
Diarrhea
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What is diarrhea?
Diarrhea is loose, watery stools. A person with diarrhea
typically passes stool more than three times a day. People with
diarrhea may pass more than a quart of stool a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on
its own without special treatment. Prolonged diarrhea persisting for
more than 2 days may be a sign of a more serious problem and poses
the risk of dehydration. Chronic diarrhea may be a feature of a
chronic disease.
Diarrhea can cause dehydration, which means the body lacks enough
fluid to function properly. Dehydration is particularly dangerous in
children and older people, and it must be treated promptly to avoid
serious health problems. See Dehydration.
People of all ages can get diarrhea and the average adult has a
bout of acute diarrhea about four times a year. In the United
States, each child will have had seven to 15 episodes of diarrhea by
age 5.
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What causes diarrhea?
Acute diarrhea is usually related to a bacterial, viral, or
parasitic infection. Chronic diarrhea is usually related to
functional disorders such as irritable bowel syndrome or
inflammatory bowel disease.
A few of the more common causes of diarrhea include the
following:
-
Bacterial infections. Several types of
bacteria consumed through contaminated food or water can cause
diarrhea. Common culprits include Campylobacter, Salmonella,
Shigella, and Escherichia coli (E. coli).
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Viral infections. Many viruses cause diarrhea,
including rotavirus, Norwalk virus, cytomegalovirus, herpes
simplex virus, and viral hepatitis.
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Food intolerances. Some people are unable to
digest food components such as artificial sweeteners and
lactose—the sugar found in milk.
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Parasites. Parasites can enter the body
through food or water and settle in the digestive system.
Parasites that cause diarrhea include Giardia lamblia,
Entamoeba histolytica, and Cryptosporidium.
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Reaction to medicines. Antibiotics, blood
pressure medications, cancer drugs, and antacids containing
magnesium can all cause diarrhea.
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Intestinal diseases. Inflammatory bowel
disease, colitis, Crohn’s disease, and celiac disease often lead
to diarrhea.
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Functional bowel disorders. Diarrhea can be a
symptom of irritable bowel syndrome.
Some people develop diarrhea after stomach surgery or removal of
the gallbladder. The reason may be a change in how quickly food
moves through the digestive system after stomach surgery or an
increase in bile in the colon after gallbladder surgery.
People who visit foreign countries are at risk for traveler’s
diarrhea, which is caused by eating food or drinking water
contaminated with bacteria, viruses, or parasites. Traveler’s
diarrhea can be a problem for people visiting developing countries.
Visitors to the United States, Canada, most European countries,
Japan, Australia, and New Zealand do not face much risk for
traveler’s diarrhea. See Preventing
Traveler’s Diarrhea.
In many cases, the cause of diarrhea cannot be found. As long as
diarrhea goes away on its own, an extensive search for the cause is
not usually necessary.
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What are the symptoms of diarrhea?
Diarrhea may be accompanied by cramping, abdominal pain,
bloating, nausea, or an urgent need to use the bathroom. Depending
on the cause, a person may have a fever or bloody stools.
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Diarrhea in Children
Children can have acute and chronic forms of diarrhea. Causes
include bacteria, viruses, parasites, medications, functional bowel
disorders, and food sensitivities. Infection with the rotavirus is
the most common cause of acute childhood diarrhea. Rotavirus
diarrhea usually resolves in 3 to 9 days. Children who are 6 to 32
weeks old can be vaccinated against the virus with a vaccine called
Rotateq.
If your child has diarrhea, do not hesitate to call the doctor
for advice. Diarrhea is especially dangerous in newborns and
infants, leading to dehydration in just a day or two. A child can
die from dehydration within a few days. The main treatment for
diarrhea in children is rehydration to replace lost fluid quickly.
See Dehydration.
Take your child to the doctor if there is no improvement after 24
hours or if any of the following symptoms appear:
- stools containing blood or pus
- black stools
- a temperature above 102 degrees
- signs of dehydration
Medications to treat diarrhea in adults can be dangerous for
children and should only be given with a doctor’s guidance.
