Diarrhea is more than three loose, liquid stools in a single day. Diarrhea can be:

• Acute – occurring suddenly, and lasting briefly

• Chronic – long-term

• Recurring – occurring in recurrent episodes

Diarrhea depletes your body of fluids and electrolytes. If you lose too much fluid, you can become dehydrated. Diarrhea is particularly dangerous for babies, young children, and elderly people. Diarrhea that lasts for more than 2 weeks is considered persistent or chronic. In an otherwise healthy person, chronic diarrhea may be a nuisance problem, or, for someone who has a weak immune system, a life-threatening illness. There are many causes of chronic diarrhea; these may be different for children and adults. Causes of chronic diarrhea can be grouped into two categories: diarrhea caused by an infection and diarrhea not caused by an infection. Sometimes, the cause of chronic diarrhea remains unknown.

Causes

Causes may include:

• Food intolerance, such as lactose intolerance

• Medications, including:

• • Antibiotics

• • Magnesium-containing antacids

• • High blood pressure medications

• • Quinine

• • Cancer chemotherapy

• • Laxatives

• Irritable bowel syndrome (episodes of diarrhea often alternate with periods of constipation)

• Injury to the bowel after radiation treatments for cancer

• Malabsorption syndromes, such as:

• • Celiac sprue

• • Tropical sprue

• • Short bowel syndrome

• • Whipple's disease

• • Intestinal lymphangiectasia

• Diseases of the pancreas and/or gallbladder

• Inflammatory bowel diseases (ulcerative colitis, Crohn's disease)

• Chronic diseases, such as:

• • Liver disease

• • Diabetes

• • Hyperthyroidism

• • Addison's disease

• • Pellagra

• • Scleroderma

• • Amyloidosis

• • AIDS

• • Colon cancer

• Intestinal surgery

• Infections, including food poisoning, such as:

• • Bacterial: Campylobacter, Clostridium difficile, Salmonella, Shigella, and Escherichia coli

• • Viral: rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis

• • Parasitic: Giardia lamblia, Entamoeba histolytica, and Cryptosporidium, tapeworm, roundworm, flukes

• • Fungal: Candida (yeast)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Traveling to a developing country where the water and food supply may be contaminated

• Having a severely weakened immune system, such as with AIDS or after an organ transplant

• Taking certain medications

Symptoms

Symptoms include:

• Frequent, loose, liquid stools

• Abdominal pain, cramping

• Urgent need to defecate

• Blood and/or mucus in stool

• Fever

• Dehydration

• Nausea, vomiting

• Muscle aches and pains

• Weight loss

• Malnutrition

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. To determine the cause of your diarrhea, the doctor will ask questions, such as:

• Does anyone else in your family have diarrhea?

• What kinds of food have you eaten recently?

• Do you drink well water?

• Do your children attend daycare?

• Have you traveled recently?

• Do you use laxatives?

• What medications do you take?

• Do you have any symptoms other than diarrhea (eg, fever, rash, aching joints)?

• What is your sexual history?

• Have you ever had abdominal surgery?

Tests may include:

• Laboratory Analysis of a Stool Sample

• Blood Tests

• Fasting or Food Elimination Tests

• Digital Rectal Exam – examination of the rectum with the doctor's gloved finger inserted into your rectum

• Flexible Sigmoidoscopy – a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon

• Colonoscopy – a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon

• Biopsy – removal of a sample of colon tissue for testing. This may be performed as part of a flexible sigmoidoscopy or colonoscopy.

• Upper GI Series – a series of x-rays of the upper digestive system taken after drinking a barium solution (also called barium swallow)

• Barium Enema – insertion of fluid into the rectum that makes the linining of your colon show up on an x-ray

Treatment

Prevention

To reduce your chance of getting diarrhea:

• Practice good handwashing.

• Practice safe food preparation and food storage.

• If you've got diarrhea, don't prepare food for others.

• If you're traveling:

• • Drink bottled water.

• • Use bottled water when brushing your teeth.

• • Avoid drinks that contain ice.

• • Don't eat food purchased from street vendors.

• • Don't eat raw vegetables or fruits (all produce should be peeled and/or cooked).

• • Make sure meats are cooked thoroughly.

• • Eat only pasteurized dairy products.

• • If you eat seafood, make sure it's very hot.

RESOURCES:

American Gastroenterological Association
http://www.gastro.org

National Institute of Diabetes and Digestive and Kidney Diseases
http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/index.htm

References:

American Gastroenterological Association website. Available at: http://www.gastro.org.

National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/index.htm.

Primary Care Medicine. 4th ed. Lippincott, Williams, and Wilkins; 2000.