About Loose Stool (Diarrhea)
Learn about the disease, illness and/or condition Loose Stool (Diarrhea) including: symptoms, causes, treatments, contraindications and conditions at ClusterMed.info.
Loose Stool (Diarrhea)
|Loose Stool (Diarrhea)|
Loose Stool (Diarrhea) Information
Disease-causing bacteria usually invade the small intestines and colon and cause enterocolitis (inflammation of the small intestine and colon). Bacterial enterocolitis is characterized by signs of inflammation (blood or pus in the stool, fever, abdominal tenderness), as well as abdominal pain and diarrhea. Campylobacter jejuni is the most common bacterium that causes acute enterocolitis in the U.S. Other bacteria that cause enterocolitis include Shigella, Salmonella, and EPEC. These bacteria usually are acquired by drinking contaminated water or eating contaminated foods such as vegetables, poultry, and dairy products.Enterocolitis caused by the bacterium Clostridium difficile is unusual because it often is caused by antibiotic treatment. Clostridium difficile is also the most common nosocomial infection (infection acquired while in the hospital) to cause diarrhea. Unfortunately, infection also is increasing among individuals who have neither taken antibiotics nor have been in the hospital.E. coli O157:H7 is a strain of E. coli that produces a toxin that causes hemorrhagic enterocolitis (enterocolitis with bleeding). There was a famous outbreak of hemorrhagic enterocolitis in the U.S. traced to contaminated ground beef in hamburgers (hence, it is also called hamburger colitis). A small percentage of patients infected with E. coli O157:H7, particularly children, can develop hemolytic uremic syndrome (HUS), a syndrome that can lead to kidney failure. Some evidence suggests that prolonged use of anti-diarrhea agents or use of antibiotics may increase the chance of developing HUS.
Diarrhea definition and facts
Food poisoning is a brief illness that is caused by toxins produced by bacteria. The toxins cause abdominal pain (cramps) and vomiting, and also cause the small intestine to secrete large amounts of water that leads to diarrhea. The symptoms of food poisoning usually last less than 24 hours. With some bacteria, the toxins are produced in the food before it is eaten, while with other bacteria, the toxins are produced in the intestine after the food is eaten.Symptoms usually appear within several hours when food poisoning is caused by toxins that are formed in the food before it is eaten. It takes longer for symptoms to develop when the toxins are formed in the intestine (because it takes time for the bacteria to produce the toxins). Therefore, in the latter case, symptoms usually appear after 7-15 hours.Staphylococcus aureus is an example of a bacterium that produces toxins in food before it is eaten. Typically, food contaminated with Staphylococcus (such as salad, meat, or sandwiches with mayonnaise) is left un-refrigerated at room temperature overnight. The Staphylococcal bacteria multiply in the food and produce toxins. Clostridium perfringens is an example of a bacterium that multiplies in food (usually canned food), and produces toxins in the small intestine after the contaminated food is eaten.
Medicines that causes diarrhea
Drug-induced diarrhea is very common because many drugs cause diarrhea. The clue to drug-induced diarrhea is that the diarrhea begins soon after treatment with the drug is begun. The medications that most frequently cause diarrhea are antacids and nutritional supplements that contain magnesium. Other classes of medication that cause diarrhea include:
Parasitic infections are not common causes of diarrhea in the U. S. Infection with Giardia lamblia occurs among individuals who hike in the mountains or travel abroad and is transmitted by contaminated drinking water. Infection with Giardia usually is not associated with inflammation; there is no blood or pus in the stool and little fever. Infection with amoeba (amoebic dysentery) usually occurs during travel abroad to undeveloped countries and is associated with signs of inflammation--blood or pus in the stool and fever.Cryptosporidium is a diarrhea-producing parasite that is spread by contaminated water because it can survive chlorination. Cyclospora is a diarrhea-producing parasite that has been associated with contaminated raspberries from Guatemala.
