Diarrhea in Children | Johns Hopkins Medicine

What is diarrhea?

Diarrhea is when stools (bowel movements) are loose and watery. Your child may also need to go to the bathroom more often.

Diarrhea is a common problem. It may last 1 or 2 days and go away on its own. If diarrhea lasts more than 2 days, your child may have a more serious problem.

Diarrhea may be either:

• Short-term (acute). Diarrhea that lasts 1 or 2 days and goes away. This may be caused by food or water that was contaminated by bacteria (bacterial infection). Or it may happen if your child gets sick from a virus.

• Long-term (chronic). Diarrhea that lasts for a few weeks. This may be caused by another health problem such as irritable bowel syndrome. It can also be caused by an intestinal disease. This includes ulcerative colitis, Crohn’s disease, or celiac disease. Giardia may also cause chronic diarrhea.

What causes diarrhea?

Diarrhea may be caused by many things, including:

• Bacterial infection

• Viral infection

• Trouble digesting certain things (food intolerance)

• An immune system response to certain foods (food allergy)

• Parasites that enter the body through food or water

• Reaction to medicines

• An intestinal disease, such as inflammatory bowel disease

• A problem with how the stomach and bowels work (functional bowel disorder), such as irritable bowel syndrome

• Surgery on the stomach or gallbladder

Children who visit some foreign countries are at risk for traveler’s diarrhea. This is caused by having food or water that is not safe because of bacteria, viruses, or parasites.

Severe diarrhea may mean a child has a serious disease. Talk with your child’s healthcare provider if symptoms don’t go away. Also talk with the provider if symptoms stop your child from doing daily activities. It may be hard to find out what is causing your child’s diarrhea. 

What are the symptoms of diarrhea?

Symptoms can occur a bit differently in each child. They can include:

The symptoms of diarrhea may look like other health problems. Severe diarrhea may be a sign of a serious disease. Make sure your child sees his or her healthcare provider for a diagnosis.

How is diarrhea diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may have lab tests to check blood and urine.

Other tests may include:

• A stool culture to check for abnormal bacteria or parasites in your child’s digestive tract. A small stool sample is taken and sent to a lab.

• A stool evaluation to check the stool for blood or fat

• Blood tests to rule out certain diseases

• Imaging tests to rule out structural problems

• Tests to check for food intolerance or allergies

• A sigmoidoscopy. This test lets the healthcare provider check the inside of part of your child’s large intestine. It helps to tell what is causing diarrhea, stomach pain, constipation, abnormal growths, and bleeding. It uses a short, flexible, lighted tube (sigmoidoscope). The tube is put into your child’s intestine through the rectum. This tube blows air into the intestine to make it swell. This makes it easier to see inside.

How is diarrhea treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Dehydration is the major concern with diarrhea. In most cases, treatment includes replacing lost fluids. Antibiotics may be prescribed when bacterial infections are the cause.

Children should drink lots of fluids. This helps replace the lost body fluids. If your child is dehydrated, be sure to:

• Offer drinks called glucose-electrolyte solutions. These fluids have the right balance of water, sugar, and salts. Some are available as popsicles.

• Avoid juice or soda. They may make diarrhea worse.

• Not give plain water to your baby

• Not give too much plain water to kids of any age. It can be dangerous.

• Keep breastfeeding your baby. Breastfed babies often have less diarrhea.

• Keep feeding your baby formula, if you were already doing so

What are the complications of diarrhea?

The greatest complication of diarrhea is dehydration. This is more likely with young children and those with a weakened immune system. Dehydration can be mild, moderate, or severe. Mild dehydration is the loss of fluid. Moderate or severe dehydration puts stress on the heart and lungs. In the worst cases it can lead to shock, which is life-threatening.

What can I do to prevent diarrhea?

Proper handwashing can reduce the spread of bacteria that may cause diarrhea.

A rotavirus vaccine can prevent diarrhea caused by rotaviruses. Ask your child’s healthcare provider which vaccines are right for your child.

When you travel, make sure anything your child eats and drinks is safe. This is even more important if you travel to developing countries.

Travel safety tips for drinking and eating include:

• Not drinking tap water or using it to brush teeth

• Not using ice made from tap water

• Not drinking unpasteurized milk (milk that has not gone through a process to kill certain bacteria)

• Not eating raw fruits and vegetables unless you wash and peel them yourself

• Not eating raw or undercooked meat or fish

• Not eating food from street vendors or food trucks

Talk with your child’s healthcare provider before traveling.

When should I call my child’s healthcare provider?

Call your child’s provider if your child is less than 6 months old or has any of the following symptoms:

• Belly pain

• Blood in the stool

• Frequent vomiting

• Doesn’t want to drink liquids

• High fever

• Dry, sticky mouth

• Weight loss

• Urinates less frequently (wets fewer than 6 diapers per day)

• Frequent diarrhea

• Extreme thirst

• No tears when crying

• Sunken soft spot (fontanelle) on baby’s head

Key points about diarrhea

• Diarrhea is loose, watery stool. Your child may also have to go to the bathroom more often.

• It may be caused by many things, including bacterial infection or viral infection.

• Dehydration is the major concern with diarrhea.

• In most cases, treatment involves replacing lost fluids.

• The rotavirus vaccine can prevent diarrhea caused by that virus.

• Proper handwashing can help prevent diarrhea.

• When you travel, make sure anything your child eats and drinks is safe.

Next steps

Tips to help you get the most from a visit to your child’s health care provider:

• Before your visit, write down questions you want answered.

• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Diarrhea (for Teens) – Nemours Kidshealth

What Is Diarrhea?

Diarrhea is frequent, soft or loose bowel movements (poop). Most people get diarrhea from time to time. It usually doesn’t last long and often gets better on its own.

What Causes Diarrhea?

Diarrhea is usually caused by an infection in the intestines. The germs that cause the infection are:

• viruses (most common)
• bacteria
• parasites

Viruses

Viral gastroenteritis (the “stomach flu”) is a common illness. It causes diarrhea and, often, nausea and vomiting. The symptoms usually last a few days. The viruses that cause viral gastroenteritis can pass through a household (or a college dorm or other place where lots of people live together) quickly because they’re highly infectious.

