What are the common causes of diarrhea lasting more than 3 days. How can persistent diarrhea be treated effectively at home. When should you seek medical attention for prolonged diarrhea.

Understanding Diarrhea: Types and Duration

Diarrhea is a common digestive issue characterized by loose, watery stools occurring at least three times a day. While most cases resolve quickly, some individuals experience prolonged symptoms that can be concerning. To better understand this condition, it’s essential to recognize the different types of diarrhea based on duration:

• Acute diarrhea: Lasts 1-2 days and typically resolves without medical intervention
• Persistent diarrhea: Continues for 2-4 weeks
• Chronic diarrhea: Lasts more than 4 weeks, either continuously or intermittently

The duration of diarrhea often depends on its underlying cause. While acute cases are usually linked to viral infections, persistent and chronic diarrhea may have more complex triggers that require further investigation.

Common Causes of Persistent Diarrhea

When diarrhea lasts longer than a few days, it’s crucial to identify the root cause. Here are some common factors that can lead to persistent diarrhea:

Infections

Various pathogens can cause prolonged diarrhea, including:

• Viruses (e.g., norovirus, rotavirus)
• Bacteria (e.g., Salmonella, E. coli)
• Parasites (e.g., Giardia, Cryptosporidium)

These infections can be contracted through contaminated food, water, or close contact with infected individuals.

Travelers’ Diarrhea

Travelers’ diarrhea (TD) is a common issue for those visiting countries with poor sanitation. While it typically causes acute symptoms, some parasitic infections associated with TD can lead to persistent diarrhea.

Medication Side Effects

Certain medications can trigger diarrhea as a side effect. These may include:

• Antibiotics
• Antacids containing magnesium
• High blood pressure medications
• Anticancer drugs

If you suspect your medication is causing persistent diarrhea, consult your healthcare provider before making any changes to your regimen.

Chronic Diarrhea: Underlying Causes and Conditions

When diarrhea persists for more than four weeks, it’s classified as chronic. This type of diarrhea can be indicative of more serious underlying conditions:

Food Allergies and Intolerances

Chronic diarrhea may be a sign of food allergies or intolerances. Common culprits include:

• Lactose intolerance
• Fructose intolerance
• Gluten intolerance
• Sensitivity to sugar alcohols (sorbitol, mannitol, xylitol)

Identifying and eliminating trigger foods can often provide relief from chronic diarrhea related to these issues.

Digestive Conditions

Several digestive disorders can manifest as chronic diarrhea:

• Irritable Bowel Syndrome (IBS)
• Small Intestinal Bacterial Overgrowth (SIBO)
• Celiac Disease
• Inflammatory Bowel Diseases (IBD) such as Ulcerative Colitis and Crohn’s Disease

These conditions often require long-term management and may involve dietary changes, medication, or other treatments.

Post-Surgical Complications

Chronic diarrhea can develop following abdominal surgeries involving organs such as the stomach, appendix, gallbladder, intestines, liver, pancreas, or spleen. This complication may be due to changes in digestive function or alterations in gut bacteria.

Long-term Antibiotic Use

Extended use of antibiotics can disrupt the balance of gut bacteria, potentially leading to chronic diarrhea. In some cases, this imbalance may increase susceptibility to infections like Clostridium difficile, which can cause severe, persistent diarrhea.

Recognizing Symptoms and Associated Conditions

While diarrhea itself is a symptom, it often occurs alongside other issues. Understanding these associated symptoms can help in identifying the underlying cause:

• Nausea and vomiting
• Stomach ache or abdominal cramps
• Headache
• Chills
• Fever

The presence of these additional symptoms, especially fever, can indicate an infection or more serious condition requiring medical attention.

Home Remedies and Over-the-Counter Treatments

For mild to moderate cases of diarrhea, several home remedies and over-the-counter treatments can provide relief:

Hydration

Staying hydrated is crucial when experiencing diarrhea. Drink plenty of clear fluids, including water, clear broths, and electrolyte solutions to replace lost fluids and minerals.

Dietary Adjustments

Following the BRAT diet (Bananas, Rice, Applesauce, Toast) can help firm up stools and provide easily digestible nutrients. Avoid fatty, spicy, or sugary foods that may exacerbate symptoms.

Probiotics

Consuming probiotic-rich foods or supplements can help restore the balance of beneficial gut bacteria, potentially reducing the duration of diarrhea.

Over-the-Counter Medications

Two main types of anti-diarrheal medications are available without a prescription:

• Loperamide (Imodium): Slows digestion, allowing the body to absorb more water from the intestines, firming stools and reducing bowel movement frequency.
• Bismuth subsalicylate (Pepto Bismol): Helps reduce inflammation in the intestines and may have antimicrobial properties.

While these medications can provide relief, they should be used with caution and avoided in cases of bloody diarrhea or suspected bacterial infections.

When to Seek Medical Attention

While many cases of diarrhea resolve on their own, certain situations warrant medical attention:

• Diarrhea persisting for more than 3 days
• Severe abdominal or rectal pain
• Bloody or black stools
• Signs of dehydration (extreme thirst, dry mouth, dark urine, dizziness)
• Fever above 102°F (39°C)
• Unexplained weight loss

If you experience any of these symptoms, consult a healthcare provider promptly for proper diagnosis and treatment.

