Diarrhea is a common problem. It is characterized by stools of liquid or soft consistency, larger and more numerous than usual (more than 3 stools per day).
But what are its causes and complications?
Diarrhea: what is it?
This is not a disease, but a symptom of colitis. Its most common cause is the ingestion of contaminated water or food. It lasts 1 or 2 days, then disappears without requiring treatment.
Throughout its duration, it is necessary to hydrate well, because the body can lose a lot of water and mineral salts through the stool.
This measure is particularly important for children and the elderly, for whom dehydration can have more serious consequences. Indeed, after only 1 or 2 days of diarrhea, young children can be very severely dehydrated.
In industrialized countries, it is very rare for diarrhea to cause death. Nevertheless, in underdeveloped countries, it is the second leading cause of death among children under 51.
What is digestion?
Digestion is a biological process in which food is broken down and transformed into nutrients .
Digestion begins in the mouth, where food is crushed and mixed with saliva, then continues in the stomach, which secretes acidic digestive juices and continues to grind food for a few hours.
Upon exiting the stomach, predigested food (called chyme) continues to be broken down in the small intestine by digestive juices from the pancreas and gallbladder. Transformed into nutrients, they can then cross the semi-permeable membrane of the intestine and be absorbed by the blood and the lymph. From there, they can circulate in the body and be used according to the needs of the organism. What hasn’t been absorbed is turned into fecal matter in the colon.
An adult drinks about 2 liters of liquid per day. Its digestive system receives an additional 7 to 8 liters (saliva, digestive juices, bile, etc.). Thus, a total of 9 to 10 liters of fluid passes through the intestines daily.
Most of the water present in feces is extracted during passage through the intestines. The body absorbs or “recycles” about 99% of the water that passes through the digestive system. This system is finely tuned: all it takes is for this absorption rate to drop by 1% (due to infection, bowel disease, etc.) to trigger diarrhea.
The causes of diarrhea
Diarrhea is an intestinal problem that involves one or more of the following 3 mechanisms. Sometimes they are present simultaneously.
- a lack of absorption by the intestines of the liquid contained in the stool;
- an accelerated intestinal transit, which prevents the drying out of faeces;
- an abnormal passage of water and mineral salts from the body through the wall of the intestines.
Causes of diarrhea in intestinal diseases
When bowel disease is involved, the diarrhea is often chronic.
Here are the most common causes:
- food poisoning (for example, poultry infected with salmonella or meat contaminated with Escherichia coli bacteria);
- viral gastroenteritis;
- stress or anxiety;
- taking antibiotics: it alters the intestinal flora, and thus reduces the absorption capacity of the intestinal wall. Antibiotics cause diarrhea in 5-30% of users, depending on the type of antibiotic consumed;
- chronic intestinal disease: celiac disease (gluten intolerance), Crohn’s disease, irritable bowel syndrome, etc. ;
- lactose intolerance;
- hyperthyroidism.
Note that cholera can cause losses of 10 liters of diarrhea per day. However, it is very rare in industrialized countries.
La turista, traveler’s diarrhea
We colloquially call « tourista » all infectious diarrhea contracted during a trip.
Every year, 20-50% of travelers experience it. The destinations at risk are Latin America, Africa, the Middle East and Asia.
Ingestion of food or water contaminated with bacteria is the main cause. That said, when travelling, the stress of adventure, fatigue, jet lag and disrupted eating habits can also trigger diarrhea.
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Possible complications of diarrhea
Dehydration and all the problems it can cause are the main complications that can occur and that it is important to try to avoid.
In addition, people on antibiotic therapy may see their diarrhea worsen if they contract an infection with Clostridium difficile bacteria. This most often occurs in a hospital setting.
The C. difficile bacterium takes advantage of a weakening of the intestinal flora to grow in the intestines. It secretes 2 toxins (A and B) which cause significant diarrhea by accelerating intestinal transit and reducing the absorption of liquid in the intestines.
Thus, once antibiotic treatment is completed, if the diarrhea is severe or persists, a doctor should be consulted without delay.
