Diarrhoea is a condition characterised by loose or watery stool and an irritated bowel. There are three forms of diarrhoea as defined in terms of length of time for which the condition lasts:
- Acute
- Persistent
- Chronic
Acute diarrhoea is short in duration lasting from a few hours to some days, with the maximum duration of 2 weeks. Acute Diarrhoea is diagnosed when there are 3/more abnormal watery stools in 24 hours. This includes cholera. In case acute diarrhoea is bloody, it is known as dysentery.
Chronic diarrhoea lasts for more than 4 weeks
Persistent diarrhoea is around 2-4 weeks
Apart from stool consistency, other factors clinicians take into account while diagnosing this condition include stool frequency, volume or weight. Pathophysiological symptoms of diarrhoea define and differentiate it further.
Osmotic diarrhoea takes place when the small intestine cannot absorb a soluble compound; fluid is then prevalent in the gut
Secretory diarrhoea involved active chloride generation in the bowel causing water to follow the chloride ions and the body to suffer from loss of fluid.
Other manifestations of diarrhoea include intestinal inflammation and increase in the motility of the intestine.
Causes of Diarrhoea
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The most common cause of diarrhoea is an infection of the digestive tract. Microbes causing gastrointestinal infection leading to diarrhoea include bacteria, virus and parasites.
Most Common Causes
Most commonly identified cause o acute diarrhoea include E. Coli, Shigella, Campylobacter and Salmonella.
Chronic diarrhoea is functional because it is not caused by biochemical factors or structural issues. IBS is the most common symptom of diarrhoea whereby it comprises a complex of symptoms including pain in the stomach and constipation. IBD or inflammatory bowel disease is yet another cause.
Bloody diarrhoea may be caused by ulcerative colitis or Crohn’s disease.
Major Causes of Chronic Diarrhoea
- Microscopic colitis
- Malabsorptive and maldigestive diarrhoea
- Chronic infections
- Cancer
- Drug-induced diarrhoea
Microscopic colitis affects older people. This is an inflammation visible in microscopy of colon biopsy characterised by persistent diarrhoea.
Malabsorptive diarrhoea: This is caused by damage in nutrient absorption
Maldigestive Diarrhoea: This is the result of impaired digestive functions like Celiac disease
Chronic infections were when virus, bacteria and parasites are the cause.
Drug-induced diarrhoea includes overdose of laxatives
Endocrine causes include Addison disease, carcinoid tumours and hyperthyroidism
Gut cancers also lead to diarrhoea
Causes in Brief
Diarrhoea is a symptom of bowel infection caused by:
- Novovirus
- Rotavirus
- Campylobacter
- Clostridium difficule
- E. Coli
- Shigella
- Salmonella
- Giardia
Short term diarrhoea also includes drinking too much alcohol, appendix, rich goods , radiotherapy damaging the lining of intestines and more.
Some medications which cause diarrhoea include:
- Antibiotics
- Antacids with magnesium
- NSAIDs
- SSRIs
- Chemotherapy
- Statins
- Laxatives
Long-term diarrhoea is caused by:
- IBD
- IBS
- Bile acid malabsorption
- Celiac disease
- Chronic pancreatitis
- Bowel cancer
- Gastrectomy
Traveller’s diarrhoea can also occur due to food poisoning or water contamination. Hernia or over ingestion of stimulants also leads to diarrhoea.
Signs and symptoms linked to diarrhoea include:
- Constant loose watery stool
- Cramps in abdomen
- Pain in stomach
- Fever
- Bleeding
- Lightheadedness or dizziness from dehydrating
- Mucus release
- Thirst, bloating and weight loss is also common.
- Certain symptoms are precursors of serious diseases like persistent vomiting, blood or pus, chronic diarrhoea and weight loss.
Possible Treatment
Test and Diagnosis
Doctors commence by taking a history and asking about the problems and the past medical symptoms and conditions including details like severity, dehydration, bleeding and more.
Dehydration which is in early stages shows no signs or symptoms while moderate dehydration has symptoms like pinched face, reduced skin elasticity and sunken eyes. Extreme dehydration is characterised by rapid feeble pulse, low urine, moist extremities, low BP and pale skin; a coma can also occur.
Microscopy, culture, faecal leukocyte testing and more can be used to detect the condition. In the case of bacterial infection, WBC appears in the stool. Pathogenic gastrointestinal bacteria can be tested using a culture of stool. Path labs provide tests for pathogens causing diarrhoea .
In the case of chronic diarrhoea, full blood count, liver function test, test for malabsorption and ESR and SRP are carried out along with testing for Celiac disease.
Depending on a severity, treatment may include antibiotics for viral diarrhoea.
Treatment of Diarrhoea
Mild cases can resolve without treatment. It is only when diarrhoea is chronic and persistent that the following treatments are carried out:
Correcting dehydration: This includes replacing lost fluids through drinking to drip. ORS or Oral Rehydration Solution or Salts is when water containing salt and glucose is absorbed by small intestine to replace water and electrolyte lost through diarrhoea.
Medication
Some of the medicines for diarrhoea include:
- Zinc supplements
- Loperamide(Imodium)
- Bismuth sub salicylate
Nutrition
Bananas are high in potassium and so is fruit juice. Diluted fruit juice and high sodium fluids and liquids like salted cricketers and broths apart from potassium rich foods can prevent diarrhoea.
Nutritionists also advise drinking probiotic drinks and avoiding soft drinks. Limit certain foods that may make diarrhoea worse and eat soluble fibre to thicken the stool.
Sugar-free mint, juices and fructose from dry fruits can help. From safe drinking water to maintenance of proper hygiene, there are many factors which can also aid recovery
Vaccines
There are rotavirus vaccines which can lead to steady improvement and guard against diarrhoea especially for weak and vulnerable patients.
Conclusion
In the ultimate analysis , good hygiene and better nutrition can safeguard you against diarrhoea. This is more so if it is infection induced diarrhoea. When diarrhoea strikes, relief is of paramount concern. Generally , patients try OTC drugs. But the big question is- is this effective?
Most people get short bouts of acute diarrhoea about once a year. OTC drugs and staying hydrated is a simple matter for them. But if you suffer from persistent or chronic diarrhoea, medicine may be required to slow/stop loose, watery stools.
But even here, caution needs to be exercised. Don’t take medicine more than 2 days at a time. if the condition persists beyond it, consult a doctor. Read medical labels and be clear about how you can feel better and avoid diarrhoea in the first place. Prevention is the best cure.