Diagnostic Approaches for Persistent Diarrhea

When diarrhea persists, healthcare providers may employ various diagnostic tools to identify the underlying cause:

Medical History and Physical Examination

A thorough review of your medical history, recent travel, dietary habits, and medications can provide valuable insights. A physical exam may also be conducted to check for signs of dehydration or abdominal tenderness.

Stool Tests

Stool samples may be analyzed to detect the presence of bacteria, parasites, or other pathogens. These tests can also reveal signs of inflammation or malabsorption.

Blood Tests

Blood work can help identify signs of infection, inflammation, or nutritional deficiencies that may be associated with persistent diarrhea.

Imaging Studies

In some cases, imaging techniques such as X-rays, CT scans, or MRI may be used to examine the digestive tract for structural abnormalities or signs of inflammatory conditions.

Endoscopy

Procedures like colonoscopy or upper endoscopy allow direct visualization of the digestive tract and can be used to obtain tissue samples for further analysis.

Treatment Strategies for Persistent and Chronic Diarrhea

The treatment approach for prolonged diarrhea depends on the underlying cause. Here are some common strategies:

Antibiotics

If a bacterial infection is identified, antibiotics may be prescribed. However, these should be used judiciously, as they can sometimes exacerbate diarrhea by disrupting gut flora.

Anti-parasitic Medications

For parasitic infections, specific anti-parasitic drugs may be recommended based on the identified pathogen.

Dietary Modifications

In cases of food intolerances or allergies, eliminating trigger foods can provide significant relief. Working with a dietitian can help develop an appropriate meal plan.

Medications for Digestive Disorders

For conditions like IBS or IBD, various medications may be prescribed to manage symptoms and reduce inflammation in the digestive tract.

Probiotics and Prebiotics

These supplements can help restore a healthy balance of gut bacteria, which may be particularly beneficial after antibiotic treatment or in cases of dysbiosis.

Fluid and Electrolyte Replacement

In severe cases, intravenous fluids may be necessary to address dehydration and electrolyte imbalances caused by prolonged diarrhea.

Preventing Persistent Diarrhea

While not all cases of persistent diarrhea can be prevented, certain measures can reduce your risk:

• Practice good hygiene, including frequent handwashing
• Be cautious with food and water when traveling to areas with poor sanitation
• Avoid unpasteurized dairy products and undercooked meats
• Stay up-to-date with vaccinations, including those for rotavirus and hepatitis A
• Use antibiotics only when necessary and as prescribed
• Manage stress, as it can exacerbate digestive issues

By understanding the causes, symptoms, and treatment options for persistent diarrhea, you can better manage this condition and know when to seek professional help. Remember, while occasional bouts of diarrhea are common, prolonged symptoms should not be ignored, as they may indicate a more serious underlying condition requiring medical attention.

Is this normal, causes, and treatment

Diarrhea usually resolves in 1–2 days, but it can sometimes continue for weeks. Persistent diarrhea can be a sign of an allergy or a chronic condition, such as irritable bowel disease (IBD). It may also occur after an infection.

Diarrhea is the medical term for passing loose, watery stools at least three times a day. Acute, or short-term diarrhea may have different causes from chronic or peristent diarrhea. They may need different treatments.

This article provides information on how long diarrhea usually lasts and explores what causes this condition to persist for more than a week. We also outline home and medical treatments for diarrhea and offer advice on when to see a doctor.

Most cases of diarrhea last 1–2 days, though some may last longer. The exact duration depends on the underlying cause.

The National Institute of Diabetic and Digestive and Kidney Diseases (NIDDK) categorize the condition into three groups according to its duration:

• Acute diarrhea: Lasts for 1–2 days and goes away without medical treatment.
• Persistent diarrhea: Diarrhea that persists for 2–4 weeks.
• Chronic diarrhea: Continual or intermittent diarrhea lasting for more than 4 weeks.

Acute diarrhea often occurs due to a viral infection. These infections tend to clear up on their own within a few days.

When a person first experiences diarrhea, they may not know whether the condition will be acute, persistent, or chronic. People with diarrhea from an infection may experience additional symptoms, such as:

• nausea and vomiting
• stomach ache
• headache
• chills
• fever

According to the NIDDK, persistent and chronic diarrhea may last more than a week. Both types may have different triggers.

Causes of persistent diarrhea

Below are the most common causes of persistent diarrhea.

Infections

Persistent diarrhea can occur as a result of viral, bacterial, or parasitic infections.

The table below shows the different types of pathogens that commonly cause diarrhea and how they may enter the body.

Travelers’ diarrhea

Travelers’ diarrhea (TD) is the medical term for diarrhea that results from consuming food or water contaminated with viruses, bacteria, or parasites.

Its name originates from the fact that it typically develops when people travel to countries with poor sanitation.

According to the NIDDK, TD typically causes acute diarrhea, though some parasitic infections may trigger persistent diarrhea.

Medication side effects

Certain medications can cause diarrhea as a side effect. Examples include:

• antibiotics
• antacids containing magnesium
• high blood pressure medications
• anticancer drugs

Causes of chronic diarrhea

We explore potential triggers for chronic diarrhea below.

Infections

Without treatment, certain bacterial and parasitic infections may cause chronic diarrhea.

Following an infection, people may experience problems digesting certain carbohydrates and proteins. This can prolong the duration of diarrhea.

Food allergies and intolerances

Chronic diarrhea can sometimes indicate an underlying food allergy or intolerance. Food intolerance is when a person has difficulty digesting a particular food. This may lead to an upset stomach and diarrhea.

