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Defining, Diagnosing & Dealing with Diarrhea

~ by Jo Jordan

What Is Diarrhea?

In general, diarrhea is defined as having loose, mushy, and/or watery stool with an increase in the frequency of bowel movements. Often, diarrhea happens in short bouts that disappear after a few days. Chronic diarrhea, however, is defined as lasting more than four weeks.

Defining Diarrhea

Every individual is different, so the way each person experiences diarrhea can vary. Frequency and stool consistency are the two components to consider if you are concerned about diarrhea. Healthy people tend to have a maximum of three bowel movements each day, so diarrhea can be defined as having more than three. However, if one daily movement is normal for you, to suddenly start having three each day would be considered diarrhea.

Consistency also varies among healthy individuals, and is somewhat dependent on eating habits. While watery or liquid stools are always considered abnormal, people whose diets consist of a large quantity of fruits and vegetables will have looser stools than those who don't eat this way. Again, as with frequency, if you normally have fairly solid stools and suddenly develop looser than usual stools, this would be considered diarrhea.

What Happens Internally When You Have Diarrhea?

During normal, healthy digestion, your body absorbs nutrients and water from food as it is pushed through the intestine by muscles in the intestinal wall. Diarrhea occurs when the amount of fluid in the stool increases during this process, which can happen in various ways…

If the muscles push food through the intestine too quickly, the intestine won't have time to remove fluid from the digested food; when the intestine becomes irritated or swollen, blood, mucus, and/or water can leak from the intestinal wall; digested food can act like a sponge, drawing too much water from the intestine into the stool.¹

Diarrhea Signs & Symptoms

Typically, diarrhea is associated with loose, watery stool and abdominal cramping. Other symptoms include abdominal pain, bleeding, dizziness and/or lightheadedness from dehydration, and fever. Diarrhea associated with a viral infection such as a stomach virus or bacterial infection may also cause vomiting, and stool may contain blood and mucus.²

The Causes of Diarrhea

There are numerous underlying causes for diarrhea, some of them are well known and obvious, and others are more obscure. Causes, however, fall into two categories:

1. Infections
2. Other Illnesses

Infections

Three of the most common causes of diarrhea are viral gastroenteritis (stomach flu), food poisoning, and traveler's diarrhea. Many infections, spread through contaminated food and/or water, cause diarrhea. These include³,

• Bacterial gastroenteritis: Cholera, Salmonella infection, Shigella gastroenteritis, E. coli gastroenteritis, Campylobacter enteritis, Pseudomembranous colitis, and food poisoning
• Traveler's diarrhea
• Viral gastroenteritis: Rotavirus infection, Norwalk virus infection, Viral hepatitis, Herpes simplex virus
• Parasites, Giardiasis, Entamoeba infection, Cryptosporidium enterocolitis, pinworms, Trichinosis, and Ciguatera poisoning
• Toxic shock syndrome

Other Illnesses

A great many illnesses and conditions can cause diarrhea. These include⁴,

• Addison's disease
• Alcoholism
• Anxiety
• Anxiety disorder
• Arsenic poisoning
• Celiac sprue  
• Chemotherapy side effects
• Colorectal cancer
• Crohn's disease
• Diabetes
• Diverticulitis
• Drug side effects  
• Dumping syndrome
• Folate deficiency
• Food allergies
• Food intolerance
• Gallbladder disease
• Hirschsprung's disease
• Hyperthyroidism
• Irritable bowel syndrome (IBS)
• Ischemic bowel disease
• Kidney failure
• Lactose intolerance
• Laxative overuse
• Malabsorption
• Otitis media
• Pancreatic cancer
• Pancreatitis
• Panic attacks
• Pernicious anemia
• Radiation therapy side effects
• Stress
• Theophylline toxicity
• Tropical sprue
• Ulcerative colitis
• Vitamin B3 deficiency

Diagnosing Diarrhea

There are four aspects to diagnosing diarrhea:

Bacteria feed off carbohydrates, emitting gases as by-products absorbed into the blood stream and released via the lungs. The test assesses the presence of gas in breath. In a healthy individual, hydrogen or methane wouldn’t be present until two hours after swallowing the solution. A positive gas result prior to two hours after swallowing the sugar solution is evidence of bacteria higher up in the digestive tract, at the level of the small intestine.

• A physical examination of your abdomen
• A review of your medications, non-prescriptions drugs, and supplements
• A complete blood count (blood test)
• A stool test to look for bacterium and/or parasites

Diarrhea Treatment & Prevention

Fluids

Since dehydration and electrolyte imbalances can result, rehydrating with plenty of fluids is one of the primary diarrhea treatments. Water helps flush out toxins and maintain adequate hydration, since diarrhea can result in a significant fluid loss to the body…so serious in some cases as to be fatal.

Fluids, however, aren't helpful in reducing the overall duration of the condition, a vital aspect for reducing the risk of persistent diarrhea.⁵ Research suggests that probiotics, taken together with fluids, can help shorten the duration of diarrhea episodes.⁶

Probiotics

Also referred to as friendly or good bacteria, probiotics – the most common of which are lactobacilli and bifidobacteria – help maintain the natural balance of organisms in the intestines. They are live, microscopic living organisms – such as bacteria, viruses, and yeasts – that play a vital role in the fermentation and digestion of carbohydrates, and aid in the digestion of fats and proteins.