Luckily, the diarrhea usually goes away on its own in a few days. For healthy teens and adults, viral gastroenteritis is a common but minor inconvenience. But for little kids and people with chronic illnesses, it can lead to dehydration that needs medical attention.

Bacteria

In developed countries like the United States, outbreaks of diarrhea are most often due to what we call food poisoning. Food poisoning happens when toxins are made by bacteria in food that isn’t handled, stored, or cooked safely.

Other bacterial infections that can cause diarrhea include E. coli, salmonellosis, and shigellosis.

Parasites

The Giardia parasite spreads easily through contaminated water and human contact. This parasite can spread in water parks and pools because it is resistant to chlorine treatment. Bathing in and drinking water from contaminated streams or lakes can lead to an infection and chronic diarrhea. Infants in childcare settings can become infected with Giardia and bring the parasite home, causing diarrhea in family members.

Another parasite, Cryptosporidium, is a common culprit behind diarrhea epidemics in childcare centers and other public places. Cryptosporidium often causes watery diarrhea that can last for 2 weeks or more.

What Else Can Cause Diarrhea?

Sometimes, people get diarrhea from:

What Are the Signs & Symptoms of Diarrhea?

People often get crampy belly pain first, followed by diarrhea that can last 3–5 days. Other symptoms may include:

• fever
• loss of appetite
• nausea (uncomfortable feeling before vomiting)
• vomiting
• weight loss
• dehydration

How Is Diarrhea Treated?

Most infections that cause diarrhea, especially viral infections, will go away without treatment. Taking it easy at home and drinking plenty of fluids to avoid dehydration are the best ways to ride out the illness. If you do become dehydrated, you might need to go to the hospital for intravenous (IV) fluids to replace those lost to diarrhea, vomiting, and fever.

If you go to your doctor, you may give a stool sample so he or she can find out what type of infection you have. Whether you need medicine will depend on which germ is causing the illness. A parasitic infection will be treated with anti-parasitic medicine. Sometimes, diarrhea caused by bacteria is treated with antibiotics to prevent the infection from spreading throughout the body.

How Can Diarrhea Be Prevented?

It’s almost impossible to prevent all cases diarrhea. But there are some ways to make it less likely:

• Wash your hands well and often, especially after using the toilet and before eating. Hand washing is the best way to prevent diarrheal infections that pass from person to person.
• Keep bathroom surfaces like sinks and toilets clean.
• Wash fruits and vegetables well before eating.
• Clean kitchen counters and cooking utensils well after they’ve been in contact with raw meat, especially poultry.
• Refrigerate meats as soon as possible after bringing them home from the store. Cook them until they’re no longer pink. Refrigerate all leftovers as soon as possible.
• Never drink from streams, springs, or lakes unless local health authorities have checked that the water is safe for drinking.
• Avoid washing pet cages or bowls in the same sink that you use to prepare food. And try to keep pet feeding areas separate from family eating areas.

When Should I Call My Doctor?

Tell an adult if you have diarrhea, fever, vomiting, or severe belly pain. That person can help you decide whether to call your doctor.

If you feel listless and your mouth and skin feel dry, or if your bowel movements contain blood or mucus, you should contact or see a doctor right away. Also go to the doctor if you are vomiting so much that you can’t keep down fluids or if your symptoms last more than 3 days.

What Can I Do to Feel Better?

You’ll feel better if you stay well hydrated, so drink lots of water. Electrolytes (sodium and potassium) are also lost and need to be replaced because the body cannot function properly without them. Try sipping broth or soup, which contain sodium, and diluted fruit juice (with no added sugar), which contains potassium.

When you feel ready to eat something more substantial, try soft fruits or vegetables, which also contain potassium. Avoid milk products and fatty, high-fiber, or very sweet foods until the diarrhea eases. And don’t drink sports drinks or soft drinks — they contain electrolytes, but their high sugar content can make diarrhea worse.

As uncomfortable as diarrhea may be, it is usually short-lived. Drink enough fluids and follow your doctor’s instructions, and you feel better in no time.

Acute Diarrhea in Adults – American Family Physician

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Diarrhoea – Better Health Channel

Food nutrients are absorbed in the small intestine. The waste is pushed into the large intestine (bowel) where water is removed. The resulting faeces is stored temporarily within the rectum then passed out of the body through the anus. Faeces are usually firm, moist and easy to pass. Diarrhoea is the frequent passing of loose, watery and unformed faeces.

Acute diarrhoea is the sudden onset of three or more loose stools per day, lasting less than 14 days. The most common cause of acute diarrhoea is an infection of the intestines, such as gastroenteritis or food poisoning. Viruses are responsible for most cases. The intestinal lining becomes irritated and inflamed, which hinders the absorption of water from food waste. In severe cases, the intestinal lining may even leak water.

Generally, acute diarrhoea resolves after a day or two. Chronic diarrhoea, which lasts four weeks or more, can be caused by a range of conditions that affect the intestines, including inflammatory bowel disease (IBD).

Symptoms of diarrhoea

The symptoms associated with diarrhoea include:

• abdominal cramps
• abdominal pains
• urgency to go to the toilet
• frequent passing of loose, watery faeces
• nausea
• vomiting.

Serious symptoms of diarrhoea

In most cases, acute diarrhoea is self-limiting and will resolve by itself within a day or two.
However, contact your doctor immediately if you experience serious symptoms including:

• blood in the faeces
• pus in the faeces
• painful passage of faeces
• repeated vomiting
• inability to increase fluid intake
• reduced or absent urination
• fever (temperature greater than 38 ºc).

If you have a serious chronic medical condition, such as kidney or heart failure, even one day of diarrhoea can be dangerous. It’s safer to see your doctor as soon as possible.

Diarrhoea can be dangerous for babies and young children

Acute diarrhoea can be life threatening to babies and young children. This is because their smaller bodies are more vulnerable to dehydration. If your baby or young child develops diarrhoea, seek medical attention straight away.