Some common types of food intolerance include:

• Lactose intolerance: Inability to properly digest lactose, a sugar found in milk and dairy products.
• Fructose intolerance: When the body cannot properly digest fructose, a sugar in fruits, fruit juices, and honey.
• Gluten intolerance: When a person has symptoms after eating gluten containing foods.

In addition to the above, some people may have difficulty breaking down types of sugar alcohol in some sugar-free products. Examples include:

• sorbitol
• mannitol
• xylitol

Digestive conditions

Chronic diarrhea can sometimes indicate an underlying issue within the digestive tract.

Some digestive conditions that may cause chronic diarrhea include:

• irritable bowel syndrome
• small intestinal bacterial overgrowth
• celiac disease
• inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease

Abdominal surgery

A person may develop chronic diarrhea after surgery on the following organs:

• stomach
• appendix
• gallbladder
• small or large intestine
• liver
• pancreas
• spleen

Long-term antibiotic use

Long-term antibiotic use can also change the balance of good and bad gut bacteria. This can make a person more susceptible to infection with the diarrhea-causing bacteria Clostridium difficile.

Below are some remedies that may ease diarrhea and its associated symptoms.

Over-the-counter medication

There are two main types of anti-diarrheal medication available without a prescription:

• Loperamide: This drug is available under the brand name Imodium. It works by slowing down digestion so that the body can draw more water from the intestines. This helps firm up stools and reduces the frequency of bowel movements.
• Bismuth subsalicylate: This medication is available as Pepto Bismol. It works by coating and killing some of the gut bacteria that triggers diarrhea.

Changing the diet

People with diarrhea may find that eating bland and easily digestible foods could provide nutrition while settling the stomach and alleviating symptoms.

One such diet is the BRAT diet, which stands for bananas, rice, applesauce, and toast. Other foods that a person can eat while experiencing stomach upset include:

• steamed or boiled vegetables
• scrambled eggs
• broth
• chicken or turkey without the skin
• white bread
• white rice
• saltine crackers
• oatmeal

Learn more about the BRAT diet here.

People should also avoid foods that could worsen gastric upset and diarrhea, such as:

• fried, fatty, or spicy foods
• milk and dairy products, except for plain yogurt and kefir
• fish
• red meats
• raw vegetables
• citrus fruits
• candy
• sodas
• extremely hot or cold drinks
• caffeine
• alcohol

Learn more about foods that can contribute to diarrhea here.

Drinking plenty of fluids

Diarrhea can cause a person to lose fluids and essential electrolytes, which can lead to dehydration.

Drinking plenty of fluids will help reduce this risk. These fluids include:

• plain water
• low-sugar fruit juices
• low-sugar sports drinks
• clear broths

Treatments for persistent or chronic diarrhea depend on the underlying cause. Some possible causes and their treatment options are below.

Infections

A doctor may prescribe a course of antibiotics to treat a lingering bacterial infection, or an antiparasitic medication to manage a parasitic infection.

Food allergies and intolerances

If a person suspects they have a food allergy or intolerance, their doctor may recommend keeping a food diary.

People can use their diary to record the foods they eat on a day-to-day basis, and the symptoms they experience. Over time, this will help them detect foods that may trigger their diarrhea.

Treatment for a food allergy or intolerance typically involves avoiding known trigger foods.

Digestive conditions

The treatment for a digestive issue depends on the type of condition. Depending on the cause, it may involve one or more of the following:

• avoiding certain foods
• taking medications to control the underlying condition
• taking medicines to alleviate diarrhea and other gastrointestinal symptoms
• surgery to help treat the underlying condition

The NIDDK recommend that people see a doctor if their diarrhea lasts more than 2 days, or if they pass six or more loose stools in 24 hours.

A person should also seek medical attention for the following symptoms:

• fever
• frequent vomiting
• stools that are black, tarry, or contain blood
• severe pain in the abdomen or rectum
• signs of dehydration

Diarrhea that lasts for more than a week may be persistent or chronic.

Persistent diarrhea lasts for up to 4 weeks. This condition is typically the result of an infection or a side effect of medication.

Chronic diarrhea refers to diarrhea that lasts for 4 weeks or more. There are many potential triggers for this issue, including untreated infections, food allergies and intolerances, and underlying digestive conditions.

Anyone who experiences diarrhea that persists for more than 2 days should visit their doctor for a diagnosis and appropriate medical treatment.

Persistent Diarrhea in Returned Travelers

Author(s): Bradley Connor

Although most cases of travelers’ diarrhea (TD) are acute and self-limited, a certain percentage of people afflicted will develop persistent (>14 days) gastrointestinal (GI) symptoms. Details on the management of acute TD are available in Sec. 2, Ch. 6, Travelers’ Diarrhea.

Pathogenesis

The pathogenesis of persistent diarrhea in returned travelers generally falls into one of the following broad categories: ongoing infection or co-infection with a second organism not targeted by initial therapy; previously undiagnosed GI disease unmasked by the enteric infection; or a postinfectious phenomenon.

Ongoing Infection

Most cases of TD are the result of bacterial infection and are short-lived and self-limited. In addition to immunosuppression and sequential infection with diarrheal pathogens, ongoing infection with protozoan parasites can cause prolonged diarrheal symptoms.

