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It is usually said that you suffer from diarrhea if you have an increased number of feces per day (more than three feces) and if this is loose or watery. In adults, the diarrhea usually decreases within two to four days, but in some cases it may take longer. If diarrhea persists for more than 24-36 hours, consult a doctor. Likewise, if the patient is an older person or child under 3 years, especially if there are other symptoms, such as high fever. But in most cases you can use prescription-free products from the pharmacy to treat yourself and get rid of diarrhea.
The closest one can come to a generally accepted definition of diarrhea is what the WHO presents, namely at least three loose (watery) feces per day. Another definition of diarrhea is a discharge rate of 200 grams or more per day. A distinction between acute and chronic diarrhea is also arbitrary. An assessment of at least four weeks is a practical delimitation because most infectiously resolved diarrhea conditions heal within that period of time. Acute diarrhea is usually caused by an infection. In chronic diarrhea there are many differential diagnoses.
Why diarrhea occurs? Diarrhea causes and types
The prevalence of chronic diarrhea is not particularly well studied. One exception is a completely new publication, based on surveys targeted at randomly selected individuals, presented data from eleven countries, including the U.S., the prevalence of arrhythmia varied at least once a month between 16 percent and 23 percent. The number of episodes with diarrhea for one month varied between 2.9 and 4.2.
There are several explanations for the onset of diarrhea. In osmotic diarrhea, osmotically active substances bind water in the colon. The reason is incomplete digestion and absorption of foodstuffs, for example lactose in lactose intolerance, in the small intestine. A person with osmotic diarrhea is hassle free as long as they do not eat or drink. As long as you do not eat or drink late in the evening, it is unusual with nightly trouble.
Crohn’s disease can attack the entire gastrointestinal tract, from the oral cavity to the anal canal. This is an important difference to ulcerative colitis that only attacks colon and rectum. In secretary diarrhea, water is secreted into the intestine. For example, in cholera or more commonly, at gastroenteritis. Diarrhea does not end in case of permanent and nightly complaints. In addition to infections, secretive diarrhea occurs in certain neuroendocrine disorders.
Exsudative diarrhea is caused by inflammation of the intestinal mucosa with loss of, in addition to water, blood cells and salts. The cause is various inflammatory conditions in the intestine, such as inflammatory bowel disease.
In the event of a disturbance in the intestine, diarrhea can be caused by rapid passage which reduces the absorption of water. In the opposite, lengthy passage, bacterial overgrowth can occur which causes diarrhea.
What’s happening in the body?
When you are healthy, your intestine receives about two to three liters of liquid from food and drink every day. In addition, six to seven liters of fluid in the gastrointestinal tract are formed from sputum, stomach, pancreas, bile and small intestine.
Most of the fluid is sucked up of the intestinal wall further into the small intestine and then extends into the bloodstream. One to two liters pass into the large intestine and is raised there. Out with the feces comes only one to two deciliters per day.
When a virus or bacteria causes gastric disease, the cells are damaged in the intestinal mucosa. The intestine then loses its ability to absorb fluid and the body eliminates the fluid surplus through vomiting and diarrhea.
Calicivirus is one of the most common causes of gastrointestinal disease known as winter cancer. Calicivirus is highly contagious. It is enough for 10 to 100 virus particles to get infected. In a single drop of vomiting or stools, there may be millions of viruses. Calicivirus is also the most common cause in the U.S. to be infected with food. The incubation period, that is, the time it takes from the time you get sick, is 12-48 hours. Symptoms include vomiting, diarrhea, stomach ache, moderate fever, headache and muscle aches. You can feel really sick and bad. Symptoms may last for one to three days. Infected persons can spread infections up to two days and sometimes longer after they have recovered. That’s why it’s important to wash your hands and keep good hygiene.
Rotavirus – most common in small children. Rotavirus is another common cause of gastrointestinal disease in the U.S.. It is especially younger children who get rotavirus. The virus is the most common cause of gastric disease in children between six months and two years. Some types of rotavirus also make adult sick. The virus easily infects. From getting infected you will take one to three days. Often the symptoms begin with vomiting and continue after a few days of water-thin diarrhea and moderate fever. You may also feel cold. After four to six days the trouble usually goes over.