Causes of acute diarrhoea

A bout of diarrhoea can be caused by a wide range of disorders, infections and events including:

• food poisoning
• gastroenteritis
• tropical diseases, such as typhoid and cholera
• anxiety or emotional stress
• overconsumption of alcohol
• medications, particularly antibiotics.

Common infectious agents

Contaminated food and water are common causes of acute diarrhoea. Some of the infectious agents known to cause diarrhoea include:

• viruses – such as calici virus, adenovirus and rotavirus
• bacteria – such as E. coli, Campylobacter, V. cholerae, Shigella, Salmonella and Staphylococcus aureus
• parasites – such as Giardia lamblia, Cryptosporidium parvum and tapeworm.

Causes of chronic diarrhoea

• Some of the causes of chronic diarrhoea include:
• coeliac disease – which reduces the intestine’s ability to absorb food
• chronic constipation – the bowel is blocked by hard, impacted faeces, but some liquids manage to seep past the blockage. this condition, called ‘spurious’ or ‘overflow’ diarrhoea, is more common in the elderly
• hormone disorders – such as diabetes or hyperthyroidism (overactive thyroid gland)
• cancer – such as bowel cancer
• inflammatory bowel disease – including ulcerative colitis and Crohn’s disease
• irritable bowel syndrome – symptoms include abdominal pain, bloating, and alternating constipation and diarrhoea
• lactose intolerance – the inability to digest the milk sugar lactose
• medications – including antibiotics, antacids that contain magnesium, laxatives, and drugs for treating hypertension (high blood pressure) and arthritis.

Diagnosis of diarrhoea

Successful treatment depends on diagnosing the cause. Investigations may include:

• medical history
• physical examination
• blood tests
• laboratory analysis of stool sample
• colonoscopy (the insertion of a slender instrument into the anus so that the doctor can look at the bowel lining).

Treatment for diarrhoea

Always see your doctor if you experience serious symptoms. Babies and young children with diarrhoea need prompt medical attention.
Treatment for diarrhoea depends on the cause, but may include:

• plenty of fluids to prevent dehydration
• oral rehydration drinks to replace lost salts and minerals. These drinks are available from pharmacies. An alternative is one part unsweetened pure fruit juice diluted with four parts of water
• intravenous replacement of fluids in severe cases
• medications such as antibiotics and anti-nausea drugs
• anti-diarrhoeal medications, but only on the advice of your doctor. If your diarrhoea is caused by infection, anti-diarrhoeal drugs may keep the infection inside your body for longer
• treatment for any underlying condition, such as inflammatory bowel disease.

Risk of spreading infection

Most cases of acute diarrhoea are potentially infectious to others. Viruses are easily spread, mainly through direct contact with vomit or faeces from an infected person, or through contact with a contaminated object or surface. Occasionally, the virus may be transmitted by airborne particles generated from vomiting and diarrhoea.

People can reduce their chances of getting infected by carefully washing their hands after going to the toilet and before handling food. People looking after a person with the virus must also wash their hands thoroughly. Alcohol-based handwash solutions, available from pharmacies, have been shown to be better at reducing the spread of infection than soap and water, and are less drying to the skin.

Anyone with acute diarrhoea should stay at home if possible to reduce the spread of infection. It is strongly recommended not to visit hospitals and nursing homes, and not to swim in public pools.

Dietary adjustments may help diarrhoea

It may help to make a few short-term dietary adjustments while your bowels recover from acute diarrhoea.
Be guided by your healthcare professional, but general suggestions include:

• Limit consumption of fatty, sweet or spicy foods.
• Avoid alcohol.
• Increase consumption of starchy foods like banana, rice and bread.
• Increase consumption of yoghurt containing live cultures.
• Diarrhoea in babies and young children can be caused by fruit juice, so limit these drinks.

Where to get help

Things to remember

• Diarrhoea is the frequent passing of loose, watery faeces.
• In most cases, acute diarrhoea is self-limiting and resolves after a day or two.
• Acute diarrhoea in babies and young children can be life threatening due to the risks of dehydration.

Diarrhea as a symptom of the Coronavirus (COVID-19)

Diarrhea. You know if you have THIS digestive condition. People who suffer from diarrhea experience loose, watery stools more frequently than normal and often experience a sense of urgency to go. Generally, there are two types of diarrhea, acute and chronic. Acute diarrhea lasts a short time, about three to 5 days. Chronic diarrhea is usually related to other digestive disorders such as irritable bowel syndrome or inflammatory bowel disease and may last for as long as you have the illness. Most recently, diarrhea has been added as a symptom of the coronavirus (COVID-19).

According to the World Health Organization, the most common symptoms of COVID-19 are:

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

This list does not include all possible symptoms. Some people become infected but don’t develop any symptoms or feel unwell at all!

The Government of Canada indicates that common reported symptoms may be broadly categorized as “more frequent”, “less frequent” and “rare” (Table below). Diagnosis should always be confirmed by laboratory testing, and you should seek medical consultation if experiencing new or worsening symptoms.

Note: Symptoms among older adults (65 years of age and older) and those with underlying medical conditions may be atypical or subtle; for instance they may be more likely to present without fever or respiratory symptoms. Source here.

We’ve seen the most common list of COVID-19 symptoms repeatedly on the TV, in news articles, and from our friends and family. However, as doctors learn more about COVID-19, a study has shown that digestive symptoms, in particular diarrhea, could be a symptom for people who have a mild form of COVID-19 (without difficulty breathing or low blood oxygen levels).  In this study published in the American Journal of Gastroenterology, patients in this unique sub-group showed that diarrhea can be the initial presentation of COVID-19, and patients may only later or never present respiratory symptoms or a fever.

In more detail, this study
showed that 23% of patients were admitted with digestive symptoms, 43% with
respiratory symptoms only, and 33% with both respiratory and gastrointestinal
(gastro) symptoms. Among the patients with gastro symptoms, 67% of them had
diarrhea, and 20% experienced diarrhea as the first symptom of their illness. Diarrhea
lasted an average of 5 days, and about one-third of patients with gastro symptoms
never experienced a fever. The study also found that those with gastrointestinal
symptoms were much more likely to have the coronavirus (SARS-CoV-2) detected in
their stool samples, with about 73% of patients testing positively compared
with 14% of those with respiratory symptoms only. 

