How can you effectively treat watery diarrhea. What are the most common medications used for diarrhea management. Which over-the-counter and prescription drugs are recommended for diarrhea relief. How do antidiarrheal medications work to alleviate symptoms.

Understanding Watery Diarrhea: Causes and Symptoms

Watery diarrhea is a common gastrointestinal condition characterized by frequent, loose, and watery bowel movements. It can be caused by various factors, including viral or bacterial infections, food intolerances, medications, and underlying health conditions. Recognizing the symptoms and understanding the causes are crucial for effective treatment.

Common Causes of Watery Diarrhea

• Viral infections (e.g., norovirus, rotavirus)
• Bacterial infections (e.g., E. coli, Salmonella)
• Parasitic infections
• Food intolerances or allergies
• Medications (e.g., antibiotics)
• Stress and anxiety
• Inflammatory bowel diseases (e.g., Crohn’s disease, ulcerative colitis)

Identifying the underlying cause of watery diarrhea is essential for determining the most appropriate treatment approach. In many cases, the condition is self-limiting and resolves within a few days. However, persistent or severe diarrhea may require medical intervention.

Over-the-Counter Medications for Diarrhea Relief

Over-the-counter (OTC) medications are often the first line of defense against watery diarrhea. These drugs can help alleviate symptoms and provide relief while the body fights off the underlying cause.

Loperamide (Imodium)

Loperamide, commonly known by its brand name Imodium, is one of the most popular OTC antidiarrheal medications. It works by slowing down the movement of fluids through the intestines, reducing the frequency and volume of bowel movements.

Is loperamide safe for all types of diarrhea? Loperamide is generally safe for most cases of uncomplicated diarrhea. However, it should not be used in cases of bloody diarrhea or diarrhea accompanied by high fever, as these may indicate a more serious bacterial infection.

Bismuth Subsalicylate (Pepto-Bismol)

Bismuth subsalicylate, available under brand names like Pepto-Bismol, is another effective OTC option for treating watery diarrhea. It works by reducing inflammation in the intestines and has mild antibacterial properties.

Can bismuth subsalicylate be used for both diarrhea and upset stomach? Yes, bismuth subsalicylate is effective in treating both diarrhea and upset stomach, making it a versatile option for gastrointestinal discomfort.

Prescription Medications for Severe or Persistent Diarrhea

In cases where OTC medications are ineffective or the diarrhea is severe or persistent, prescription drugs may be necessary. These medications are typically more potent and target specific underlying causes of diarrhea.

Atropine/Diphenoxylate (Lomotil)

Lomotil is a prescription medication that combines atropine and diphenoxylate. It works by slowing down intestinal motility and reducing fluid secretion in the bowels.

How does Lomotil differ from OTC antidiarrheals? Lomotil is more potent than OTC options and is classified as a controlled substance due to its small amount of atropine. It requires a prescription and is typically reserved for more severe cases of diarrhea.

Antibiotics

In cases where bacterial infections are the cause of watery diarrhea, antibiotics may be prescribed. Common antibiotics used for this purpose include:

• Ciprofloxacin
• Azithromycin
• Metronidazole

When are antibiotics necessary for treating diarrhea? Antibiotics are typically prescribed when there is evidence of a bacterial infection, such as bloody diarrhea, high fever, or severe abdominal pain. They are not effective against viral causes of diarrhea and should only be used when necessary to avoid antibiotic resistance.

Importance of Hydration in Diarrhea Management

While medications can help alleviate symptoms, maintaining proper hydration is crucial when dealing with watery diarrhea. Diarrhea can lead to rapid fluid and electrolyte loss, potentially causing dehydration.

Oral Rehydration Solutions (ORS)

Oral rehydration solutions are specially formulated to replace lost fluids and electrolytes. They contain a balanced mixture of salts and glucose to promote optimal absorption.

Are sports drinks a suitable alternative to ORS? While sports drinks can provide some hydration, they are not ideal for treating diarrhea-induced dehydration. ORS are specifically designed to replace lost electrolytes in the proper ratios and are more effective in treating dehydration caused by diarrhea.

Recommended Fluids for Rehydration

• Water
• Clear broths
• Weak tea
• Diluted fruit juices

How much fluid should be consumed during a bout of diarrhea? The amount of fluid needed varies depending on the severity of diarrhea and individual factors. As a general guideline, adults should aim to drink at least 2-3 liters of fluid per day, or more if experiencing severe diarrhea.

Dietary Considerations for Managing Watery Diarrhea

Diet plays a crucial role in managing watery diarrhea and promoting recovery. Certain foods can help firm up stools and provide essential nutrients, while others may exacerbate symptoms.