Children under 36 weeks can be vaccinated against rotavirus. You can get information about the vaccination from your GP or a vaccination center.
Bacteria that causes gastritis
When you become sick of bacteria, it is often due to lack of hygiene. It is more common to be infected abroad than in the U.S.. Physicians are required to report most cases of such diseases to an infectious physician who can track the infection and prevent more sickness.
Campylobacter – common gastric juvenile bacteria. The bacteria that cause stomach ache in most people in the U.S. are campylobacteria. For the most part, the infection is transmitted via food where the bacteria have been attached. Poor cooked meat is the most common source of infection. Salad can be polluted by using the same cutting board for raw meat and salad. Even water can carry on the infection. Infection directly from person to person is unusual.
The time from getting infected is usually two to five days. The disease can vary widely from person to person. Common symptoms include high fever, generalized sickness, diarrhea and gastrointestinal disorders. Diarrhea can sometimes be bloody. You can also carry on the bacterium without any symptoms. Half of all who become infected become bacterial free within two weeks, but often you have the bacteria in the stool for two to five weeks. Most of the time, the disease heals quickly.
Salmonella bacteria – usually contracted abroad. Another fairly common bacterium that causes gastrointestinal disease is salmonella. It is available in many different variants and has often been infected on a foreign trip. Some people have minor complaints that go fast but it is also common with high fever and diarrhea lasting for a week. Salmonella bacteria can be found in feces and infection via water or food. It is unusual for infection to pass from person to person. Larger outbreaks of salmonella have occurred through food served on restaurants, ferries and flights. For the most common form of salmonella, it usually takes one to three days from becoming infected.
Shigella – dysentery. Another intestinal infection caused by bacteria is dysentery, or shigella as it is also called. Most people who get sick have been infected abroad. Dysentery is spread with contaminated water or with food that is not cooked. Even food that, for example, is not properly cooked or fried can cause dysentery. Symptoms usually include abdominal cramps, fever and diarrhea that may be bloody. It is common to feel sick and hungry. The infection can be from person to person. It takes between one to seven days from being infected until you get sick. Sometimes the infection is treated with drugs.
ETEC bacteria – common cause of tourist diarrhea. So-called tourist diarrhea can have several causes, but the most common is the ETEC bacterium. ETEC belongs to family coli bacteria. The infection is spread from human to human via contaminated food or drink. The time from getting infected is between one to three days. Typical problems include water-tight diarrhea, stomach ache, nausea and sometimes vomiting and light fever. The disease usually goes over within three to four days.
EHEC bacteria – spread through food and contaminated water. There are several other coli bacteria that can lead to sickness, such as EHEC. EHEC is found in cattle, and the infection is spread through food or contaminated water. It can also infect person-to-person. It usually takes two to four days from the time you get sick, but it may take between one to eight days. Typical symptoms of EHEC are diarrhea, often bloody, stomach ache and no or low fever. Usually, symptoms last for a week. In more unusual cases, you may have an effect on kidneys and blood cells, in occasional cases of very serious disease.
Food poisoning – bacteria have formed a poison in the food. Some bacteria can form a poison in the food that makes you poison food. Bacteria can grow into foods that are stored at the wrong temperature for too long. Even though the food is then heated to the bacteria, the toxin is left and can cause symptoms. Symptoms may come from two to twelve hours after a meal, and you become severely nauseous, have stomach ache and violent vomiting. Often you have diarrhea, but fever is unusual. It is typical for the disease that several people who eat the same food get sick at the same time. However, the bacteria do not infect person-to-person. Most people who get a food poisoning will get well again within one to two days. Examples of bacteria that cause food poisoning are yellow staphylococci. These are common in wound infections. Therefore, it is important that you do not cook food if you have infected wounds on your hands.
Other that may cause diarrhea and vomiting
It is common with mild bowel problems, loose stools and you feel ill when you are treated with antibiotics. The trouble usually goes over when you stop taking your medicine. Symptoms often result from a mess of bacterial flora in the intestine. It often causes trouble at the end of a cure, or just after. In some cases, a bacterium called Clostridium difficile may grow in number and cause fever, vomiting and diarrhea.