The authors of this study note that because gastro problems are so common, having diarrhea doesn’t necessarily mean that a person has COVID-19.  But this study does tell us that diarrhea can be a vital warning-sign. If patients experience new-onset gastrointestinal symptoms after possibly coming into contact with someone who has COVID-19, they should be suspected for the illness, EVEN in the absence of cough, shortness of breath, sore throat, or fever.

This study came about after previous research, also published in the American Journal of Gastroenterology found that
50% of a group of 200 patients with COVID-19 in Wuhan, China reported at least
one gastro symptom, with 18% reporting diarrhea, vomiting, or abdominal pain. This
study focused on patients with severe COVID-19, rather than a mild form.

It’s important to note that both studies were relatively small, so larger studies are needed to describe digestive symptoms in patients with COVID-19.

More recently, according to a review by University of Alberta, nearly one in five people with COVID-19 may only have gastrointestinal symptoms, according to researchers. Gastrointestinal symptoms associated with COVID-19 vary widely but can include loss of appetite, nausea, vomiting, diarrhea and generalized abdominal pain. The researchers who conducted the review report that 18 per cent of patients presented with such symptoms, while 16 per cent of COVID-19 cases may only present with gastrointestinal symptoms.

“There’s a growing amount of literature showing that abdominal symptomatology is a common presentation for COVID-19,” said Mitch Wilson, a radiologist and clinical lecturer in the University of Alberta’s Faculty of Medicine & Dentistry.

Read more here.

Not sure if your stool is healthy or not? Learning more about how colour, texture and frequency of poop can help you identify when you should speak to your doctor about your stools.

This resource is financially supported in part by sponsorship from:

Diarrhea – Causes, Symptoms, Treatment, Diagnosis

The Facts

Diarrhea is a symptom, not a disease. It is defined as passing frequent (3 or more per day) loose or watery stools. The acute form lasts less than 14 days (usually only a few days), goes away on its own, and usually isn’t serious, but it can be linked with some other problems. It affects people of all ages, and some types are infectious. The average adult may get acute diarrhea 4 times a year, and long-term effects are rare.

Chronic diarrhea lasts longer than 4 weeks. An inflammatory bowel condition such as ulcerative colitis or Crohn’s disease may be to blame.

Children and infants with diarrhea should be seen by a doctor.

Causes

People get diarrhea when the feces move too quickly through the bowels so that the intestines don’t have enough time to pull water from the waste to “firm it up.”

People get diarrhea for many reasons, including:

• bacterial and viral infections such as salmonella or rotavirus, the most common cause of acute diarrhea in children
• certain medications, such as antibiotics, blood pressure medications, or those containing magnesium
• certain intestinal diseases such as ulcerative colitis and Crohn’s disease
• intestinal parasites, especially when travelling
• not digesting food completely – for example, some people can’t digest lactose, the sugar found in milk, while others may not be able to digest or absorb fat or carbohydrates
• radiation or chemotherapy
• overactive thyroid gland

In functional bowel disorders like irritable bowel syndrome, the muscles that normally move waste along the intestine can spasm, causing diarrhea.

If you think that a medication you’re taking is causing the problem, don’t stop taking it before talking to your doctor.

Diarrhea isn’t always due to things that are eaten or swallowed. Emotional stress or turmoil can also bring it on.

Symptoms and Complications

Your stool will be loose and watery. You may suffer from abdominal cramping, nausea, or bloating. You may even have a fever, along with chills. If you’ve had diarrhea for a few days, you may feel lightheaded or weak. This comes from rapidly losing the minerals, sugar, and water that your body needs. Normally, diarrhea won’t cause you to lose control of your bowels – if this happens, you should consult your doctor.

You may also notice that you’re urinating less. This is because your body is losing water through bowel movements instead of urine. If the diarrhea lasts longer than 72 hours or you have a fever of 38.5°C or higher, if you notice blood or pus in the stool, or if you have severe abdominal pain or vomiting that prevents fluid replacement by mouth, see a doctor immediately. Complications from dehydration due to diarrhea can develop quickly in elderly, debilitated, or very young people or anyone with severe diarrhea. Acute diarrhea accompanied by fever and stools with blood can be signs of a potentially dangerous infection or parasite.

Always consult a doctor for a child with diarrhea who hasn’t urinated for 6 hours – the child could be dangerously dehydrated.

Making the Diagnosis

Your doctor will first need to find out what’s causing your diarrhea by asking questions about your eating habits and medication you’ve been taking (including non-prescription medication). Your doctor will evaluate your fluid and hydration status and examine your abdomen. Blood and stool samples may be taken to check for infection if deemed necessary. It may take several days to get the results of stool samples, but it is important for your doctor to know what is causing the diarrhea to determine the appropriate treatment.

With chronic diarrhea, a colonoscopy may need to be done to be sure it isn’t due to more serious problems. This involves inserting a flexible tube with a tiny camera in the tip (an endoscope) by way of the anus to examine the inside of the colon (the last part of the intestines).

Treatment and Prevention

The goal of treatment is to ease the symptoms and get the bowel movements back to normal. Preventing dehydration, which can happen due to the extra loss of water during episodes of diarrhea, is also important – especially in children and seniors.

People don’t always need to take medication for diarrhea. For adults, it’s a good idea to just wait 48 to 72 hours if possible to see if it stops on its own. By allowing it to “run its course,” your body can naturally get rid of whatever is causing the diarrhea. If the diarrhea continues, however, you should talk to your doctor.

If the suspected cause is a parasite or bacteria, your doctor may prescribe an antibiotic to get rid of it. Otherwise, a doctor or pharmacist may recommend medications such as bismuth subsalicylate or loperamide* to provide relief from diarrhea. If symptoms continue more than 72 hours from onset of the diarrhea, consult a doctor. Some probiotics may be helpful to prevent or treat certain causes of diarrhea. Talk to your doctor or pharmacist to find out if a probiotic would be right for you.

