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Diarrhea


Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
 
Following Up
Special Considerations
Supporting Research

Diarrhea is an increase in the wateriness, volume, or frequency of bowel movements. When you have diarrhea, foods and fluid pass too quickly -- or in too large an amount through your colon -- and your body doesn't absorb the fluid. Almost everyone has an episode of diarrhea at some time. Acute diarrhea is uncomfortable, but usually is not serious and will go away in a few days on its own. You should see a doctor, however, if your stool contains blood, if the diarrhea is severe, or if it lasts more than a few days. Children and elderly people are at higher risk of dehydration and should see their doctor sooner.

Signs and Symptoms

Diarrhea is a symptom of another health issue, such as an infection or a virus. Chronic diarrhea -- lasting longer than 4 weeks -- can be a sign of a serious illness, such as inflammatory bowel disease.

Symptoms may include:

  • Frequent and loose stools
  • Abdominal pain, cramping
  • Fever, chills, general sick feeling
  • Thirst
  • Weight loss

If your child has diarrhea, call your pediatrician if it lasts more than 24 hours or if your child seems dehydrated. For an infant, that could mean having a dry diaper for several hours or crying without tears.

What Causes It?

Most diarrhea is caused by bacteria, parasites, or viruses, often from food or water. Eating local food and drinking local water during travel can result in "traveler's diarrhea." Diarrhea can also be caused by reactions to medications (including some vitamins, minerals, and herbs) and artificial sweeteners (such as sorbitol and mannitol). People who are lactose-intolerant can get diarrhea when they consume milk or dairy products. Diarrhea that results in blood in the stool, accompanied by fever or abdominal pain, could be caused by intestinal disorders such as inflammatory bowel disease or Crohn's disease, and requires a doctor's care.

What to Expect at Your Provider's Office

Your doctor will ask questions about your symptoms. Your doctor will also check to see if you are dehydrated and may feel your abdomen to see if it is tender and listen to your abdomen with a stethoscope. Sometimes you may be asked for a blood or stool sample to check for an infection.

Treatment Options

Drug Therapies

In many cases, diarrhea will go away on its own. However, in severe cases your doctor may prescribe diphenoxylate and atropine (Lomotil). Your doctor also may prescribe antibiotics if the diarrhea is due to a bacterial infection.

Over the Counter

Since diarrhea is your body's way of getting rid of toxins, it's best to let it run its course. However, you may use over the counter antidiarrheal remedies for convenience, including loperamide (Imodium), bismuth sub-salicylate (Pepto-Bismol), and attapulgite (Kaopectate). Do not take bismuth sub-salicylate with the herbs meadowsweet (Spirea ulmaria), white willow (Salix alba), or wintergreen (Gaultheria procumbens).

Complementary and Alternative Therapies

Work with your health care provider to find remedies that are right for you.

Nutrition and Supplements

  • Rice or barley water, fresh vegetable juices (especially carrot and celery), miso broth, or other clear broths help restore proper fluid and electrolyte balance. Make rice and barley water using 1 cup of raw grain to 1 quart of boiling water. Let steep for 20 minutes. Strain and drink throughout the day.
  • Probiotics -- Lactobacillus GG, acidophilus, or bifidobacteria, taken as powder or in capsules -- help maintain the "good" bacteria in your intestines. They may help alleviate diarrhea, although scientific evidence is mixed. Active culture yogurt containing these probiotics may help prevent diarrhea. People who are severely immunocompromosed or on immune-suppressive drugs should speak with their doctor before taking probiotics.
  • A live yeast, Saccharomyces boulardii, is often used in Europe to prevent diarrhea associated with taking antibiotics. Take 1 - 3 capsules per day (3 - 9 billion colony forming units). May be taken with other probiotics. Rare but serious cases of infection in seriously ill patients have been reported, so do not take Saccraromyces boulardii without a doctor's supervision.
  • Bovine colostrum, the pre-milk fluid secreted by a cow's mammary glands just after giving birth, may help treat some kinds of infectious diarrhea (1,000 - 4,000 mg per day)
  • Glutamine (3,000 mg 3 times per day) may help treat diarrhea caused by irritation of the intestinal lining. High doses of glutamine can potentially cause mania in susceptible individuals. Glutamine can interfere with certain medications, including some anti-seizure medications and some chemotherapy agents.
  • If you are lactose intolerant, take over the counter lactase enzyme supplements before consuming dairy products.
  • Zinc (10 - 20 mg per day) may help improve immune and mucosal barrier functions.

