Diarrhoea Causes And Management

What Is Diarrhoea?

Diarrhoea is usually a result of food poisoning (bacterial) or viral infections that prevent our digestive system from absorbing the water in food as usual. The resulting loss of fluids and salts from the body can make us weak or dehydrated, which may be a serious or even fatal problem in infants or the elderly.

Diarrhoea can also be a symptom of stress or may be brought on by food allergies and some medicines. In babies diarrhoea often follows a change in their diet (e.g., a different milk formula) or, if the baby is breast-fed, a change in the mother's diet.

As long as you replace lost fluids, in most cases diarrhoea will clear up by itself in a few days without any further treatment. But if the diarrhoea lasts longer than that or the attacks are particularly frequent, you may have something else wrong with you and should see a doctor.

What Causes Diarrhoea?

Many different problems can cause diarrhoea. Here are the major causes:

You are most likely to come down with diarrhoea after coming into contact with these infectious organisms and agents:

• A virus, such as rotavirus, winter vomiting disease (Norwalk virus or norovirus), enterovirus, or a hepatitis virus.
• A bacterium, such as E. coli, salmonella, shigella, C.diff (clostridium), or cholera (Vibrio cholerae).
• A parasite, such as those that cause giardiasis and amoebiasis.

The length of time diarrhoea lasts often depends on what caused it. Diarrhoea from norovirus lasts around two days, for rotavirus, the duration is three to eight days, Campylobacter and salmonella infections may last two to seven days and diarrhoea from giardiasis can several weeks.

A number of non-infectious medical conditions may cause diarrhoea, too. These include:

Lactose intolerance, coeliac disease, pancreatic problems, Cystic fibrosis, ulcerative colitis, crohn's disease, diverticular disease, thyroid disease, diabetes, adrenal disease, and Zollinger-Ellison syndrome, carcinoid tumour and pheochromocytoma and much more.

How Do I Know If I Have Diarrhoea?

If, when you go to the toilet, your bowel movements are more frequent and liquid than usual, you may have diarrhoea. The symptoms can also include vomiting and a high temperature.
Regular or acute diarrhoea tends to start suddenly and continue for anything from a few hours to two or three days. The change in frequency and consistency of a baby's bowel movements can be particularly rapid.
You may be more prone to acute diarrhoea when entering a different country or climate, as your body has to cope with new sources of infection. This is sometimes known as 'traveller's diarrhoea', as opposed to food poisoning.



What Can I Do Immediately To Make My Diarrhoea Better?

For Adults

• Replace lost fluids by drinking oral rehydration solutions, a mixture of salt and glucose. You can buy these as powders from your local pharmacist and add them to water. You should try to drink half a litre of the solution every hour until the diarrhoea settles. It is essential that elderly people make up the fluids lost through diarrhoea, particularly if they are frail.

• You should not eat solid foods for at least 24 hours when you have diarrhoea. The glucose in the oral rehydration solution will keep your strength up.
• Take frequent drinks of clear fluids or apple juice. Avoid concentrated fruit juices, milk and coffee.
• Stay in bed if your diarrhoea is particularly bad.
• Keep a check on your temperature in case you become feverish.
• Avoid spreading infection by making sure you wash your hands after you go to the toilet and before you prepare any meals.
• As the diarrhoea subsides, you can gradually go back to solid foods. Dry bread or toast and crackers are a good way to start. You could also try grated carrots or apples, clear soups and lean meat. For the first couple of days you should steer clear of dairy products, fatty or spicy foods, vegetables and fresh fruit.
• In exceptional circumstances, where the diarrhoea is particularly inconvenient or disrupts urgent work, you may want to ask your pharmacist about antidiarrhoeal medicines. These are not generally suitable for children and may delay recovery if the diarrhoea is caused by a viral infection.

For Babies

• As with the elderly, it is vital that you make up lost fluids. Use oral rehydration solutions (with cooled boiled water) but check with the pharmacist that these are suitable for your baby.
• If your baby is bottle-fed, replace regular feeds with oral rehydration solution for 24 hours or until the diarrhoea has cleared up. You can then start gradually reintroducing milk formula by diluting the first few feeds with more water than usual.
• If your baby is breast-fed, step up the number of feeds and also give your baby oral rehydration solution. Try to get your baby to drink the solution each time he or she has a dirty nappy, feeding with a teaspoon if necessary.
• To avoid passing on infection, wash your hands every time you change your baby's nappy.

What Can I Do Generally To Prevent Diarrhoea?

• Always wash your hands after going to the toilet or changing a baby's nappy. At home, keep the toilet well cleaned with disinfectant, particularly under the seat.
• If you are bottle-feeding a baby, make sure the bottles and other equipment are properly washed and sterilised. Wash your hands before feeding.
• Take sensible precautions against traveller's diarrhoea, particularly if you are going to a country with low standards of sanitation. For example, try not to drink tap water, at least without boiling it; avoid drinks with ice cubes, salads, unpeeled fruits, etc; and always wash your hands before eating.

What Treatments Can I Buy Without A Prescription?

You will find flavoured oral rehydration solutions under different brand names at your local pharmacy. There are also a number of antidiarrhoeal medicines in tablet, capsule or liquid form that you can buy without seeing a doctor. Many of them contain loperamide, which makes the digestive system process food more slowly.

When Do I Need To See A Doctor?

• If your diarrhoea carries on for more than a week (two days in a child over one year old), despite changing your diet, replacing lost fluids, etc.
• If your diarrhoea is particularly severe, recurrent or accompanied by sickness and/or a temperature of 38°C or above.
• If you have recently started a course of medicines.
• If you also have stomach cramps and keep switching from constipation to diarrhoea.
• If your baby has mild diarrhoea for more than 48 hours.
• If a baby or elderly person has acute diarrhoea for more than 12 hours.
• If your baby's bowel movements are especially watery or green and/or unpleasant-smelling.

You Should Contact A Doctor Immediately If:

• There is blood in your diarrhoea.
• If a baby with diarrhoea has a high temperature, keeps being sick or has persistent stomach pain.
• If a baby with diarrhoea refuses to drink or shows signs of dehydration, including drowsiness, confusion, glazed eyes, no wet nappies for the last six hours, a dry and sticky mouth/tongue, and a sunken fontanelle (the soft spot on your baby's head).

In Summary

• Replace lost fluids with oral rehydration solution - particularly important in babies, young children and the elderly.
• Stay off solid foods and drink clear liquids for 24 hours.
• Give bottle-fed babies oral rehydration solution instead of formula to drink for 24 hours.
• With breast-fed babies, step up the feeds and supplement them with oral rehydration solution.
• Only buy anti-diarrhoeal medicines if you cannot cope without them.
• Consult a doctor if your diarrhoea is severe, recurrent or accompanied by other worrying symptoms.
• See a doctor urgently if a baby with diarrhoea has other symptoms such as fever or sickness, or is showing signs of dehydration.

Useful Contact

Crohn's And Colitis UK
Address: 4 Beaumont House, Sutton Road, St Albans, AL1 5HH, UK
Phone: 01727 830 038
Email: enquiries [at] crohnsandcolitis.org.uk
Website: crohnsandcolitis.org.uk

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