Dehydration caused by losing water through frequent bowel movements can cause serious complications. In particular, it can make any medications you take go through your body much more quickly than they should, so they may not work properly. Be sure to discuss this with your doctor. Dehydration can also cause kidney damage and electrolyte imbalances.

Signs of dehydration include a dry mouth, increased thirst, decreased urination, decreased sweating, and feeling weak or lightheaded. Signs may also include nausea, muscle cramps, and a higher body temperature.

At the first sign of diarrhea, drink plenty of “clear” fluids, at least two cups an hour. Oral rehydration solutions designed to match the body’s intestinal fluid are best, especially for children and seniors. Be sure to consult a health professional before treating children or if diarrhea is accompanied by vomiting. Once rehydration has been successful, age-appropriate foods should be re-introduced.

Standard recommendations no longer include “resting the bowel” after a diarrhea episode. Take it easy physically until the diarrhea is gone – you’ll need your strength to get well faster. You may want to eat foods that are known to “bind” stool and slow movement through the large intestine, such as the so-called “BRAT diet”: bananas, rice, applesauce, and toast.

Find out what caused your diarrhea – you may be able to prevent it in the future. Because infectious agents cause so many cases, take the same precautions with diarrhea as with the flu:

• Don’t touch the hands of someone with diarrhea. If you must touch them, wash your hands immediately afterwards.
• If you have diarrhea, wash your hands before making meals and after using the washroom, and dry your hands with a disposable paper towel – not the towel everyone else uses.
• Many of the infectious agents that cause diarrhea hide out in food. Avoid eating undercooked meat or raw seafood, and watch out for foods that are past their freshness date or have been left in the open.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Diarrhea

Diarrhea: Practice Essentials, Background, Pathophysiology

90,000 Causes of frequent loose stools in adults – CMT Clinic

The prevalence of diarrhea is quite high; after acute respiratory infections, this is the second problem faced by an adult.
Healthy people have a normal stool frequency of three times a day to three times a week. And only a change in the volume and consistency of stool, as well as the appearance of impurities (remnants of undigested food, blood, pus) indicate the disease.

Diarrhea (diarrhea) – an increase in stool more than 3 times a day, a change in its consistency – liquid mushy or watery and / or with pathological impurities.

Distinguish between acute diarrhea – lasts 2-3 weeks. And chronic – more than 3 weeks.

So, diarrhea is not a disease, but a symptom that can be caused by various reasons:

ACUTE

– Food poisoning

– Diarrhea on the road (diarrhea of ​​travelers), the cause may be the appearance of new species of E. coli for the body, the consumption of large amounts of fruits rich in fiber

– Intestinal infections

CHRONIC

– Irritable bowel syndrome

– Taking medications (often antibiotics)

– Food allergy

– Frequent stress and overvoltage

– Intolerance to milk and soy protein

– Gluten intolerance – gluten protein (found in wheat, barley, rye)

– Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)

– AIDS

– Various tumors (lymphoma, gastrinoma, etc.)

– Parasitic invasions (lamblia, amoeba, cryptosporids, etc.)

– Chronic diseases (diabetes mellitus, thyrotoxicosis, pancreatitis, after removal of the gallbladder, etc.).

Separately, it must be said about the coronavirus infection, in which the respiratory organs are affected. But in many patients, the virus provokes disorders of the gastrointestinal tract. Diarrhea is caused by a virus affecting the intestinal epithelium. Diarrhea may occur in the first 2-3 days after infection, even before respiratory manifestations, may be with mucus, blood. Lasts 4-7 days.

In most cases, the digestive tract begins to function normally within 2 weeks after recovery.In people with chronic gastrointestinal pathology, the recovery period can last longer – up to 1-1.5 months.

The causes of diarrhea by the mechanism of occurrence are different:

– Acceleration of peristalsis (irritable bowel syndrome, functional diarrhea)

– Increased secretion of fluid into the intestinal lumen (inflammatory diseases, tumors)

– Violation of the reverse absorption of water and salts from the intestine (enzyme deficiency)

– Damage to intestinal cells by pathological microorganisms (infections, while taking antibiotics, etc.).

Dangerous complications of diarrhea are dehydration, loss of electrolytes and trace elements. Many illnesses can be hidden behind one single symptom. Don’t diagnose and treat diarrhea yourself! The doctor will determine the cause faster and more accurately!

90,000 Intestinal infection in children

Intestinal infection in children – a group of infectious diseases of various etiology, occurring with a predominant lesion of the digestive tract, toxic reaction and dehydration of the body.

In children, intestinal infection is manifested by fever, lethargy, lack of appetite, abdominal pain, vomiting, diarrhea. Diagnosis of intestinal infection in children is based on clinical and laboratory data (history, symptoms, excretion of the pathogen in feces, detection of specific antibodies in the blood). In case of intestinal infection in children, antimicrobial drugs, bacteriophages, enterosorbents are prescribed; during the treatment period, it is important to adhere to a diet and conduct rehydration.

Intestinal infection in children – acute bacterial and viral infectious diseases accompanied by intestinal syndrome, intoxication and dehydration. In the structure of infectious morbidity in pediatric intestinal infections in children occupy the second place after ARVI. The susceptibility to intestinal infection in children is 2.5-3 times higher than in adults. About half of cases of intestinal infection in children occur at an early age (up to 3 years). Intestinal infection in a young child is more severe, may be accompanied by malnutrition, the development of dysbiosis and enzymatic insufficiency, and a decrease in immunity.Frequent recurrence of episodes of infection causes impairment of the physical and neuropsychic development of children.

Causes of intestinal infection in children

The range of pathogens of intestinal infections in children is extremely wide. The most common pathogens are gram-negative enterobacteria (Shigella, Salmonella, Campylobacter, Escherichia, Yersinia) and opportunistic flora (Klebsiella, Clostridium, Proteus, Staphylococcus, etc.). In addition, there are intestinal infections caused by viral pathogens (rotaviruses, enteroviruses, adenoviruses), protozoa (lamblia, amoeba, coccidia), fungi.The common properties of all pathogens that determine the development of clinical manifestations are enteropathogenicity, the ability to synthesize endo- and exotoxins.