There are many strains of E. coli bacteria. Most of the E. coli bacteria are normal inhabitants of the small intestine and colon and are non-pathogenic, meaning they do not cause disease in the intestines. Nevertheless, these non-pathogenic E. coli can cause diseases if they spread outside of the intestines, for example, into the urinary tract (where they cause bladder or kidney infections) or into the blood stream (sepsis).Certain strains of E. coli, however, are pathogenic (meaning they can cause disease in the small intestine and colon). These pathogenic strains of E. coli cause diarrhea either by producing toxins (called enterotoxigenic E. coli or ETEC) or by invading and inflaming the lining of the small intestine and the colon and causing enterocolitis (called enteropathogenic E. coli or EPEC). Traveler's diarrhea usually is caused by an ETEC strain of E. coli that produces a diarrhea-inducing toxin.Tourists visiting foreign countries with warm climates and poor sanitation (Mexico, parts of Africa, etc.) can acquire ETEC by eating contaminated foods such as fruits, vegetables, seafood, raw meat, water, and ice cubes. Toxins produced by ETEC cause the sudden onset of diarrhea, abdominal cramps, nausea, and sometimes vomiting. These symptoms usually occur 3-7 days after arrival in the foreign country and generally subside within 3 days. Occasionally, other bacteria or parasites can cause diarrhea in travelers (for example, Shigella, Giardia, and Campylobacter). Diarrhea caused by these other organisms usually lasts longer than 3 days.
Viral gastroenteritis (viral infection of the stomach and the small intestine) is the most common cause of acute diarrhea worldwide.Symptoms of viral gastroenteritis typically last only 48-72 hours and include:
How can dehydration from diarrhea be prevented and treated?
Oral rehydration solutions (ORS) are liquids that contain a carbohydrate (glucose or rice syrup) and electrolyte (sodium, potassium, chloride, and citrate or bicarbonate). Originally, the World Health Organization (WHO) developed the WHO-ORS to rapidly rehydrate victims of the severe diarrheal illness, cholera. The WHO-ORS solution contains glucose and electrolytes. The glucose in the solution is important because it forces the small intestine to quickly absorb the fluid and the electrolytes. The purpose of the electrolytes in the solution is the prevention and treatment of electrolyte deficiencies.In the U.S., convenient, premixed commercial ORS products that are similar to the WHO-ORS are available for rehydration and prevention of dehydration. Examples of these products are Pedialyte, Rehydralyte, Infalyte, and Resol.Most of the commercially available ORS products in the U.S. contain glucose. Infalyte is the only one that contains rice carbohydrate instead of glucose. Most doctors believe that there are no important differences in effectiveness between glucose and rice carbohydrate.
How is the cause of diarrhea diagnosed?
Acute diarrhea: Acute diarrhea usually requires few tests.
What are common causes of acute diarrhea?
The most common cause of acute diarrhea is infection--viral, bacterial, and parasitic. Bacteria also can cause acute food poisoning. A third important cause of acute diarrhea is starting a new medication since many medications can cause diarrhea.
What are common causes of chronic diarrhea?
Irritable bowel syndrome: The irritable bowel syndrome (IBS) is a functional cause of diarrhea or constipation. Inflammation does not typically exist in the affected bowel. (Nevertheless, recent information suggests that there MAY be a component of inflammation in IBS.) It may be caused by several different underlying problems, but it is believed that the most common cause is rapid passage of the intestinal contents through the colon.Infectious diseases: A few infectious diseases can cause chronic diarrhea, for example, Giardia lamblia. Patients with AIDS often have chronic infections of their intestines that cause diarrhea.Bacterial overgrowth of the small intestine: Because of small intestinal problems, normal colonic bacteria may spread from the colon and into the small intestine. When they do, they are in a position to digest food that the small intestine has not had time to digest and absorb. The mechanism that leads to the development of diarrhea in bacterial overgrowth is not clear.Post-infectious: Following acute viral, bacterial, or parasitic infections, some individuals develop chronic diarrhea. The cause of this type of diarrhea is not clear, but some of the individuals may have bacterial overgrowth of the small intestine. They also have been found to have abnormalities, either microscopic or biochemical, in biopsies of the intestines that suggest that there may be inflammation. This condition also is referred to as post-infectious IBS.Inflammatory bowel disease (IBD): Crohn's disease and ulcerative colitis, diseases causing inflammation of the small intestine and/or colon, commonly cause chronic diarrhea.Colon cancer: Colon cancer can cause either diarrhea or constipation. If the cancer blocks the passage of stool, it usually causes constipation. Sometimes, however, there is secretion of water behind the blockage, and liquid stool from behind the blockage leaks around the cancer and results in