Prevention... When Taking Antibiotics

Unfortunately, antibiotics cannot discriminate between good and bad bacteria, so when we're ill and taking them, they kill off the beneficial bacteria along with the bacteria causing our illness. This can lead to digestive problems, including diarrhea.

Supplemental probiotics, however, can replace the lost beneficial bacteria, and help prevent the diarrhea, gas, and cramping sometimes caused by antibiotics. Studies show that Lactobacillus reduces the risk of developing antibiotic-associated diarrhea.⁷

The Mayo Clinic cites supplemental probiotics – including that contained in cheese miso, yoghurt, and tempeh – as a treatment alternative that may help alleviate diarrhea.⁸

Chocolate, cider, fermented and unfermented milk, kimchi, pickles, sauerkraut, some juices and soy beverages, soy sauce, and Yakult also contain beneficial probiotics.

Prevention... If You Have Chronic Diarrhea

Various conditions, such as irritable bowel syndrome (IBS), are associated with chronic diarrhea. If you have IBS, consider supplementing your diet with bulk both to increase your stool density and regulate bowel movements.⁹ Increasing fiber is one option as are psyllium-containing products such as Puristat’s Preserve. This product’s bulking effect, the absorption of water, promotes firmer bowel movements, in turn helping to reduce diarrhea. Probiotics are also recommended for IBS sufferers.

Prevention... While Traveling

To avoid contracting diarrhea while travelling, drink only bottled water and refrain from using ice. When eating uncooked fruits and vegetables, eat only those with peels that can be discarded. Avoid raw shellfish, undercooked meat, and dairy products.

10 Easy Solutions for Diarrhea

1. Get plenty of rest.
2. Drink lots of fluid: i.e. water, broths, and tea with honey.
3. Avoid caffeinated beverages, fruit juices, and soft drinks as they can worsen diarrhea symptoms.
4. Try peppermint tea; it may help to settle your stomach.
5. Incorporating foods from the BRAT diet (bananas, rice, apple sauce, and toast) is recommended by some physicians for adults as well as children as these foods may help to reduce the severity of diarrhea.¹⁰
6. Eat lightly: yoghurt, noodles, grape juice, smooth peanut butter, white bread, chicken or turkey without the skin, tender or ground beef, fish, cottage cheese, and cream cheese are also recommended as diarrhea-friendly foods.¹¹
7. Avoid greasy, fatty, or fried foods; raw vegetables and fruits; strong spices, and whole-grain cereals and breads. ¹²
8. Avoid gas-forming foods and beverages such as beans, cabbage, beer, and carbonated beverages. ¹³
9. Try taking a probiotic supplement, especially after taking an antibiotic.
10. Mild cases of diarrhea can be treated with over-the-counter products such as Imodium A-D^®, Kaopectate^®, or Pepto-Bismol^®.

In Closing

Don’t let diarrhea get you down! While it can be socially awkward and embarrassing, and is often uncomfortable, with these tips it can be short-lived. In many other instances it can be prevented or made less severe by lifestyle changes including probiotic supplementation and avoiding certain foods and beverages.

In chronic cases, it is important to consult your health care provider to determine the underlying cause, and then take the necessary steps to try to alleviate both the cause and the potential for further diarrheal upset.

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Notes:

1. Freemd.com, "Is your diarrhea serious?" http://www.freemd.com/diarrhea/underlying-cause.htm (accessed June 13, 2011).
2. University of California San Francisco Medical Center, "Diarrhea
Signs and Symptoms," http://www.ucsfhealth.org/conditions/diarrhea/signs_and_symptoms.html (accessed June 13, 2011).
3. Freemd.com, "Is your diarrhea serious?" http://www.freemd.com/diarrhea/underlying-cause.htm (accessed June 13, 2011).
4. Ibid.
5. Wiley-Blackwell, "Probiotics Shorten Diarrhea Episodes, Review Suggests," Science Daily, (2010, November 10), http://www.sciencedaily.com/releases/2010/11/101109191748.htm (accessed June 13, 2011).
6. Ibid.
7. Pramodini B Kale-Pradhan et al., "Role of Lactobacillus in the Prevention of Antibiotic-Associated Diarrhea: A Meta-analysis," The Journal of Human Pharmacology and Drug Therapy, Volume 30, Issue 2 (February 2010), http://pharmacotherapyjournal.org/doi/abs/10.1592/phco.30.2.119 (accessed June 13, 2011).
8. Mayo Clinic, "Diarrhea/Alternative Medicine," http://www.mayoclinic.com/health/diarrhea/DS00292/DSECTION=alternative%2Dmedicine (accessed June 13, 2010).
9. MedicinePlus, A service of the U.S. National Library of Medicine, National Institutes of Health, "Diarrhea," http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm (accessed June 13, 2011).
10. Wikipedia, "Diarrhea," http://en.wikipedia.org/wiki/BRAT_diet (accessed June 13, 2011).
11. Cleveland Clinic, "Diarrhea," http://www.clevelandclinic.org/health/health-info/docs/0100/0100.asp (accessed June 13, 2011).
12. Ibid.
13. Ibid