Infection of children with intestinal infections occurs through the fecal-oral mechanism through alimentary (through food), water, contact and household routes (through dishes, dirty hands, toys, household items, etc.). In weakened children with low immunological reactivity, endogenous infection with opportunistic bacteria is possible.The source of OCI can be a carrier, a patient with an erased or manifest form of the disease, pets. In the development of intestinal infection in children, an important role is played by the violation of the rules for the preparation and storage of food, the admission to children’s kitchens of persons carriers of infection, patients with tonsillitis, furunculosis, streptoderma, etc.

Sporadic cases of intestinal infection in children are most often recorded, although group and even epidemic outbreaks are possible with the food or water route of infection.The rise in the incidence of some intestinal infections in children has a seasonal dependence: for example, dysentery occurs more often in summer and autumn, rotavirus infection – in winter.

The prevalence of intestinal infections among children is due to epidemiological features (high prevalence and contagiousness of pathogens, their high resistance to environmental factors), anatomical and physiological features of the child’s digestive system (low acidity of gastric juice), imperfection of protective mechanisms (low concentration of IgA).The incidence of acute intestinal infection in children is facilitated by the disruption of the normal intestinal microbiota, non-observance of the rules of personal hygiene, and poor sanitary and hygienic living conditions.

Classification of intestinal infection in children

According to the clinical and etiological principle, among the intestinal infections most often recorded in the pediatric population, there are shigellosis (dysentery), salmonellosis, coli infection (escherichiosis), yersiniosis, campylobacteriosis, cryptosporidiosis, rotavirus infection, staphylococcal infection and other intestinal infections.

According to the severity and characteristics of the symptoms, the course of intestinal infection in children can be typical (mild, moderate, severe) and atypical (erased, hypertoxic). The severity of the clinic is assessed by the degree of gastrointestinal tract damage, dehydration and intoxication.

The nature of local manifestations in intestinal infection in children depends on the lesion of one or another part of the gastrointestinal tract, and therefore gastritis, enteritis, colitis, gastroenteritis, gastroenterocolitis, enterocolitis are distinguished.In addition to localized forms, in infants and weakened children, generalized forms of infection can develop with the spread of the pathogen outside the digestive tract.

During the course of intestinal infection in children, acute (up to 1.5 months), protracted (over 1.5 months) and chronic (over 5-6 months) phases are distinguished.

Dysentery in children

After a short incubation period (1-7 days), the temperature rises sharply (up to 39-40 ° C), weakness and weakness increase, appetite decreases, vomiting is possible.Against the background of fever, there is a headache, chills, sometimes – delirium, convulsions, loss of consciousness. Intestinal infection in children is accompanied by cramping abdominal pain localized in the left iliac region, symptoms of distal colitis (soreness and spasm of the sigmoid colon, tenesmus with rectal prolapse), symptoms of sphincteritis. The frequency of bowel movements can vary from 4-6 to 15-20 times per day. With dysentery, the stool is liquid, containing impurities of cloudy mucus and blood. In severe forms of dysentery, hemorrhagic syndrome may develop, up to intestinal bleeding.

In young children with intestinal infection, general intoxication prevails over colitis syndrome, hemodynamic, electrolyte and protein metabolism disorders occur more often. The most easily in children is intestinal infection caused by Shigella Zone; heavier – Shigella Flexner and Grigoriez-Shiga.

Salmonellosis in children

Most often (in 90% of cases), the gastrointestinal form of salmonellosis develops, proceeding as gastritis, gastroenteritis, gastroenterocolitis.Characterized by subacute onset, febrile rise in temperature, weakness, vomiting, hepatosplenomegaly. Stool with salmonellosis is liquid, abundant, feces, the color of “swamp mud”, with admixtures of mucus and blood. Usually, this form of intestinal infection ends with recovery, however, in infants, death is possible due to severe intestinal toxicosis.

Influenza-like (respiratory) form of intestinal infection occurs in 4-5% of children. With this form, Salmonella is found in the inoculation of material from the pharynx.Its course is characterized by febrile temperature, headache, arthralgia and myalgia, symptoms of rhinitis, pharyngitis, conjunctivitis. From the side of the cardiovascular system, tachycardia and arterial hypotension are noted.

Typhus-like form of salmonellosis in children accounts for 2% of clinical cases. It proceeds with a long period of fever (up to 3-4 weeks), severe intoxication, dysfunction of the cardiovascular system (tachycardia, bradycardia).

The septic form of intestinal infection usually develops in children of the first months of life with an unfavorable premorbid background.It accounts for about 2-3% of cases of salmonellosis in children. The disease is extremely difficult, accompanied by septicemia or septicopyemia, violation of all types of metabolism, the development of severe complications (pneumonia, parenchymal hepatitis, otoantritis, meningitis, osteomyelitis).

Escherichiosis in children

This group of intestinal infections in children is extremely extensive and includes coli-infections caused by enteropathogenic, enterotoxigenic, enteroinvasive, enterohemorrhagic escherichias.

Intestinal infection in children caused by Escherichia occurs with subfebrile or febrile temperature, weakness, lethargy, decreased appetite, persistent vomiting or regurgitation, flatulence. Characterized by watery diarrhea (profuse, spluttering yellow stools mixed with mucus), quickly leading to dehydration and the development of exsicosis. With escherichiosis caused by enterohemorrhagic escherichias, diarrhea is bloody.

As a result of dehydration, the child develops dry skin and mucous membranes, decreases tissue turgor and elasticity, sinks a large fontanelle and eyeballs, decreases urine output by the type of oliguria or anuria.

Rotavirus infection in children

Usually proceeds according to the type of acute gastroenteritis or enteritis. The incubation period lasts on average 1-3 days. All symptoms of intestinal infection in children develop within one day, while the lesion of the gastrointestinal tract is combined with catarrhal phenomena.