diarrhea. Cancer, particularly in the distal part of the colon, can lead to thin stools. The diarrhea or constipation caused by cancer usually is progressive, that is, becomes progressively worse. Cancer in the rectum can lead to a sense of incomplete evacuation.Severe constipation: By blocking the colon, hardened stool can lead to the same problems as colon cancer, as discussed previously.Carbohydrate (sugar) malabsorption: Carbohydrate or sugar malabsorption is an inability to digest and absorb sugars. The most recognized malabsorption of sugar occurs with lactase deficiency (also known as lactose or milk intolerance) in which milk products containing the milk sugar, lactose, lead to diarrhea. The lactose is not broken up in the intestine because of the absence of an intestinal enzyme, lactase that normally breaks up lactose into its component sugars, galactose, and glucose. Without being broken up, lactose cannot be absorbed into the body. The undigested lactose reaches the colon and pulls water (by osmosis) into the colon. The lactose also is digested by colonic bacteria into gas (hydrogen and methane) as well as chemicals that promote the retention or secretion of fluid in the colon. The result of these events leads to diarrhea. Although lactose is the most common form of sugar malabsorption, other sugars in the diet also may cause diarrhea, including fructose and sorbitol.Fat malabsorption: Malabsorption of fat is the inability to digest or absorb fat. Fat malabsorption may occur because of reduced pancreatic secretions that are necessary for normal digestion of fat (for example, due to pancreatitis or pancreatic cancer) or by diseases of the lining of the small intestine that prevent the absorption of digested fat (for example, celiac disease). Undigested fat enters the last part of the small intestine and colon where bacteria turn it into substances (chemicals) that cause water to be secreted by the small intestine and colon. Passage through the small intestine and colon also may be more rapid when there is malabsorption of fat.Endocrine diseases: Several endocrine diseases (imbalances of hormones) may cause diarrhea, for example, an over-active thyroid gland (hyperthyroidism) and an under-active pituitary or adrenal gland (Addison's disease).Laxative abuse: The abuse of laxatives by individuals who want attention or to lose weight is an occasional cause of chronic diarrhea.
What are the complications of diarrhea?
Dehydration occurs when there is excessive loss of fluids and minerals (electrolytes) from the body due to diarrhea, with or without vomiting.
What home remedies help the symptoms of diarrhea?
Many home remedies have been suggested for the treatment of diarrhea; however, few of them have been well-studied. Three that have been studied and appear to be effective are:
What is considered diarrhea?
Diarrhea can be defined in absolute or relative terms based on either the frequency of bowel movements or the consistency (looseness) of stools.Frequency of bowel movements: Absolute diarrhea is having more bowel movements than normal. Thus, since among healthy individuals the maximum number of daily bowel movements is approximately three, diarrhea can be defined as any number of stools greater than three, although some consider five or more bowel movements to be diarrhea. "Relative diarrhea" is having more bowel movements than usual. Thus, if an individual who usually has one bowel movement each day begins to have two bowel movements each day, then relative diarrhea is present-even though there are not more than three or five bowel movements a day, that is, there is not absolute diarrhea.Consistency of stools: Absolute diarrhea is more difficult to define on the consistency of stool because the consistency of stool can vary considerably in healthy individuals depending on their diets. Thus, individuals who eat large amounts of vegetables will have looser stools than individuals who eat few vegetables and/or fruits. Stools that are liquid or watery are always abnormal and considered diarrheal. Relative diarrhea is easier to define based on the consistency of stool. Thus, an individual who develops looser stools than usual has relative diarrhea--even though the stools may be within the range of normal with respect to consistency.Why does diarrhea develop?With diarrhea, stools usually are looser whether or not the frequency of bowel movements is increased. This looseness of stool--which can vary all the way from slightly soft to watery--is caused by increased water in the stool. During normal digestion, food is kept liquid by the secretion of large amounts of water by the stomach, upper small intestine, pancreas, and gallbladder. Food that is not digested reaches the lower small intestine and colon in liquid form. The lower small intestine and particularly the colon absorb the water, turning the undigested food into a more-or-less solid stool with form. Increased amounts of water in stool can occur if the stomach and/or small intestine secrete too much fluid, the distal small intestine and colon do not absorb enough water, or the undigested, liquid food passes too quickly through the small intestine and colon for enough water to be removed.Another way of looking at the reasons for diarrhea is to divide it into five types.
