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Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery
bowel movement frame, Anatomy of the anus and rectum Defecation is the final act of digestion Digestion is the breakdown of large insoluble food Food is any substance consumed to provide nutritional support for an organism In biology, an orga ...
s each day. It often lasts for a few days and can result in
dehydration In physiology, dehydration is a lack of total body water In physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology Biology is the natural science that studies ...

dehydration
due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased
urination Urination is the release of urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted ...
, loss of skin color, a
fast heart rate Tachycardia, also called tachyarrhythmia, is a heart rateHeart rate is the speed of the heartbeat measured by the number of contractions (beats) of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pu ...
, and a decrease in responsiveness as it becomes more severe. Loose but non-watery s in babies who are exclusively , however, are normal. The most common cause is an infection of the
intestine The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the anus which includes all the organs of the digestive system The human digestive system consists of the human ...

intestine
s due to either a
virus A virus is a submicroscopic infectious agent In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecu ...

virus
,
bacterium Bacteria (; common noun bacteria, singular bacterium) are a type of biological cell The cell (from Latin ''cella'', meaning "small room") is the basic structural, functional, and biological unit of all known organisms. Cells are the sma ...
, or
parasite Parasitism is a Symbiosis, close relationship between species, where one organism, the parasite, lives on or inside another organism, the Host (biology), host, causing it some harm, and is adaptation (biology), adapted structurally to this w ...
—a condition also known as
gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the ...

gastroenteritis
. These infections are often acquired from food or water that has been contaminated by
feces Feces ( faeces) is the solid or semi-solid remains of food that was not digested in the , and has been broken down by bacteria in the . Feces contains a relatively small amount of products such as bacterially altered , and dead epithelial cel ...

feces
, or directly from another person who is infected. The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody). The short duration watery diarrhea may be due to
cholera Cholera is an infection An infection is the invasion of an organism's body by , their multiplication, and the reaction of tissues to the infectious agents and the s they produce. An infectious disease, also known as a transmissible disea ...

cholera
, although this is rare in the developed world. If blood is present, it is also known as
dysentery Dysentery () is a type of gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, aliment ...
. A number of non-infectious causes can result in diarrhea. These include
lactose intolerance Lactose intolerance is a common condition caused by a decreased ability to digest lactose, a sugar found in dairy products. Those affected vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include abdominal pa ...
,
irritable bowel syndrome Irritable bowel syndrome (IBS), referred to previously as spastic or nervous colon, and spastic bowel, is a functional gastrointestinal disorder Functional may refer to: * Movements in architecture: ** Functionalism (architecture) In archit ...

irritable bowel syndrome
,
non-celiac gluten sensitivity Non-celiac gluten sensitivity (NCGS) or gluten sensitivity is "a clinical entity induced by the ingestion of gluten Gluten is a group of seed storage protein Proteins are large biomolecules or macromolecules that are comprised of one or more ...
,
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye and barley. Classic symptoms include gastrointe ...
,
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine an ...
such as
ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, d ...

ulcerative colitis
,
hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. ...
, bile acid diarrhea, and a number of medications. In most cases, stool cultures to confirm the exact cause are not required. Diarrhea can be prevented by improved
sanitation Sanitation refers to public health Public health has been defined as "the science and art of preventing disease", prolonging life and improving quality of life Quality of life (QOL) is defined by the World Health Organization The ...

sanitation
, clean
drinking water Drinking water, also known as potable water, is water that is safe to drinking, drink or use for food preparation. The amount of drinking water required to maintain good health varies, and depends on physical activity level, age, health-related ...

drinking water
, and
hand washing Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hand A hand is a prehensile, multi- fingered appendage located at the end of the forearm The forearm is the region of the upper limb between the El ...

hand washing
with soap.
Breastfeeding Breastfeeding, also called nursing, is the process of feeding a mother's breast milk to her infant, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant. The World Healt ...

