Diarrhea and Urgency – IBD Journey – Symptom Management

Diarrhea is when you have loose, watery stools or a frequent need to have a bowel movement. It is one of the most common symptoms of IBD.

Diarrhea can reflect the frequency at which you go to the washroom, the volume of stools that is being passed, the urgency of passing stools, or a combination of these factors. Therefore, it is important to describe what you are experiencing that when you talk to your healthcare provider about this symptom of IBD.

Causes related to IBD

It is important to treat the underlying disease, that is treat the gut inflammation, in cases of active Crohn’s or active colitis.

During an IBD flare, the lining of the intestine becomes inflamed and cannot absorb all fluid. This results in stools being loose and watery, or even entirely liquid. The looser stool can also move more rapidly through the colon, causing more frequent bowel movements. 

In general, people who have extensive inflammation of the colon (large intestine) or small intestine are more likely to have persistent diarrhea and urgency, rectal bleeding (bleeding from anus), and abdominal cramping. In ulcerative colitis, blood in the stool is common with diarrhea. 

Causes not related to IBD

It is also important to take into account factors that are not directly related to IBD but that could still cause diarrhea. These non IBD-related causes of diarrhea can include:

• side effects of medications.

• bile acid malabsorption. This issue is more common in people who have had surgery to remove parts of the small bowel. 

• small intestinal bacterial overgrowth (SIBO). This happens when bacteria take up residence in parts of the bowel where they are not supposed to be. There, they interfere with your digestion and compete with you for your food and in doing so, cause diarrhea.

• changes in diet and dietary intolerances. Examples include lactose and dairy products, fructose (e.g. corn syrup, fruits), caffeine, sweetener (e.g. sorbitol, sugar-free gum or candy), and alcohol. Too much fibre and fats can also lead to diarrhea. 

• gut-brain axis. It could happen that changes in your bowel movements are reflective of your body’s way of dealing with stress. 

• infections (e.g., Clostridium difficile, which can arise after use of antibiotics).

It is important to identify the triggers of frequent and persistent diarrhea. Talk to your healthcare provider to help determine the cause of your diarrhea, and find out if you need testing for IBD inflammation. 

Find out the underlying cause

Your healthcare provider will first consider the potential causes of your diarrhea in order to adjust your treatment. For example, if your IBD is active and causing inflammation, it may result in diarrhea and your treatment plan may be adjusted to deal with this symptom. 

Changing your diet

In terms of diet, it may be helpful if you eat frequent, small meals. Try to sit for at least 15 to 20 minutes after meals, as it can slow down peristalsis – the rate that food passes through the gut. 

Some people experience diarrhea after eating foods containing gluten, dairy, spice, fat, or high amounts of fibre. Dairy and fibre can be important to your nutrition, so speak to your physician and dietitian if you need to reduce their intake. 

Examples of foods that may produce loose stool include dried beans, corn, raw vegetables, cabbage or spinach, dried fruits or foods that contain high fructose, bacon, processed meats, chips, and fried foods. 

Drinks containing fructose, caffeine, alcohol, or carbonation can also trigger diarrhea so try limiting those. 

If you are experiencing diarrhea, try to include foods with sodium and potassium daily. Foods that may help control diarrhea include boiled or mashed potatoes (also contains potassium), bananas or banana flakes (contains potassium), rice, noodles or pasta, peanut butter, white bread, and lean meats. Broth can help maintain hydration (it also contains sodium). 

If you are experiencing persistent diarrhea, you could also discuss the possibility of trying the BRAT diet which consists of eating a banana, rice, applesauce, and toast, with your dietitian.

Try tracking what you eat, to help identify foods or fluids that may be bothersome and triggering your diarrhea. Check out our MyGut app to help you track your diet and food intake. 

It is important to remember that one diet does not fit all people with Crohn’s or colitis, and general dietary advice may not work for you. Visit our Diet and Nutrition section for more information. 

Medications

If tests show your diarrhea is related to inflammation from IBD, medications to control disease activity include aminosalicylates (also called mesalamine or 5-ASA), corticosteroids such as prednisone, immunomodulators, and biologics. Visit our Treatment and Medication section for more information. 

Other medications may include the antidiarrheal agents, loperamide or diphenoxylate. These help slow motility – movement of contents through your intestines – and increase the absorption of fluids and nutrients. Do not take antidiarrheals during a flare-up without your doctor’s advice, as they may cause further complications. 