Tarmparasites – unusual in the U.S. Several different intestinal parasites may cause gastrointestinal disease. Most commonly, Giardia is. It occurs especially in warmer parts of the world and is unusual in the U.S.. Often you have had the parasite through contaminated water or contaminated food. Many people who are infected have no trouble, but some get watery, puffy and smelly diarrhea, stretched stomachs, gases and smelly rapids. There also occur vomiting and abdominal pain, but rarely fever. Sometimes the disease can be long and you lose weight and get a nutritional deficiency in your body. It may take one to three weeks after you become infected until the inconvenience occurs. Giardia infections are treated with drugs.
- Diarrhea and vomiting can also be caused by various diseases of the abdomen:
- IBS, also known as sensitive bowel
- Inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease
- Food allergy to the protein gluten, so-called gluten intolerance or celiac disease.
- Diabetes in children
- Addison’s disease, which means you have lack of adrenal cortex hormone.
Diarrhea symptoms and clinical signs
Soluble, watery stools more than three times a day are defined as diarrhea. In historical terms, it is important to research further information, for example:
1. Does patient have any other symptoms than diarrhea? Fever? Abdominal pain? Gases? Alarming signs such as blood in the stool or weight loss?
2. Duration longer than four weeks speaks against infection.
3. What was the onset, sudden with full force right from the start or gradual? The former speaks for infection.
4. How are the symptoms of food intake affected? Will they disappear at fasting?
5. Does patient feel nauseous?
6. Are there any diseases in the environment? However, infections need not necessarily affect more than one person in the same company.
7. Has patient traveled abroad?
8. Are there any other diseases present?
9. Has there been a recent antibiotic treatment? Drug treatment? Use of laxatives? Surgery?
10. Does a patient have heredity for gastrointestinal diseases?
In physical status, some findings may provide important clues, for example, edema may indicate hypoalbuminemia due to protein malabsorption. BMI below 18.5 is defined as underweight and may be caused by malnutrition. Ascites may be caused by graft protein absorption. Iterus, may be due to cholestasis and, in that case, fat malabsorption. Resistance to the abdomen may occur in Crohn’s disease and malignancies.
Whether the trouble relieves / stops when fasting and the occurrence of nightly problems can provide valuable clues. In acute diarrhea, infection is by far the most common cause. Infections are usually self-healing or easy to treat. Most bacteria and viral infections heal within seven days. If it goes further than that, there are reasons to suspect protozoans, such as giardia or cryptosporidia. Although a few agents (e.g. aeromonas and yersiniaspecies) may cause an immunocompetent individual, chronic diarrhea is rarely infected with infections.
If the inconvenience lasts more than four weeks, the condition is classified as chronic and there are a variety of differential diagnoses. For didactic reasons, the reasons can be grouped into five different groups.
What causes diarrhea? Common diarrhea causes by groups
|Group of causes||Examples of diseases|
|Bile salt malabsorption|
If an investigation does not show any underlying disease or explanation for the inconvenience, the inconvenience is defined as functional diarrhea.
Diagnosis criteria for functional diarrhea
Dissolve (spotty) or watering stools without pain at least 75 percent of all bowel movements during the last three months and debut at least six months back in time at the time of diagnosis.
The extent of the investigation can be determined individually based on the duration of the appeals, how they debuted, any warning signs and the age of the patient. The examining specialist will focus primarily on finding answers for the following questions: what is patient’s blood status (is there anemia? If so, what type? Are there any signs of inflammation or infection?). Is there CRP, inflammation or infection?
Feces samples should then be collected and examined. Calprotectin rises, inter alia, in inflammation and malignancies in the intestine. Elastase is low in pancreatic insufficiency. Malabsorption samples should be taken, establishing the counts for vitamin B12, folate, iron status, albumin and calcium.
Thyroid disorders, hyperhyreosis can cause diarrhea. Respective analysis should be carried out in order to rule out the possibilities of endocrine problems.
