It is not unusual for some people to pass stool more frequently than others. Bowel habit as it is known varies among individuals. You could have a bowel movement just once every second day and this is considered normal whereas others may have two bowel movements in a 24 hour period. Provided that the stool is soft but well formed and is not difficult or painful to pass out then it is considered to be a normal bowel movement.
Diarrhoea (US ~ diarrhea) on the other hand is where you have a bowel movement more than three times a day and usually the stool is watery or less well formed than normal. It is a common problem that affects babies, children, teens and adults every now and then for various reasons. Apart from outbreaks of viral gastroenteritis, diarrhoea occurs as a symptom of several acute and chronic diseases.
Most of us in South Africa refer to diarrhoea as runny tummy or a “running stomach”. We also frequently use the terms “stomach bug”, “stomach flu” or “tummy bug”. However, it is important to understand that diarrhoea is not always a problem with the stomach itself and not every case of diarrhoea is due to an infection (bugs). Furthermore diarrheal stool is not only water and the food that was last eaten.
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 intestinal diseases like inflammatory bowel disease (IBD).
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. This is a common cause of baby and toddler diarrhoea.
- 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).
- 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.
- 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.
- 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.
- 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.
- 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.
Foods to Eat and Avoid After a Runny Tummy
A diarrhoea diet is the foods that you should eat during and immediately after a bout of diarrhoea. These foods will be less likely to aggravate the diarrhoea or trigger another spell of diarrhoea once your condition settles. Every case of diarrhoea should be investigated and you should not try to manage your diarrhoea at home without medical treatment.
Fluids During Diarrhoea
When you have a runny tummy, you may not want to eat any solid food. While drinking fluids only will suffice for a day or two, you should not avoid food altogether for long periods of time. The lack of nutrition will lower your immune system and not allow you to recover or other medical conditions may develop.
If you are sticking to fluids only, then don’t only drink water. This is not sufficient as you will need electrolytes (salts) and a source of energy like carbohydrates. Avoid energy drinks and carbonated beverages. The preservatives, colourants and flavouring within these drinks may aggravate your diarrhoea.
Speak to your pharmacist and buy a rehydrating solution which is usually available as a powder or granules that can be dissolved in water. Alternatively you you can opt for a cheaper home remedy where you mix 8 teaspoons of sugar and half a teaspoon of salt into litre of clean water. You can use this as your rehydrating solution.
Foods After Diarrhea
Once your bowel movements settle to some extent and if you have regained your appetite, you may want to start on small amounts of food. The basic foods that are less likely to aggravate you diarrhoea are :
- Bananas, mashed.
- Rice, soft.
- Apples, grated.
- Toast, soft with no butter, margarine, jam or peanut butter.
This is known as the BRAT diet and is the simplest way to introduce food to your bowels. Home made soup is always an option but avoid large chunks of vegetables and meat and do not use spices. Rather drink small amounts of the broth. Do not opt for sachet soups available in supermarkets as the additives within these food products may aggravate your diarrhoea.
Avoid milk, alcohol, foods and drinks with preservatives. Fruit juices may may also aggravate diarrhoea.
Persistent Diarrhoea After a Tummy Bug or Antibiotics
If your diarrhoea has not eased despite medical treatment, then your ‘good’ bowel bacteria (intestinal flora) may be lacking. This can occur due to the bowel condition that you just experienced or may be a result of certain antibiotics. In these cases, it is not the food that is causing the diarrhoea but rather a lack of ‘good’ bacteria.You may experience explosive or watery diarrhoea after eating, stomach cramps and abdominal gas bloating with flatulence.
Do not eat large amounts of probiotic yoghurt to restore your good bowel bacteria as the lactose may aggravate the condition. You will need to take a course of capsules containing Saccharomyces boulardii which will help restore your normal intestinal flora. This product is available in all pharmacies in South Africa under various brand names like Interflora. You will not need a prescription and your pharmacist will advise you on how to use it.