Fibre supplements may be helpful as they mix with water to form a gel, and that reduces looseness as well as frequency. 

Examples of such medications and supplements to treat diarrhea include:

• Opioid anti-diarrheal – Loperamide (Imodium^®), diphenoxylate (Lomotil^®), eluxadoline (Viberzi^®).

• Bile salt resins – Cholestyramine (Olestyr^®), colestipil (Colestid^®), colesevelam (Lodalis^TM).

• Spasmolytics – Pinaverium (Dicetel^®), trimebutine (Modulon^®).

• Probiotics (e.g. Align^®).

• Antibiotics (e.g. Xifaxan^®).

• Psyllium (Metamucil^®).

Talk to your healthcare provider before starting any prescribed or over-the-counter medications for the treatment of diarrhea. 

Avoiding dehydration

When you are having diarrhea, make sure to drink a lot of water and electrolytes to replace the lost fluid. You may also want to consider drinking an oral rehydration solution to help replenish any lost sugars and salts.

These solutions include three main ingredients: water, electrolytes or ‘salts’ which are chemicals your body needs to function normally, and carbohydrates, usually in the form of sugar. Packets of oral rehydration salts are available in pharmacies in most countries.

Signs of dehydration include thirst, less frequent urination, dry skin, persistent fatigue, light headedness, and dark-coloured urine.  

Managing expectations

There are cases where you will not be able to get rid of diarrhea. For example, people who have a ileoanal pouch (where the small bowel is connected to the anus) are highly likely to experience diarrhea. The average person in this situation would go to the washroom about eight times a day to pass loose stools. 

In these cases, it would be advised to talk to your healthcare provider about how you could manage this expectation of frequently experiencing diarrhea to improve your quality of life.

Many people with Crohn’s or colitis experience an urgency to have a bowel movement that arises frequently during the day. People with colitis may also an extremely urgent need to expel feces, and yet, when they try to do so, they find out that they only have a small amount to pass. This is also known as “false urges” and is due to inflammation of the rectum. 

Bowel retraining can help to manage urgent or frequent bowel movements. Create a regular time to empty your bowels and find ways to stimulate your bowels to empty more fully. 

Another way to manage urgency is practicing pelvic floor exercises to strengthen the muscles around your rectum and anus to improve bowel control.

 

Diarrhea: Care Instructions | Kaiser Permanente

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Overview

Diarrhea is loose, watery stools (bowel movements). The exact cause is often hard to find. Sometimes diarrhea is your body’s way of getting rid of what caused an upset stomach. Viruses, food poisoning, and many medicines can cause diarrhea. Some people get diarrhea in response to emotional stress, anxiety, or certain foods.

Almost everyone has diarrhea now and then. It usually isn’t serious, and your stools will return to normal soon. The important thing to do is replace the fluids you have lost, so you can prevent dehydration.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• Watch for signs of dehydration, which means your body has lost too much water. Dehydration is a serious condition and should be treated right away. Signs of dehydration are:
  • Increasing thirst and dry eyes and mouth.
  • Feeling faint or lightheaded.
  • A smaller amount of urine than normal.
• To prevent dehydration, drink plenty of fluids. Choose water and other clear liquids until you feel better. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• When you feel like eating, start with small amounts of food.
• The doctor may recommend that you take over-the-counter medicine, such as loperamide (Imodium). Read and follow all instructions on the label. Do not use this medicine if you have bloody diarrhea, a high fever, or other signs of serious illness. Call your doctor if you think you are having a problem with your medicine.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• Your stools are maroon or very bloody.

Call your doctor now or seek immediate medical care if:

• You are dizzy or lightheaded, or you feel like you may faint.
• Your stools are black and look like tar, or they have streaks of blood.
• You have new or worse belly pain.
• You have symptoms of dehydration, such as:
  • Dry eyes and a dry mouth.
  • Passing only a little urine.
  • Cannot keep fluids down.
• You have a new or higher fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• Your diarrhea is getting worse.
• You see pus in the diarrhea.
• You are not getting better after 2 days (48 hours).

