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Dr. Robert D. Fusco, Medical Director    
Diarrhea

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There is little worse than an upset stomach, or more precisely, an upset intestine...the kind that keeps you housebound, sprinting to the bathroom. Like most things in life, we take our digestive system for granted. As long as things are going well, the last thing you think about is your intestinal tract. But, if you are bothered by an attack of acute diarrhea, there is little else on your mind. What has gone wrong? How can you get relief?

What Is Acute Diarrhea?

Acute Diarrhea means the sudden onset of frequent, loose, watery stools which are urgent and often associated with abdominal cramping. If you have it, you don't need a medical dictionary. You just know.

What Causes Acute Diarrhea?

Diarrhea is not a disease but a symptom that can have many possible causes. Nervous stress or a change in ones diet can cause minor, usually short-lived, diarrhea. Everyone has such stomach upsets on occasion, but diarrhea that comes on suddenly and ends in a day or two is usually caused by an infection or food poisoning. Also prescription and nonprescription medications such as antibiotics, certain antacids, antiinflammatory drugs, and high doses of vitamin C can cause problems.

Food Poisoning

Believe it or not, despite all of our efforts in public health and sanitation, food poisoning is becoming more and more common in this country with about six million cases diagnosed each year. Of course, many millions more go unreported. Crampy abdominal pain, diarrhea, and nausea usually develop within a few hours of eating some tainted food. Symptoms may be mild or severe depending upon the degree of contamination and your bodys natural immunity. Summer is the prime time because bacteria multiply faster in the warmer temperatures.

Why does food poisoning occur?

Health officials usually give two reasons: improper food storage by consumers and poor personal hygiene of food handlers a rather unpleasant thought. Even though outbreaks occurring in restaurants are what make the nightly news, the truth is that most cases of food poisoning occur because of improper food handling and sloppy hygiene in the home itself.

Travelers Diarrhea

When it occurs at home, it is called food poisoning, but when you are out of the country, it is called travelers diarrhea. Also termed Montezumas Revenge and turista, travelers diarrhea is quite common. An estimated 3 million of the 44 million Americans who travel abroad each year come down with diarrhea, nausea, fever, or other ills. The number of cases is climbing since people are no longer journeying only to major western European capitals and exclusive waterside resorts where health standards are similar to our own; theyre also traveling to more exotic and often less developed places like Africa, Asia, the Middle East, the Caribbean, and South America. A study suggests that the rate of travelers' misery is high -- for example almost 25% of tourists visiting Jamaica between March 1996 and May 1997 experienced traveler's diarrhea, researchers report. Travelers diarrhea can certainly be frustrating the last thing anyone wants is to be stuck in a hotel room after saving time and money for a vacation, a honeymoon, or arranging a business trip. And when it occurs in a country where medical care is not always easy to come by, it can be frightening. The Center for Disease Control in Atlanta estimates that over 80% of the time travelers diarrhea is caused by bacteria such as Salmonella, Shigella, E. coli, Campylobacer, and Staphylococcus. Occasionally, waterborne parasites such as Giardia and Amoeba may be the culprit.

Avoing the Problem

The best way to avoid travelers diarrhea is to be very careful about what is eaten. Boil it, peel it, cook it, or dont eat it, should apply to everything on the menu of even the fanciest restaurant in Latin America, Asian, or African countries. Avoid ice and all tap water even to brush your teeth. (An exception: ice cubes with central holes like a donut are made with heated water and safe.) Avoid salads. Drink only bottled carbonated water that is opened in your presence. Do not eat raw or undercooked meat or fish. Avoid eating food from street vendors. Eat only hot, thoroughly cooked foods, baked goods, and fruits which you have peeled yourself. Foods eaten there should be prepared just prior to serving. Of course, taking the utmost precautions to avoid travelers diarrhea is still no guarantee that the problem will not strike. Drink Plenty of Fluids At the first sign of acute diarrhea you should increase your fluid intake since the main risk is loss of water, or dehydration. The colon normally reabsorbs and recycles excess water from the undigested wastes. Diarrhea disrupts this reabsorption, causing excessive water loss and loose watery stools. Diarrhea also involves loss of sodium, potassium, and other electrolytes. Dehydration can be serious especially in infants, children, and the elderly because the body is largely water, and significant water loss impairs just about every body system. The main symptoms of dehydration are dry mouth, thirst, darkening and decreased flow rate of urine, fast heart rate, and dizziness or a faint feeling when you stand up from sitting or lying. The latter symptom in particular is a sign that it is becoming severe.

