Diarrhoea

Diarrhoea

Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhoea, nor is the passing of loose, "pasty" stools by breast fed babies. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. There are three clinical types of diarrhoea: acute watery diarrhoea – lasts several hours or days, and includes cholera; acute bloody diarrhoea – also called dysentery; and persistent diarrhoea – lasts 14 days or longer.

Cause & Risk

Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-contaminated water.

Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhoea.

Source: Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Animal faeces also contain microorganisms that can cause diarrhoea.

Other causes: Diarrhoeal disease can also spread from person-to-person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea when it is prepared or stored in unhygienic conditions. Water can contaminate food during irrigation. Fish and seafood from polluted water may also contribute to the disease.

Symptoms

The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced. The degree of dehydration is rated on a scale of three. Early dehydration – no signs or symptoms. Moderate dehydration: thirst restless or irritable behaviour decreased skin elasticity sunken eyes Severe dehydration: symptoms become more severe shock, with diminished consciousness, lack of urine output, cool, moist extremities, a rapid and feeble pulse, low or undetectable blood pressure, and pale skin. Death can follow severe dehydration if body fluids and electrolytes are not replenished, either through the use of oral re-hydration salts (ORS) solution, or through an intravenous drip.

Diagnosis & Treatment

Key measures to prevent diarrhoea include: access to safe drinking-water; use of improved sanitation; hand washing with soap; exclusive breastfeeding for the first six months of life; good personal and food hygiene; health education about how infections spread; and rotavirus vaccination. Key measures to treat diarrhoea include the following:

Re-hydration: with oral re-hydration salts (ORS) solution. ORS is a mixture of clean water, salt and sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.

Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.

Re-hydration: with intravenous fluids in case of severe dehydration or shock. Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet – including exclusive breastfeeding for the first six months of life – to children when they are well. Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.

Further Information

What to do if you have diarrhoea: It is important to drink plenty of fluids to avoid dehydration. Take small, frequent sips of water. You are more likely to become dehydrated if you are also vomiting. It is very important for babies and small children not to become dehydrated. Give your child frequent sips of water, even if they are vomiting. A small amount is better than none. Fruit juice or fizzy drinks should be avoided because they can make diarrhoea worse in children. Contact your GP immediately if your child shows signs of dehydration, such as: irritability or drowsiness passing urine infrequently pale or mottled skin cold hands and feet becoming increasingly unwell.

Children: at increased risk of dehydration, your child's risk of becoming dehydrated is increased if they: are younger than one year old (particularly if they are less than six months) are younger than two years old and had a low birth weight have had more than six episodes of diarrhoea in the last 24 hours have vomited more than twice in the last 24 hours have been unable to hold down fluids have suddenly stopped breastfeeding If you are breastfeeding or bottle feeding your baby and they have diarrhoea, you should continue to feed them as normal. While breastfeeding, you should increase your fluid intake to help maintain your milk supply. You may be able to give your baby oral re-hydration solution (ORS) if they become dehydrated. However, check with your pharmacist or health visitor before giving re-hydration fluids to young babies and infants. Read more about diarrhoea and vomiting in children. Oral re-hydration solutions (ORS) Your G.P. or pharmacist may suggest using an oral re-hydration solution (ORS) if you or your child are at risk from the effects of dehydration. For example, if you: are 60 years of age or over are frail have a pre-existing health condition, such as cardiovascular disease Re-hydration drinks usually come in sachets available from your local pharmacist without a prescription. They are dissolved in water and replace salt, glucose and other important minerals that are lost through dehydration. Re-hydration drinks do not cure diarrhoea but they can help treat or prevent dehydration. Avoid using homemade salty or sugary drinks.

Children: Your G.P. or pharmacist may recommend giving your child an ORS if they are dehydrated or at risk of becoming dehydrated. The usual recommendation is for your child to drink an ORS each time they have an episode of diarrhoea. The amount they should drink will depend on their size and weight. Your pharmacist will be able to advise you about this. The manufacturer's instructions should also give information about the recommended dose.

Eating: Opinion is divided over when and what you should eat if you have diarrhoea. However, most experts agree that you should eat solid food as soon as you feel able to. Eat small, light meals, avoiding fatty, spicy or heavy foods. If you feel you cannot eat, it should not do you any harm. Make sure you continue to drink fluids and eat as soon as you feel able to.

Children: If your child is dehydrated, do not give them any solid food until they have drunk enough fluids. Once they have stopped showing signs of dehydration, they can start eating their normal diet. If your child is not dehydrated, offer them their normal diet. If they refuse to eat, continue to give them fluids and wait until their appetite returns.

Medicines: Anti-diarrhoeal medicines may help reduce your diarrhoea and shorten how long it lasts by around 24 hours. However, they are not usually necessary unless shortening the duration of your diarrhoea helps you get back to essential activities sooner. Loperamide is the preferred anti-diarrhoeal medicine because it has been shown to be effective and causes few side effects. Loperamide slows down the muscle movements in your gut so that more water is absorbed from your stools. This makes your stools firmer and they are passed less frequently. Some anti-diarrhoeal medicines can be bought from a pharmacy without a prescription. Check the patient information leaflet that comes with the medicine to find out whether it is suitable for you and what dose you should take. Ask your pharmacist for advice if you are unsure. Do not take anti-diarrhoeal medicines if there is blood or mucus in your stools and/or you have a fever (high temperature). Contact your G.P. Children should not be given anti-diarrhoeal medicines.

Painkillers: Painkillers will not cure your diarrhoea, but you can take the recommended dose of paracetamol or ibuprofen if you have a fever or a headache. Do not take ibuprofen if you have asthma or stomach, liver or kidney problems. If necessary, you can give your child liquid paracetamol or ibuprofen. Check the patient information leaflet to find out whether it is suitable for your child. Children under 16 years of age should not be given aspirin.

Antibiotics: Treatment with antibiotics is not recommended for diarrhoea if the cause is unknown. This is because antibiotics: will not work if the diarrhoea is caused by a virus can cause unpleasant side effects can become less effective at treating more serious conditions if they are repeatedly used to treat mild conditions Antibiotics may be recommended if you have very severe diarrhoea and a specific type of bacteria has been identified as the cause. They may also be recommended if you have a pre-existing risk factor that makes you more vulnerable to infection, such as a weakened immune system. Hospital treatment Occasionally, hospital treatment may be needed if you or your child is seriously dehydrated due to diarrhoea. Treatment will involve administering fluids and nutrients directly into a vein (intravenously).