The BRAT Diet

The BRAT diet (Bananas, Rice, Applesauce, Toast) is a commonly recommended dietary approach for managing diarrhea. These foods are easily digestible and can help firm up stools.

Is the BRAT diet sufficient for long-term nutrition during diarrhea? While the BRAT diet can be helpful in the short term, it should not be followed for extended periods as it lacks essential nutrients. As symptoms improve, a more balanced diet should be gradually reintroduced.

Foods to Avoid During Diarrhea

• Dairy products (except for yogurt with live cultures)
• Fatty or greasy foods
• Spicy foods
• Caffeine and alcohol
• High-fiber foods

When can a normal diet be resumed after experiencing diarrhea? As symptoms improve, usually within 24-48 hours, you can gradually reintroduce a normal diet. Start with easily digestible foods and slowly incorporate a wider variety of foods as tolerated.

Natural Remedies and Probiotics for Diarrhea Relief

In addition to conventional medications, several natural remedies and probiotic supplements may help alleviate symptoms of watery diarrhea and support digestive health.

Effective Natural Remedies

• Chamomile tea
• Peppermint oil
• Ginger
• Apple cider vinegar

Can natural remedies replace conventional medications for diarrhea treatment? While natural remedies can provide some relief, they should not be used as a substitute for proven medical treatments, especially in severe cases. Always consult with a healthcare provider before relying solely on natural remedies.

Probiotics for Diarrhea Management

Probiotics are beneficial bacteria that can help restore balance to the gut microbiome and may reduce the duration and severity of diarrhea.

Which probiotic strains are most effective for treating diarrhea? Studies have shown that certain strains, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, may be particularly effective in treating acute infectious diarrhea and antibiotic-associated diarrhea.

When to Seek Medical Attention for Watery Diarrhea

While most cases of watery diarrhea resolve on their own or with over-the-counter treatments, certain symptoms may indicate a more serious condition requiring medical attention.

Warning Signs

• Severe abdominal or rectal pain
• Blood in the stool
• High fever (above 102°F or 39°C)
• Signs of severe dehydration (extreme thirst, dry mouth, little or no urine output)
• Diarrhea lasting more than 3 days

Should you always see a doctor for watery diarrhea? Not all cases of watery diarrhea require medical attention. However, if you experience any of the warning signs mentioned above or if you have a weakened immune system, it’s important to consult a healthcare provider promptly.

Special Considerations for High-Risk Groups

Certain groups may be at higher risk for complications from watery diarrhea and should seek medical attention sooner:

• Infants and young children
• Older adults
• Pregnant women
• Individuals with chronic health conditions
• Immunocompromised individuals

How quickly should high-risk individuals seek medical care for diarrhea? High-risk individuals should contact their healthcare provider at the onset of diarrhea, especially if accompanied by fever or other concerning symptoms. Prompt evaluation can prevent potentially serious complications.

Prevention Strategies for Watery Diarrhea

While it’s not always possible to prevent watery diarrhea, several strategies can help reduce the risk of developing this condition.

Hygiene Practices

• Frequent handwashing with soap and water
• Proper food handling and storage
• Avoiding contaminated water sources
• Sanitizing surfaces regularly

How effective is hand sanitizer in preventing diarrhea-causing infections? While hand sanitizers can be effective against some pathogens, they are not as effective as handwashing with soap and water, especially against certain viruses and parasites that commonly cause diarrhea.

Dietary and Lifestyle Considerations

Maintaining a healthy diet and lifestyle can help strengthen your immune system and reduce the risk of developing watery diarrhea.

• Consuming a balanced diet rich in fruits, vegetables, and whole grains
• Staying hydrated
• Managing stress
• Getting adequate sleep
• Exercising regularly

Can probiotics help prevent diarrhea? Regular consumption of probiotic-rich foods or supplements may help maintain a healthy gut microbiome and potentially reduce the risk of certain types of diarrhea, particularly antibiotic-associated diarrhea.

By understanding the causes, treatments, and prevention strategies for watery diarrhea, individuals can better manage this common condition and reduce its impact on their daily lives. Remember to consult with a healthcare provider for personalized advice, especially in cases of severe or persistent diarrhea.

List of 39 Diarrhea Medications Compared

Diarrhoea | Causes, Symptoms, Treatment & Support

Overview

This factsheet is about diarrhoea

Most healthy people open their bowels between three times a day and three times a week. Normal stools are usually solid because the small intestine and colon are highly efficient in absorbing nutrients, fluid and salts from the gut contents.

