What is Diarrhoea?

Diarrhoea is an illness that is characterised by frequent, runny and loose stools. Those with diarrhoea will experience three or more loose movements throughout the day. It can best be visualised as types 5-7 on The Bristol Stool Form Scale which can be found here. The unusual appearance of faeces occurs because of excess water production and/or reduced water absorption from the bowel. Research shows that approximately 15% of people in developed countries, such as the USA, will suffer from diarrhoea [1]. There are many causes of diarrhoea, including inflammatory conditions and food poisoning. While most diarrhoea episodes resolve quickly, symptoms can persist for some people. Seeking the opinion of a GP is crucial for receiving an accurate diagnosis and getting the appropriate treatment for recovery.

Acute Diarrhoea vs. Chronic Diarrhoea

Diarrhoea is classified as acute or chronic. Acute diarrhoea describes symptoms that last less than 14 days and are usually caused by infections. On the other hand, chronic diarrhoea persists longer than four weeks and typically arise from non-infectious origins [2]. While all symptoms should warrant a trip to the doctors, more prolonged episodes of diarrhoea may require further investigations [3].
 

Diarrhoea Symptoms

Symptoms of diarrhoea will differ from person-to-person and episode-to-episode. Depending on the cause of the illness, symptoms can vary. Examples include [3][4]:

• Frequent watery and loose bowel movements (>3 times a day)
• Presence of blood in stool
• Tenesmus (the urge to go to the toilet even though you don’t need to)
• Upper abdominal pain
• Increased flatulence or farting
• Bloating
• Abdominal cramping
• Fever
• Vomiting

 

Causes of Diarrhoea

Diarrhoea can sometimes be challenging to treat because of the various causes. Chronic and acute diarrhoea are listed in separate categories as they possess distinct origins.

Acute Diarrhoea [4]

Acute diarrhoea is commonly triggered after exposure to viral and bacterial infections. Examples of common viral causes are norovirus or rotavirus. In comparison, common causes of bacterial infection include Escherichia coli or Clostridium difficile.

• Side-effects of specific medications
• Food allergy
• Appendicitis
• Anxiety and stress
• Gastroenteritis caused by:
  • Food poisoning (e.g. raw milk, seafood, undercooked meats, etc.)
  • Pregnancy
  • Antibiotics
  • Being immunocompromised
  • Exposure to infectious environments, such as day-cares and hospitals

Chronic Diarrhoea [2]

On the other hand, chronic diarrhoea is frequently caused by inflammatory origins instead of bacterial or viral infections. Examples include:

• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (IBD) (Please see: ulcerative colitis, Crohn’s Disease)
• Consumption or over-consumption of certain foods (e.g. dairy, artificial sweeteners, certain sugars, gluten, fried foods, caffeine, spicy foods, etc.)
• Intestinal infections
• Endocrine disorders
• Medications (e.g. antibiotics, NSAIDS, magnesium, etc.)

Is Diarrhoea Contagious?

Causes of diarrhoea, particularly acute conditions, can be highly contagious. Gastroenteritis is one of the most common causes of diarrhoea and can quickly spread to others. Viral gastroenteritis is very contagious. It can be spread through person-to-person contact, contaminated objects and particles in the air [7]. Although bacterial gastroenteritis can also be spread from person-to-person, it’s usually contracted through contaminated food and drink. Infections from microscopic parasites can lead to infectious diarrhoea. Giardia are parasites commonly found in countries with dirty and poorly sanitised water. Once they infest the bowel, they spread through contact, sharing contaminated food, water, and even animals [8].
 

Tests and Diagnosis

Due to a large number of causes of diarrhoea, GPs may need to conduct thorough examinations and investigations for a formal diagnosis. Those with severe symptoms (e.g. fever, vomiting, bloody stools, etc.) or younger patients (i.e. babies, younger children) should seek an urgent consultation with a GP. Examples of tests used for diagnosis include:

• A physical examination
• Blood tests
• Stool tests
• Colonoscopy
• Endoscopy
• Immunochemical testing
• Abdominal CT Scan

 

Treatments - How to Stop Diarrhoea?