Respiratory syndrome is characterized by throat hyperemia, rhinitis, sore throat, coughing. Simultaneously with the defeat of the nasopharynx, signs of gastroenteritis develop: liquid (watery, foamy) stools with a frequency of bowel movements from 4-5 to 15 times a day, vomiting, temperature reaction, general intoxication.The duration of the course of intestinal infection in children is 4-7 days.

Staphylococcal intestinal infection in children

Distinguish between primary staphylococcal intestinal infection in children, associated with the consumption of food seeded with staphylococcus, and secondary, caused by the spread of the pathogen from other foci.

The course of intestinal infection in children is characterized by severe exicosis and toxicosis, vomiting, increased stool up to 10-15 times a day. The stool is loose, watery, greenish in color, with a slight admixture of mucus.With secondary staphylococcal infection in children, intestinal symptoms develop against the background of the leading disease: purulent otitis media, pneumonia, staphyloderma, tonsillitis, etc. In this case, the disease can take a long undulating course.

Diagnosis of intestinal infection in children

Based on the examination, epidemiological and clinical data, the pediatrician (pediatric infectious disease specialist) can only assume the likelihood of intestinal infection in children, however, etiological decoding is possible only on the basis of laboratory data.

The main role in confirming the diagnosis of intestinal infection in children is played by bacteriological examination of stool, which should be carried out as early as possible, before the initiation of etiotropic therapy. With a generalized form of intestinal infection in children, blood culture is performed for sterility, bacteriological examination of urine, cerebrospinal fluid.

Serological methods (RPHA, ELISA, RSK) are of a certain diagnostic value, which allow detecting the presence of Ab to the pathogen in the patient’s blood from the 5th day from the onset of the disease.The study of the coprogram allows you to clarify the localization of the process in the gastrointestinal tract.

In case of intestinal infection in children, it is required to exclude acute appendicitis, pancreatitis, lactase deficiency, biliary dyskinesia and other pathologies. For this purpose, consultations are held with a pediatric surgeon and a pediatric gastroenterologist.

Treatment of intestinal infection in children

Complex treatment of intestinal infections in children involves the organization of medical nutrition; oral rehydration, etiotropic, pathogenetic and symptomatic therapy.

The diet of children with intestinal infection requires a decrease in the amount of food, an increase in the frequency of feedings, the use of mixtures enriched with protective factors, the use of mashed, easily digestible food. An important component of the therapy of intestinal infections in children is oral rehydration with glucose-saline solutions, drinking plenty of fluids. It is carried out until the loss of fluid ceases. If it is impossible to take oral nutrition and drink fluids, infusion therapy is prescribed: solutions of glucose, Ringer, albumin, etc. are injected intravenously.

Etiotropic therapy of intestinal infections in children is carried out with antibiotics and intestinal antiseptics (kanamycin, gentamicin, polymyxin, furazolidone, nalidixic acid), enterosorbents. The administration of specific bacteriophages and lactoglobulins (salmonella, dysentery, coliprotein, klebsiella, etc.), as well as immunoglobulins (anti-rotavirus, etc.) is shown. Pathogenetic therapy involves the appointment of enzymes, antihistamines; symptomatic treatment includes taking antipyretics, antispasmodics.During the period of convalescence, it is necessary to correct dysbiosis, take vitamins and adaptogens.

Prediction and prevention of intestinal infection in children

Early detection and adequate therapy ensure complete recovery from intestinal infections in children. Immunity after OCI is unstable. In severe forms of intestinal infection, children may develop hypovolemic shock, disseminated intravascular coagulation syndrome, pulmonary edema, acute renal failure, acute heart failure, and infectious toxic shock.

At the heart of the prevention of intestinal infections in children is the observance of sanitary and hygienic standards: proper storage and heat treatment of products, protection of water from pollution, isolation of patients, disinfection of toys and utensils in children’s institutions, instilling in children the skills of personal hygiene. When caring for a baby, the mother should not neglect the processing of the mammary glands before feeding, processing the nipples and bottles, washing hands after swaddling and washing the baby.

Children who have been in contact with a patient with intestinal infection are subject to bacteriological examination and observation for 7 days.

Pathogens of intestinal infections (Shigella spp. + E. coli (EIEC, enteroinvasive strains) / Salmonella spp. / Campylobacter spp.) DNA qualitative determination

Intestinal infections caused by different pathogens predominantly have similar clinical symptoms. The study allows you to most effectively decipher the etiological cause of acute intestinal infections. The ratio of the frequency of detection of viral and bacterial pathogens in acute intestinal infections varies at different ages: in children under 3 years of age, viral agents account for 80-90% of diseases, and bacterial ones – 10-20%; among adult patients, the proportion of viral pathogens is reduced to 30%.

Shigella spp.
Shigellosis (dysentery) is an infectious disease caused by Shigella, occurring with symptoms of intoxication and predominantly affecting the distal colon. Shigella are thin, motionless gram-negative sticks. The genus Shigella includes 4 species Shigella diseneriae, Shigella flexneri, Shigella boydii, Shigella sonnei, which differ in somatic O-antigen and the spectrum of utilized carbohydrates.
Shigella spp – are one of the most common causative agents of acute infectious gastroenteritis.Shigella infection is the result of poor personal hygiene, poor sanitary and hygienic conditions, and is also associated with the consumption of soups, salads and sandwiches contaminated with these microorganisms. For the development of fever, it is enough to enter the gastrointestinal tract (GI tract) – a very low dose of the pathogen (<102 bacterial cells).

Source of infection: patients and carriers of bacteria. Patients are contagious throughout the acute period of infection and remain so as long as the microorganism is sown from the stool.

Route of transmission: fecal-oral and contact-household. Insect vectors – flies, cockroaches – play a certain role in the spread of infection.

Clinical manifestations.
Incubation period 1-7 days (but can be 2-12 hours).