The values for IgA class transglutaminase antibodies should be established. Positive predictive value is almost 70% and positive outcome should in principle cause biopsy. Negative outcome has a negative predictive value of more than 95 percent. In case of pronounced coughs and / or heredity for celiac disease, small-arm biopsy can be considered even in case of negative outcomes.
Endoscopy examinations suggested in diagnosing the type of diarrhea and its cause are as follows: colonoscopy, in case of suspicion of colorectal cancer and inflammatory bowel disease (emphasizing the importance of biopsies even in normal appearance); gastroscopy with biopsies from bulbus and pars descends duodenia in suspicion of celiac disease or other malabsorption; X-ray / MRI; MRI examination of the small intestine when suspected of Crohn’s disease; survey of suspicion of coprostasis / fecaloma.
Chronic diarrhea caused by IBS
IBS is a functional disorder in the gastrointestinal tract where the intestine, among other things, has a disturbed movement pattern. IBS causes abdominal pain, constipation, diarrhea and often gas problems. Symptoms can sometimes be very difficult, but often they can be reduced by avoiding certain foods or with non-prescription drugs.
IBS is a shortening of irritable bowel syndrome, and means approximately inflammable or hypersensitive bowel. It is also called colon irritable and functional bowel disease.
You may have a stomach ache in different places and in different ways. For example, you can get a lot of stomach jabs under the ribs, or a more diffuse and molar ache throughout the gastrointestinal tract. Often you get more pain after you have eaten, and the pain decreases when you are bouncing.
The consistency of the stool often switches between being hard and loose at IBS. Sometimes it can be a hard lump that comes first when you move bowels, which is then followed by diarrhea-like stools. You can also have only diarrhea or just be constipated. You may experience having to pass stool again, even though you have just done it. Sometimes you get such diarrhea that you are in a hurry to get to the toilet.
You may have a lot of pain caused by stomach gases ad flatulence. Many times the stomach may swell so much that the clothes tighten and you may need to snap up buttons. Gas problems increase during the day or when you have eaten some foods such as those rich in fiber, cabbage, beans or onion.
Tourist diarrhea is a collective name of the stomach upsets that can be experienced during travel, mostly in countries with poor water and sewage treatment. The most common cause of tourist diarrhea is bacteria of various kinds spread between humans. Often it is a type of bacteria called ETEC.
The infection is spread mainly through water or food that is not cooked. This may include raw seafood, cold cuts and tap water. Even food that is not properly cooked or fried can provide tourist diarrhea. There is no sure way to avoid being infected. It usually takes between half to two days from becoming infected. The disease often occurs within three to four days.
There is a drinkable vaccine that protects against cholera. Earlier, one could be advised that the same vaccine could help even against tourist diarrhea. FDA has examined the studies on the effect of the vaccine against diarrhea caused by ETEC and the vaccine is only approved for protection against cholera. If you have a tourist diarrhea, it is common to have the following symptoms, too: fever, nausea and vomiting.
Diarrhea in children
Children who have diarrhea usually have a viral infection in the form of gastric disease, which comes quickly and infects easily. Then it is common to even vomit. Diarrhea can also be due to, for example, too little fat or too much fiber in the food, or because the child has eaten something that is not tolerated and has an allergic reaction. When you get diarrhea, you get loose stools, which usually come several times a day. The consistency is like water, vellum or thin porridge with or without solids. It can also contain blood and mucus.
What the feces look like depends much on what you eat. Children under one year of breastfeeding often have loose or gray stools, which are yellow and sometimes greenish. It is normal, although the stools are as often as seven to eight times a day or after each meal. If the feces become much thinner than usual, one can suspect that the breastfeeding child has diarrhea due to an infection.
There are many reasons why children get diarrhea. The most common cause of diarrhea in children is gastrointestinal disease caused by a viral infection. The most common infectious agents are called rotavirus and calicivirus. Calicivirus is also called gastroenteritis. Incorrect mixing of breast milk replacement or supplementary nutrition may lead to severe diarrhea in children up to one year. Therefore it is important to mix as shown on the packaging.