While mild cases of diarrhoea can be managed through self-care, severe and prolonged symptoms require medical treatment. Seeing a GP early is crucial for preventing further complications and speeding up recovery. Treatments will vary depending on individual circumstances and what could be causing symptoms.

Hydration

Rehydration and electrolyte intake is vital for replenishing lost fluids during an episode of diarrhoea. Dilated fruit drinks or sports drinks (e.g. Gatorade, Powerade, etc.) can be considered. Those with severe dehydration may require intravenous (IV) replacements.

Dietary Changes

When experiencing diarrhoea, choosing foods that are easy to digest helps absorb water from the stool [9]. Examples of foods you may opt for include porridge, broth, congee, mashed potatoes and apple puree. Additionally, foods that may upset the stomach should be avoided, such as spicy meals, dairy, fatty meats and high-fibre foods. However, consulting a dietitian is advised as this may not be the case for everyone.

Diarrhoea Medicine

GPs can prescribe anti-motility medications to reduce the frequency of bowel movements [4]. While effective in acute diarrhoea, they can have side effects if misused. Always consult a GP before using these types of medications. Additionally, your doctor may also recommend medications to treat the underlying cause of your diarrhoea (e.g. gastroenteritis, inflammatory bowel disease, etc.). For example, antibiotics may be prescribed if there is any suspected bacterial infection.

Prevention

While diarrhoea can be an unfortunate occurrence, there are ways to prevent getting and spreading it to others. One of the most common ways of spreading illnesses that cause diarrhoea is through contact with faeces, vomit and contaminated objects. Incorporating hygienic practices into your daily routine is particularly important, especially if you’re travelling or dealing with food. Examples of good hygiene practices include: Wash your hands with soap or hand-wash with water, especially after going to the toilet and before preparing food. Wash your fruits and vegetables before consuming, especially if eaten uncooked. Stay at home if you have infectious diarrhoea and/or gastroenteritis. Cleaning your kitchenware and countertops, especially after dealing with meat. Avoid drinking water from streams, lakes or tap water from developing countries. Either boil before consuming or purchase bottled water instead.
 

Recovery - How Long Does Diarrhoea Last For?

Generally, mild cases of diarrhoea will resolve within a few days without treatment. However, this can vary depending on the underlying cause of the symptoms. Episodes of acute diarrhoea will last no more than two weeks, while chronic diarrhoea can persist longer than 4 weeks [3]. Those with continuing and severe symptoms (e.g. fever, blood stools, etc.) should see a GP as soon as possible.

Complications

Complications can arise if diarrhoea symptoms persist and are left untreated (especially in babies or young children). They include:

• Risk of spreading illness and infections to others.
• Undiagnosed underlying conditions (e.g. inflammatory bowel disease, colorectal cancer, etc.)
• Dehydration and electrolyte imbalance
• Progressively worsening diarrhoea symptoms
• Kidney failure and organ damage

 

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  References

1. 1. Scallan, E., Majowicz, S. E., Hall, G., Banerjee, A., Bowman, C. L., Daly, L., ... & Angulo, F. J. (2005). Prevalence of diarrhoea in the community in Australia, Canada, Ireland, and the United States. International journal of epidemiology, 34(2), 454-460.
   2. Arasaradnam, R. P., Brown, S., Forbes, A., Fox, M. R., Hungin, P., Kelman, L., ... & Walters, J. R. (2018). Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology. Gut, 67(8), 1380-1399.
   3. Nemeth, V., & Pfleghaar, N. (2017). Diarrhea.
   4. Barr, W., & Smith, A. (2014). Acute diarrhea in adults. American family physician, 89(3), 180-189.
   5. https://patient.info/doctor/acute-diarrhoea-in-adults-pro#nav-0 
   6. https://www.uptodate.com/contents/chronic-diarrhea-in-adults-beyond-the-basics#H2
   7. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/viral-gastroenteritis.aspx 
   8. https://www.healthline.com/health/giardiasis
   9. https://www.medicalnewstoday.com/articles/320124#foods-to-eat