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter W335 in the search box to learn more about “Diarrhea: Care Instructions”.

causes and recommendations for treatment

Diarrhea is a pathological condition in which the patient has frequent (more than 2 times a day) defecation, while the stool becomes watery, has a volume of more than 200 ml and is often accompanied by pain in the abdomen, emergency urges and anal incontinence.

Diarrhea affects most people from time to time and is not a serious condition. However, it can be uncomfortable and interfere with daily activities. Diarrhea symptoms usually subside after a few days and complete recovery occurs in an average of a week.

There are many different causes of diarrhea, but an intestinal infection (gastroenteritis) is the most common in both adults and children.

Diarrhea can also be the result of anxiety, food allergies, medications, or a long-term condition such as irritable bowel syndrome (IBS).

In most cases, diarrhea resolves in a few days without any further treatment, and you may not need to see a doctor.

However, diarrhea can lead to dehydration, so you should drink plenty of fluids. It is especially important that infants and young children do not become dehydrated.

You should eat solid food as soon as you feel you can. If you are breastfeeding or bottle-feeding your baby and he has diarrhea, try to continue feeding him as usual.

Stay at home until at least 48 hours after your last episode of diarrhea to prevent spreading the infection to others.

Various medicines are available to reduce the symptoms of diarrhea, such as loperamide. However, there is usually no need for medication, and most fixatives are not suitable for children.

Contact your diarrheal physician if you are concerned about yourself or your child.

Seek help if diarrhea is particularly frequent or severe or is associated with other symptoms such as:

The main symptoms of diarrhea are frequent bowel movements and loose stools. Some people may have other symptoms depending on the cause.

Excessive loss of body water can also sometimes lead to dehydration, which can be a health hazard if not recognized and treated immediately.

You should also contact your GP in the following situations, as they may mean that you or your child are at risk for a more serious condition.

You should contact your GP immediately if your child has had 6 or more episodes of diarrhea in the last 24 hours, or if they have vomited 3 or more times in the last 24 hours. You should also seek help if your child has any symptoms of dehydration.

Call your doctor if your child has: more than 6 episodes of diarrhea in the last 24 hours;

You should also contact your GP if you have persistent diarrhea. Most cases in adults clear up in 2 to 4 days.

Diarrhea usually occurs when fluid cannot be absorbed from the intestinal contents, or when excess fluid passes into the intestine, causing watery stools.

Diarrhea is usually a symptom of an intestinal infection (gastroenteritis) which can be caused by viruses, bacteria, or parasites.

The package leaflet that comes with your medicine should tell you if diarrhea is a possible side effect.

Persistent diarrhea may also occasionally occur after stomach surgery such as gastrectomy. This is surgery to remove part of the stomach – for example, to treat stomach cancer.

Diarrhea usually goes away without any treatment after a few days, especially if it is caused by an infection.

In children, diarrhea usually resolves within 5-7 days and rarely lasts longer than 2 weeks.

In adults, diarrhea usually resolves within 2 to 4 days, although some infections may last a week or more.

While waiting for the diarrhea to pass, you can relieve the symptoms by following the recommendations below.

It is important to drink plenty of fluids to stay hydrated, especially if you are vomiting. Drink water in small frequent sips. If you drink enough fluids, your urine will be light yellow or almost clear.

It is also very important that babies and young children do not become dehydrated. Let your child drink water often, even if he is throwing up. However, fruit juices and carbonated drinks should be avoided as they can aggravate diarrhea in children.

If you are breast-feeding or bottle-feeding a baby with diarrhea, you should continue to feed as usual.

Call your doctor right away if you or your child develops any symptoms of dehydration or other complications.

Your GP or pharmacist may suggest using an oral rehydration solution to prevent dehydration if you are at risk, such as if you are an elderly person. RPR can also be used to treat dehydration that has already occurred.

Rehydration solutions are usually supplied in sachets that can be purchased from pharmacies without a prescription. They dissolve in water and replace salt, glucose and other important minerals that are lost during dehydration.

Your GP or pharmacist may recommend giving your child ORS if they are dehydrated or at risk of dehydration. The amount of ORS to drink will depend on the child’s size and body weight. The manufacturer’s instructions should also contain information about the recommended dose.

There are divided opinions about when and what to eat if you have diarrhea. However, most experts agree that solid foods should be eaten as soon as the symptoms get a little better. Eat light meals in small portions and avoid fatty or spicy foods as these can aggravate the situation.

