- Diarrhea is defined as passage of loose, watery stools with increased frequency.
- When it is associated with vomiting with or without fever, it is called as gastroenteritis.
- Diarrhea is common in all age groups but children are more vulnerable.
- It is more common in poorly nourished children living in poor sanitary environment.
- Most cases of diarrhea are due to infection in the alimentary canal by virus, bacteria, parasites and fungi.
- Certain medicines such as antibiotics, pain-killers and medicines for cancer can give rise to diarrhea.
Diarrhea can be divided into two categories
- Short duration (few hours or 1-2 days origin).
- Long duration (few weeks to month’s origin).
Short duration diarrhea
- Sometimes eating heavy food can cause diarrhea. In this case, it is advised to drink lots of liquids (water, buttermilk or fresh apple juice). Diarrhea will pass off with these precautions.
- If the origin of diarrhea and vomiting is due to eating food outside, then most probably one must be suffering from food poisoning. In this condition, it is advised to drink lot of fluids (water, buttermilk or fresh apple juice). If the diarrhea is very severe, the tongue is becoming dry and the patient is passing scanty urine then hospitalization is required as the patient might be going into dehydration and hypovolemic (due to decreased water amount in the body) shock.
- Viral gastroenteritis can cause watery severe loose stools with fever and vomiting and if signs of hypovolemic shock are seen, hospitalization may be required.
- If the patient is passing mucus or blood in the stools, then he has dysentery and stool examination with culture has to be done to find out the causative organism and treat accordingly.
- If the patient is passing black, small stools he must be having ‘silent stomach ulcer’ and may require blood transfusion due to blood loss.
Long duration diarrhea
- If the person is having mucus in stools but has a good appetite, he is healthy and not losing weight. Mostly, this is a case of amoebic colitis or giardiasis. Usually antibiotics such as flagyl will take care of it. It the patient is not better, then he has irritable colon which is a self limiting.
- If the person experiences pain in abdomen, loss of weight, poor appetite, fever and excessive sweating at night he must be having tuberculosis of the intestine. In this case, he has to be evaluated for it and treated accordingly with anti-tubercular drugs.
- Incase the person is elderly and there is blood in the stools, it can be a case of carcinoma of the colon.
- Incase of mal-absorption syndrome the person loses weight gradually, the stools are bulky, buttery and foul smelling.
- Thyrotoxicosis can also cause diarrhea. Here the stools are more in frequency but normal in looks and consistency.
Investigations for diarrhea
Diarrhea in short duration
- Routine stool examination and culture to find out if there is any abnormality and any unexpected organisms are seen.
- In majority of acute cases, these two tests give the result as to the cause of diarrhea.
Diarrhea in long duration
- Stool is investigated.
- Sigmoidoscopic examination of the rectum and colon is very helpful. Biopsy of the colon should be taken if anything abnormal (which usually is either amoebic or ulcerative colitis) is sited.
- Often barium enema X-ray examination of the colon is done in elderly to rule out colon cancer.
- For tuberculosis of intestine, X-ray of the small intestines should be done. An elevated ESR confirms the diagnosis.
- In patients with irritable colon (most common cause of chronic diarrhea), all the above investigations including blood ESR are normal.
Treatment For Diarrhea
- In a patient suffering from sudden severe diarrhea, replacement of fluid and salts by mouth is necessary. Re-hydration solution can be prepared by adding to every glass of plain water, one teaspoonful ‘Electral’ or a large pinch (1/8th teaspoon) of common salt and a teaspoonful of sugar. This is given as frequently as possible.
- Buttermilk, fresh apple juice and pomegranate juice are other alternatives.
- Mostly, the sudden diarrhea stops by itself. However (especially in children) some antibiotics and constipating medicines may be administered.