Bacterial

Individual bacterial infections rarely cause persistent symptoms, but travelers infected with Clostridioides difficile or enteroaggregative or enteropathogenic Escherichia coli (see Sec. 5, Part 1, Ch. 7, Diarrheagenic Escherichia coli) can experience ongoing diarrhea. C. difficile–associated diarrhea can occur after treatment of a bacterial pathogen with a fluoroquinolone or other antibiotic, or after malaria chemoprophylaxis. The association between C. difficile and antimicrobial treatment is especially important to consider in patients with persistent TD that seems refractory to multiple courses of empiric antibiotic therapy. The initial work-up of persistent TD should always include a C. difficile stool toxin assay. Clinicians can prescribe oral vancomycin, fidaxomicin, or, less optimally, metronidazole to treat C. difficile.

Parasitic

As a group, parasites are the pathogens most likely to be isolated from patients with persistent diarrhea. The probability of a traveler having a protozoal infection, relative to a bacterial one, increases with increasing duration of symptoms. Parasites might also be the cause of persistent diarrhea in patients already treated for a bacterial pathogen.

Giardiasis

Giardia (see Sec. 5, Part 3, Ch. 12, Giardiasis) is the most likely parasitic pathogen to cause persistent diarrhea. Suspect giardiasis particularly in patients with upper GI–predominant symptoms. Untreated, symptoms can last for months, even in immunocompetent hosts.

PCR-based diagnostics, particularly the multiplex DNA extraction PCR, are becoming the diagnostic methods of choice to identify Giardia and other protozoal pathogens, including Cryptosporidium, Cyclospora, and Entamoeba histolytica. Diagnosis also can be made by stool microscopy, antigen detection, or immunofluorescence. In the absence of diagnostics (given the high prevalence of Giardia as a cause for persistent TD), empiric therapy is a reasonable option in the clinical setting. Rare causes of persistent symptoms include the intestinal parasites Cystoisospora, Dientamoeba fragilis, and Microsporidia.

Tropical Sprue & Brainerd Diarrhea

Persistent TD also has been associated with tropical sprue and Brainerd diarrhea. Tropical sprue is associated with deficiencies of vitamins absorbed in the proximal and distal small bowel and most commonly affects long-term travelers to tropical areas, as the name implies. The incidence of tropical sprue appears to have declined dramatically over the past 2 decades. Diagnosed only rarely in travelers, its cause is unknown.

Brainerd diarrhea is a syndrome of acute onset of watery diarrhea lasting ≥4 weeks. Symptoms include 10–20 episodes of explosive, watery diarrhea per day, fecal incontinence, abdominal cramping, gas, and fatigue. Nausea, vomiting, and fever are rare. Although the cause is believed to be infectious, a culprit pathogen has yet to be identified, and antimicrobial therapy is ineffective as treatment. Investigation of an outbreak of Brainerd diarrhea among passengers on a cruise ship to the Galápagos Islands in 1992 identified that individuals with persistent diarrhea (range: 7 to >42 months) were more likely to have consumed contaminated water or eaten raw fruits or vegetables washed with contaminated water.

Underlying Gastrointestinal Disease

Celiac Disease

In some cases, persistent symptoms relate to chronic underlying GI disease or to a susceptibility unmasked by the enteric infection. Most prominent among these is celiac disease, a systemic disease manifesting primarily with small bowel changes. In genetically susceptible people, exposure to antigens found in wheat causes villous atrophy, crypt hyperplasia, and malabsorption. Serologic tests, including tissue transglutaminase antibody testing, support the diagnosis; a small bowel biopsy showing villous atrophy confirms the diagnosis. Patients can be treated with a gluten-free diet.

Colorectal Cancer

Depending on the clinical setting and age group, clinicians might need to conduct a comprehensive search for other underlying causes of chronic diarrhea. Consider colorectal cancer in the differential diagnosis of patients passing occult or gross blood rectally or in patients with new-onset iron-deficiency anemia.

Inflammatory Bowel Disease

Idiopathic inflammatory bowel disease, including Crohn’s disease, microscopic colitis, and ulcerative colitis, can occur after acute bouts of TD. One prevailing hypothesis is that in genetically susceptible people, an initiating exogenous pathogen changes the microbiota of the gut, thereby triggering inflammatory bowel disease.

Postinfectious Phenomena

In a certain percentage of patients who present with persistent GI symptoms, clinicians will not find a specific cause. After an acute diarrheal infection, patients might experience a temporary enteropathy characterized by villous atrophy, decreased absorptive surface area, and disaccharidase deficiencies, which can lead to osmotic diarrhea, particularly after consuming large amounts of fructose, lactose, sorbitol, or sucrose. Use of antimicrobial medications during the initial days of diarrhea might also lead to alterations in intestinal flora and diarrhea symptoms.

Occasionally, onset of irritable bowel syndrome (IBS) symptoms occurs after a bout of acute gastroenteritis, known as postinfectious IBS (PI-IBS). PI-IBS symptoms can occur after an episode of gastroenteritis or TD. The clinical work-up for microbial pathogens and underlying GI disease in patients with PI-IBS will be negative. Whether using antibiotics to treat acute TD increases or decreases the likelihood of PI-IBS is unknown.