Diarrhoea occurs when these processes are impaired, for example when bacteria or viruses damage the lining of the gut and/or there is excessive secretion of fluid such as water, into the bowel that overwhelms the ability of the gut to reabsorb this fluid and salts. The stools become loose and watery and more frequent bowel movements occur. Diarrhoea is also a symptom of some diseases of the digestive tract. In acute (short lasting) diarrhoea, symptoms come on suddenly but usually clear up within five to 10 days. Chronic (long lasting) diarrhoea continues longer than 4 weeks, and the cause should always be investigated by a GP.

Causes

Causes of diarrhoea

There are many reasons why diarrhoea can occur. Common causes include:

• Intestinal infection (gastroenteritis): this is the most common cause of acute diarrhoea with infants and young children particularly susceptible. Bouts of norovirus diarrhoea often make the news since they can occur in local epidemics.
• Food poisoning: another common form of acute diarrhoea usually caused by the Salmonella and Campylobacter bacteria. These infections can be passed via contaminated water or food, such as poultry and eggs, or by a carrier (i.e. someone who has the infection but no symptoms).
• Medications: acute diarrhoea can sometimes occur during or after a course of antibiotics or as a result of other medications which cause the contents of the bowel to move too rapidly through the gut resulting in insufficient time for absorption. It is always worth asking your doctor whether your medications can cause diarrhoea. Laxatives can result in an excessive secretion of fluid into the bowel.
• Anxiety: as with some medications, anxiety can cause the bowel contents to move too rapidly through the gut.
• Overactive thyroid: The thyroid gland produces hormones that affect the running of the body, such as regulating heart rate or temperature. If the thyroid produces too many hormones this can cause the body to ‘run’ too quickly, causing diarrhoea, among other symptoms. Overactive thyroid can be diagnosed by a GP using a simple blood test.
• Irritable bowel syndrome (IBS): bowel frequency is increased in 1 in 3 of those suffering from IBS. IBS is a functional gastrointestinal condition where the large bowel is moving too fast and this doesn’t allow enough time for absorption of fluid and salts, causing diarrhoea. Around 1 in 4 people with IBS-D* may have bile acid diarrhoea.
• Food intolerance: The main culprit for diarrhoea symptoms due to food intolerance is lactose intolerance, it is caused by reduction in levels of lactase, an enzyme produced in the small bowel that helps digest lactose, the sugar found in milk. It can be as a result of having lower levels of lactose from birth or can occur secondary to other digestive diseases. Fructose intolerance can also occur, although less frequently, resulting in diarrhoea. Please note that blood tests for food intolerances are not used by the NHS because they are ineffective at identifying the cause and can lead to the diet being overly restricted. If you suspect a food intolerance, ask your GP for a referral to a state registered dietitian.
• Inflammatory bowel disease (IBD): These are a range of autoimmune diseases that result in inflammation of the digestive tract (Crohn’s disease) or only the large bowel in the case of ulcerative colitis.
• Bowel cancer: diarrhoea is a common symptom, however, a prolonged change in bowel habit lasting more than two or three months should always be investigated. If you have a family history of bowel cancer you should visit your doctor within a few weeks of any changes.
• Coeliac disease: This is an autoimmune condition where gluten, a protein found in wheat, barley or rye causes damage to the small bowel lining. This results in food not being absorbed into the body and in some cases results in diarrhoea.
• Microscopic colitis: Microscopic colitis is an inflammatory disease of the bowel which is not visible by looking at the bowel wall with a camera (endoscopy). It is characterised by watery diarrhoea, usually accompanied by urgency and problems with bowel control.

• Bile acid malabsorption (BAM): this is a disturbance of the cycle of bile acid distribution in the body. Bile acid, produced by the liver, is released into the small bowel to help absorb fats from food. The problem occurs when it does not get reabsorbed at the end of the small bowel. The bile then enters and irritates the tissues of the large bowel generally causing frequent episodes of watery diarrhoea.
• Pancreatic exocrine insufficiency (PEI): The pancreas has two functions, one of these is to produce digestive enzymes to help digest the food we eat, problems with the pancreas can reduce it’s ability to produce these enzymes. This can result in malabsorption of fats and diarrhoea.
• Pelvic radiation disease: radiation treatment for cancers of the lower abdomen and pelvis can cause damage to the digestive tract resulting in diarrhoea in some people.
• Surgery: Any removal of significant parts of the digestive tract can result in diarrhoea, sometimes this can also cause dumping syndrome. Ask your surgeon for further advice.

• Dumping syndrome: this usually happens after surgery to the digestive tract and is where food is released too quickly from the stomach causing excess fluid in the small intestine and altering hormone levels, resulting in diarrhoea.