Good examples of food for diarrhea are potatoes, rice, bananas, soup and boiled vegetables. Salty food helps the most.

You do not need to eat if you have lost your appetite, but you must continue to drink fluids to stay hydrated.

If your child is dehydrated, do not give him solid food until he has had enough liquids to drink. Once they stop showing signs of dehydration, they can go back to their regular diet.

If the child does not have an appetite, do not force him to eat, but continue to give him liquids until the appetite itself appears.

Diarrhea is a concomitant symptom of many diseases that affect the digestive system. So if the condition causing diarrhea is treated, it can relieve symptoms and improve your condition.

Hygiene should always be maintained to prevent the spread of infections that cause diarrhea.

You or your child should also avoid swimming pools for 2 weeks after the last bout of diarrhea.

Good food hygiene can help prevent diarrhea from food poisoning. Key recommendations:

Traveler’s diarrhea is a collection of causes that cause travel diarrhea. There is no vaccination for this type of diarrhea, so the best way to avoid it is to practice good food and water hygiene while out and about.

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Diarrhea in chronic bowel disease: from symptom to treatment

Under diarrhea (diarrhea) understand the rapid (more than 2-3 times a day) bowel movements with the release of liquid or mushy stools. Diarrhea is characterized by a higher than normal water content in the feces. If in cases of formalized feces, the water content is 60-75% of the volume of feces, then with diarrhea it increases to 85-95 %. The appearance in the feces of impurities of pus, blood, undigested food indicates the presence of a pathological condition. The mechanisms of development of chronic diarrhea are associated with an increase in intestinal secretion, intestinal exudation, osmotic pressure in the intestinal cavity, and an acceleration of the transit of intestinal contents. In the pathogenesis of non-infectious diarrhea, as a rule, several mechanisms are simultaneously involved with the predominance of any of them [1-3].

The secretory type of diarrhea is characterized by a lower osmolar pressure of intestinal contents compared to the osmolar pressure of plasma. This mechanism takes place in “microscopic colitis” (lymphocytic, collagenous), characteristic of tumors that secrete polypeptide hormones (vipoma), observed in conditions accompanied by the appearance of bile acids in the intestine. Of the infectious agents, the secretory type of diarrhea is caused by: exposure to enterotoxins of Vibrio cholerae, enterotoxigenic Escherichia, some Salmonella, opportunistic bacteria, viruses (rotaviruses). Secretory diarrhea is observed when taking laxatives of the anthraquinone group (senna leaf, buckthorn bark) and may occur when taking certain chemotherapy drugs (in particular, 5-fluorouracil).

The exudative type of diarrhea is observed in conditions accompanied by damage to the epithelial cover of the large or small intestine, as a result of which liquid, mucus, protein, and blood are released through the damaged epithelium into the intestinal lumen; the volume of intestinal contents increases. Exudative diarrhea develops in inflammatory bowel diseases (ulcerative colitis (NUC), Crohn’s disease), ischemic colitis, malignant neoplasms of the intestine. It should be remembered that exudative diarrhea is caused by infections such as dysentery, salmonellosis, escherichiosis, intestinal yersiniosis, campylobacteriosis, and tuberculosis.

Osmotic (hyperosmolar) diarrhea often occurs with malabsorption syndrome. For example, unabsorbed carbohydrates in disaccharidase deficiency increase the osmolarity of intestinal contents and thus prevent water absorption. The action of a number of laxatives (magnesium sulfate, sorbitol, forlax) is based on the ability to create an osmotic pressure of the chyme above the osmotic pressure of the plasma.

Hyperkinetic diarrhea is associated with increased peristaltic activity of the intestine. This type of diarrhea is observed in patients with irritable bowel syndrome, functional diarrhea. The occurrence of hyperkinetic diarrhea is associated with dysregulation of intestinal motor function.

Diagnosis of the cause of diarrhea begins with finding out its duration. With diarrhea lasting up to 3 weeks, an infectious cause should be looked for first of all. Diarrhea lasting more than a month is rated as chronic.

The program of examination of a patient with chronic diarrhea includes:

– study of complaints with the identification of a symptom of diarrhea, a detailed clarification of the cause of occurrence, connection with food and other factors;

– collecting an anamnesis specifying the time of onset of diarrhea, the presence of intestinal diseases in blood relatives;

– examination of the patient;

– laboratory research;

– carrying out tests to exclude fermentopathy;

– additional (endoscopic, x-ray, ultrasound) studies.