Evaluation

Traditional methods of microbial diagnosis rely on the use of microscopy. Examine stool specimens collected over 3 or more days for ova and parasites; include acid-fast staining for Cryptosporidium, Cyclospora, and Cystoisospora. Giardia antigen testing and a C. difficile toxin assay are appropriate elements of a work-up. In addition, a D-xylose absorption test can determine whether patients are properly absorbing nutrients. If underlying gastrointestinal disease is suspected, include serologic testing for celiac disease and consider inflammatory bowel disease during initial evaluation. Subsequently, studies to visualize both the upper and lower gastrointestinal tracts, with biopsies, might be indicated.

Diagnostic tests to determine specific microbial etiologies in cases of persistent diarrhea have advanced in the past number of years. One of the most useful tools is high-throughput multiplex DNA extraction PCR. This technology uses a single stool specimen to detect multiple bacterial, parasitic, and viral enteropathogens simultaneously. Except for Cryptosporidium, these assays have high sensitivity and specificity; the clinical ramifications and the economic impact of using these diagnostic molecular panels have not been determined fully, however. In some cases, molecular testing detects colonization rather than infection, making it difficult for clinicians to interpret and apply the results properly.

Management

Specific treatment of identified enteropathogens is usually indicated, and appropriate management of underlying gastrointestinal disease warranted (e.g., a gluten-free diet for celiac disease, medication for inflammatory bowel disease). Dietary modifications might help patients with malabsorption. Symptomatic treatment or the use of nonabsorbable antibiotics offer potential benefit if small intestinal bacterial overgrowth accompanies the symptom complex. Additionally, chronic diarrhea might cause fluid and electrolyte imbalances requiring medical management involving oral or intravenous replacement based on clinical presentation.

The following authors contributed to the previous version of this chapter: Bradley A. Connor

Connor BA. Sequelae of traveler’s diarrhea: focus on postinfectious irritable bowel syndrome. Clin Infect Dis. 2005;41(Suppl 8):S577–86.

Connor BA. Chronic diarrhea in travelers. Curr Infect Dis Rep. 2013;15(3):203–10.

Connor BA, Rogova M, Whyte O. Use of a multiplex DNA extraction PCR in the identification of pathogens in travelers’ diarrhea. J Trav Med. 2018;25(1):tax087.

Duplessis CA, Gutierrez RL, Porter CK. Review: chronic and persistent diarrhea with a focus in the returning traveler. Trop Dis Travel Med Vaccines. 2017;3(9):1–17.

Hanevik K, Dizdar V, Langeland N, Hausken T. Development of functional gastrointestinal disorders after Giardia lamblia infection. BMC Gastroenterol. 2009;9:27.

Libman MD, Gyorkos TW, Kokoskin E, Maclean JD. Detection of pathogenic protozoa in the diagnostic laboratory: result reproducibility, specimen pooling, and competency assessment. J Clin Microbiol. 2008;76(7):2200–5.

Mintz ED, Weber JT, Guris D, Puhr N, Wells JG, Yashuk JC, et al. An outbreak of Brainerd diarrhea among travelers to the Galapagos Islands. J Infect Dis. 1998;177(4):1041–5.

Norman FF, Perez-Molina J, Perez de Ayala A, Jimenez BC, Navarro M, Lopez-Velez R. Clostridium difficile–associated diarrhea after antibiotic treatment for traveler’s diarrhea. Clin Infect Dis. 2008;46(7):1060–3.

Porter CK, Tribble DR, Aliaga PA, Halvorson HA, Riddle MS. Infectious gastroenteritis and risk of developing inflammatory bowel disease. Gastroenterology. 2008;135(3):781–6.

Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology. 2009;136:1979–88.

Diarrhea during pregnancy. What is Diarrhea During Pregnancy?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Diarrhea during pregnancy is a pathological condition during gestation, characterized by the rapid release of unformed feces. Disorder of the stool can proceed painlessly or be accompanied by belching, nausea, vomiting, discomfort in the mouth, abdominal pain, imperative urge to defecate, fever, weight loss, weakness, fatigue. To determine the cause of diarrhea, clinical, bacteriological, biochemical studies of feces, blood, probing, sigmoidoscopy are carried out. Treatment is most often conservative – medications, dietary adjustments.

ICD-10

K59.1 A09.0

• Causes
• Pathogenesis
• Classification
• Symptoms
• Complications
• Diagnostics
• Treatment
• Prognosis and prevention
• Prices for treatment

General

Diarrhea (diarrhea) – an increase in the frequency of bowel movements up to four or more times a day with the separation of liquid or mushy stools, the volume of which exceeds 200-300 ml. Diarrhea is not a separate disease, but one of the manifestations of a violation of the functions or anatomical structure of any organ or body system. Sometimes diarrhea is the first symptom of a pathology that can complicate gestation. The frequency of diarrhea in obstetrics is 34%. Diarrhea is recorded less frequently than constipation, it is more susceptible to age-related (after 35 years), as well as young (under 19years) mother. Usually there are forms with a mild course, ending in a quick recovery. Severe forms pose a serious threat to the life of the mother and fetus. Inpatient treatment with intensive care is necessary for 1.5% of pregnant women suffering from diarrhea.

diarrhea during pregnancy

Causes

Most often, diarrhea during pregnancy is caused by physiological (that occurred during gestation, associated with this condition, which is a variant of the norm during this period) changes in the digestive, endocrine, and nervous systems. Another common reason is dietary errors. Diarrhea is manifested by diseases that developed during gestation in women whose body could not adapt to increased stress, and that arose before conception. There are the following sources of intestinal upset in pregnant women:

• Non-communicable diseases of the digestive system. Diarrhea may be accompanied by a physiological decrease in gastric secretion during gestation, as well as pathologies: dysbiosis, cholestatic hepatosis of pregnant women, hypoacid gastritis, less often – ulcerative colitis, Crohn’s disease, chronic pancreatitis, tumors.
• Features of the diet. Diarrhea can lead to addiction to coffee, excessive consumption of fatty (including nuts), spicy, spicy foods, sweets, pastries, as well as foods containing a large amount of fiber (fruits, vegetables, cereals). In addition, diarrhea may be accompanied by hypovitaminosis of pregnant women, which occurs due to an imbalance or scarcity of the diet.
• Food intolerance. The cause of diarrhea can be a food idiosyncrasy associated with a lack of enzyme production (for example, lactulose with intolerance to whole milk) or an allergic reaction (more often to citrus fruits, berries, cereals, eggs, chocolate, legumes). At the same time, hypersensitization often develops for the first time during the gestational period.
• Neurogenic factors. By the last trimester of pregnancy, the processes of excitation of the cerebral cortex begin to prevail over the mechanisms of inhibition, which increases the likelihood of developing irritable bowel syndrome. Other causes of neurogenic diarrhea are prolonged psycho-emotional stress, neuropathy.
• Infections and infestations. Diarrhea is caused by acute intestinal infections – bacterial, viral, protozoal, affecting the digestive tract. Nonspecific infections may be the result of the growth of opportunistic flora against the background of a natural decrease in immune activity during pregnancy. The flu is often accompanied by diarrhea. Of the helminths, roundworms are most often involved in diarrhea.
• Taking medications. Iron preparations, magnesium salts, antibiotics, antacids, sugar substitutes, antidiabetic, laxatives, dietary supplements cause diarrhea, using various mechanisms of gastrointestinal dysfunction.

Other, more rare causes of diarrhea in pregnant women include metabolic endocrine diseases (diabetes mellitus, hyperthyroidism, amyloidosis), surgical pathologies (acute appendicitis, intestinal obstruction, mesenteric vascular embolism). False diarrhea is sometimes accompanied by persistent constipation, which is often observed in pregnant women: a prolonged stay of feces leads to irritation of the colon wall, increased secretion of mucus, and the release of liquid stools.

Pathogenesis

About nine liters of fluid enter the intestinal lumen daily, 22% of which is water obtained from food, the rest is formed as a result of the secretion of the digestive organs. About 89% of this liquid is absorbed by the small intestine, about 10% – by the large intestine, only 1.1% (about 100 ml) is excreted in the feces. Diarrhea occurs with increased fluid intake (mostly due to excess intestinal secretion) or as a result of a decrease in absorption capacity. Hypersecretion of the small intestine is associated with infection by pathogenic microorganisms, the use of irritant laxatives. The secretion of the lower intestine is most often increased due to a decrease in the absorption of bile acids.

Enzymatic insufficiency and acceleration of the passage of contents leads to a disorder in the absorption capacity of the small intestine. At the same time, unabsorbed substances accumulate in its lumen, retaining water due to their osmotic action. Reduced absorption in the lower sections is a consequence of increased fluid intake from the ileum, damage to the epithelium, impaired motility of the colon, and a lack of bacteria that ferment carbohydrates. As a result of severe diarrhea, hypovolemia, acidosis, deficiency of nutrients, vitamins, microelements develop. Irritation of the colon leads to a reflex increase in the tone of the pregnant uterus, and the release of active substances associated with inflammation into the blood enhances the effect.

Classification

According to the form of the flow, acute and chronic diarrhea are distinguished. The acute form is characterized by vivid symptoms observed for no more than 3 weeks. The chronic course is characterized by a longer duration of manifestations and less pronounced symptoms. According to the pathogenetic mechanism that contributed to the development of the disorder, four types of diarrhea are distinguished:

• Secretory. This type of diarrhea develops with an increase in the secretion of fluid and electrolytes in the intestine due to damage by pathogenic microorganisms, their toxins, as well as an excess of bile acids.
• Hyperosmolar. It occurs due to the influx of water during the accumulation in the intestine of osmotically active substances (potassium and sodium ions, glucose) as a result of impaired digestion and absorption (with chronic pancreatitis, dysbiosis, enteritis, food intolerance, amyloidosis, obstruction of the biliary tract), intake of excessively salty or sweet food .
• Hyperexudative. Diarrheal syndrome is caused by sweating of exudate through the damaged mucosa in autoimmune, neoplastic diseases of the intestine, some infections (dysentery, salmonellosis, intestinal tuberculosis, campylobacteriosis).
• Motor (dyskinetic). The cause of diarrhea is an increase or decrease in the rate of chyme transit due to impaired intestinal motility. Hyperkinetic diarrhea is accompanied by nervous shocks, neuroses, neuropathies, hyperthyroidism, taking laxatives. The hypokinetic type is associated with small bowel obstruction.

Symptoms

Symptoms of diarrhea during pregnancy depend on the causes of diarrhea, its type, localization of the lesion, intensity of manifestation. Enteritis is manifested by abundant voluminous loose stools without impurities, bowel emptying is often “explosive” in nature. Colitis is characterized by sharp tenesmus (frequency up to 30 times a day), increased defecation with scanty mucous discharge, often mixed with pus and blood. A significant increase in stool in acute diarrhea leads to a rapid decline in strength, severe weakness. Chronic diarrhea is characterized by fatigue, weight loss.