Breastfeeding
for at least six months and vaccination against rotavirus is also recommended.
Oral rehydration solution Oral rehydration therapy (ORT) is a type of fluid replacement Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be ...
(ORS)—clean water with modest amounts of salts and
sugar Sugar is the generic name for sweet-tasting, soluble carbohydrate is a disaccharide A disaccharide (also called a double sugar or ''biose'') is the sugar formed when two monosaccharides are joined by glycosidic linkage. Like monosacc ...

sugar
—is the treatment of choice. Zinc tablets are also recommended. These treatments have been estimated to have saved 50 million children in the past 25 years. When people have diarrhea it is recommended that they continue to eat healthy food and babies continue to be breastfed. If commercial ORS is not available, homemade solutions may be used. In those with severe dehydration,
intravenous fluids Intravenous therapy (abbreviated as IV therapy) is a medical technique that delivers fluids, medications and nutrition directly into a person's vein Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood f ...
may be required. Most cases, however, can be managed well with fluids by mouth.
Antibiotic An antibiotic is a type of antimicrobial An antimicrobial is an agent that kills microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism In biology, an organism () is any organic, life, living system t ...
s, while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling, and those who grow specific bacteria or parasites in their stool.
Loperamide Loperamide, sold under the brand name Imodium, among others,Drugs.co Page accessed September 4, 2015 is a medication used to decrease the frequency of diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three lo ...

Loperamide
may help decrease the number of bowel movements but is not recommended in those with severe disease. About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in
developing countries A developing country is a sovereign state with a less developed Industrial sector, industrial base and a low Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no ...

developing countries
, where young children get diarrhea on average three times a year. Total deaths from diarrhea are estimated at 1.26 million in 2013—down from 2.58 million in 1990. In 2012, it was the second most common cause of younger than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of
malnutrition Malnutrition is 'a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effect on tissue and body form (body shape, size and composition) and function and clinical ou ...
and the most common cause in those younger than five years of age. Other long term problems that can result include
stunted growth Stunted growth is a reduced growth rate in human developmentHuman development may refer to: * Development of the human body * Developmental psychology * Human development (economics) * Human Development Index, an index used to rank countries by ...
and poor intellectual development.


Definition

Diarrhea is defined by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organization.


Secretory

Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a
cholera toxin Cholera toxin (also known as choleragen and sometimes abbreviated to CTX, Ctx or CT) is AB5 multimeric protein complex is a protein complex functioning as a molecular biological machine. It uses protein domain dynamics on nanoscales A protei ...

cholera toxin
that stimulates the secretion of
anion An ion () is an atom An atom is the smallest unit of ordinary matter In classical physics and general chemistry, matter is any substance that has mass and takes up space by having volume. All everyday objects that can be touched are ...
s, especially
chloride The chloride ion An ion () is an atom An atom is the smallest unit of ordinary matter In classical physics and general chemistry, matter is any substance that has mass and takes up space by having volume. All everyday objects th ...

chloride
ions (Cl). Therefore, to maintain a charge balance in the
gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system The human digestive system consists of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, d ...
, sodium (Na+) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is with plasma even during fasting. It continues even when there is no oral food intake.


Osmotic

Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also result from maldigestion, e.g. pancreatic disease or
coeliac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
, in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic
laxatives Laxatives, purgatives, or aperients are substances that loosen human feces, stools and increase defecation, bowel movements. They are used to treat and prevent constipation. Laxatives vary as to how they work and the side effects they may have. C ...
(which work to alleviate
constipation Constipation refers to bowel movements that are infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications ...
by drawing water into the bowels). In healthy individuals, too much
magnesium Magnesium is a chemical element upright=1.0, 500px, The chemical elements ordered by link=Periodic table In chemistry Chemistry is the science, scientific study of the properties and behavior of matter. It is a natural science ...

magnesium
or
vitamin C Vitamin C (also known as ascorbic acid and ascorbate) is a vitamin found in various foods and sold as a dietary supplement. It is used to prevent and treat scurvy. Vitamin C is an Nutrient#Essential nutrients, essential nutrient involved in t ...

vitamin C
or undigested
lactose Lactose, a disaccharide A disaccharide (also called a double sugar or ''biose'') is the sugar Sugar is the generic name for sweet-tasting, soluble carbohydrate is a disaccharide found in animal milk. It consists of a molecule of D-g ...

lactose
can produce osmotic diarrhea and distention of the bowel. A person who has
lactose intolerance Lactose intolerance is a common condition caused by a decreased ability to digest lactose, a sugar found in dairy products. Those affected vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include abdominal pa ...
can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have
fructose malabsorption Fructose malabsorption, formerly named dietary fructose intolerance (DFI), is a digestive disorder in which absorption of fructose Fructose, or fruit sugar, is a simple ketonic simple sugar found in many plants, where it is often bonded to gluc ...
, excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when the offending agent, e.g. milk or sorbitol, is stopped.


