Runny feces, motions, poop and poo. Dealing with diarrhea.

Diarrhea can be a troubling symptom that is either acute – comes on suddenly and lasts for a short time – or chronic, lasting for longer than 4 weeks.  Doctors often call this ‘persistent diarrhea’.

The function of the digestive system is to process the food and remove the nutrients – minerals, vitamins, proteins, fats and carbohydrates – so that the body can use them.  It also re-absorbs some of the water from the resulting stool.  It takes time to do this and certain parts of the digestive system absorb certain nutrients.

Diarrhea happens when the gut moves its contents along too quickly and if this goes on too long, you don’t get those nutrients, you can become dehydrated and this makes you feel weak and unwell.

Diarrhea can be serious if it’s not treated correctly, so here we’ll look at the causes and treatments for both types of diarrhea.

The causes of diarrhea.

  • Infection in the gut from food or water that you’ve eaten/drunk is a common cause of diarrhea.  An example is food poisoning which can happen in your home country or abroad.  Bacteria, parasites and viruses can be passed on by an infected person if they don’t wash their hands properly. Traveller’s diarrhea is common in people travelling to Africa, Asia, the Caribbean and Latin America.
  • Gut disorders such as irritable bowel syndrome (IBS), Crohn’s Disease, diverticulitis, celiac disease or ulcerative colitis.
  • Anxiety.
  • Drinking too much beer.
  • Side effects of some medications, for example some antibiotics, some cancer meds and antacids containing magnesium can all cause diarrhea.
  • Food intolerances or sensitivities.
  • Over active thyroid disease.

When should I worry about diarrhea?

If your symptoms of diarrhea, with or without vomiting, last only for 1-2 days and you are otherwise healthy, there is no need to worry.  But see below for other essential cautions when you have diarrhea.

Infectious diarrhea symptoms are usually:

  • Feeling increasingly unwell over only a few hours.
  • Watery or loose stools/faeces/poo which you pass at least 3 times in 24 hours.
  • The stools may have blood or mucous in them.
  • Cramping pains in the stomach.  They may ease a little when you pass some diarrhea.
  • Urgent feeling of needing to pass a stool.
  • You may also have a vomiting, fever, aching limbs and headache.

Symptoms of chronic diarrhea are usually:

  • Feeling fairly well but having loose stools 1-2 times each day (may be more).  Feeling unwell or tired usually comes on later, after several weeks of diarrhea.
  • Stools may be loose or watery.  See the picture of the Bristol Stool Chart here to gauge this.

If you develop diarrhea and it doesn’t go away on its own after a few weeks, talk to your doctor who may order some tests.

See your doctor sooner if there is blood in the stool.  There may be an easy explanation for this – bleeding from piles or fissures in the anus or irritation at the anus from the diarrhea – but your doctor should check as bleeding from the back passage can be an early sign of cancer.

If you are:

  • Pregnant
  • Elderly or frail or the person you’re caring for is elderly/frail and has diarrhea
  • Have Addison’s Disease or are dependent on taking steroid tablets
  • Unable to drink or keep fluid down due to severe vomiting and diarrhea and have symptoms of dehydration (see below)
  • Diabetic, have kidney disease or inflammatory bowel disease
  • Aware you have a weakened immune system because of HIV, chemotherapy or long term steroid treatment
  • Experiencing severe abdominal pain, high fever or feel your symptoms are getting worse
  • Experiencing black or tarry stools
  • Recently returned from travel in Africa, Asia, Latin America or the Caribbean and have bloody diarrhea

Then you should seek medical help sooner rather than later as you are at more risk of dehydration and/or more severe consequences.

Dehydration and diarrhea.

The main symptoms of dehydration are passing little and concentrated urine, feeling dizzy, having a headache, muscle cramps, dry mouth and tongue, feeling weak and getting irritable.

Severe dehydration symptoms include confusion, rapid heart rate and coma.  Emergency medical help is essential.

How do I treat diarrhea?

If you have short-term diarrhea that’s caused by an infection it’s important to let the infection pass out of the body.  So avoid any meds that stop the diarrhea.

  • Drink plenty of water and monitor the volume colour of the urine you’re passing – it should be pale in colour, which indicates that you’re not dehydrated.
  • Eat small amounts of plain food such as toast, bananas, poached fish or chicken, rice etc.  Avoid fatty or spicy foods.
  • If the diarrhea persists for more than a few days and then you may want to take rehydration salts (eg Dioralyte sachets, sports drinks) which contain salts and minerals lost during vomiting and diarrhea.
  • Paracetamol and/or ibuprofen will help with the aches and pains if you have these.
  • ALWAYS make sure you wash and dry your hands thoroughly.  Use a toilet cleaner; don’t share towels with other householders; avoid preparing food but wash your hands thoroughly if you must; wipe toilet handles and bathroom door handles with disinfectant.  These measures will prevent the infection spreading to others.

Chronic diarrhea that is part of irritable bowel syndrome or anxiety can be treated with a drug that slows down the bowel action.  The safest and most effective of these drugs are loperamide (Imodium).

If you’re pregnant, have a high temperature, bloody diarrhea, mucous in the diarrhea DO NOT take loperamide.

Don’t take it for longer than 5 days or take more than 8 capsules in 24 hours.

Chronic diarrhea that’s part of inflammatory bowel disease – Crohn’s disease, celiac, diverticulitis, ulcerative colitis – must be treated in conjunction with your specialist doctor.

Other essential cautions when you have diarrhea:

If you are taking some medications, such as the birth control pill, meds for epilepsy and meds for diabetes, talk to your health care provider as their effectiveness may be reduced.

If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault, read this page now:  How to talk to a doctor about an embarrassing problem.

Elspeth Raisbeck

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