What is diarrhea?
Diarrhea is an increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool). Although changes in frequency of bowel movements and looseness of stools can vary independently of each other, changes often occur in both.Diarrhea needs to be distinguished from four other conditions. Although these conditions may accompany diarrhea, they often have different causes and different treatments than diarrhea. These other conditions are:
What is the treatment for diarrhea in older children and adults?
During mild cases of diarrhea, diluted fruit juices, soft drinks containing sugar, sports drinks such as Gatorade, and water can be used to prevent dehydration. Caffeine and lactose containing dairy products should be temporarily avoided since they can aggravate diarrhea, the latter primarily in individuals with transient lactose intolerance. If there is no nausea and vomiting, solid foods should be continued. Foods that usually are well tolerated during a diarrheal illness include rice, cereal, bananas, potatoes, and lactose-free products.Oral rehydration solutions can be used for moderately severe diarrhea that is accompanied by dehydration in children older than 10 years of age and in adults. These solutions are given at 50 ml/kg over 4-6 hours for mild dehydration or 100 ml/kg over 6 hours for moderate dehydration. After rehydration, the oral rehydration solution can be used to maintain hydration at 100 ml to 200 ml/kg over 24 hours until the diarrhea stops. Directions on the solution label usually state the amounts that are appropriate. After rehydration, older children and adults should resume solid food as soon as any nausea and vomiting subside. Solid food should begin with rice, cereal, bananas, potatoes, and lactose free and low fat products. The variety of foods can be expanded as the diarrhea subsides.
What is the treatment of diarrhea in infants and children?
Most acute diarrhea in infants and young children is due to viral gastroenteritis and is usually short-lived. Antibiotics are not routinely prescribed for viral gastroenteritis. However, fever, vomiting, and loose stools can be symptoms of other childhood infections such as otitis media (infection of the middle ear), pneumonia, bladder infection, sepsis (bacterial infection in the blood) and meningitis. These illnesses may require early antibiotic treatment.Infants with acute diarrhea also can quickly become severely dehydrated and therefore need early rehydration. For these reasons, sick infants with diarrhea should be evaluated by their pediatricians to identify and treat underlying infections as well as to provide instructions on the proper use of oral rehydration products.Infants with moderate to severe dehydration usually are treated with intravenous fluids in the hospital. The pediatrician may decide to treat infants who are mildly dehydrated due to viral gastroenteritis at home with oral rehydration solutions.Infants that are breastfed or formula-fed should continue to receive breast milk during the rehydration phase of their illness if not prevented by vomiting. During, and for a short time after recovering from viral gastroenteritis, babies can be lactose intolerant due to a temporary deficiency of the enzyme, lactase (necessary to digest the lactose in milk) in the small intestine. Infants with lactose intolerance can develop worsening diarrhea and cramps when dairy products are introduced. Therefore, after rehydration with oral rehydration solutions, an undiluted lactose-free formula and diluted juices are recommended. Milk products can be gradually increased as the infant improves.
What medications are used to treat diarrhea?
AbsorbentsAbsorbents are compounds that absorb water. Absorbents that are taken orally bind water in the small intestine and colon and make diarrheal stools less watery. They also may bind toxic chemicals produced by bacteria that cause the small intestine to secrete fluid; however, the importance of toxin binding in reducing diarrhea is unclear.The two main absorbents are attapulgite (a naturally occurring complex mineral) and polycarbophil (a fiber) both available without prescriptions. Psyllium, another absorbent has been used for mild diarrhea, but is primarily used for constipation.Examples of products containing attapulgite are:
What symptoms are associated with diarrhea?
The symptoms that are associated with diarrhea depend on the cause and type of diarrhea.
When should antibiotics be used for diarrhea?
Most episodes of diarrhea are acute and of short duration and do not require antibiotics. Antibiotics are not even necessary for the most common bacterial infections that cause diarrhea.Antibiotics, however, often are used when
When should you call a doctor for diarrhea?
Most episodes of diarrhea are mild and of short duration and do not need to be brought to the attention of a doctor. The doctor should be consulted when there is:
Which types of doctors treat diarrhea?
Gastroenterologists are the specialists who usually manage patients with diarrhea and pursue the diagnosis of its cause, particularly when the diarrhea is chronic.
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