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The frequency of bowel movement in a normal states can range from three motions per day to one every third day. Normal stool consistency can vary from soft, porridge-like, to hard and pellet-like. Increased stool frequency, more than three times in a day, with passage of loose, unformed, watery stools is known as diarrhoea – runny tummy or loose motion.

The stool in diarrhoea may be mixed with mucous, pus or blood or it may be greasy and offensive-smelling. Most cases resolve on their own, but if severe, diarrhoea can lead to dehydration, which can become life-threatening, particularly in small children and the elderly.

Diarrhoea can either come on suddenly (acute diarrhoea) or may be present over a longer period of time (chronic diarrhoea is diarrhoea persisting for over 4 weeks).

Causes of Diarrhoea

Acute diarrhoea is usually caused by viral, bacterial or parasitic infection. Chronic diarrhoea is more likely to occur as a result of some functional disorder, such as irritable bowel syndrome (IBS) or inflammatory bowel disease.

Traveller’s diarrhoea may develop in people visiting foreign countries, particularly the developing countries, if adequate care is not taken regarding food and water consumption. Food or water contaminated with bacteria, viruses or parasites can cause traveller’s diarrhoea.

Diarrhoea is a common symptom of many conditions and diseases. In some cases, no definite cause can be found and the diarrhoea goes away on its own without any treatment. The common causes of diarrhoea may include :

  • Viral gastroenteritis is the most common cause of acute diarrhoea. The symptoms are often mild and resolve on their own. The gastric flu or ‘tummy bug’ may be caused by a rotavirus, adenovirus, Norwalk virus, viral hepatitis or cytomegalovirus.
  • Bacterial infection usually occurs due to consumption of contaminated food or water and may present either as food poisoning or traveller’s diarrhoea. Bacterial infections causing diarrhoea could be due to Campylobacter, Salmonella, Shigella and Escherichia coli (E. coli).
  • Parasitic infection – parasites causing diarrhoea enter the digestive system through contaminated food or water. They may include Giardia lamblia, Entamoeba histolytica or Cryptosporidium.
  • Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.
  • Food intolerances such as lactose or gluten intolerance.
  • Reaction to medicines – particularly antibiotics, antacids containing magnesium and chemotherapy.
  • Laxative abuse.
  • Coeliac disease (celiac disease or sprue).
  • Irritable bowel syndrome (IBS).
  • Diverticulitis.
  • Drastic changes in diet.

Other rarer causes may be :

  • Following stomach surgery (partial gastrectomy) or cholecystectomy (surgical removal of the gall bladder). Diarrhoea after weight loss surgery, especially radical procedures some of which are now banned like jejuno-ileal (JIB) surgery.
  • Radiation therapy.
  • Thyrotoxicosis.
  • Zollinger-Ellison syndrome.
  • Carcinoid syndrome.
  • Autonomic neuropathy.
  • Diabetic neuropathy.

Signs and Symptoms of Diarrhoea

Signs and symptoms may vary according to the cause of diarrhoea.

  • Frequent loose, watery or liquid stools.
  • Stool may be mixed with mucous, pus or blood.
  • Urgent need to pass stool (urging).
  • Nausea with/without vomiting.
  • Fever.
  • Abdominal cramps or pain.
  • Dehydration may present as excessive thirst, dry mouth, dry skin, and small quantities of dark yellow, concentrated urine.
  • Stomach distention (abdominal bloating).
  • Weakness and fatigue.
  • Headache.
  • Muscle pain.

Treatment of Diarrhoea

Treatment at home, without any specific medicine, is usually effective in controlling mild to moderate diarrhoea within two or three days. If the diarrhea is persisting for more than 3 days or if there are any signs of dehydration or other symptoms, medical treatment should be sought.

  • The main aim of treatment is to replace lost fluid and electrolytes to prevent development of dehydration. Plenty of fluids should be taken by mouth but alcohol, caffeine and dairy products should be avoided. Oral rehydration solutions (ORS) are helpful, especially in case of young children.
  • Bland diet containing soft rice, toast, bananas and apple is advisable. Refer to the Diarrhoea Diet.
  • Medication – use of medication such as loperamide to stop diarrhoea is controversial but may become necessary in some cases. It should never be used in the case of diarrhoea due to a bacterial or parasitic infection. Antibiotics may be necessary.
  • Avoiding foods that may be causing the diarrhoea if you have identified it.
  • In chronic diarrhoea, adding bulk by means of fibre (whole wheat or bran) in the diet often helps.
  • In case of severe diarrhoea and dehydration and if the patient is not able to keep anything down due to uncontrolled vomiting, hospitalization may need to be done and intravenous fluids will be administered.
  • Persistent, watery diarrhoea after the flu or diarrhoea after antibiotics (antibiotic associated diarrhoea or AAD) may mean that your ‘good’ bacteria in the bowel need to be supplemented. You should use a probiotic like Interflora (TM). Live culture yoghurt may aggravate your diarrhoea further.

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