Diarrhea - causes, treatment, prevention overview

Diarrhea is when you have frequent loose watery bowel motions. In most cases, the symptoms resolve on their own within a couple of days without the need for medical treatment.
Diarrhea that lasts one or two days and goes away on its own is known as acute diarrhea, which is a common condition that affects people of all ages. Diarrhea lasting four weeks or more (whether continuous or intermittent) is known as chronic diarrhea and can be a symptom of an underlying chronic disease or condition.

Acute (or brief) diarrhea is usually caused by a bacterial (eg, salmonella), viral (eg, norovirus or rotavirus), or parasitic (eg, giardia) infection of the bowels. Diarrhea caused by any of these infections is referred to as gastroenteritis.

Travel to places where the climate or sanitary practices differ form one's home country may cause short-term gastroenteritis (eg from contaminated food or water) and is known as traveller's diarrhea.  Diarrhea associated with jet lag will usually subside in a matter of days without treatment.

The most common causes of chronic diarrhea are underlying diseases or conditions, including: 

Gluten intolerance (e.g. coeliac disease )
Lactose intolerance (inability to properly digest lactose in dairy products)
Irritable bowel syndrome
Chronic bowel infection
Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis
Bowel cancer.
You should see your doctor if you are concerned that you might have any of these conditions.

Chronic diarrhea can also occur when taking certain medications, e.g. some antibiotics and cancer drugs. 

Signs and symptoms
The main symptom of diarrhea is loose, watery bowel motions (stools, faeces) three or more times a day.
Accompanying signs and symptoms may include: 
Urgent need to go to the toilet
Abdominal pain and cramping
Change in color of your stools
Mucous, pus, blood, or fat in your stools
General body weakness and tiredness.
Diarrhea is easily diagnosed by its symptoms.

If the diarrhea lasts longer than two or three days, or is accompanied by symptoms such as fever or bloody stools, your doctor may perform diagnostic tests to determine the cause.

These diagnostic tests could include: 

Stool culture to test for infection
Blood tests to rule out other diseases
Fasting tests to reveal food intolerance
Sigmoidoscopy or colonoscopy to look for signs of inflammatory bowel diseases (these tests involve using a device with thin flexible tube and a camera and light at one end to look inside the bowel).

You should see a doctor if you or your baby / child develop any of the following signs: 
Blood, pus, or mucous in stools
A rash
Diarrhea lasting longer than one week or gets better and comes back
New or worse symptoms.
Chronic or severe diarrhea can lead to rapid dehydration, which is the excessive loss of fluids from the body. Dehydration is particularly dangerous in infants and children, the elderly, and people with weakened immune systems (e.g. people with HIV/AIDS or undergoing chemotherapy).

A doctor should also be seen if you, or a family member, becomes dehydrated. The signs and symptoms of dehydration include: 

Extreme thirst 
Little or no urine passed in the last eight hours
Urine is dark in color and smelly
Reduced saliva in the mouth, dry lips, no tears, sunken cheeks or eyes
Infants may have dry nappies (for longer than 4-6 hours) and/or have a sunken fontanelle (the soft spot on top of a baby’s head)
Dizziness, lethargy, floppiness
Rapid heart rate and breathing
Cold hands and feet
Skin that does not relax after being pinched.

Because most cases of diarrhoea resolve on their own within a day or two, self-care to relieve symptoms is usually sufficient for treatment: 
Avoid caffeine, dairy products, and greasy, high fibre, or sugary foods
Placing a hot water bottle or wheat pack on your stomach, or taking paracetamol (e.g. Panadol), may provide some relief from abdominal cramps
Apply zinc and castor oil ointment or a barrier cream to affected areas if you, or your child, develops a rash (like nappy rash) from the diarrhea
Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or diclofenac, for pain relief as these medications can cause diarrhea
Anti-diarrhea medications that slow diarrhea (e.g. Imodium) should be avoided as these drugs prevent your body from getting rid of the bacteria or virus that may have caused the diarrhea.
To avoid dehydration, drink plenty of liquid every day, taking small, frequent sips. Ideal liquids are clear thin broths or soups, diluted non-caffeinated sports drinks (e.g. Powerade or Gatorade), and rehydration formulations (e.g. Gastrolyte) that are available without prescription from a pharmacy. 

Hand washing is one of the most effective ways of preventing the spread of viruses and bacteria that can cause diarrhoea. You should always wash your hands thoroughly after using the toilet, changing nappies, and before meals.
The following rules when preparing food can also help prevent diarrhea: 
Always put foods that could spoil in the fridge
Ensure that meat is cooked thoroughly
Avoid eating raw meats, fish, and shellfish unless you are sure that they have been freshly prepared and are from a reliable source
Never place cooked meat on surfaces or plates that have held raw meat
Disinfect bench tops, stove tops, and chopping boards with a diluted bleach solution. 

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