Exudative

Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such as
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the m ...

Crohn's disease
or
ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, d ...

ulcerative colitis
, and other severe infections such as '''' or other forms of food poisoning.


Inflammatory

Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.


Dysentery

If there is blood visible in the stools, it is also known as
dysentery Dysentery () is a type of gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, aliment ...
. The blood is a trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, ''
Shigella ''Shigella'' is a genus Genus (plural genera) is a taxonomic rank Taxonomy (general) is the practice and science of classification of things or concepts, including the principles that underlie such classification. The term may also refer to ...
'', ''
Entamoeba histolytica ''Entamoeba histolytica'' is an parasitic n, part of the '. Predominantly infecting humans and other primates causing , ''E. histolytica'' is estimated to infect about 35-50 million people worldwide. ''E. histolytica'' infection is estimated t ...

Entamoeba histolytica
'', and ''
Salmonella ''Salmonella'' is a genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruse ...
''.


Health effects

Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults," and diarrhea is a primary cause of childhood malnutrition. Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for
helminth Parasitic worms, also known as helminths, are large macroparasites; adults can generally be seen with the naked eye. Many are intestinal worms that are soil-transmitted and infect the gastrointestinal tract The gastrointestinal tract, (GI ...
infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on a series of tests of intelligence. Diarrhea can cause
electrolyte imbalance Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes An electrolyte is a substance that produces an electrically conducting solution when dissolved in a polar solvent, such as water. The di ...
s, kidney impairment,
dehydration In physiology, dehydration is a lack of total body water In physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology Biology is the natural science that studies ...

dehydration
, and defective
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as Tumor immunology, cancer cells and objects such ...
responses. When oral drugs are administered, the efficiency of the drug is to produce a
therapeutic effect Therapeutic effect refers to the response(s) after a treatment of any kind, the results of which are judged to be useful or favorable. This is true whether the result was expected, unexpected, or even an unintended consequence. An adverse effect (i ...
and the lack of this effect may be due to the medication travelling too quickly through the digestive system, limiting the time that it can be absorbed. Clinicians try to treat the diarrheas by reducing the dosage of medication, changing the dosing schedule, discontinuation of the drug, and rehydration. The interventions to control the diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the leading factors for placing older adults in long term care facilities (nursing homes).


Causes

In the latter stages of human digestion, ingested materials are inundated with water and digestive fluids such as
gastric acid Gastric acid, gastric juice, or stomach acid, is a digestive fluid formed within the stomach lining. With a pH between 1 and 3, gastric acid An acid is a or capable of donating a (hydrogen ion H+) (a ), or, alternatively, capable of for ...
,
bile Bile (from latin ''bilis''), or gall, is a dark-green-to-yellowish-brown fluid produced by the of most s that aids the of s in the . In humans, bile is produced continuously by the liver (liver bile) and stored and concentrated in the . After ...
, and
digestive enzyme Digestive may refer to: Biology *Digestion Digestion is the breakdown of large insoluble food Food is any substance consumed to provide nutritional Nutrition is the biochemical Biochemistry or biological chemistry, is the study of c ...
s in order to break them down into their nutrient components, which are then absorbed into the bloodstream via the
intestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth In animal anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology concerned with the study of ...
in the small intestine. Prior to defecation, the large intestine reabsorbs the water and other digestive solvents in the waste product in order to maintain proper hydration and overall equilibrium. Diarrhea occurs when the large intestine is prevented, for any number of reasons, from sufficiently absorbing the water or other digestive fluids from fecal matter, resulting in a liquid, or "loose", bowel movement.
Acute Acute may refer to: Science and technology * Acute angle ** Acute triangle ** Acute, a leaf shape in the glossary of leaf morphology#acute, glossary of leaf morphology * Acute (medicine), a disease that it is of short duration and of recent onset. ...
diarrhea is most commonly due to viral
gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the ...

gastroenteritis
with
rotavirus ''Rotavirus'' is a genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank In biological classification In biology, taxonomy () is the scientific study of naming, defining (Circumscription (taxonomy), cir ...

rotavirus
, which accounts for 40% of cases in children under five. In , however,
bacterial infections Pathogenic bacteria are bacteria that can cause disease. This article deals with human pathogenic bacteria. Although most bacteria are harmless or often beneficial, some are pathogenic, with the number of species estimated as fewer than a hundre ...
predominate. Various toxins such as
mushroom poisoning Mushroom poisoning refers to harmful effects from ingestion of toxic Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism In biology, an organism (from Ancient Greek, Greek: ...

mushroom poisoning
and drugs can also cause acute diarrhea. Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include
ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, d ...

ulcerative colitis
,
Crohn disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract from the mouth to the anus. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), ...
, microscopic colitis,
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
,
irritable bowel syndrome Irritable bowel syndrome (IBS), referred to previously as spastic or nervous colon, and spastic bowel, is a functional gastrointestinal disorder Functional may refer to: * Movements in architecture: ** Functionalism (architecture) In archit ...

irritable bowel syndrome
, and bile acid malabsorption.