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Dehydration
Diarrhea can cause dehydration, which means the body has lost too
much fluid and too many electrolytes and can’t function properly.
Dehydration is particularly dangerous in children and in older
adults and must be treated promptly to avoid serious health
problems.
Signs of dehydration include
- thirst
- less frequent urination
- dry skin
- fatigue
- light-headedness
- dark-colored urine
Signs of dehydration in children include
- dry mouth and tongue
- no tears when crying
- no wet diapers for 3 hours or more
- sunken abdomen, eyes, or cheeks
- high fever
- listlessness or irritability
- skin that does not flatten when pinched and released
If you suspect that you or your child is dehydrated, call the
doctor immediately. Severe dehydration may require
hospitalization.
Preventing Dehydration
The fluid and electrolytes lost during diarrhea need to be
replaced promptly because the body cannot function without them.
Electrolytes are the salts and minerals that affect the amount of
water in your body, muscle activity, and other important
functions.
Although water is extremely important in preventing dehydration,
it does not contain electrolytes. Broth and soups that contain
sodium, and fruit juices, soft fruits, or vegetables that contain
potassium, help restore electrolyte levels. Over-the-counter
rehydration solutions such as Pedialyte, Ceralyte, and Infalyte are
also good electrolyte sources and are especially recommended for use
in children.
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When should a doctor be consulted?
Diarrhea is not usually harmful, but it can become dangerous or
signal a more serious problem. You should see the doctor if you
experience any of the following:
- diarrhea for more than 3 days
- severe pain in the abdomen or rectum
- a fever of 102 degrees or higher
- blood in your stool or black, tarry stools
- signs of dehydration
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How is the cause of diarrhea diagnosed?
Diagnostic tests to find the cause of diarrhea may include the
following:
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Medical history and physical examination. The
doctor will ask you about your eating habits and medication use
and will examine you for signs of illness.
-
Stool culture. A sample of stool is analyzed
in a laboratory to check for bacteria, parasites, or other signs
of disease and infection.
-
Blood tests. Blood tests can be helpful in
ruling out certain diseases.
-
Fasting tests. To find out if a food
intolerance or allergy is causing the diarrhea, the doctor may ask
you to avoid lactose, carbohydrates, wheat, or other foods to see
whether the diarrhea responds to a change in diet.
-
Sigmoidoscopy. For this test, the doctor uses
a special instrument to look at the inside of the rectum and lower
part of the colon.
-
Colonoscopy. This test is similar to a
sigmoidoscopy, but it allows the doctor to view the entire
colon.
-
Imaging tests. These tests can rule out
structural abnormalities as the cause of diarrhea.
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How is diarrhea treated?
In most cases of diarrhea, replacing lost fluid to prevent
dehydration is the only treatment necessary. Medicines that stop
diarrhea may be helpful, but they are not recommended for people
whose diarrhea is caused by a bacterial infection or parasite. If
you stop the diarrhea before having purged the bacteria or parasite,
you will trap the organism in the intestines and prolong the
problem. Rather, doctors usually prescribe antibiotics as a
first-line treatment. Viral infections are either treated with
medication or left to run their course, depending on the severity
and type of virus.
Tips About Food
Until diarrhea subsides, try to avoid caffeine, milk products,
and foods that are greasy, high in fiber, or very sweet. These foods
tend to aggravate diarrhea.
As you improve, you can add soft, bland foods to your diet,
including bananas, plain rice, boiled potatoes, toast, crackers,
cooked carrots, and baked chicken without the skin or fat. For
children, the pediatrician may also recommend a bland diet. Once the
diarrhea has stopped, the pediatrician will likely encourage
children to return to a normal and healthy diet if it can be
tolerated.
