resolves usually within two weeks. Chronic diarrhea lasts for more than a few weeks reflecting different causes compared to acute forms of illness - although there is some overlap.

Causes of Diarrhea

1. Infectious Diarrhea: The most common cause of acute diarrhea is an infectious agent (bacteria, virus). This may take the form of a gastrointestinal "flu" (gastroenteritis) or food poisoning. Symptoms tend to come on suddenly and will resolve even without treatment within a few days. Both bacteria and viruses can be responsible for this form of diarrhea. Examples include Salmonella, Shigella, E.Coli, Campylobacter, and C. Difficile.

2. Medications: Many prescription and over-the-counter medications can have diarrhea as a side effect. In particular, antibiotics are frequently a cause of diarrhea. Antacids and heartburn remedies that contain magnesium can cause diarrhea, if taken frequently.

3. Milk/Lactose Intolerance: Intolerance to milk and milk products develops when there is a loss of enzyme (lactase) in the small intestine that breaks down milk sugar (lactose). Milk intolerance can develop after a bout of gastroenteritis or without any obvious precipitating factor. Persons genetically more predisposed to milk intolerance include African-Americans, Jews, Asians, and South-Americans.

4. Foods: People can develop individual sensitivity to foods which may cause diarrhea. For example, hot spicy foods may bother some people, but not others. Food additives or hidden milk products (see above) can also be a factor. Some diet foods and candies contain sweeteners, such as sorbitol, that can have a laxative effect.

5. Medical Diseases: There are a wide variety of disease states that can cause diarrhea, such as inflammatory bowel diseases (Crohn's disease, ulcerative colitis, microscopic colitis, and collagenous colitis), colon cancer or colon polyps, circulatory insufficiency and thyroid disorders, celiac sprue, and pancreatic disease. Stress and irritable bowel syndrome (please see section on Irritable Bowel Syndrome) are commonly associated with diarrhea.

Diagnosis

Often, no specific diagnostic tests need to be performed if the history reveals a likely underlying causative factor, such as infection or medications. Stool cultures for bacteria, or examinations of the stool for blood or pus cells can help guide further testing. Flexible sigmoidoscopy or colonoscopy (please see section on Colonoscopy) can directly examine the colon using a lighted, flexible scope. A measurement of all stool collected over a three day period can help determine the amount of diarrhea a person is experiencing and also check for malabsorption (inadequate digestion and absorption of food). A variety of blood tests and X-rays can also be performed, as needed.

Treatment

The mainstay of treatment for acute diarrhea is maintaining adequate hydration. Certain commercially available solutions (i.e. Pedialyte) can more effectively maintain hydration than plain water or carbonated beverages. Avoiding medications or food substances that may be causing diarrhea is important and should be discussed with your doctor. If milk intolerance is the problem, one can either avoid milk products or take an enzyme supplement containing lactase (Lactaid Ultra, Lactrase, Dairy-Ease) at the time when milk or milk products are ingested. The use of over-the-counter anti-diarrheal products can be used for most patients with acute or chronic diarrhea (Pepto-Bismol, Kaopectate, Imodium, and others), but should be approved by your physician first. If there is an underlying medical condition otherwise causing the diarrhea, specific therapy aimed at that problem would be pursued.