Infections

There are many causes of infectious diarrhea, which include
virus A virus is a submicroscopic infectious agent In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecu ...

virus
es,
bacteria Bacteria (; common noun bacteria, singular bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of prokaryotic microorganisms. Typ ...

bacteria
and parasites. Infectious diarrhea is frequently referred to as
gastroenteritis Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the ...

gastroenteritis
.
Norovirus Norovirus, sometimes referred to as the winter vomiting bug, is the most common cause of gastroenteritis. Infection is characterized by non-bloody diarrhea, vomiting, and stomach pain. Fever or headaches may also occur. Symptoms usually develop ...
is the most common cause of viral diarrhea in adults, but
rotavirus ''Rotavirus'' is a genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank In biological classification In biology, taxonomy () is the scientific study of naming, defining (Circumscription (taxonomy), cir ...

rotavirus
is the most common cause in children under five years old.
Adenovirus Adenoviruses (members of the family In human society, family (from la, familia) is a group of people related either by consanguinity (by recognized birth) or affinity (by marriage or other relationship). The purpose of families is to ma ...

Adenovirus
types 40 and 41, and es cause a significant number of infections. Shiga-toxin producing Escherichia coli, such as E coli o157:h7, are the most common cause of infectious bloody diarrhea in the United States. ''
Campylobacter ''Campylobacter'' (meaning "curved bacteria") is a genus Genus (plural genera) is a taxonomic rank Taxonomy (general) is the practice and science of classification of things or concepts, including the principles that underlie such classificat ...

Campylobacter
''
spp. In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, physiological mechanis ...

spp.
are a common cause of bacterial diarrhea, but infections by ''
Salmonella ''Salmonella'' is a genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruse ...
'' spp., ''
Shigella ''Shigella'' is a genus Genus (plural genera) is a taxonomic rank Taxonomy (general) is the practice and science of classification of things or concepts, including the principles that underlie such classification. The term may also refer to ...
'' spp. and some strains of ''Escherichia coli'' are also a frequent cause. In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by ''
Clostridioides difficile ''Clostridioides difficile'' (synonym (taxonomy), syn. ''Clostridium difficile''), also known as ''C. difficile'', or ''C. diff'' (), is Gram-positive species of Bacterial spore, spore-forming bacteria. ''Clostridioides'' spp. are Anaerobic or ...
'' often causes severe diarrhea. Parasites, particularly
protozoa Protozoa (singular protozoon or protozoan, plural protozoa or protozoans) is an informal term for a group of single-celled eukaryote Eukaryotes () are organism In biology, an organism () is any organic, life, living system that ...

protozoa
e.g., ''
Cryptosporidium ''Cryptosporidium'', sometimes informally called crypto, is a genus of apicomplexan parasitic Parasitism is a Symbiosis, symbiotic biological interactions, relationship between species, where one organism, the parasite, lives on or insid ...
'' spp., ''
Giardia ''Giardia'' ( or ) is a genus of anaerobic flagellated protozoan parasites of the phylum metamonada that colonise and reproduce in the small intestines of several vertebrates, causing giardiasis. Their life cycle alternates between a swimmi ...

Giardia
'' spp., ''
Entamoeba histolytica ''Entamoeba histolytica'' is an parasitic n, part of the '. Predominantly infecting humans and other primates causing , ''E. histolytica'' is estimated to infect about 35-50 million people worldwide. ''E. histolytica'' infection is estimated t ...

Entamoeba histolytica
'', ''
Blastocystis ''Blastocystis'' is a genus of single-celled heterokont Heterokonts are a group of protists A protist () is any eukaryotic organism In biology, an organism (from Ancient Greek, Greek: ὀργανισμός, ''organismos'') is an ...
'' spp., ''
Cyclospora cayetanensis ''Cyclospora cayetanensis'' is a coccidian parasite that causes a diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and c ...