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Preventing Traveler’s Diarrhea
Traveler’s diarrhea happens when you consume food or water
contaminated with bacteria, viruses, or parasites. You can take the
following precautions to prevent traveler’s diarrhea when you travel
outside of the United States:
- Do not drink tap water or use it to brush your teeth.
- Do not drink unpasteurized milk or dairy products.
- Do not use ice made from tap water.
- Avoid all raw fruits and vegetables, including lettuce and
fruit salads, unless they can be peeled and you peel them
yourself.
- Do not eat raw or rare meat and fish.
- Do not eat meat or shellfish that is not hot when served.
- Do not eat food from street vendors.
You can safely drink bottled water—if you are the one to break
the seal—along with carbonated soft drinks, and hot drinks such as
coffee or tea.
Depending on where you are going and how long you will stay, your
doctor may recommend that you take antibiotics before leaving to
protect you from possible infection.
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Hope Through Research
The Division of Digestive Diseases and Nutrition at the National
Institute of Diabetes and Digestive and Kidney Diseases supports
basic and clinical research into gastrointestinal conditions,
including diarrhea. Among other areas, researchers are studying how
the processes of absorption and secretion in the digestive tract
affect the content and consistency of stool, the relationship
between diarrhea and Helicobactor pylori, motility in
chronic diarrhea, and chemical compounds that may be useful in
treating diarrhea.
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Points to Remember
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Diarrhea is a common problem that usually resolves on its
own.
-
Diarrhea is dangerous if a person becomes dehydrated.
-
Causes include viral, bacterial, parasitic infections, food
intolerance, reactions to medicine, intestinal diseases, and
functional bowel disorders.
-
Treatment involves replacing lost fluid and electrolytes.
Depending on the cause of the problem, a person might also need
medication to stop the diarrhea or treat an infection. Children
may need an oral rehydration solution to replace lost fluid and
electrolytes.
-
Call the doctor if the person with diarrhea has severe pain in
the abdomen or rectum, a fever of 102 degrees or higher, blood in
the stool, signs of dehydration, or diarrhea for more than 3
days.
The U.S. Government does not endorse or favor any specific
commercial product or company. Trade, proprietary, or company names
appearing in this document are used only because they are considered
necessary in the context of the information provided. If a product
is not mentioned, the omission does not mean or imply that the
product is unsatisfactory.
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For More Information
American Gastroenterological
Association
National Office
4930 Del Ray
Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax:
301–654–5920
Email: member@gastro.org
Internet: http://www.gastro.org/
International Foundation for Functional Gastrointestinal
Disorders
P.O. Box 170864
Milwaukee, WI
53217–8076
Phone: 1–888–964–2001 or 414–964–1799
Fax:
414–964–7176
Email: iffgd@iffgd.org
Internet: http://www.iffgd.org/
The National Digestive Diseases Information Clearinghouse
collects resource information about digestive diseases for the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) Reference Collection. This database provides titles,
abstracts, and availability information for health information and
health education resources. The NIDDK Reference Collection is a
service of the National Institutes of Health.
You may view the results of the automatic search on diarrhea.
If you wish to perform your own search of the database, you may
access and search the NIDDK Reference
Collection database online.
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Email: http://digestive.niddk.nih.gov/about/contact.htm
The National Digestive Diseases Information Clearinghouse (NDDIC)
is a service of the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK). The NIDDK is part of the National
Institutes of Health of the U.S. Department of Health and Human
Services. Established in 1980, the Clearinghouse provides
information about digestive diseases to people with digestive
disorders and to their families, health care professionals, and the
public. The NDDIC answers inquiries, develops and distributes
publications, and works closely with professional and patient
organizations and Government agencies to coordinate resources about
digestive diseases.
Publications produced by the Clearinghouse are carefully reviewed
by both NIDDK scientists and outside experts.
This publication is not copyrighted. The Clearinghouse encourages
users of this publication to duplicate and distribute as many copies
as desired.
NIH Publication No. 07–2749
March 2007
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