There are other causes for diarrhoea to occur, but these are generally much rarer.

Symptoms

What are the usual symptoms of diarrhoea?

Diarrhoea is commonly associated with cramping pain in the central or lower abdomen. If this is caused by infections or inflammatory bowel disease it may cause fever. Infections due to Shigella and Campylobacter that get into the lining of the bowel and cause acute inflammation and fever. When there is direct damage to the bowel, blood may be associated with the diarrhoea, which is known as dysentery when it has an infective cause, plus blood in stools is common symptom with ulcerative colitis, a type of IBD.

How is diarrhoea diagnosed?

Most episodes of acute diarrhoea get better without the need for specific medical advice. However, if you are a food handler then you should always consult your doctor and inform your employer. Otherwise you should seek medical advice if any of the following apply:

• If diarrhoea persists for more than 14 days
• If you notice blood in the diarrhoea
• If you develop a high fever
• If your cramping and abdominal pains become severe and constant

The doctor will want to talk to you about your symptoms to try to identify a cause. The doctor will also want to physically examine your abdomen and possibly your back passage. The priority at this stage is to ensure that your stool is checked to determine whether there are any infective agents present that might be the cause of the diarrhoea and your other symptoms. Another test, available to some GPs, is called a faecal calprotectin test, a stool test that identifies inflammation in the digestive tract normally due to IBD, IBD can also be checked for using simple blood tests, if the calprotectin test is not available. The doctor may also do some other blood tests to rule out other causes, such as coeliac disease. It is very important that you do not stop eating sources of gluten, wheat, barley and rye (bread pasta and wheat containing breakfast cereals) before you see your GP, as you need to have gluten antibodies in your system, to correctly identify coeliac disease.

Treatment

How is acute diarrhoea treated?  

Most episodes of acute diarrhoea will settle within a few days without any intervention. However, if the episode is severe there are several treatments that can help.

Rehydration: ensure that enough additional fluids and salts are taken to replace those lost in the diarrhoea. For infants, young children and the elderly, who are more sensitive to fluid losses, it is wise to use a pre-prepared oral rehydration solution, which can be purchased over the counter in most pharmacies. For most adults, oral rehydration can usually be achieved simply by increasing fluid intake in the form of mineral water, fruit juices (which also contain potassium) and salty soups (sodium), together with some form of carbohydrate (rice, pasta, salty crackers), which is important for promoting fluid and salt absorption.

Food intake: there is no need to stop eating although sufferers often prefer a lighter diet in the early phase of the illness. There is no need to interrupt breast-feeding for breast-fed infants. Bottle-fed infants should still receive full-strength formula milk. In general, for adults, avoidance of dairy products and spicy foods short term during the initial phase of illness until foods are well tolerated again. Any problems in tolerating dairy products long term needs to be reported to your doctor.

Medication: an anti-diarrhoea drug such as loperamide is available from pharmacies without prescription. This is often helpful early in the illness to reduce bowel frequency. However, it should not be used in infants and very young children because of concerns that is may depress respiration.

Antibiotics: for travellers with severe diarrhoea for whom the loss of one or two days would seriously affect their activities, the severity and duration of the illness can be dramatically reduced by taking a short course, or even a single dose of broad-spectrum antibiotic.

CAN ACUTE DIARRHOEA BE AVOIDED?

One of the most important and basic ways to avoid it is by careful handwashing after using the bathroom and before consuming food. Because most acute diarrhoea is related to intestinal infection that is usually transmitted by contaminated food or water, then it is possible to avoid an illness by being scrupulously careful about food and fluid intake. Only drink bottled or boiled water and avoid ice cubes when the origin of the water is uncertain. Avoid raw, unpeeled fruits and salads, shellfish and all foods that might contain raw egg. The safest food is that which is hot and well cooked. Bouts of diarrhoea due to norovirus occur in local epidemics, and it is important not to spread infection, so avoid visiting hospitals and unwell relatives at such times.

CAN ACUTE DIARRHOEA BE PREVENTED?

Hygiene measures as outlined above should always be the first line protection against acute diarrhoea. However, there are some other measures that may help to reduce the chances of being affected.

Antibiotics: for those travelling to high-risk areas (such as Indian sub-continent, South East Asia, Africa and Latin America) the chance of experiencing an attack of acute diarrhoea can be reduced by taking a broad-spectrum antibiotic. However, this is not generally advised because antibiotics do have adverse effects and widespread use in this way can lead to the emergence of antibiotic resistance. There is a danger, therefore, that the treatment might be worse than the disease.