Cyclospora cayetanensis
'', are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent
nitazoxanide Nitazoxanide, sold under the brand name Alinia among others, is a broad-spectrum antiparasitic and broad-spectrum antiviral medication that is used in medicine for the treatment of various helminthic, protozoal, and viral infections. It is i ...

nitazoxanide
has shown efficacy against many diarrhea-causing parasites. Other infectious agents, such as
parasites Parasitism is a Symbiosis, close relationship between species, where one organism, the parasite, lives on or inside another organism, the Host (biology), host, causing it some harm, and is adaptation (biology), adapted structurally to this w ...
or
bacteria Bacteria (; common noun bacteria, singular bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of prokaryotic microorganisms. Typ ...

bacteria
l toxins, may exacerbate symptoms. In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or
malnourished Malnutrition is a condition that results from eating a diet which does not supply a healthy amount of one or more nutrient A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient in ...
individuals, diarrhea can lead to severe
dehydration In physiology, dehydration is a lack of total body water In physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology Biology is the natural science that studies ...

dehydration
and can become life-threatening.


Sanitation

Open defecation Open defecation is the human practice of defecating frame, Anatomy of the anus and rectum Defecation is the final act of digestion Digestion is the breakdown of large insoluble food Food is any substance consumed to provide nutri ...
is a leading cause of infectious diarrhea leading to death. Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste (
sanitation Sanitation refers to public health Public health has been defined as "the science and art of preventing disease", prolonging life and improving quality of life Quality of life (QOL) is defined by the World Health Organization The ...

sanitation
), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care." One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human
pathogens In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, physiological mechanisms, ...
.


Nutrition

Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system.
Zinc deficiency Zinc deficiency is defined either as insufficient zinc to meet the needs of the body, or as a serum zinc level below the normal range. However, since a decrease in the serum concentration is only detectable after long-term or severe depletion, se ...
, a condition often found in children in
developing countries A developing country is a sovereign state with a less developed Industrial sector, industrial base and a low Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no ...

developing countries
can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly,
vitamin A deficiency Vitamin A deficiency (VAD) or hypovitaminosis A is a lack of vitamin A in blood and tissue (biology), tissues. It is common in poorer countries, especially among children and women of reproductive age, but is rarely seen in more developed countries. ...
can cause an increase in the severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, Others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction.


Malabsorption

Malabsorption Malabsorption is a state arising from abnormality in absorption (small intestine), absorption of Nutrient, food nutrients across the gastrointestinal tract, gastrointestinal (GI) tract. Impairment can be of single or multiple nutrients depending on ...
is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the
pancreas The pancreas is an Organ (anatomy), organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine ...

pancreas
. Causes include: * ''enzyme deficiencies or mucosal abnormality'', as in
food allergy A food allergy is an abnormal immune response An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of different microorganisms including viru ...
and
food intolerance Food intolerance is a detrimental reaction, often delayed, to a food, beverage, food additive, or compound found in foods that produces symptoms in one or more body organs and systems, but generally refers to reactions other than food allergy. Foo ...
, e.g.
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
(gluten intolerance),
lactose intolerance Lactose intolerance is a common condition caused by a decreased ability to digest lactose, a sugar found in dairy products. Those affected vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include abdominal pa ...
(intolerance to milk sugar, common in non-Europeans), and
fructose malabsorption Fructose malabsorption, formerly named dietary fructose intolerance (DFI), is a digestive disorder in which absorption of fructose Fructose, or fruit sugar, is a simple ketonic simple sugar found in many plants, where it is often bonded to gluc ...
. * ''
pernicious anemia Vitamin B12 deficiency anemia, of which pernicious anemia (PA) is a type, is a disease in which not enough red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleu ...
'', or impaired bowel function due to the inability to absorb , * ''loss of pancreatic secretions'', which may be due to
cystic fibrosis Cystic fibrosis (CF) is a genetic disorder A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene In biology, a gene (from ''genos'' "...Wilhelm Johan ...
or
pancreatitis Pancreatitis is a condition characterized by inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irrit ...
, * ''structural defects'', like
short bowel syndrome Short bowel syndrome (SBS, or simply short gut) is a malabsorption disorder caused by a lack of functional small intestine. The primary symptom is diarrhea, which can result in dehydration In physiology, dehydration is a lack of total body w ...
(surgically removed bowel) and radiation fibrosis, such as usually follows cancer treatment and other drugs, including agents used in
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
; and * ''certain drugs'', like
orlistat Orlistat is a drug designed to treat obesity Obesity is a medical condition in which excess body fat has accumulated to an extent that it may have a negative effect on health. People are generally considered obese when their body mass in ...

orlistat
, which inhibits the absorption of fat.