Up to a third of antibiotic-associated diarrhea is caused by this bacterium: a small proportion of it gets worse.
When to consult for diarrhea?
See a doctor as soon as possible if any of the following signs appear:
- very profuse diarrhea (more than 10 stools per day) that persists for more than 48 hours;
- signs of dehydration, especially in a young child or an elderly person (see below);
- a fever of 38.5°C (101.5°F) or higher;
- blood in the stool;
- severe abdominal pain;
- chronic diarrhoea.
All individuals can be affected by diarrhea.
Discover the symptoms, people at risk and risk factors to understand everything about this disease.
Symptoms of diarrhea
There are several symptoms in case of diarrhea:
- loose or watery stools;
- more frequent urges to have a bowel movement;
- abdominal pain and cramps;
- bloating.
Signs of dehydration
- the thirst ;
- dry mouth and skin;
- less frequent urges to urinate, and darker urine than usual;
- irritability;
- muscle cramps;
- loss of appetite;
- physical weakness;
- sunken eyes;
- shock and fainting.
People at risk
All individuals can have diarrhea at one time or another.
Several situations can be the cause: see the list of causes above.
Risk factors for diarrhea
See the list of causes above.
In order to prevent diarrhea, there are basic preventive measures.
Do you suffer from infectious diarrhea, tourista or diarrhea related to taking antibiotics?
All the measures are detailed below, as are those to prevent complications from diarrhoea.
How to Prevent Diarrhea
infectious diarrhea
- washing your hands frequently with soap and water or with an alcohol-based gel is the surest way to prevent contagion (especially before eating, during food preparation and in the bathroom). bath) ;
- do not drink water from a source whose purity is unknown (boil the water for at least 1 minute or use an appropriate water filter);
- always keep perishable food in the refrigerator;
- avoid buffets where food stays at room temperature for a long time;
- monitor and respect the expiry date of food;
- isolate yourself or your child during the illness, since the virus is very contagious;
- for people at risk, consume preferably pasteurized dairy products. Pasteurization kills bacteria with heat.
Traveler’s diarrhea
- drink water, soft drinks or beer straight from the bottle. Drink tea and coffee prepared with boiled water;
- avoid ice cubes;
- sterilize water by boiling it for at least 5 minutes or by using filters or water purifiers;
- brush your teeth with bottled water;
- only eat fruit that you can peel yourself;
- avoid salads, raw or undercooked meat and dairy products.
Diarrhea associated with taking antibiotics
- take antibiotics only if absolutely necessary;
- scrupulously respect the indications given by the doctor as to the duration and dose of antibiotics.
Measures to prevent complications from diarrhea
Be sure to rehydrate well (see below).
In general, acute diarrhea resolves after 1 or 2 days with rest and some changes in diet. During this time, the diet should include only fluids to prevent dehydration, followed by a gradual intake of certain foods.
In the case of diarrhea associated with taking antibiotics, the symptoms usually stop within a few days of stopping the antibiotic therapy.
What are the medical treatments that can be put in place?
Prevent dehydration
Drink at least 1 to 2 liters of water, vegetable or lean meat broths, rice or barley water, clear teas or caffeine-free sodas each day.
Avoid alcohol and drinks that contain caffeine, which have the effect of increasing the loss of water and mineral salts.
Also, avoid drinking several glasses of soft drinks, since their high sugar content can cause diarrhea.
Adults with severe diarrhea, such as traveler’s diarrhea sometimes occurs, should drink rehydration solution. They can get it from a pharmacy (Gastrolyte®) or prepare one themselves (see recipes below).
Some older people, just like young children, may have more difficulty feeling their thirst or reporting it to those around them. The help of a loved one is then very important.
Rehydration solutions
Recipe from the World Health Organization (WHO)
Mix 1 liter of sterile water, 6 tbsp. coffee (= tea) of sugar and 1 tbsp. coffee (= tea) of salt.
Another recipe: mix 360 ml of unsweetened orange juice with 600 ml of cooled boiled water, added with 1/2 tsp. coffee (= tea) of table salt.