The following forms and variants of the course of infection are distinguished:
1. Acute dysentery: colitis and gastroenterocolitic variants.
According to their severity, they are divided into light, medium, heavy and very heavy.
According to the peculiarities of the course, the erased, subclinical and protracted ones are distinguished.
2. Chronic dysentery: recurrent and continuous.
3. Shigella bacteria: convalescent and transient.
The main clinical variant of the disease is colitis.
The disease begins acutely. At the beginning, a syndrome of general intoxication develops, characterized by an increase in body temperature, chills, a feeling of heat, weakness, decreased appetite, adynamia, headache, bradycardia, and a decrease in blood pressure. Lesions of the gastrointestinal tract are manifested by pains in the abdomen, at the beginning, dull, spread all over the abdomen, which are permanent.Then they become more acute, cramping, localized in the lower abdomen, often on the left. The pains intensify before defecation, tenesmus and false desires appear. Palpation is determined by the spasm and soreness of the colon, more pronounced in the area of ​​the sigmoid region. Stool becomes more frequent, bowel movements at first have a fecal character, then decrease in volume and become liquid. In this case, pathological impurities appear in the form of mucus and blood streaks. In more severe cases, a small amount of blood-streaked mucus (“rectal spit”) is released during bowel movements.To confirm the diagnosis of “Dysentery” (shigellosis), a laboratory study of feces by bacteriological method or PCR is carried out.

Enteroinvasive E. coli.
Escherichia coli (E. coli) – the causative agent of Escherichiosis, the main aerobic part of the intestinal microflora. They are gram-negative rod bacteria belonging to the Enterobacteriaceae family. E. coli is a common inhabitant of the intestines of many mammals and primates, including humans. Therefore, it is called Escherichia coli.In the human body, E. coli plays a useful role by inhibiting the growth of harmful bacteria and synthesizing some vitamins. However, there are varieties of E. coli bacteria that can cause acute intestinal diseases in humans. Currently, more than 150 types of pathogenic (enterovirulent) bacilli E. coli are isolated, combined into 4 classes:
-Enteropathogenic (EPEC)
-Enterotoxigenic (ETEK)
-Enteroinvasive (ENEK)
-Enterohaemorrhea –
causative agents of lesions very reminiscent of bacterial dysentery.The pathogenesis also has features of obvious similarity: like Shigella, enteroinvasive E. coli penetrate and multiply in the cells of the intestinal epithelium. Like Shigella, they are immobile and unable to ferment lactose.
The lesions are characterized by severe abdominal pain and profuse watery diarrhea mixed with blood. Invasiveness is indicated by the large number of polymorphic nuclear leukocytes in the stool. Route of transmission: fecal-oral.

Source of infection:
-Sick person and animals
-Bacteria carriers
-Fecal-contaminated food and water
One of the confirmatory methods for diagnosing escherichiosis is PCR.

Salmonella spp.
Salmanellosis are acute intestinal infections of animals and humans caused by Salmonella. Salmonella spp are motile, gram-negative bacilli belonging to the genus Salmonella, the Enterobacteriacea family (enterobacteria).

Source of infection:
-Sick animals
-Sick person
-Bacteria carriers

Route of transmission: alimentary – through infected food products, usually of animal origin (meat, meat products, milk, eggs, especially duck and goose, jelly), in case of forced improper slaughter of animals, violations of the rules for storage and preparation of products (contact between finished and raw products, insufficient heat treatment of products before use, etc.)etc.).

Clinical picture.
The incubation period ranges from 2-6 hours to 2-3 days. Clinical manifestations of salmonellosis from asymptomatic carriage of the infectious agent to severe septic forms.

There are several clinical forms of salmonellosis:
1. Gastrointestinal form. In this form, the disease begins with acute profuse vomiting and diarrhea (watery stools, often green, fetid). There are pains, rumbling, bloating, weakness, headaches, dizziness, chills, fever up to 38-40 degrees, pain in muscles and joints, muscle cramps in the limbs.The duration of the disease is 3-7 days.
2. Typhoid-like form – has the same onset as the gastrointestinal form, but it is characterized by fever for 10-14 days, enlarged liver and spleen, more pronounced symptoms of general intoxication (headache, lethargy, sometimes rash).
3. Septic form – after a short initial period, a picture of sepsis develops. In 15-17% of cases of salmonellosis during the period of convalescence, there is a short-term carrier of bacteria. Possible “transient” carriage (single isolation of Salmonella without clinical manifestations) and chronic bacterial carriage.
Salmonellosis is diagnosed based on clinical and epidemiological data and laboratory results. One of the methods of modern diagnostics is PCR.

Campylobacter spp.
Campylobacteriosis is an acute infectious zoonotic disease characterized by a syndrome of general intoxication, lesions of the gastrointestinal tract and the possibility of generalization of the pathological process.
Campylobacter spp. Representatives of the Campylobacteriaceae family are small non-spore-forming gram-negative bacilli.
Currently, the Campylobacteriaceae family includes three genera: Campylobacter, Helicobacter, Arcobacter.
Epidemiology.

Source of infection: farm animals, birds, rodents, sick people.
Way of transmission: alimentary (food), water, contact and household.
Transmission factors: meat, meat products, poultry, milk, water.
The disease occurs in all age groups, but mainly in children under the age of 5 years. In adults, campylobacteriosis is more common among rural residents associated with livestock and poultry farming.And also in tourists visiting developing countries in the form of “traveler’s diarrhea”. Campylobacteriosis is recorded throughout the year, but the seasonal rise in incidence occurs in the summer months.

Clinical picture.
Incubation period: 1-10 days (usually 2-5 days).

There are two forms of campylobacteriosis:
-Typical (gastrointestinal and generalized)
-Atypical (asymptomatic, inappropriate)
The disease begins acutely: chills, fever up to 38-39 degrees, headache, weakness, muscle pain and joints.In 50% of patients, these manifestations last from several hours to two days, and only then there is a gastrointestinal symptomatology. In the other half of the patients, signs of damage to the gastrointestinal tract appear already at the very beginning of the disease. The most persistent of these are cramping abdominal pains and loose, watery, fetid stools 5 to 10 times a day. Some patients experience nausea and vomiting. On the 2-3rd day of illness, an admixture of blood and mucus is found in the stool.