Inflammatory bowel disease

The two overlapping types here are of unknown origin: *
Ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, d ...

Ulcerative colitis
is marked by chronic bloody diarrhea and inflammation mostly affects the distal
colon Colon commonly refers to: * Colon (punctuation) (:), a punctuation mark * Major part of large intestine, the final section of the digestive system Colon may also refer to: Places * Colon, Michigan, US * Colon, Nebraska, US * Kowloon, Hong Kong, s ...

colon
near the
rectum The rectum is the final straight portion of the large intestine The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in vertebrates. Water is absorbed here and the re ...

rectum
. *
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the m ...

Crohn's disease
typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.


Irritable bowel syndrome

Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by
defecation frame, Human anatomy of the ''anorecturm'' (anus and rectum">anus.html" ;"title="Human anatomy of the ''anorecturm'' (anus">Human anatomy of the ''anorecturm'' (anus and rectum) Defecation (or defaecation) is the final act of digestion, by whi ...
and unusual (diarrhea or
constipation Constipation refers to bowel movements that are infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications ...
) for at least three days a week over the previous three months. Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as
loperamide Loperamide, sold under the brand name Imodium, among others,Drugs.co Page accessed September 4, 2015 is a medication used to decrease the frequency of diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three lo ...

loperamide
or
codeine Codeine is an opiate and prodrug of morphine used to treat pain, cough medicine, coughing, and diarrhea. It is found naturally in the sap of the opium poppy, ''Papaver somniferum''. It is typically used to treat mild to moderate degrees of pain ...

codeine
. About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test.


Other diseases

Diarrhea can be caused by other diseases and conditions, namely: * Chronic
ethanol Ethanol (also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic Organic may refer to: * Organic, of or relating to an organism, a living entity * Organic, of or relating to an anatomical organ (anatomy), ...

ethanol
ingestion *
Hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. ...
* Certain medications * Bile acid malabsorption *
Ischemic Ischemia or ischaemia is a restriction in blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally continuum mechanics, incompressi ...
bowel disease: This usually affects older people and can be due to blocked arteries. * Microscopic colitis, a type of
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine an ...
where changes are seen only on histological examination of colonic biopsies. * Bile salt malabsorption (primary bile acid diarrhea) where excessive bile acids in the Colon (anatomy), colon produce a secretory diarrhea. * Hormone-secreting tumors: some hormones, e.g. serotonin), can cause diarrhea if excreted in excess (usually from a tumor). * Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is called toddler's diarrhea. * Environmental enteropathy * Radiation enteropathy following treatment for pelvic and abdominal cancers.


Medications

Some medications, such as the side effects of penicillin, penicillum can cause diarrhea. Over 700 medications are known to cause diarrhea. The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements.


Pathophysiology


Evolution

According to two researchers, Randolph M. Nesse, Nesse and George C. Williams (biologist), Williams, diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery. They cite in support of this argument research published in 1973 that found that treating ''
Shigella ''Shigella'' is a genus Genus (plural genera) is a taxonomic rank Taxonomy (general) is the practice and science of classification of things or concepts, including the principles that underlie such classification. The term may also refer to ...
'' with the anti-diarrhea drug (Co-phenotrope, Lomotil) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".


Diagnostic approach

The following types of diarrhea may indicate further investigation is needed: * In infants * Moderate or severe diarrhea in young children * Associated with blood * Continues for more than two days * Associated non-cramping abdominal pain, fever, weight loss, etc. * In Traveler's diarrhea, travelers * In food handlers, because of the potential to infect others; * In institutions such as hospitals, child care centers, or geriatric and convalescent homes. A severity score is used to aid diagnosis in children.