Secretory diarrhea is characterized by abundant light watery or frothy stools without severe abdominal pain, the disorder does not depend on diet, and is not stopped by fasting. Osmolar diarrhea is manifested by an abundant separation of feces containing particles of undigested food: light, pasty in case of pathologies of the hepatobiliary system and gray, with a rancid odor in case of pancreatic insufficiency; diarrhea usually resolves after fasting. The exudative type is characterized by an admixture of blood and pus in the feces. A distinctive feature of hyperkinetic diarrhea is a slight increase in the daily volume of liquefied yellow or greenish stools. With diarrhea caused by decreased motor function, mucus is usually present in the stool.

Diarrhea may be accompanied by other pathological manifestations. Fever accompanies infectious and autoimmune enterocolitis. Tachycardia, sweating is accompanied by a significant loss of water and electrolytes, hyperthyroidism, irritable bowel syndrome. The latter also proceeds with alternating diarrhea with constipation, epigastric discomfort; there may be intense pain, simulating a picture of an acute abdomen, characteristic of surgical pathologies. Epigastric discomfort is also observed with diarrhea associated with the pathology of the liver, pancreas, dysbiosis. Cholestatic diarrhea is accompanied by jaundice, and caused by autoimmune colitis, amyloidosis – inflammation of the joints. With diarrhea associated with Addison’s disease, diabetes mellitus, skin pigmentation disorders are observed.

Complications

The most common and dangerous complication of diarrhea is miscarriage. In 30-44% of cases, the cause of spontaneous abortion is gastrointestinal diseases that occur with diarrhea. Severe diarrhea with a large loss of fluid poses a threat to the life of the patient due to the development of collapse and shock, often leading to death. For the mother and the unborn child, it is also not the intestinal disorder itself that can be dangerous, but its causes. So, the result of an intestinal infection can be purulent-inflammatory gynecological complications (the most formidable is obstetric sepsis) in a woman and intrauterine infection with the development of fetal pathology in the fetus.

Diagnostics

Diagnostic search is aimed at finding out the causes of diarrhea (alimentary factors, internal diseases, endocrine, neurological or obstetric pathology). Most often, to establish the root cause, it is enough to consult a therapist and an obstetrician-gynecologist: differential diagnosis is carried out on the basis of anamnesis data (information on the frequency and volume of defecation, the nature of the stool, dietary characteristics, the presence of general somatic diseases) and the results of an objective examination (identification and evaluation of concomitant symptoms). To clarify the diagnosis, narrow specialists (gastroenterologist, infectologist, endocrinologist) are involved and instrumental and laboratory research methods are used:

• Fecal analysis. Bacterial culture allows you to identify the pathogen in case of infection and choose an antibiotic for its treatment. According to the results of the coprogram, it is possible to confirm or exclude functional pathologies of the stomach, digestive glands, intestines, and also to suspect a violation of the integrity of the mucous membranes (by occult blood). A positive test result for helminth eggs indicates a helminthic invasion.
• Blood tests. Based on the results of the general clinical analysis, it is possible to establish the inflammatory, allergic nature of diarrhea, suggest malabsorption or malignancy. Biochemical research allows to reveal pathologies of the hepatobiliary system, pancreas, diabetes mellitus.
• Endoscopy. Sigmoidoscopy is performed to detect colitis, tumor changes. With the help of gastric and duodenal sounding, it is possible to detect a decrease in the pH of gastric juice, an increase in the concentration of bile acids, and violations of the exogenous function of the pancreas.

Treatment

Treatment of diarrhea during pregnancy is carried out under the supervision of an obstetrician-gynecologist. In mild cases, symptomatic and etiotropic therapy is prescribed, aimed at eliminating intoxication and correcting the water-salt balance: enterosorbents, oral rehydration solutions. Particular attention is paid to the diet: food should not irritate the mucous membranes of the gastrointestinal tract, increase peristalsis, or cause fermentation. Fresh pastries, cabbage, legumes, onions, garlic, spices, seasonings, strong broths, fried and stewed foods, carbonated drinks are excluded from the diet. With severe dehydration, intensive therapy is used. Specific treatment is prescribed for chronic, severe acute diarrhea and is selected depending on the underlying disease.

Prognosis and prevention

The prognosis depends on the cause of the intestinal disorder. With alimentary diarrhea, neurogenic diarrhea, easily occurring infections, recovery occurs quickly, complications do not develop. With advanced, progressive pathologies manifested by chronic diarrhea, severe infections, the prognosis worsens, especially for the fetus. Preventive measures include the detection and treatment of chronic internal diseases before pregnancy, regular visits to the antenatal clinic during the gestational period, hygiene, eating fresh, optimally balanced in vitamins, macro- and micronutrients food, avoiding uncontrolled intake of drugs, herbs, dietary supplements, fight against constipation.

You can share your medical history, what worked for you in the treatment of diarrhea during pregnancy.