Storage: these solutions can be stored for 12 hours at room temperature and 24 hours in the refrigerator.
Medications
It is best not to treat diarrhea, even if it causes discomfort. Consult a physician before taking any diarrhea medication, even those available over the counter. Some products prevent the body from eliminating the infection: they are then of no help. In addition, if blood is in the stool or if strong abdominal cramps are felt, it is imperative to consult a doctor.
Some medications may be convenient for travelers who have long bus or car journeys, or who do not have easy access to medical services. Antiperistaltic drugs stop diarrhea by slowing bowel movements (for example, loperamide, such as Imodium® or Diarr-Eze®). Others decrease the secretion of water in the intestines (for example, bismuth salicylate, or Pepto-Bismol®, which also acts as an antacid).
If necessary, antibiotics can overcome diarrhea caused by bacteria or a parasite.
| Remark. Diarrhea can interfere with the absorption of medicines, which can make them less effective. Consult a doctor if in doubt. |
Diet advice for diarrhea
As long as significant discomfort persists, it is best to avoid consuming the following foods, which aggravate cramps and diarrhea:
- dairy products ;
- citrus juices;
- meat ;
- spicy dishes;
- the sweets ;
- foods high in fat (including fried foods);
- foods that contain wheat flour (bread, pasta, pizza, etc.);
- corn and bran, which are high in fiber;
- fruits, with the exception of bananas, which would be rather beneficial, even in young children from 5 to 12 months 2 ;
- raw vegetables.
Reintroduce starchy foods like white rice, unsweetened cereals, white bread and crackers first.
These foods may cause mild discomfort. It is better to persevere than to stop eating, unless the discomfort becomes significant again.
Gradually add fruits and vegetables (potatoes, cucumber, squash), yogurt, then protein foods (lean meat, fish, egg, cheese, etc.).
Medicines to treat diarrhea
It is best not to treat diarrhea, even if it causes discomfort.
Consult a doctor before taking any diarrhea medicine, even those available over the counter. Some products prevent the body from eliminating the infection: they are then of no help.
In addition, if blood is in the stool or if strong abdominal cramps are felt, it is imperative to consult a doctor.
Some medications may be convenient for travelers who have long bus or car journeys, or who do not have easy access to medical services.
Antiperistaltic drugs stop diarrhea by slowing bowel movements (for example, loperamide, such as Imodium® or Diarr-Eze®).
Others decrease the secretion of water in the intestines (for example, bismuth salicylate, or Pepto-Bismol®, which also acts as an antacid).
If necessary, antibiotics can overcome diarrhea caused by bacteria or a parasite.
Caution: Diarrhea can interfere with the absorption of medications, which can make them less effective. Consult a doctor if in doubt.
Hospitalization for diarrhea
In more severe cases, hospitalization may be necessary. Doctors then use an intravenous drip to rehydrate the body.
Antibiotics are prescribed as needed to treat severe bacterial diarrhea.
As part of its quality approach, Passeportsanté.net invites you to discover the opinion of a health professional.
Dr. Dominic Larose, emergency physician, gives you his opinion on diarrhea.
Our Doctor’s Opinion on Diarrhea
“Acute diarrhea must be clearly distinguished from chronic diarrhea.
Acute means “recently onset and of short duration”. It has nothing to do with the intensity of the symptoms.
Chronic means, in the case of diarrhea, 4 weeks or more.
The majority of acute diarrhea is harmless and can be treated very well with the advice mentioned in this sheet. However, there is a downside: acute diarrhea caused by taking antibiotics can be serious. Some acute diarrhea caused by E. coli bacteria (“hamburger disease”) as well.
In case of chronic diarrhea, a medical consultation is recommended. «
Dr Dominic Larose, M.D.
The following complementary approaches can help prevent diarrhea and relieve its symptoms, in addition to rehydration.
Complementary approaches to treat diarrhea
Probiotics (infectious diarrhea)
Probiotics are beneficial bacteria that notably constitute the intestinal flora.
The most recent research summaries agree that taking supplements of lactic acid bacteria (lactobacilli) can reduce the risk of contracting gastroenteritis of viral origin, both in children and in adults3-6,17.