When collecting an anamnesis in order to exclude the possibility of an infectious etiology of diarrhea, an epidemiological history, travel route, and sexual contacts are analyzed. They find out the presence of intolerance to milk and dairy products, surgery on the gastrointestinal tract, indications for taking antibacterial, laxative and other drugs.

An assessment of the frequency of defecation acts and the nature of bowel movements in some cases suggests a pathophysiological mechanism for the development of diarrhea and a diagnosis of bowel disease. If the patient has watery, copious stools for 3–4 weeks or more, then most likely the secretory type of diarrhea predominates. After exclusion of the infectious etiology of diarrhea, one can think of microscopic (lymphocytic, collagenous) colitis, a tumor that secretes polypeptide hormones [3].

With exudative diarrhea, the stool in patients is liquid, mixed with mucus, blood and pus. Patients complain of frequent urge to defecate (tenesmus), in which mucus and blood can be released with little or no feces – the so-called “intestinal spitting”. These symptoms may indicate UC or Crohn’s disease of the colon. With a high degree of activity of the inflammatory process in the intestines, patients experience symptoms of general intoxication, fever. Inflammatory bowel disease is characterized by the involvement of other organs and systems in the pathological process, which causes a variety of extraintestinal symptoms (damage to the joints, eyes, skin, liver) [1, 4].

In ischemic colitis, tenesmus and unstable stools mixed with blood and mucus usually accompany pain. The intensity of pain varies widely, is provoked by nutritional and physical factors, and depends on the degree of violation of the blood supply to the colon. In some cases, blood in the stool appears after a few days or even weeks from the onset of the disease. The amount of blood excreted in the feces is usually small; it can be both dark and bright red. After an attack, a large amount of mucus is often excreted with feces.

α-heavy chain disease is characterized by chronic diarrhea, paroxysmal abdominal pain, vomiting, enlarged mesenteric lymph nodes, pallor of the skin, edema, impaired calcium-phosphorus metabolism, baldness, migrating arthralgia, episodic fever, and weight loss.

Profuse liquid stools with an admixture of semi-digested food and a low pH value indicate hyperosmolar diarrhea. In this case, it is necessary to exclude disaccharidase deficiency.

Small, mushy stools (3-4 times), noted mainly in the morning, are characteristic of irritable bowel syndrome. Often the urge to defecate is imperative, observed after breakfast, for which they received the name “morning onslaught syndrome”. Hyperkinetic diarrhea is accompanied by pain manifestations: pain occurs/intensifies before defecation and decreases after the passage of stool and gases [5].

Laboratory examination of a patient with chronic diarrhea includes determining the presence of leukocytes and erythrocytes in the feces, neutral fat, the total amount of feces excreted per day. If mucus, leukocytes are detected in the clinical analysis of feces, then the presence of intestinal infections, protozoa and worms should be excluded.

In patients with watery diarrhea caused by microscopic colitis, a small amount of mucus and leukocytes can be detected in the clinical analysis of feces in a small amount. Due to large losses of sodium, potassium, chlorine with feces, metabolic acidosis develops and the pH of feces increases. An immunological study in approximately 50% of patients (both lymphocytic and collagenous colitis) may reveal circulating antibodies to intestinal epithelial cells, microsomes, thyroglobulin.

In patients with a peptide-producing tumor (vipoma), radioimmunoassay may show an elevated level of vasoactive intestinal peptide.

With IBD in the acute stage, mucus, leukocytes, and erythrocytes are determined in the analysis of the feces of patients in large numbers, and a low pH level of the feces is noted. When conducting a clinical blood test, leukocytosis with a shift to the left, increased ESR, thrombocytosis, and signs of anemia can be detected. In a biochemical study – hypoproteinemia, a decrease in albumin, hypokalemia, an increase in gamma globulins, seromucoid, sialic acids, aminotransferases, alkaline phosphatase, bilirubin, creatinine, fibrin, thrombinemia. Immunological studies reflect a decrease in the content of T-lymphocytes, T-active lymphocytes, a change in the CD4 / CD8 ratio, dysimmunoglobulinemia. A high titer of antibodies to neutrophils is found in patients with UC, but is absent in Crohn’s disease.