Herbs

Do not use herbs to treat diarrhea without talking to your health care provider first, and always talk to your doctor before treating diarrhea in an infant. If your diarrhea is caused by certain types of infections, herbal treatments could make it worse. The most common herbal remedies for diarrhea are described below. They can be used as teas unless otherwise noted. Make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. Always tell your doctor about any herbs you may be taking.

Astringent herbs:

  • Astringent herbs, such as blackberry leaf (Rubus fruticosus) or raspberry leaf (Rubus idaeus), help "dry up" the mucous membranes in the intestine. Make a tea with 1 heaping tsp. per cup. Drink a ½ cup per hour.
  • Carob powder (Ceratonia siliqua), which is rich in fiber, may be dissolved into a hydrating solution such as Pedialyte.
  • Extract of bilberry (Vaccinum myrtillus) also has astringent properties (4 g, spread over several doses). Do not take bilberry if you take anticoagulants (blood thinners). Bilberry can also potentially interact with diabetes medications.
  • Agrimony (Agrimonia eupatorium) is a traditional remedy for diarrhea. Usual dosage is 3 g (about 1/2 tsp.) per day. Agrimony can have a blood thinning effect and can lower blood pressure; speak with your doctor before taking agrimony if you are dealing with these health issues.

Inflammation reducers:

  • Quercetin (250 - 500 mg 2 - 4 times per day), a plant based flavonoid, may help to reduce inflammation.
  • Chamomile (Matricaria recutita) is usually taken as a tea. Dissolve 3 - 4 g powder (about 3 tsp.) in 1 cup hot water, strain and cool. Drink 3 times per day. Chamomile can interfere with hormonal medications and can cause reactions in people allergic to ragweed.
  • Marshmallow root (Althea officinalis) can be taken as cold-water tea. Soak 2 tbs. root in 1 quart of water overnight. Strain. Drink throughout the day. Marshmallow can interfere with som medications taken by mouth, including lithium.
  • Slippery elm powder (Ulmus fulva) or marshmallow root powder (Althaea officinalis) can be soothing to the intestines. Use 1 oz. powder to 1 quart of water. Make a paste with the powder and a small amount of water. Gradually add in the rest of the water and then simmer down to 1 pint. Take 1 tsp. every 30 - 60 minutes. Slippery elm has a folk reputation of promoting miscarriage; it can also interfere with some medications.

Infection fighters:

  • Plants containing berberine may help treat infectious diarrhea. These include barberry (Berberis vulgaris), goldenseal (Hydrastis canadensis), and Oregon grape (Berberis aquifolium). Do not take berberine if you are pregnant or breastfeeding. Check with your doctor first if you are taking any prescription medicines.

Bulk forming agent:

  • Psyllium, a soluble fiber that comes from the husks of the seeds of a plant called Plantago ovata, may help treat diarrhea. It is a bulk forming agent that soaks up water in the colon, helping to firm stool. You will need to take psyllium with a large amount of water.

Homeopathy

Some evidence suggests that homeopathic treatment may help diarrhea. In one study, children with acute diarrhea who received an individualized homeopathic treatment for 5 days had diarrhea for significantly less time than children who had placebo. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the most effective homeopathic remedies include:

  • Arsenicum album -- for foul smelling diarrhea from food poisoning or traveler's diarrhea with burning sensation in the abdomen and around the anus. This remedy is most appropriate for individuals who feel exhausted yet restless and whose symptoms tend to worsen in the cold and improve with warmth. Vomiting may also occur. You may also use arsenicum to prevent diarrhea when traveling.
  • Chamomilla -- for greenish, frothy stool that smells like rotten eggs. Used primarily for children, especially those who are irritable, argumentative, and difficult to console. Chamomilla is commonly recommended for colicky or teething infants.
  • Calcarea carbonica -- for children who fear being in the dark or alone and who perspire heavily while sleeping. Stools may have a sour odor.
  • Mercurius -- for foul smelling diarrhea that may have streaks of blood accompanied by a sensation of incomplete emptying. This remedy is most appropriate for people who tend to feel exhausted following bowel movements, experience extreme changes in body temperatures, perspire heavily, and have a thirst for cold fluids.
  • Podophyllum -- for explosive, gushing, painless diarrhea that becomes worse after eating or drinking. Exhaustion often follows bowel movements and the individual for whom this remedy is appropriate may experience painful cramps in lower extremities. Podophyllum is often used in infants for diarrhea experienced from teething.
  • Sulphur -- for irritable and weepy children. They may have a red ring around the anus and diarrhea with the odor of rotten eggs.
  • Veratrum album -- for profuse, watery diarrhea accompanied by stomach cramps, bloated abdomen, vomiting, exhaustion, and chills. The diarrhea is worsened by fruit, and the individual craves cold liquids.

