Diarrhea

DIARRHEA

DEFINITION

  • Diarrhea is the sudden increase in the frequency and looseness of BMs (bowel movements, stools).
  • Mild diarrhea is the passage of a few loose or mushy BMs.
  • Severe diarrhea is the passage of many watery BMs.

General Information

  • The majority of adults with diarrhea of less than two weeks duration have an infectious cause for their diarrhea, and in most cases the infection is a virus. Other common causes of acute diarrhea are food poisoning and medications.
  • Maintaining good hydration is the cornerstone of treatment of adults with acute diarrhea. In general, an adult who is alert, feels well, and who is not thirsty or dizzy - is not dehydrated.
  • Antibiotic therapy is only rarely required in the treatment of acute diarrhea. One type of acute diarrhea that requires antibiotic therapy is Traveler's Diarrhea.

See More Appropriate Topic (instead of this one) If

^Back to Top

WHEN TO CALL YOUR DOCTOR

Call 911 (you may need an ambulance) if:

  • Very weak (can't stand)

Call your doctor now (night or day) if:

  • You feel weak or very sick
  • Fever of 103 F (39.4 C) or higher
  • Signs of dehydration (e.g. no urine in more than 12 hours, very dry mouth, lightheaded, etc.)
  • Severe abdominal pain
  • Constant abdominal pain for more than 2 hours
  • Bloody bowel movements
  • Black bowel movements
  • More than 10 diarrhea stools in the past 24 hours

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think you need to be seen
  • Fever of 101 F (38.3 C) or higher
  • Abdominal pain (EXCEPTION: Pain clears with each passage of diarrhea stool)
  • Mucus or pus in stool for greater than 2 days
  • Small amount of blood in the stool (EXCEPTION: only on toilet paper. Reason: diarrhea can cause rectal irritation with blood on wiping)
  • Recent antibiotic treatment
  • Have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)
  • Recent travel to a foreign country and diarrhea started during trip or within 7 days of return
  • Receiving tube feedings (e.g. nasogastric, g-tube, j-tube)
  • Age greater than 70

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Diarrhea persists for more than 7 days
  • Diarrhea is a recurrent problem

Self care at home if:

  • Mild diarrhea and you don't think you need to be seen
^Back to Top

HOME CARE ADVICE

  • Reassurance: In healthy adults, new onset diarrhea is usually caused by a viral infection of the intestines, which you can treat at home. Diarrhea is the body's way of getting rid of the infection.  Here are some tips on how to keep ahead of the fluid losses.
  • Fluids:
    • Drink more fluids, at least 8-10 glasses (8 oz) daily.
    • For example: sports drinks, diluted fruit juices, soft drinks.
    • Supplement this with saltine crackers or soups to make certain that you are getting sufficient fluid and salt to meet your body's needs.
    • Avoid caffeinated beverages (Reason: caffeine is mildly dehydrating).
  • Nutrition:
    • Maintaining some food intake during episodes of diarrhea is important.
    • Ideal initial foods include boiled starches/cereals (e.g. potatoes, rice, noodles, wheat, oats) with a small amount of salt to taste.
    • Other acceptable foods include: bananas, yogurt, crackers, soup.
    • As your stools return to normal consistency, resume a normal diet.
  • Diarrhea Medication - Bismuth Subsalicylate (e.g. PeptoBismol):
    • Helps reduce diarrhea, vomiting, and abdominal cramping.
    • Adult dosage: two tablets or two tablespoons by mouth every hour (if diarrhea continues) to a maximum of 8 doses in a 24-hour period.
    • Do not use for more than 2 days
  • Diarrhea Medication - Imodium AD:
    • Helps reduce diarrhea.
    • Adult dosage: 2 caplets or 4 teaspoonfuls initially by mouth. May take an additional caplet or 2 teaspoonfuls with each subsequent loose BM. Maximum of 4 caplets or 8 teaspoonfuls each day.
    • Do not use if there is a fever greater than 100 F or if there is blood or mucus in the stools.
    • Do not use for more than 2 days.
    • Read and follow the package instructions carefully.
  • Expected Course:Viral diarrhea lasts 4-7 days. Always worse on days 1 and 2.
  • Call Your Doctor If:
    • Signs of dehydration occur (e.g. no urine > 12 hours, very dry mouth, lightheaded, etc.)
    • Diarrhea persists > 7 days  
    • You become worse

And remember, contact your doctor if you become worse or develop any of the "Call Your Doctor" symptoms.

^Back to Top

REFERENCES

  1. Acheson DW, Fiore AE. Preventing foodborne disease--what clinicians can do. N Engl J Med. 2004 Jan 29;350(5):437-40.
  2. Centers for Disease Control and Prevention. Diagnosis and management of foodborne illnesses: a primer for physicians. MMWR Recomm Rep. 2004;53(RR-4):133.
  3. DuPont HL. New insights and directions in travelers' diarrhea. Gastroenterol Clin North Am. 2006; 35(2): 337-53, viii-ix.
  4. DuPont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1997;92(11):1962-75.
  5. Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology. Am J Gastroenterol. 1997;92(5):739-50.
  6. Goodgame R. A Bayesian approach to acute infectious diarrhea in adults. Gastroenterol Clin North Am. 2006; 35(2): 249-73.
  7. Gore JI, Surawicz C. Severe acute diarrhea. Gastroenterol Clin North Am. 2003;32(4):1249-67.
  8. Guerrant RL, Van Gilder TV, Steiner TS, et.al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32(3);331.
  9. Kamat D, Mathur A. Prevention and Management of Travelers' Diarrhea. Dis Mon. 2006;52(7):289-302.
  10. Ryan ET, Wilson ME, Kain KC. Illness after international travel. N Eng J Med. 2002;347:505-516.
  11. Schiller LR. Diarrhea. Med Clin North Am. 2000;84(5);1259-1274.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

See Other Topics:

View Anatomic Index of Topics