An immunological study in individuals with celiac enteropathy determines an increased titer of antigliadin antibodies and finds gliadin-specific DQ2 T cells, antireticulin and antimysial antibodies.

Diagnosis of α-heavy chain disease is based on the detection of a monoclonal immunoglobulin containing only a fragment of the IgA heavy chain. Malabsorption is expressed in hypocalcemia, hypocalciuria, hypophosphatemia, an increase in the level of alkaline phosphatases, a decrease in the level of lipids, prothrombin, and blood sugar.

To assess absorption in the small intestine, a test with D-xylose is performed. Special studies include the Schilling test (impaired absorption of vitamin B12), breath tests: determination of hydrogen in exhaled air after taking lactose (lactase deficiency), glycocholic acid (impaired absorption in the ileum), triolein (impaired absorption of fats), secretin and bentyromide tests ( pancreatic insufficiency).

To clarify the diagnosis of bowel disease, certain additional studies are required. The diagnosis of microscopic colitis is established only after a histological examination of the biopsy of the colon mucosa. In lymphocytic colitis, flattening and desquamation of epithelial cells, an increase in the number of interepithelial CD8+ T-lymphocytes (> 20 per 100 epithelial cells) and infiltration of the lamina propria of the colon mucosa with CD4+ T-lymphocytes, eosinophils are determined. Collagen colitis, in addition to the above changes, is characterized by a thickening of subepithelial collagen fibers up to 10 microns or more.

To verify IBD, an endoscopic examination of the intestine (sigmoidoscopy, fibrocolonoscopy, double-balloon enteroscopy) with a biopsy is performed. With NUC, hyperemia, edema, slight vulnerability of the mucous membrane, petechial hemorrhages, and ulcers are revealed. In Crohn’s disease, lymphatic follicles, linear ulcers, fissures, and cobblestone symptom are observed. Strictures and pseudopolyps resulting from healing of ulcers may be found.

Esophagogastroduodenoscopy with a morphological study of biopsy specimens taken from the descending duodenum allows you to clarify the diagnosis of celiac disease. At the same time, atrophy of the villi of the epithelium of the small intestine with crypt hyperplasia and intraepithelial lymphocytosis of varying severity is determined.

Instrumental diagnosis of ischemic colitis is carried out using Doppler ultrasound of the visceral branches of the abdominal aorta (celiac trunk, splenic artery, common hepatic artery, superior and inferior mesenteric arteries), angiographic examination of the abdominal aorta; combinations of these methods with functional tests to detect hidden forms of abdominal ischemic disease.

Treatment of non-infectious diarrhea depends on the disease of which it is a symptom, and can be both etiotropic and pathogenetic. Treatment of diarrheal syndrome is carried out taking into account the mechanism of its development. With indications of a connection between diarrheal syndrome and the intake of any drugs, they are canceled [4, 5].

The organization of therapeutic nutrition provides for the appointment of a diet that helps to reduce the secretory and motor function of the intestine. Recommend lean meat, fish in the form of steam cutlets, dumplings, meatballs, boiled meat, steam omelettes. Limit the amount of fat to 55-60 g, carbohydrates – up to 250 g, exclude milk, limit fiber intake. In case of intolerance to any products, they are excluded from the diet. For celiac disease, a gluten-free diet is prescribed. It is possible to use decoctions of plants containing tannins and having an astringent effect (pomegranate, decoction of blueberries, bird cherry, oak bark).

In the treatment of microscopic colitis with moderate clinical symptoms, astringents and enveloping preparations are used. These drugs have antidiarrheal, anti-inflammatory, cytoprotective and antibacterial effects, as a result of which they help to improve the functional state of the intestine and stop the inflammatory process in secretory diarrhea. Bismuth subsalicylate is prescribed 2 tablespoons (or 2 tablets) 4 times a day; smectu – 1 sachet 3-4 times a day, before meals. The duration of therapy is up to 2 months.

A good effect as a symptomatic therapy is achieved with the appointment of antidiarrheal agents (loperamide, imodium). Loperamide has an antisecretory opiate-like effect. The antidiarrheal effect of loperamide is due to the inhibition of the motor component of diarrhea, and therefore it is recommended to use the drug in the hyperkinetic type of diarrhea (functional bowel disorders with diarrhea). Loperamide is prescribed 2-4 mg orally once, followed by 2 mg after each act of defecation, not more than 16 mg per day. Loperamide is not recommended for nonspecific ulcerative colitis because of the blocking effect on the tone of the intestinal wall and the risk of developing toxic dilatation of the intestine.