Acupuncture

Although several studies in Traditional Chinese Medicine journals have reported success in treating childhood diarrhea, acupuncturists in the United States do not generally treat this condition in children. However, acupuncture may be used when conventional treatment has failed. In this case, acupuncturists would look at both the nutritional value and the "energetic" qualities of food that might be affecting digestion.

Acupuncture is also combined with conventional medicine in treating diarrhea in adults.

Acupuncturists treat people with diarrhea based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of diarrhea, a qi deficiency is usually detected in the spleen meridian. As a result, acupuncture treatments often focus on strengthening this meridian. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is often used because it is thought to reach deeper into the body than needling alone.

Following Up

If your diarrhea does not stop in 3 - 5 days, or if you become dehydrated, call your doctor.

Special Considerations

If you are pregnant, tell your doctor. Dehydration can trigger early labor. Also, the diarrhea related spasms may cause you to have contractions. Do not take goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), or high doses of vitamin A if you are pregnant.

Diarrhea can be serious, even fatal, for infants and elderly people because of dehydration and the loss of electrolytes.

Supporting Research

Chen CC, Walker WA. Clinical applications of probiotics in gastrointestinal disorders in children. [Review]. Natl Med J India. 2011;24(3):153-60.

Choi CH, Jo SY, Park HJ, Chang SK, Byeon JS, Myung SJ. A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life. J Clin Gastroenterol. 2011;45(8):679-83.

Eren M, Dinleyici EC, Vandenplas Y. Clinical efficacy comparison of Saccharomyces boulardii and yogurt fluid in acute non-bloody diarrhea in children: a randomized, controlled, open label study. Am J Trop Med Hyg. 2010;82(3):488-91.

Feldman. Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 8th ed. Philiadelphia, PA: Saunders, An Imprint of Elsevier; 2006.

Grandy G, Medina M, Soria R, Terán CG, Araya M. Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children. BMC Infect Dis. 2010;10:253.

Guandalini S. Probiotics for children with diarrhea: an update. J Clin Gastroenterol. 2008; 42 Suppl 2:S53-7.

Jacobs J, Jiménez M, Malthouse S, Chapman E, Crothers D, Masuk M, Jonas WB. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med. 2000;6(2):131-139.

Jones K. Probiotics: preventing antibiotic-associated diarrhea. J Spec Pediatr Nurs. 2010;15(2):160-2. 

Lukacik M, Thomas RL, Aranda JV. A meta-analysis of the effects of oral zinc in the treatment of acute and presistent diarrhea. Pediatrics. 2008;121(2):326-36.

McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006;101:812-22.

McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. [Review]. World J Gastroenterol. 2010;16(18):2202-22.

Otto W, Najnigier B, Stelmasiak T, Robins-Browne RM. Randomized control trials using a tablet formulation of hyperimmune bovine colostrum to prevent diarrhea caused by enterotoxigenic Escherichia coli in volunteers. Scand J Gastroenterol. 2011;46(7-8):862-8.

Patel AV, Rojas-Vera J, Dacke CG. Therapeutic constitutents and actions of Rubus species. Curr Med Chem. 2004 Jun;11(11):1501-12.

Playford RJ, Macdonald CE, Johnson WS. Colostrum and milk-derived peptide growth factors for the treatment of gastrointestinal disorders. Am J ClinNutr. 2000;72:5-14.

Rohde Cl, Bartolini V, Jones N. The use of probiotics in the prevention and treatment of antibiotic-associated diarrhea with special interest in Clostridium difficile-associated diarrhea. Nutr Clin Pract. 2009; 24(1):33-40.

Saavedra J. Probiotics and infectious diarrhea. Am J Gastroenterol. 2000;95:S16-18.

Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med. 2003;163(3):265-74.

Thomas DW, Greer FR; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Probiotics and prebiotics in pediatrics. [Review]. Pediatrics. 2010;126(6):1217-31.

Thomas MR, Litin SC, Osmon DR, et al. Lack of effect of Lactobacillus GG on antibiotic-associated diarrhea: a randomized, placebo-controlled trial. Mayo Clin Proc. 2001;76:883-9.

Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002;109:678-84.

Zhang HY, Lu SF, Xiao N. Effect of warming moxibustion on Shenque acupoint for the treatment of acute diarrhea in children with infantile cerebral palsy. Chin J Integr Med. 2009;15(6):454-7.


Review Date: 3/2/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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