Vaccines:  vaccines for traveller’s diarrhoea are under development and one moderately effective vaccine is now available in the United Kingdom (Dukoral). It is aimed at a type of bacteria known as enterotoxigenic Escherichia coli (E.coli), which is the most common cause of traveller’s diarrhoea.

Probiotics: there is some evidence that probiotics (such as lactobacilli and bifidobacteria) found in ‘live yoghurts’ and other preparations may also reduce the chances of experiencing an episode of infective diarrhoea. In addition, over the counter medications may also be useful and your pharmacist can advise you.

WHAT ABOUT CHRONIC DIARRHOEA?

Treatment of chronic diarrhoea will vary and will depend on the cause of the diarrhoea.

Support

Does diarrhoea need to be monitored and if so, how?

Most episodes of acute diarrhoea will settle spontaneously without the need for any medical treatment. However, if it persists, you may also be referred for an endoscopy, where a flexible tube with a camera is passed into the bowel via the anus, to determine whether there is any inflammation in the rectum or colon (colitis). In addition, if your stool tests show any sign of infection this may be treated with antibiotics or further investigations. For episodes of chronic diarrhoea, the cause will be identified, and monitoring will vary depending on the cause of the diarrhoea.

What to ask your doctor?

• Could my diarrhoea be caused by any medications I am currently taking and, if so, is there an alternative?
• Are there any over the counter treatments I can take?
• Do I need my stools checked?
• Do I need to have any other tests to identify the cause of diarrhoea that lasts longer than 10 days?

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Watery diarrhea – causes, diagnosis and treatment

Watery diarrhea is repeated (up to 15-20 times a day) defecation, which is accompanied by the release of loose loose stools. Usually the symptom is combined with other dyspeptic disorders: vomiting, cramps, abdominal pain. Diarrhea with water is most often associated with intestinal infections, but can be observed with non-infectious intestinal pathologies, enzyme deficiency. To establish the causes of diarrhea, ultrasound, x-rays, endoscopy, and laboratory tests are used. To stop diarrhea, adsorbents, enveloping and astringent preparations are used.

Causes of watery diarrhea

Water bowel movements often indicate infectious or non-infectious intestinal diseases. Sometimes pregnant women complain about the appearance of liquid unformed feces, which is caused by gestational changes in the digestive and endocrine systems. In children, watery stools can be a sign of a toxic form of dyspepsia or the initial stage of colitis. Diarrhea with water with dyspeptic disorders, weakness, hemorrhages is characteristic of alimentary-toxic aleukia. Profuse diarrhea occurs in 90% of patients with toxic shock.

Bacterial infections

Ingestion of pathogenic intestinal microflora is usually accompanied by secretory type watery diarrhea. Bacteria are able to secrete a specific enterotoxin that affects the epithelial cells of the mucosa and causes the accumulation of adenylate cyclase and cAMP in them. This contributes to an increased release of ions into the intestinal lumen with subsequent entry into the intestine along the concentration gradient of a large amount of liquid. The condition is exacerbated by concomitant inflammatory lesions of the gastrointestinal tract. The following intestinal infections lead to diarrhea with water:

• Cholera . This infectious disease manifests as diarrhea, which quickly loses its fecal character and odor, becoming watery. A few hours later, repeated vomiting joins, which aggravates the condition, provoking severe dehydration. A distinctive feature is the complete absence of abdominal pain or moderate discomfort, detected in no more than 30% of patients.
• Escherichiosis . Watery diarrhea often develops when infected with enterotoxigenic strains of the microbe, when the disease proceeds as a mild variant of cholera. In young children, waterborne diarrhea is usually caused by enteropathogenic strains. Diarrhea is combined with vomiting, pain in the epigastrium, along the intestines. An increase in body temperature to subfebrile numbers is possible. General condition of patients of moderate severity.
• Salmonellosis . Dyspeptic disorders are the main manifestations of the gastrointestinal form of infection. The first symptoms of salmonellosis are general intoxication and headache, after a few hours there are severe cramping pains in the intestines, profuse bowel movements, first with the release of unformed feces, and then water with food particles, mucus. A greenish frothy stool (“swamp mud”) is characteristic.
• Botulism . With the gastroenterological variant of the infection, dyspeptic symptoms come to the fore: watery diarrhea, repeated vomiting, spastic abdominal pain. Patients complain of dry mouth, sensation of a lump in the throat. Botulism is characterized by eye manifestations: double vision, flickering of “flies” before the eyes, blurred vision. In severe cases, paresis, paralysis of mimic muscles with asymmetry of the face are observed.
• Campylobacteriosis . The disease begins acutely with a rise in temperature to 38 ° C or more, pain in the muscles and joints. Multiple diarrhea immediately joins with the release of liquid, fetid feces, in which streaks of mucus and blood are detected. Patients often complain of abdominal cramps, while nausea and vomiting occur in only a quarter of patients with campylobacteriosis.