Authorities recommend drinking at least 8 to 10 glasses of fluid daily while the symptoms are active. Dont drink plain water, but instead use a commercial rehydration solution such as Gatorade which also contains sodium and potassium. The commercial solutions come pre-mixed and are foolproof. If they are not available, an inexpensive home rehydration solution can be made by combining:
  • 1 quart of clean tap or bottled water
  • 1 level teaspoon of table salt
  • 8 level teaspoons of sugar
  • 1 cup of orange juice (or eat two bananas)
Be sure not to reverse the amounts of salt and sugar as too much salt can be harmful and not enough sugar will fail. You can tell that your efforts at rehydration are successful when your urine volume increases and it becomes light yellow like the color of lemonade. Small amounts of dark concentrated urine signify persistent dehydration. You should sip rehydration fluids, not gulp them. Gulping tends to stimulate the intestinal tract, which may contribute to cramping. Stay away from alcohol, which is dehydrating. In severe cases, it is best to avoid most solid foods for a few days.

BRATT A Simple Remedy

If you are suffering from an attack of acute diarrhea, you should also know about the BRATT diet. This stands for five foods that can help most cases of intestinal upset, especially mild attacks:
  • Bananas
  • Rice
  • Applesauce
  • Tea
  • Toast
These simple foods contain complex carbohydrates, are usually readily available, and are easily digested. Eating only these five foods for a few days provides some basic nourishment without adding fat which can further upset your system. One objection to the BRATT diet is the limited choice of foods. This sounds boring, but is really quite tolerable. One tip: dont eat all the items at every meal. It helps break up the monotony. Stay on the diet until the diarrhea begins to subside, usually two to three days. Then gradually reintroduce other foods: baked, boiled or broiled fish and meats, crackers, cooked vegetables, rice cereal, skinless chicken, yogurt; but stay away from foods like high fat foods like pizza, fried foods like burgers and fries, milk products like milk or ice cream, spices, tomatoes, citrus, fresh fruit and vegetables (cooked are OK), excess caffeine, and avoid alcohol and tobacco products until stools are fully formed.

Relief In A Bottle

Dont try to stop diarrhea as soon as it develops. Diarrhea is the bodys way of getting rid of whatever food, virus, or bug that is causing it. However, if diarrhea does not respond to fluid and diet changes in a day or two, try one of the over-the-counter antidiarrheal medicines such as Kaopectate, Pepto-Bismol, or Imodium AD. Just follow the instructions on the label and dont overdo it as it is possible to get too much of a good thing. (Hint: Pepto-Bismol normally discolors the stools and tongue dark or black. Dont be alarmed. Pepto-Bismol should not be taken by anyone allergic to aspirin.) Do not take these medications in the presence of rectal bleeding, severe abdominal pain, or high fever. See your doctor instead. Another often-used approach is to take two teaspoons of a bulk-forming agent such as Metamucil in a small amount of water several times a day. While most often recommended to treat constipation, Metamucil contains fiber which absorbs water and adds mass to the stool, which may also help relieve symptoms of diarrhea.

When To Call Your Doctor

Most cases of acute diarrhea are minor and self-limited and can be managed at home without the need for medical attention. Sometimes acute diarrhea cannot be controlled by simple measures or may be the manifestation of a more serious illness or infection. Call your doctor if your symptoms are severe. last longer than three weeks or if you develop associated symptoms of severe abdominal pain, fever over 101 degrees, shaking chills, rectal bleeding, weakness, confusion, or dry mouth. Your doctor can perform special blood, stool, and scope tests to better pinpoint the cause of your symptoms and can then prescribe prescription medications when necessary. Most cases can be managed as an outpatient with the use of oral rehydration solutions, the BRATT diet, and the addition of an oral antibiotic such as Bactrim, Vibramycin, Flagyl, or Cipro. Severe cases may require a few days of inpatient hospitalization, antibiotics, and intravenous fluid replacement.

Chronic Diarrhea

Most cases of of travelers diarrhea resolve within a few days, occassionally a few weeks. Episodes of diarrhea that last longer than three weeks are termed chronic diarrhea. Such cases may not be due to a simple bowel infection, but one of many more chronic conditions such as irritable bowel syndrome, milk intolerance, parasites, or colitis. Occassionally, such symptoms can be caused by colon cancer. Obviously, persistent diarrhea requires a trip to your doctor to determine what is really wrong and what should be done about it.

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