With secretory diarrhea, the appointment of enterosorbents (aluminum silicate, kaolin, pectins, attapulgite, diosmectite, others) is indicated. These drugs do not increase the absorption of water, but bind it, thus reducing the amount of free water in the stool. Enterosorbents are not indicated for osmotic diarrhea caused by impaired digestion and absorption, since additional sorption of nutrients can contribute to the progression of the malabsorption syndrome.

In ulcerative colitis, treatment is aimed at stopping the inflammatory process and restoring the integrity of the intestinal barrier, resulting in a decrease in exudation and secretion. The appointment of mesalazine preparations (salofalk, pentasa) is recommended. Mesalazine preparations reduce the activity of the inflammatory process by inhibiting the metabolic products of arachidonic acid, the activity of neutrophilic lipoxygenase, and suppressing the synthesis of pro-inflammatory mediators by lymphocytes. Mesalazine (pentasa, salofalk) is prescribed in tablets (granules) at a dose of more than 3 g for 1-2 months until a clinical effect is achieved, then maintenance therapy is carried out for 2-3 months with a gradual decrease in the daily dose. The release of mesalazine preparations in the form of suppositories, enemas allows us to recommend them for the treatment of the inflammatory process in the distal colon in combination with taking tablets (granules). If necessary, mesalazine preparations are prescribed for a long time.

In Crohn’s disease and high activity of UC, the appointment of corticosteroid drugs, immunosuppressants is indicated. Prednisolone and its methylated analogues (methylprednisolone) are most commonly prescribed. Oral administration of prednisolone is considered to be an effective dose – 30-60 mg per day. After 4-6 weeks of treatment, when remission is achieved, the dose begins to be reduced by 5 mg per week until a maintenance dose of 5-10 mg per day is reached or completely canceled. Due to the side effects of corticosteroid hormones in Crohn’s disease of the small intestine and ileocecal region, preference should be given to non-systemic (topical) steroids. A well-known topical steroid is budesonide (Budenofalk). The drug is prescribed orally – 9mg per day in 3 divided doses for 2-3 months. In the future, it is possible to continue maintenance therapy with mesalazine preparations.

If the clinical symptoms of IBD are accompanied by the presence of a large number of leukocytes in the feces, signs of a general inflammatory reaction (leukocytosis, elevated ESR), antibiotic therapy (metronidazole, ciprofloxacin) is possible.

Serotonin 5-HT3 receptor antagonists (ondansetron, alosetron) are recommended in the treatment of hyperkinetic diarrhea in patients with functional bowel disorders. Ondansetron is prescribed 4 mg orally 2 times a day. With hyperkinetic type of diarrhea, it is possible to prescribe sedatives.

Enzyme preparations are the basic means for the treatment of osmotic diarrhea caused by a violation of the abdominal and membrane digestion. With gluten enteropathy, long courses of enzyme therapy are indicated. To improve digestion processes, enteric-coated enzyme preparations are prescribed in a daily dose of 30–150 thousand units of lipase.

With secretory and osmotic diarrhea, the appointment of antisecretory drugs (somatostatin, octreotide) is indicated. The therapeutic effects of somatostatin include inhibition of motor, secretory activity, the synthesis of a number of biologically active substances (vasointestinal polypeptide, serotonin, motilin, gastrin, cholecystokinin), promoting the absorption of water in the intestine. Somatostatin is the drug of choice for conditions accompanied by copious watery stools (for carcinoid tumors with diarrheal syndrome, extensive distal bowel resections).

Drug treatment for a-heavy chain disease, intestinal tumors involves chemotherapy.

Probiotics as an additional remedy can be used in cases of bacterial overgrowth syndrome. Violation of microbiocenosis can develop in any of the chronic diseases of the intestine and almost always increases the diarrheal syndrome.

Terminals

Knowledge of the clinical features and the mechanism of the formation of the symptom of diarrhea is necessary for conducting targeted studies and establishing an accurate diagnosis of bowel disease, which, in turn, allows prescribing adequate drug therapy and improving treatment outcomes.