Viral infections

Dyspeptic disorders, in particular watery diarrhea, are considered the main manifestations of most viral intestinal lesions. Viruses, when they enter the gastrointestinal tract, multiply inside the epithelial cells, causing their death and desquamation from the surface of the mucosa, which leads to impaired parietal digestion, diarrhea. Pathogens also slow down the processes of reabsorption of water from the intestinal lumen, which causes profuse diarrhea. The most common viral diseases that occur with intestinal damage:

• Rotavirus gastroenteritis . Watery stools are the main manifestation of rotavirus infection. With a mild variant, the frequency of defecation is up to 10 times per day, the stools are fecal in nature, in severe cases, the leading one is profuse diarrhea with the discharge of a cloudy, fetid, yellow-green liquid. Diarrhea is combined with cramping pains in the umbilical region, subfebrile fever.
• Norovirus infection . Norovirus is characterized by simultaneous damage to the respiratory and digestive systems. The disease begins with a sore throat, nasal congestion, then dyspepsia joins – watery stools, vomiting, abdominal pain. Multiple defecation with the release of a large volume of fluid becomes a prerequisite for severe dehydration, which is manifested by dry skin, mucous membranes, decreased blood pressure, oliguria.
• Hong Kong influenza . With this type of influenza infection, gastrointestinal symptoms are combined with signs of damage to the respiratory system, general intoxication of the body. Along with headache, high fever, repeated diarrhea with water, moderate pain in the abdomen, nausea, and lack of appetite are noted. Respiratory manifestations (dry cough, sore throat, nasal congestion) occur on the 2nd-3rd day of illness.
• Marburg hemorrhagic fever. The disease manifests itself acutely with the onset of headache, myalgia, conjunctivitis, erosions on the oral mucosa. Dyspeptic disorders in the form of watery diarrhea, vomiting, severe pain in the abdominal cavity develop on the 3rd-4th day of hemorrhagic fever. Pathognomonic signs are maculopapular rash, uterine, nasal and gastrointestinal bleeding that appear on days 5-6 of illness.
• HIV infection . AIDS is characterized by abundant watery stools without pathological inclusions, due to digestive disorders and the addition of a secondary infection against the background of severe immunodeficiency. In addition to loose stools, other nonspecific symptoms are determined – prolonged subfebrile fever, increased sweating at night. Most patients lose more than 10% of body weight.

Protozoal and helminthic invasions

Helminths and protozoa have a direct pathogenic effect on mucosal enterocytes, causing severe disorders of digestion and absorption of food components. Severe malabsorption syndrome, combined with increased secretion of water and electrolytes into the intestinal cavity, provokes profuse diarrhea. With insufficient replenishment of fluid losses, a dehydration syndrome of varying severity develops. Watery diarrhea is noted with such invasions as:

• Cryptosporidiosis . The protozoa parasitize in the lumen of the small intestine, potentiating malabsorption and inhibition of the activity of digestive enzymes, resulting in a watery stool with a fetid odor. Diarrhea is accompanied by severe abdominal cramps, nausea, and vomiting. The disease often affects people with immunodeficiencies. In such cases, there is a long course (up to 4 months) with severe dehydration.
• Strongyloidiasis . Intestinal manifestations are observed in the second phase of the disease, 2-3 weeks after the onset of the first symptoms – urticaria, rashes and arthralgia. The development of diarrhea is associated with an inflammatory lesion of the small intestine mucosa, the formation of hemorrhages, erosions. In addition to diarrhea, pain in the epigastric region, nausea, and vomiting are typical. Sometimes there is yellowness of the skin, pain in the right hypochondrium.

Noncommunicable bowel diseases

Watery diarrhea often complicates the course of organic diseases of the digestive tract, especially in the early stages. The increase in the volume of feces is due to both violations of the processes of parietal and abdominal digestion, and the impact of various inflammatory mediators. Diarrhea is associated with disorders of intestinal motility of the hyperkinetic or hypokinetic type. With a change in the frequency and consistency of the stool, the following non-infectious pathologies of the gastrointestinal tract occur:

• Enteritis . Watery diarrhea is a symptom of non-infectious inflammation of the small intestine, which is allergic, drug-induced, or autoimmune in nature. The appearance of liquid, fetid feces is mainly caused by malabsorption and maldigestion syndromes. The chair is observed up to 10-15 times during the day, accompanied by flatulence, rumbling in the abdomen, decreased appetite, nausea, significant weight loss.
• Enteropathy . Chronic watery diarrhea is manifested in non-inflammatory intestinal pathologies. A change in the consistency of stool masses can be caused by both fermentopathy and a violation of the motility of the gastrointestinal tract (for example, a hypomotor variant of diabetic enteropathy). The pain syndrome is weakly expressed, digestive disorders that contribute to weight loss and protein-energy malnutrition predominate.
• Acute colitis . For colitis, spasms in the left iliac region, painful urge to defecate, the presence of pathological impurities of mucus, blood in the feces are typical. The stool at first has a fecal character, a fetid odor, as the disease progresses it becomes watery. The frequency of bowel movements reaches 25 times a day. Similar changes are noted in pseudomembranous colitis with exudative enteropathy.

Enzyme deficiency

In the absence of enzymes in the initial sections of the small intestine, the appearance of profuse diarrhea with water is associated with an osmotic mechanism. The presence of a large number of undigested large molecules, especially disaccharides and peptones, is a prerequisite for an increase in pressure in the intestinal lumen, the release of fluid and sodium ions. Diarrhea occurs with fibrosis of the pancreas and a decrease in its exocrine function by 80-90%, as a result of which the digestion of all types of food is disturbed. The condition is aggravated by the addition of the secretory mechanism of diarrhea associated with cAMP activation.

Watery stools are possible with gastrinoma, Zollinger-Ellison syndrome. Increased secretion of gastrin and hydrochloric acid leads to the destruction of digestive enzymes, an increase in the osmolarity of the chyme. Diarrhea is combined with intense pain in the epigastrium, sour belching. In children, defecation with water becomes a consequence of galactosemia – intolerance to milk due to a congenital lack of an enzyme. The symptom appears immediately after the start of breastfeeding, accompanied by malnutrition, jaundice, inhibition of reflexes.

Examination

Watery diarrhea always indicates problems with the digestive system. Examination of patients with complaints of watery diarrhea is carried out by a gastroenterologist or infectious disease specialist. To verify the clinical diagnosis, a comprehensive examination of the gastrointestinal tract using laboratory and instrumental methods is necessary to detect morphological changes and determine the cause of diarrhea. The most valuable in terms of diagnostics are:

• Radiography . With the help of a survey radiography of the abdominal cavity, the condition of the gastrointestinal tract of the patient is quickly assessed. For a detailed study of the internal surface of the digestive tract, oral contrasting with barium sulfate is used. The method is quite informative in detecting non-infectious processes that cause watery stools.
• Ultrasound A non-invasive examination method is used as a screening diagnosis to exclude severe organic diseases of the digestive system, neoplasms. Ultrasound of the abdominal cavity allows you to identify signs of the inflammatory process. Sonography is also performed to assess the condition of the pancreas.
• Fecal analysis . To study the processes of digestion, absorption of food, a microscopic examination of feces with pH measurement is carried out. Watery diarrhea is often caused by infectious processes, so all patients undergo bacteriological culture of feces, analysis for helminth eggs. To exclude ulcerative-destructive processes, the Gregersen reaction is shown.
• Serological tests . The search for antimicrobial antibodies or specific antigens in the blood is the most accurate way to identify various infectious diseases, especially those of a viral nature. The study is not sufficiently informative in the first few days from the onset of the disease, when the concentration of antibodies in the blood has not yet increased.

As an additional general clinical method, a biochemical blood test is used to help determine the degree of malabsorption and protein deficiency. If specific lesions of the gastrointestinal wall are suspected, endoscopic examination with biopsy is recommended. To assess the exocrine function of the pancreas, a blood test for amylase, lipase is sometimes prescribed.

Adsorbents are used to reduce the frequency of watery diarrhea

Symptomatic therapy

Diet modification required. With an acute disorder, a starvation diet is indicated with the gradual introduction of rice dishes, products containing pectins, salted soups, broths, dietary protein foods (veal, turkey, chicken, hard-boiled eggs). With watery diarrhea, a significant amount of fluid is lost, therefore, when the patient is in a satisfactory condition, it is important to provide plenty of fluids to prevent severe dehydration.

Adsorbents, astringents, and coating agents are used to reduce the frequency of watery diarrhea until the exact cause of stool problems is determined. In no case should you take medications that inhibit intestinal motility, as this can increase intoxication and lead to a deterioration in the patient’s condition. Antibacterial agents and antidiarrheal drugs are selected only by a doctor, taking into account the results of the examination, the sensitivity of pathogenic microorganisms.

Diarrhea in a child: causes, effects and treatment of diarrhea

Turganova Elena

Published: 01/15/2023

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Diarrhea in infants: causes and methods of treatment

Diarrhea (diarrhea) is an increase in stool and a change in its consistency.