Chronic diarrhea

When diarrhea lasts for more than four weeks a number of further tests may be recommended including: * Complete blood count and a ferritin if anemia is present * Thyroid stimulating hormone * Tissue transglutaminase for
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
* Fecal calprotectin to exclude
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine an ...
* Stool tests for ova and parasites as well as for ''
Clostridioides difficile ''Clostridioides difficile'' (synonym (taxonomy), syn. ''Clostridium difficile''), also known as ''C. difficile'', or ''C. diff'' (), is Gram-positive species of Bacterial spore, spore-forming bacteria. ''Clostridioides'' spp. are Anaerobic or ...
'' * A colonoscopy or fecal immunochemical testing for cancer, including biopsies to detect microscopic colitis * Testing for bile acid diarrhea with SeHCAT, 7α-hydroxy-4-cholesten-3-one or fecal bile acids depending on availability * Hydrogen breath test looking for
lactose intolerance Lactose intolerance is a common condition caused by a decreased ability to digest lactose, a sugar found in dairy products. Those affected vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include abdominal pa ...
* Further tests if immunodeficiency, pelvic radiation disease or small intestinal bacterial overgrowth suspected. A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for giardia. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not recommended.


Prevention


Sanitation

Numerous studies have shown that improvements in drinking water and sanitation (
WASH Wash or the Wash may refer to: Industry and sanitation * WASH or WaSH, "water, sanitation and hygiene", three related public health issues * Wash (distilling), the liquid produced by the fermentation step in the production of distilled beverages ...
) lead to decreased risks of diarrhoea. Such improvements might include for example use of water filters, provision of high-quality drinking water, piped water and sanitary sewer, sewer connections. In institutions, communities, and households, interventions that promote
hand washing Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hand A hand is a prehensile, multi- fingered appendage located at the end of the forearm The forearm is the region of the upper limb between the El ...

hand washing
with soap lead to significant reductions in the incidence of diarrhea. The same applies to preventing open defecation at a community-wide level and providing access to improved sanitation. This includes use of toilets and implementation of the entire
sanitation Sanitation refers to public health Public health has been defined as "the science and art of preventing disease", prolonging life and improving quality of life Quality of life (QOL) is defined by the World Health Organization The ...

sanitation
chain connected to the toilets (collection, transport, disposal or reuse of human waste, human excreta). There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease.


Hand washing

Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30–48%. Hand washing in developing countries, however, is compromised by poverty as acknowledged by the Centers for Disease Control and Prevention, CDC: "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours.


Water

Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean water supply and improved sanitation have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene. Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a 21–30% reduction in mortality rate associated with diarrheal disease. Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens.


Vaccination

Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2–3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6–10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease. Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society. Rotavirus vaccine decrease the rates of diarrhea in a population. New vaccines against rotavirus, ''Shigella'', Enterotoxigenic Escherichia coli, Enterotoxigenic Escherichia coli (ETEC), and cholera are under development, as well as other causes of infectious diarrhea.


Nutrition

Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group. The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence. Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective.


Breastfeeding

Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive Breastfeeding#Exclusive breastfeeding, exclusive breastfeeding during their first 6 months of life are better protected against infection with diarrheal diseases. One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants. Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the World Health Organization, WHO, with continued breastfeeding until at least two years of age.


Others

Probiotics decrease the risk of diarrhea in those taking antibiotics. Insecticide spraying may reduce fly numbers and the risk of diarrhea in children in a setting where there is seasonal variations in fly numbers throughout the year.


Management

In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in severe cases, intravenously. Diet restrictions such as the BRAT diet are no longer recommended. Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea. To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain, and that continuing to eat also speeds up recovery of normal intestinal functioning. CDC recommends that children and adults with cholera also continue to eat. There is no evidence that early refeeding in children can cause an increase in inappropriate use of intravenous fluid, episodes of vomiting, and risk of having persistent diarrhea. Medications such as
loperamide Loperamide, sold under the brand name Imodium, among others,Drugs.co Page accessed September 4, 2015 is a medication used to decrease the frequency of diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three lo ...

loperamide
(Imodium) and bismuth subsalicylate may be beneficial; however they may be contraindicated in certain situations.


Fluids

Oral rehydration therapy, Oral rehydration solution (ORS) (a slightly sweetened and salty water) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given. There are commercial solutions such as Pedialyte, and relief agencies such as UNICEF widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added (approximately the "taste of tears"A Guide on Safe Food for Travellers
, Welcome to South Africa, Host to the 2010 FIFA World Cup (bottom left of page 1).
). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness.Rehydration Project, Homemade Oral Rehydration Solution Recipe. Both agree that drinks with too much sugar or salt can make dehydration worse. Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible. In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment.Community Health Worker Training Materials for Cholera Prevention and Control
, CDC, slides at back are dated 17 November 2010. Page 7 states "... Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment. Adults and older children should continue to eat frequently."
Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly. Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under five as they may ''increase'' dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water. Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable. Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall. A nasogastric tube can be used in young children to administer fluids if warranted.


