Diarrhea

Diarrhea is a condition that involves the frequent passing of loose or watery stools - it is the opposite of constipation and can have many causes, which may be infectious or non-infectious.

Diarrhea comes from the Greek word diarrhoia. Dia means "through" and rheo means "flow". The term "flowing through" was coined by Hippocrates.

Spelling: In American English it is spelled "diarrhea", and in British English it is "diarrhoea".

Acute diarrhea, meaning diarrhea that is not long-term, is a very common cause death in developing nations, especially among young children and babies. It usually appears rapidly and may last from between five to ten days.

Chronic diarrhea, meaning long-term diarrhea is the second cause of death among children in developing countries.


People with diarrhea often have fever and/or stomachache (abdominal cramps). Diarrhea may be caused by inflammatory bowel syndrome (IBS), Crohn's disease, an allergy, or an infection.

According to the World Health Organization (WHO) approximately 3.5 million deaths each year are attributable to diarrhea. 80% of those deaths occur in children under the age of 5 years. Children are more susceptible to the complications of diarrhea because a smaller amount of fluid loss leads to dehydration, compared to adults.

A bacterium called enteroaggregative E. coli, is responsible for 10 percent of cases of diarrhea in children, researchers at Cincinnati Children's Hospital Medical Center, USA, found.

According to Medilexicon's medical dictionary, Diarrhea is:

"An abnormally frequent discharge of semisolid or fluid fecal matter from the bowel."

What are the five types of diarrhea?

• Secretory diarrhea
  
  Either the gut is secreting more fluids than usual, or it cannot absorb fluids properly. In such cases structural damage is minimal. This is most commonly caused by a cholera toxin - a protein secreted by the bacterium Vibrio cholera.


• Osmotic diarrhea
  
  Too much water is drawn into the bowels. This may be the result of celiac disease, pancreatic disease, or laxatives. Too much magnesium, vitamin C, undigested lactose, or undigested fructose can also trigger osmotic diarrhea.


• Motility-related diarrhea
  
  Food moves too quickly through the intestines (hypermotility). If the food moves too quickly there is not enough time to absorb sufficient nutrients and water. Patients who had a vagotomy (removal or severing of the vagus nerve) as well as those with diabetic neuropathy are susceptible to this type of diarrhea.


• Inflammatory diarrhea
  
  The lining of the gut becomes inflamed. This is usually caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as IBS (inflammatory bowel disease). Tuberculosis, colon cancer and enteritis can also cause inflammatory diarrhea.


• Dysentery
  
  The presence of blood in the stools is usually a sign of dysentery, rather than diarrhea. Dysentery is caused by a release of excess water caused by an antidiuretic hormone from the posterior pituitary gland. Dysentery is one of the symptoms of Shigella, Entamoeba histolytica, and Salmonella.

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When it occurs in people age 60 and older, there's a good possibility bloody diarrhea indicates ischemic colitis, according to the Mayo Clinic, USA.

What are the symptoms of diarrhea?

Some sufferers may pass slightly watery stools and have brief episodes of stomachache, while others may pass very watery stools and have more severe stomach cramping. The most common symptoms include:

• Abdominal cramps
• Abdominal pain
• An urge to go to the toilet, sometimes this may be sudden
• Vomiting
• Nausea
• Temperature (fever)
• Headache
• Loss of appetite
• Fatigue
• Loose, watery stools
• Bloating
• Blood in stool

Anybody who has had diarrhea for more than one week should see their doctor. The UK National Health Service advises parents to take their child to the doctor if:

• The child is aged 3 months to 1 year and the diarrhea has lasted over two days
• The child is over 1 year of age and the diarrhea has lasted more than five days

You should also see your doctor if you experience or witness any of the following:

• You have symptoms of dehydration - excessive thirst, very dry mouth, very little or no urination
• Your abdominal pain is severe
• You have severe rectal pain
• There is blood in the stools, the stools are black
• Your temperature is over 39C (102 F)
• A baby has not wet the diaper (UK: nappy) in over three hours
• A child/baby is very sleepy, irritable, or unresponsive
• A child/baby has a sunken abdomen
• A child/baby has sunken eyes and/or cheeks
• The child's/baby's skin does not flatten after being pinched

What causes diarrhea?

Causes of acute diarrhea (short term diarrhea)

This is usually caused by an infection, and is also a symptom of a bowel infection when the stomach and the intestines become inflamed (gastroenteritis). This may be caused by:

• A virus - most commonly a norovirus or a rotavirus. It could also be caused by a hepatitis virus, or the herpes simplex virus. Viral diarrhea spreads easily.


• A bacteria - if food or water is contaminated bacteria and parasites can be transmitted into the body. Parasites may include Giardia lamblia and cryptosporidium. Examples of bacteria are campylobacter, salmonella, shigella and Escherichia coli (E. coli). Traveler's diarrhea is usually caused by bacteria or parasites. Researchers at Boston University School of Medicine identified the structure of bacteria responsible for traveler's diarrhea.


• An antibiotic - antibiotics can disturb the natural balance of bacteria in our intestines, which can lead to infection, commonly with a bacterium called Clostridium difficile.

The following may also be causes of acute diarrhea:

• Anxiety
• Consuming too much alcohol
• Consuming too much coffee
• Some other medications, apart from antibiotics

Causes of chronic diarrhea (persistent, longer term diarrhea)

• Bacteria
• A virus
• Laxatives
• Some dietary habits - long term regular alcohol, coffee consumption may cause persistent diarrhea. Regular eating of candy (sweets) can too. Many sugar-free chewing gums containing a sweetener called sorbitol can cause chronic diarrhea, The British Medical Journal reported.
• The FDA sent out a communiqué in February 2012 warning that proton pump inhibitor usage considerably increases the risk of persistent diarrhea caused by Clostridium difficile.

The following long-term conditions can cause chronic diarrhea

• Celiac disease
• Crohn's disease
• Diabetes
• Irritable bowel syndrome (IBS)
• Lactose intolerance
• Pancreatitis
• Ulcerative colitis