Children can react to any food, for example, against cow’s milk, against soy, against gluten in flour, so-called gluten intolerance. Children can react to lactose in milk. If the child responds to any food, it may also cause other problems such as eczema and respiratory distress. Sometimes children between six months and three years can have long diarrhea without affecting how the child grows or how the baby is, and often there is no reason. Children who get too little fat in the food or who often eat fiber rich foods can also be loose in the stomach.
Treatment with antibiotics affects the normal bowel flora bacteria, that is, the bacteria that are there naturally to protect against dangerous infections. The disturbed bacterial balance in the intestine may cause diarrhea.
The child has received intestinal bacteria, such as salmonella and campylobacter, or parasites, such as Gardia. These bacteria and parasites are spread through contaminated water and food, usually in countries with poor water and sewage treatment. Campylobacteria are usually spread through foods that are not sufficiently cooked, for example, poorly cooked chicken. Occasionally, infections like colds, urinary tract infections or pneumonia can cause the baby to get diarrhea.
Food poisoning, caused by certain bacteria, can cause diarrhea, but it is less common. Often it will take place after one to two days. Diarrhea may also be due to poisoning caused by the child having eaten such as plants, berries, mushrooms or toxic metals. Often the baby is vomiting. In diseases of the pancreas, such as cystic fibrosis, the intestine may have difficulty absorbing the fat in the food and the baby gets diarrhea. The stripping is then greasy and difficult to flush into the toilet.
If children over the age of three, usually this child in school age, have diarrhea for a long time, it may be due to an inflammatory bowel disease. The child may sometimes have nausea or blood or stomach ache, the child may also grow worse than expected.
If the baby has stomach it is common that it also vomits, has a stomach ache and sometimes fever. Gastric disease is usually caused by a virus with no medicine. Macrosis is easily transmitted. The vomiting usually ends within one to two days, while the diarrhea can last for a week.
Gluten intolerance, also known as celiac disease, can cause diarrhea while you have several other symptoms that vary according to how old you are. You can get stomach ache, and do not grow and lose weight as you should. You can also have gluten intolerance without having diarrhea. Gluten is a protein found in wheat, rye and grains. When you cannot tolerate gluten, the mucous membrane is damaged in the intestine. This means that food in the food is not taken up in the usual way. A blood sample may show if you need to be investigated for gluten intolerance.
Allergy to cow’s milk protein can cause diarrhea in children. Two percent of all children up to a year have cow’s milk allergy, that is, they are allergic to the protein found in cow’s milk. This may cause diarrhea and vomiting. Many people who have allergies grow from it when they grow older.
Children who have cumin allergy sometimes also have other symptoms, such as stomach ache, eczema and asthma. The most common thing is that a blood sample cannot show if the child has an allergy to cow’s milk and stomach ache, but you must remove all cow’s milk from the baby’s food for at least a few weeks to see if the trouble disappears. You should not do this yourself, but only after contact with the pediatrician and dietitian.
Lactose intolerance means that the baby’s intestine cannot break down the milk sugar, lactose, into the milk. The most common symptoms are that the baby has a stomach ache, gases and diarrhea after drinking milk or eating food containing milk. Lactose intolerance is very unusual before the age of five, but may occur earlier and also occur temporarily in small children after having had stomach and mucous membranes in the intestine have been temporarily injured. Then it will take over a few weeks, but you may need to give less of food and drink containing milk sugar for a short period of time.
Small children may have diarrhea for a long time without explanation. It is not uncommon for small children between six months and three years, who are well-behaved to have diarrhea for a longer period of time, more than two weeks. It is usually called toddler diarrhea. Typically, these abductions are that the child is biting a lot and often, and that the feces contain unprocessed fruit and vegetable residues. The child is losing weight as it should and has no signs of nutritional deficiency, and you do not have to worry about fluid shortage.
Children who have diarrhea for a long time often seem to be quite obsessed with it, but because the loose feces can make the child‘s tail red and irritated, it is good to change the diaper immediately after the child has bathed. It is also good to air the child’s tail, to let the child be without diaper. If the skin is irritated you can lubricate with a protective ointment. If the child has this type of diarrhea for a long time without explanation, it usually ends when the child is between two and three years old. It may be helpful to inform those who take care of the child during the days that there is no question of contagious intestinal infection.