The frequency and nature of the stool depends on the age of the child, the type of feeding (breast, mixed, artificial) and its individual characteristics (table 1).

Thus, breastfeeding stools in children of the first half of the year (before the introduction of complementary foods) are usually homogeneous, mushy, yellowish in color, up to 5-7 times a day. This is the norm. Increased frequency up to 10 times or more, complete absorption of the stool into the diaper – manifestations of diarrhea.

With the introduction of formula and complementary foods, the stool becomes less frequent and thicker, changes in color and smell. Bowel movements more than three times a day and a change in consistency to liquid or watery are signs of diarrhea.

Tab. 1. Stool frequency in young children

Age	Number of bowel movements per week	Number of bowel movements per day (average)
0-3 months breastfeeding artificial feeding	5 – 40 5 – 20	2. 9 2.0
6 – 12 months	5 – 28	1.8
1 – 3 years	4 – 21	1.4
4 years and older	3 – 14	1.0

What can cause diarrhea in babies?

According to the Bristol stool form scale 5-7, stool types are associated with diarrhea and indicate an increase in the speed of passage of the food bolus through the gastrointestinal tract.

The main causes can be divided into two large groups: infectious and non-infectious.

Viruses, bacteria, fungi and protozoa can cause infectious diarrhea.

Food allergy (FMA), food intolerance (lactose), antibiotics, pancreatic disease, and congenital diseases can cause non-infectious diarrhea.

Why is diarrhea dangerous?

Acute watery diarrhea is accompanied by a large loss of fluid and electrolytes. This leads to the development of dehydration (dehydration). Symptoms are shown in Table 2.

Tab. 2. Dehydration scale

Assess the degree of dehydration by the sum of points:

Alarms

• vomiting
• (fever)
• blood in stool and vomit
• marked abdominal distension and flatulence
• lethargy
• severe lethargy
• spatial disorientation

Unfavorable consequences (complications)

• convulsions
• impairment of consciousness
• development of acidosis (disturbance of acid-base balance in the body)
• shock

What should I do if my baby has diarrhea?

Non-drug therapy consists of three points.

1. Recovery of water and electrolyte losses
2. Diet therapy
3. Probiotics with proven efficacy

Rehydration therapy is a specialized solution. What is important is not just a liquid (water), but its combination with important components, as in blood plasma.

These are usually dry powders for the preparation of solutions.

Diet therapy is to reduce the load on the digestive system. This is especially true for
milk sugar (lactose) and cow’s milk protein. Therefore, it is necessary (temporarily) to exclude any products containing animal milk (cows, goats, mares, etc.).

Breastfeeding must continue! To reduce the risk of developing lactase deficiency, it is possible to use lactase enzyme preparations in consultation with the attending pediatrician.

It is preferable to replace the usual mixture with a lactose-free one, for example, Nutrilak Premium Lactose-free, but not completely, but partially (1/3 – 1/2 of the main volume). A complete transition to a therapeutic mixture for an acute period is possible, as prescribed by a doctor.

If there are manifestations of allergy to cow’s milk proteins, then it is justified to prescribe deeply hydrolyzed Nutrilak Peptidi MCT or Nutrilak Premium soy mixture, which do not contain lactose and BCM.

Nutrilak Premium Sour Milk

What to look out for

In case of prolonged diarrhea (more than two weeks) and repeated episodes, you should consult a specialist to rule out hereditary diseases and chronic pathology of the gastrointestinal tract.

Recovery period

Intestinal infections cause a big blow to the child’s gastrointestinal tract, so the normalization of the stool is not a reason to relax and abruptly return to normal nutrition or stop taking lactase without the doctor’s permission.

In dishes, preference should be given to cereal products (cereals, pasta) and meat. Vegetables and fruits are preferably thermally processed. It is better to exclude dairy products or replace them with sour-milk ones. They contain probiotics and their metabolites, which have a beneficial effect on the gastrointestinal tract. In children under one year old, the usual mixture can be partially or even completely replaced with a specialized one, for example, Nutrilak Premium Sour-milk. It helps to facilitate the process of digestion, regular stools and maintain the balance of the microbiota.

Prevention measures

Traveler’s diarrhea and loose stools after taking antibiotics are easier to prevent than to treat.

Studies have shown that taking L. rhamnosus (LGG)® significantly reduces the risk of diarrhea when away from home and after taking antibiotics. For adults, there are dietary supplements, and for children, food with probiotics.

How to choose a formula for diarrhea?

Only the Nutrilak range of formulas have products with LGG®.