Eating

The WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. The WHO states "Food should ''never'' be withheld and the child's usual foods should ''not'' be diluted. Breastfeeding should ''always'' be continued." In the specific example of cholera, the CDC makes the same recommendation. Breast-fed infants with diarrhea often choose to breastfeed more, and should be encouraged to do so. In young children who are not breast-fed and live in the developed world, a lactose-free diet may be useful to speed recovery. Eating food containing dietary fiber, fibers may help.


Medications

Antidiarrheal agents can be classified into four different groups: antimotility, antisecretory, adsorbent, and anti-infectious. While antibiotics are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations. There are concerns that antibiotics may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7. In resource-poor countries, treatment with antibiotics may be beneficial. However, some bacteria are developing antibiotic resistance, particularly ''Shigella''. Antibiotics can also cause diarrhea, and antibiotic-associated diarrhea is the most common adverse effect of treatment with general antibiotics. While bismuth compounds (Pepto-Bismol) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness. Anti-motility agents like
loperamide Loperamide, sold under the brand name Imodium, among others,Drugs.co Page accessed September 4, 2015 is a medication used to decrease the frequency of diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three lo ...

loperamide
are also effective at reducing the number of stools but not the duration of disease. These agents should be used only if bloody diarrhea is not present. Diosmectite, a natural aluminomagnesium silicate clay, is effective in alleviating symptoms of acute diarrhea in children, and also has some effects in chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Another absorbent agent used for the treatment of mild diarrhea is kaopectate. Racecadotril an antisecretory medication may be used to treat diarrhea in children and adults. It has better tolerability than
loperamide Loperamide, sold under the brand name Imodium, among others,Drugs.co Page accessed September 4, 2015 is a medication used to decrease the frequency of diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three lo ...

loperamide
, as it causes less
constipation Constipation refers to bowel movements that are infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications ...
and flatulence. However, it has little benefit in improving acute diarrhea in children. Bile acid sequestrants such as cholestyramine can be effective in chronic diarrhea due to bile acid malabsorption. Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as SeHCAT retention.


Alternative therapies

Zinc supplementation may benefit children over six months old with diarrhea in areas with high rates of malnourishment or zinc deficiency. This supports the World Health Organization guidelines for zinc, but not in the very young. A Cochrane Review from 2020 concludes that probiotics make little or no difference to people who have diarrhoea lasting 2 days or longer and that there is no proof that they reduce its duration. The probiotic lactobacillus can help prevent antibiotic-associated diarrhea in adults but possibly not children. For those with
lactose intolerance Lactose intolerance is a common condition caused by a decreased ability to digest lactose, a sugar found in dairy products. Those affected vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include abdominal pa ...
, taking digestive enzymes containing lactase when consuming dairy products often improves symptoms.


Epidemiology

Worldwide in 2004, approximately 2.5 billion cases of diarrhea occurred, which resulted in 1.5 million deaths among children under the age of five. Greater than half of these were in Africa and South Asia. This is down from a death rate of 4.5 million in 1980 for gastroenteritis. Diarrhea remains the second leading cause of infant mortality (16%) after pneumonia (17%) in this age group. The majority of such cases occur in the developing world, with over half of the recorded cases of childhood diarrhea occurring in Africa and Asia, with 696 million and 1.2 billion cases, respectively, compared to only 480 million in the rest of the world. Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days. In the Americas, diarrheal disease accounts for a total of 10% of deaths among children aged 1–59 months while in South East Asia, it accounts for 31.3% of deaths. It is estimated that around 21% of child mortalities in developing countries are due to diarrheal disease.


Terminology

The word diarrhea is from the Ancient Greek from ' "through" and ' "flow". ''Diarrhea'' is the spelling in American English, whereas ''diarrhoea'' is the spelling in British English. Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain) and "the trots".


See also

* Dysentery * Travelers' diarrhea


References

{{Authority control Diarrhea, Intestinal infectious diseases Waterborne diseases Diseases of intestines Conditions diagnosed by stool test Symptoms and signs: Digestive system and abdomen Feces Wikipedia medicine articles ready to translate Sanitation Wikipedia emergency medicine articles ready to translate Articles containing video clips