Diarrhea

Diarrhea is a disease that causes by toxins, microorganisms, and other substances, which do not usually occur commonly in the gastrointestinal tract (GIT). These foreign agents and organisms are causing the GIT to react violently through faster peristalsis to either eliminate or purge them.

When the substance or organism is too many to eliminate diarrhea will be prolonged and dehydration will be the consequence. Also when a patient has diarrhea regular eating habits will not meet and the body will be deprived of nutrients and energy coming from food. Thus, treatment should be given to avoid dehydration, weakness, vomiting, and worst death.

What Is Diarrhea?

• Diarrhea is defined as frequent loose, watery bowel movements. Normally, the stool is 60-90% water. Diarrhea occurs when not enough water is removed from the stool, causing it to become loose and poorly formed.
• These frequent bowel movements can be caused by a variety of different conditions from temporary viral and bacterial infections such as food poisoning, and irritable bowel syndrome (IBS), to more serious conditions like inflammatory bowel disease (IBD) and gastrointestinal bleeding.
• Acute cases of diarrhea last up to two weeks, while chronic or persistent diarrhea can last between two and four weeks and maybe a sign of a more serious problem. 

What are the symptoms of diarrhea?

• The main symptom of diarrhea is passing loose, watery stools three or more times a day.
• Patients with diarrhea may also have one or more of the following symptoms:

1. an urgent need to use the bathroom
2. cramping
3. loss of control of bowel movements
4. nausea
5. pain in the abdomen

• People with diarrhea caused by some infections may also have one or more of the following symptoms:

1. bloody stools
2. fever and chills
3. light-headedness and dizziness
4. vomiting

Diarrhea may cause dehydration and malabsorption.

Causes for Diarrhea

The most common causes of diarrhea include:

• Viruses
• Bacteria
• Parasites

Other causes include medications, such as antibiotics that disturb the natural balance of the bacteria in your intestines, artificial sweeteners, and lactose, which is a sugar found in milk.

Causes of acute diarrhea

• Acute diarrhea is commonly caused by viruses. The most common one in children is rotavirus and in adults is norovirus. If you are experiencing consistent diarrhea for short periods of time, it could be due to one of the following issues:

1. A viral infection
2. A bacterial infection
3. A parasitic infection
4. Food intolerance
5. Food allergy
6. Food poisoning
7. Adverse reaction to a medication
8. Certain foods (such as milk and artificial sweeteners)

Causes of chronic diarrhea

• Chronic diarrhea may be a symptom of a more serious or chronic condition such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). Frequent and severe diarrhea could be a sign of these associated conditions:

1. Inflammatory bowel disease (IBD)
2. Irritable bowel syndrome (IBS)
3. Infection
4. Radiation therapy
5. Adverse reaction to a medication
6. Diabetes
7. Gluten insensitivity (celiac disease)
8. Lactose intolerance or other food intolerance
9. Alcohol abuse
10. HIV or other immunodeficiencies
11. Overgrowth in harmful colon bacteria due to recent antibiotic use (c. difficile colitis)

Traveler's Diarrhea

• Travelers’ diarrhea is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. 
• Travelers’ diarrhea is most often acute. However, some parasites cause diarrhea that lasts longer. Travelers’ diarrhea can be a problem for people traveling to developing countries.

Types of Diarrhea

• Types of diarrhea include:

1. Acute diarrhea: Diarrhea that lasts for less than two weeks. Most cases of acute, watery diarrhea are caused by viruses or bacteria (such is the case for the common travelers’ diarrhea). Most cases of acute diarrhea will approve on their own within two to three days.
2. Chronic diarrhea: Diarrhea that lasts longer than four weeks (also known as persistent diarrhea). This type of diarrhea may be a result of a more serious condition and should be brought to the attention of your doctor.

• Diarrhea can also be classified by look or color:

1. Watery diarrhea: Liquid stool is common in both acute and chronic cases of diarrhea.
2. Bloody diarrhea: A potentially serious condition where blood mixes in with loose, watery stools. Bloody diarrhea may be a sign of gastrointestinal bleeding due to injury or disease. Small amounts of blood may also be due to irritation of the rectal tissue or hemorrhoids.
3. Black diarrhea: Could indicate bleeding from a location somewhere in the higher portion of the digestive tract. Other potential causes of black diarrhea include taking iron supplements or bismuth subsalicylate (Pepto-Bismol), or consuming foods or liquids that are blue or black in color.
4. Yellow diarrhea: Could indicate an underlying disorder in the liver or gallbladder. This is normal in infants.
5. Green diarrhea: May be seen after eating leafy greens or foods with artificial green coloring. This can also be a normal color in infants and toddlers.

Treatment for Diarrhea

First-Line Treatment:

1. Oral Rehydration Solution (ORS)

• This is the first and foremost supportive treatment when diarrhea occurs. Either infant or adult is the victim ORS must not be abandoned as the first line of supportive treatment because it rehydrates the body with balanced and proper electrolytes, energy and fluids. 
• ORS comes with the combination of sodium, chloride, potassium, and citrate (bicarbonate in some formulas) electrolytes for cellular function to continue, including glucose for a source of energy and purified water for hydration. 
• Oral Rehydration Solution will be given during the course of diarrhea. As long as diarrhea is there ORS should also be present unless the patient is brought to a hospital where intravenous fluids are given to him/her.

2. Loperamide and other gastrokinetic drugs

• Loperamide is used to reduce the movement of the intestines during the loss of bowel movement. Because of this effect, sometimes Loperamide is not advisable to use because it impedes eliminating toxins or microorganisms that cause diarrhea. It is advisable to use it when muscle cramps or spasms occur to pacify the pain in the GI muscles. 
• Hyoscine is also used for spasms or cramps. When vomiting is occurring metoclopramide is given to stop the puking. Hyoscine and metoclopramide must be given with prescription order through oral (at home) or IV in the hospital. 
• Sometimes dicycloverine is given but it depends on the doctor’s order. Loperamide can be procured in pharmacy over-the-counter. Ask the pharmacist about its use of it.

3. Antisecretory agent and Probiotics

• Anti-secretory agents such as Racecadotril can prevent the secretion of fluids in the GIT that adds more to the fluidity of diarrhea. When this drug is administered it will stop the site of production of fluids in the intestines. 
• Probiotics can help to rebalance the normal bacterial flora in the intestines. Microorganisms will absolutely purge also when diarrhea occurs, which reduces their number in the tract or especially when antibiotic treatment is administered. Good bacteria keep the GIT balanced by fighting the bad bacteria and neutralizing the toxins and some substances that prevent the normal function of the GI system. Remember to take these drugs with the proper physician’s order.

4. Antibacterial Prescription Drugs

• Such as Metronidazole and Cotrimoxazole. These drugs can be given when bacteria are the leading cause of diarrhea. There are more antibacterial drugs that can be prescribed but these are the common ones.

Conclusion

• Diarrhea is a serious case of disease that when left untreated will lead to death. There are many types of it, which depends on the causative agent. When diarrhea occurs supportive treatment should be given only at home. However, when diarrhea does not stop within 12 - 24 hours from its commencement the patient should be brought to the hospital for proper treatment, and IV fluids to be administered. 
• Especially when vomiting occurs do not hesitate to bring them to the hospital or clinic. Do not self-diagnose or self-medicate. Follow the emergency treatment in which if the treatment is not effective visit a physician or bring the patient to the nearest hospital.