Sources

1. Acute diarrhea in obstetric practice / Uspenskaya Yu.B. – 2014.
2. Differential diagnosis of internal diseases / Hagglin R. – 1993.
3. Difficult diagnosis: in 2 volumes / Taylor R.B. – 1991 – T1.
4. This article was prepared based on the site: https://www.krasotaimedicina.ru/

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Viral diarrhea

Causes of viral diarrhea. The fact that viruses can cause diarrhea began to be said as early as the thirties of the last century based on descriptions of outbreaks of diarrhea among children, it was suggested that it was viruses that cause diarrhea, and these diarrheas began to be called “intestinal flu”, “epidemic diarrhea”, viral dysentery or winter diarrhea. To date, enough evidence has been accumulated that viruses can provoke diarrhea and digestive disorders in children and adults. As the cause of the development of viral diarrhea, enterovirus, rotavirus and reovirus etiologies of the disease are considered today. Viral diarrhea is widespread all over the world; up to millions of children and adults are ill with it every year; they can occur both in isolated cases and epidemic outbreaks, mainly among young children or among closed organized groups. Characteristics of viruses One of the most characteristic features of viruses that can cause digestive disorders and diarrhea is their relative stability in the external environment, as well as their good ability to survive at low temperatures in water and air. They survive at 20°C water for more than 2 weeks, and at 10°C – up to several months. Many viruses are indifferent to the acidic environment of the stomach, they calmly pass it without being destroyed. Viruses are stored in open water bodies and reservoirs, seas and rivers, and from there they can enter drinking water sources. Also, viruses are excreted from the body of the affected with feces, where they remain for a long time, and can pollute the environment and water of reservoirs. How can you get infected? – Sources of infection for any viral diarrhea can be people who are ill, or recovering, releasing viruses into the environment, or carriers of the virus, not themselves ill, but releasing viruses. With some of the viral diarrhea, the actual route of infection may be the transmission of infection from domestic animals and cattle, such viruses, depending on the method of entry into the body, can give different symptoms – with airborne infection, a cold infection clinic with damage to the respiratory system, and with ingestion by the fecal-oral route – damage to the digestive system. The source of viruses in viral diarrhea can be food and water contaminated with viruses, things and toys of children that they pull into their mouths, rotaviruses can be isolated from tap water that children did not boil and drink.
The portal of entry for diarrheal viral infections is the mouth and gastrointestinal tract.

The mechanism of development of viral diarrhea – viruses enter the epithelium in the upper respiratory tract, and are swallowed with saliva, penetrating into the stomach and intestines. There, the cells of the epithelium of the stomach, intestines are damaged, and viruses begin to multiply on the epithelium of enterocytes, intestinal cells, they penetrate into the blood, causing manifestations of general toxicosis and fever, and can affect individual organs and systems – nervous, pulmonary, liver. Ideal conditions for the reproduction of intestinal viruses are the duodenum and small intestine, the formation of profuse and frequent diarrhea occurs. The absorption of water by the cells is disturbed, a fermentation reaction occurs due to problems with the breakdown of food, this gives the symptoms of diarrhea in the complex (diarrhea is plentiful, watery, without impurities of blood and greenery).


The manifestations of viral diarrhea depend on which virus and at what age the diarrhea is caused. With enteroviral diarrhea, children under 2 years of age are affected, it can be either only diarrhea or its combination with muscle damage, meningitis, tonsillitis or myocarditis. Isolated forms of enterovirus give mild, not prolonged diarrhea, pass on their own. Only enteroviruses with diarrheal syndrome in newborns and debilitated children are dangerous. With diarrhea caused by the Coxsackie virus, there may be a different clinical picture, depending on the age of the child (mild diarrhea in children from 2 to 5 years old with virtually no fever and toxicosis, with paroxysmal abdominal pain and loose stools up to 3-10 times a day without impurities) . After 1-2 days, the condition returns to normal.

Sometimes the disease occurs with fever, colds, abdominal pain, loose stools and repeated vomiting, fever lasts up to 3 days, and diarrhea for the first 2-3 days. Coxsackie viruses are severe in the first 2 years of life, treatment is only in a hospital. Viral damage to ECHO-etiology occurs at any age, is not severe, usually manifesting itself in the form of gastritis and enteritis, while intestinal dysfunctions are minor and not long-lasting (nausea, vomiting, frequent stools within 1-2 days, loss of appetite, low temperature , stool liquefied, without impurities, 5-6 times a day). In infancy or in children during the neonatal period, viral diseases can be severe, but usually they begin as colds, and intestinal symptoms occur later (repeated regurgitation, vomiting, bloating, stool thinning). Due to fluid loss, toxicosis develops with exicosis, dehydration, and the severity of the condition increases.

Respiratory infections with intestinal syndrome
Intestinal disorders may be one of the symptoms of acute respiratory viral infections, initially starting as a cold. Intestinal disorders in them arise as a result of toxic effects on the intestine, enzyme disorders, the addition of microbial flora against the background of weakened immunity, the formation of dysbacteriosis. In such cases, as such, there can no longer be viral diarrhea, but they say toga about SARS with intestinal manifestations.

The peculiarity of viral diarrhea – disorders of the intestines, in which the small intestine is involved in the process of damage, the course proceeds according to the type of gastroenteritis or enteritis (with or without vomiting). With viral diarrhea in the blood of children – lymphocytosis and leukopenia, there is no pronounced inflammation of the walls of the intestine (colon), diarrhea occurs without impurities (mucus, blood, greens, there are no leukocytes and erythrocytes in the coprogram). Stool with particles of undigested food, fatty from problems with the pancreas, copious. Viral diarrhea does not proceed for a long time, does not give a severe course and disturbs the microbial balance. Rotavirus diarrhea can be. quite severe (in early childhood), therefore, today, active prevention methods and vaccines are being developed for viral diarrhea.