Alternate Names: Stools - watery; Frequent bowel movements; Loose bowel movements

Considerations: The majority of diarrheal disease results from enteric infection and is generally a short lived self-limiting condition. Common forms of diarrhea are grouped under terms such as "stomach flu" and gastroenteritis. These conditions may include vomiting, and often appear in mini-epidemics in schools, neighborhoods or families. Quite often parents and local physicians are aware the stomach flu is "going around".

Most diarrhea will stop without treatment in a few days. Certain drugs can cause or worsen diarrhea.

Common Causes: Diarrheal diseases can be grouped into several general categories.
INFECTIOUS

• viruses
  • rotavirus
  • cytomegalovirus (CMV)
  • adenovirus
  • echovirus
  • HIV virus (see HIV disease)
• bacteria
  • shigella
  • salmonella
  • cholera
  • E. coli
  • Staphylococcus aureus
• parasites
  • Giardia Lamblia
  • Cryptosporidium parvum
  • Balantidium coli
  • occasionally roundworm (ascariasis) or tapeworm (cestodiasis) infestation
• funguses
  • Candida albicans (seen in immunocompromised individuals)

• lactose intolerance,
• celiac disease (sprue) or gluten malabsorption
• cystic fibrosis
• disaccharide malabsorption
• cows milk protein intolerance.

• Crohn’s disease
• ulcerative colitis

• severe combined immunodeficiency
• hypogammaglobulinemia
• panhypogammaglobulinemia (Bruton)
• chronic granulomatous disease
• IgA deficiency

• antibiotics
• chemotherapy

• gastrectomy
• gastroenterostomy
• high-dose radiation therapy

• Zollinger-Ellison syndrome
• autonomic neuropathy (diabetic neuropathy)

Home Care: The risk of developing the most common forms of diarrhea can be reduced by observing good hygiene including hand washing and avoiding contaminated food, utensils or other objects. Children should be taught not to put objects in their mouth. Hand washing is recommended before and after using the bathroom and before meals.

Don’t try to stop diarrhea as soon as it develops. Diarrhea is the body’s way of getting rid of whatever food, virus, or bug that is causing it.

Diarrhea that comes on suddenly and ends in a day or two is usually caused by an infection or food poisoning.

Treatment for simple diarrheal illness consists of giving clear liquids and maintaining adequate hydration. This may be accomplished by giving fluids including oral rehydration fluids. (see dehydration). If a child has nausea or vomiting the liquids should be given in small amounts but very frequently, often every 15 minutes. If the child has no nausea or vomiting, larger volumes of liquids may be given. Home mixed electrolyte solutions should be avoided; mixing mistakes can cause significant problems. Commercial preparations are safe and may be useful.

Nonprescription medications such as Pepto-Bismol, Kaopectate, Imodium, and Diasorb will change the consistency of the stool from a liquid to a semi-solid state and may decrease stooling frequency. (Note: Pepto-Bismol can discolor the stools dark black and can cause the tongue to turn black. This is a normal response to the medication and not something to be concerned about).

Antidiarrheal medications (loperamide, diphenoxylate, and codeine) should be used only after consulting a health care provider.

During diarrhea episodes, avoid coffee, milk, and fats. Enteral (formula tube feedings) feedings often cause diarrhea. If you are experiencing diarrhea related to enteral tube feedings, consult your health care provider or dietician. The rate of the feedings may need to be changed or bulk agents may need to be added to the formula.

Adding bulk to the diet may thicken the stool and decrease the frequency of stools. Certain foods thicken the stools, including rice, bananas, yogurt, and cheese. An increase in fiber from whole-wheat grains and bran add bulk to the diet. Additionally, psyllium containing products such as Metamucil or similar products can be used to add bulk to the stools.

Traveler’s diarrhea:

• The best way to avoid traveler’s diarrhea is to be careful about what is consumed.
• "Boil it, peel it, cook it, or don’t eat it," should apply to everything on the menu of even the fanciest restaurant in Latin American, Asian, or African countries. Food eaten there should be prepared just prior to serving.
• "Traveler’s diarrhea" usually stops spontaneously.
• Drink lots of liquids to replace the lost fluids.

Call If:

• black or bloody stools are present or if abdominal pain is severe.
• there are signs of dehydration. These include dry skin, dry mouth, sunken fontanelles ("soft spot") in infants, rapid heart rate, confusion, weakness, abnormal skin turgor (when skin is pinched gently it remains together rather than resuming the normal shape; or the skin feels like bread dough). Dehydration can develop in infants and small children within hours.
• diarrhea persists for more than 4 days.
• other symptoms are present that may indicate a more serious problem
  • explosive diarrhea
  • bloody diarrhea (gastrointestinal bleeding)
  • tenesmus (pain while passing stool)
  • high fever or fever with shaking chills
  • large amounts of mucus with bowel movement or mucus alone
  • stools - floating
  • dehydration
  • other systemic symptoms not normally seen with simple diarrhea

What To Expect: The medical history will be obtained and a physical examination will be performed, including detailed examination of the abdomen.

Medical history questions documenting diarrhea in detail may include:

• TIME PATTERN:
  • When did the diarrhea start?
  • Are any other family members sick?
  • Have you recently traveled out of the country?
  • How long have you been experiencing diarrhea?
• CHARACTERISTICS:
  • Is there blood in the stool?
  • Are you passing large amounts of mucus with the stool?
  • Are you experiencing abdominal pain and severe cramping with the diarrhea?
  • What is the color and consistency of the stool?
• AGGRAVATING FACTORS:
  • Is it worse when you are stressed?
  • Do any specific foods make it worse?
• ASSOCIATED FACTORS:
  • What surgeries have you had?
  • What injuries have you had?
  • What medications do you take?
  • Do you drink coffee? How much?
  • Do you drink alcohol? How much? How often?
  • Do you smoke? How much each day?
  • Are you on a special diet? Enteral feedings (formula feedings)?
• OTHER:
  • What other symptoms are also present?
  • Are you experiencing fever and chills?

• chem-20 (to check electrolytes)
• urine specific gravity
• BUN
• creatinine