Prevention of infection-caused diarrhea
Viral infections that give diarrhea are often very contagious. Therefore, it is good to avoid meeting people who know you have a stomach ache. For the youngest children there is a vaccine against rotavirus. Children between 6 and 24 weeks old can receive the vaccine via the mouth in two or three doses. You can get information about the vaccination via BVC or a vaccination center.
If someone in the family has diarrhea, everyone needs to wash their hands with liquid soap before meals and after toilet visits, and use their own towel or disposable towel. It is also good to clean the toilet with detergents frequently and after washing your hands with soap, lubricate them with a hand spray to prevent infection. Care should be taken to wash your hands when you have helped the child in the toilet. If possible, a sick child should use his own toilet. Remember to regularly wipe surfaces in the toilet room where the virus can spread, such as toilet rings and water tap.
If the baby wears diapers, it is advisable to use diapers in a separate plastic bag before disposing of them in the bin. Clean the changing table after use and wash your hands thoroughly after changing the diaper.
Laundry should be washed in a washing machine, preferably at 60 degrees. To prevent diarrhea caused by viruses and bacteria, it is advisable to keep good hygiene in the kitchen, both for cooking and for storing food. It is extra important when traveling in hot countries.
Diarrhea that needs medical care
It is common for gastric disease to pass by itself within a few days to a week. If you are going to seek care or not when the child has diarrhea depends on how the child is generally clean and if the child receives enough fluid. When the baby has diarrhea, it loses fluid and salts. If the child loses more fluid than it gets, it can get dehydrated, which can be serious. High fever causes the child to lose even more fluid.
A child who urinates regularly is not dehydrated. Children under one year, and especially those younger than six months or prematurely born babies are particularly sensitive to fluid deficiency and dehydration. Even children up to three years of age can withstand fluid losses worse than older children and adults. Children with a chronic disease, such as diabetes, metabolic disease, cystic fibrosis, liver and kidney disease, heart disease and neurological diseases, may be more sensitive to fluid deficits.
You should contact a healthcare center or pediatric clinic if the child has one or more of these problems:
- The child after a few days still has abundant or water-thin diarrhea, which does not diminish.
- You are worried that your child will not get enough fluid.
- The child has had diarrhea in connection with a foreign trip.
- The child has a chronic illness and has diarrhea.
- The child is younger than two months.
- The child in addition to diarrhea also has vomiting for more than a day.
You should seek care immediately, regardless of time of day, at the health center or emergency department if the child has diarrhea, and has one or more of these problems:
- Is under one year and does not get enough liquid.
- Is under a year and shouts in a different way than it usually is, is sleepy, uninterested, or seems to have a stomach ache.
- Is tired and tired, has sore eyes and dry mucous membranes in the mouth, and there are no tears when the child is crying.
- Has a high fever and seems to be badly clean generally, or is irritated.
- Has a lot of pain in the stomach.
- Have bad and blood in the diarrhea.
- Have not peed in six to ten hours.
You can call the healthcare counsel on the phone if you need help assessing the child’s symptoms.
If the child needs to be investigated, you and the child, if possible, will tell the doctor about the symptoms of the child, how long it has been, and how much fluid the child has received. The doctor usually studies the child’s fluid balance by weighing and measuring the child. Then examine how the baby breathes, and what pulse and what blood pressure the child has. The doctor is also investigating whether the child has a fever. The doctor usually also investigates if the child has dry mucous membranes in the eyes and mouth, if the eyes are sore and if the skin is extensible.
The doctor listens how the heart beats and how the lungs work, feel on the stomach and see if the child has a rash on the body. Sometimes the child needs to leave blood samples and urine samples.
If the doctor suspects that the diarrhea is caused by something else than an infection, or if the child has diarrhea for a long time, sometimes several months, more usually more studies are required. The child usually leaves blood tests and abductions. Sometimes x-ray examinations and further examination of the stomach and intestines are needed.