Probiotics can also decrease its duration, after it has started.
Probiotics have been shown to be effective in preventing traveler’s diarrhea (tourista)15.
According to the most recent meta-analysis18, daily doses of at least 10 billion CFU (colony forming units) of Saccharomyces boulardii or a mixture of Lactobacillus rhamnosus GG and Bifibobacterium bifidus offer protection against tourista.
The authors also confirm the safety of such use.
Dosage: see our Probiotics fact sheet for more information on types of probiotics and dosage.
Contraindication: do not use without medical advice in case of weakening of the immune system due to a disease (AIDS, lymphoma) or to medical treatment (corticotherapy, chemotherapy, radiotherapy).
Probiotics (antibiotics)
The risk of diarrhea associated with taking antibiotics can be reduced with the concomitant use of probiotics, according to a meta-analysis13. These results confirmed those of previous meta-analyses7-10.
Among the species studied, only Saccharomyces boulardii, Lactobacillus rhamnosus GG and certain combinations of 2 probiotics had significant effects.
In addition, taking a Saccharomyces boulardii-type yeast during antibiotic therapy would reduce the risk of infection with the C. difficile bacterium, a possible complication of antibiotic therapy (especially in a hospital environment).
Dosage: consult our Probiotics sheet.
Psyllium (Plantago sp.)
Although it may seem contradictory, since it is also effective in combating constipation, psyllium can be used to treat diarrhea.
Indeed, as the mucilage it contains absorbs water in the intestine, it allows liquid stools to become more consistent. As psyllium also slows stomach and intestinal emptying, it allows the body to reabsorb more water.
Positive results have been obtained in people with diarrhea caused by taking certain medications or with faecal incontinence25-30.
Dosage: Take 10-30 g daily in divided doses, with a large glass of water. Start with the smallest dose and increase it until you get the desired effect. It may be necessary to increase the dose up to 40 g per day (4 doses of 10 g each).
Warnings: regular intake of psyllium may require adjustment of antidiabetic medication. In addition, the consumption of psyllium would reduce the absorption of lithium, a drug used to treat bipolar disorder.
Bilberry (Vaccinium myrtillus)
Commission E approves the medicinal use of dried bilberry to treat any type of diarrhea. It is generally believed that its healing action is due to the natural astringency of the pigments (anthocyanosides) that the berry contains.
It is assumed that these properties also apply to dried blueberries, which contain the same type of pigments.
Dosage: make a decoction by immersing 30 to 60 g of dried fruit in 1 liter of cold water. Bring to a boil and simmer gently for 10 minutes. Strain while the mixture is still hot. Let cool and keep in the fridge. Drink up to 6 cups a day as needed. Note that unlike dried berries, blueberries and fresh blueberries have a laxative action if consumed in large quantities.
Cassis (juice or fresh berries)
Blackcurrant berries contain tannins and a very dark blue pigment. The presence of these substances could explain certain traditional medicinal uses of blackcurrant juice, such as the treatment of diarrhea33.
Dosage: take a glass of blackcurrant juice during each meal or consume the fresh berries.
Goldenseal (Hydrastis canadensis)
The roots and rhizomes of goldenseal are traditionally used to treat infectious diarrhea.
This is probably due to their content of berberine, a substance with antimicrobial properties whose effectiveness in treating gastrointestinal infections has been demonstrated by clinical studies in humans and by animal trials20,21.
However, these trials were not always well controlled.
Dosage: consult our Goldenseal sheet for its dosage.
Contraindications: pregnant and breastfeeding women.
Naturopathy
According to the American naturopath JE Pizzorno, it can be interesting to discover the factors that make a person more susceptible to infectious diarrhea23.
According to him, people with difficult digestion, due to a lack of acidity in the stomach or an insufficient amount of digestive enzymes, are more at risk. In these cases, taking hydrochloric acid and digestive enzyme supplements can be beneficial, he says. This type of approach must be undertaken under the supervision of a duly trained naturopath.
See our Naturopathy sheet.
Chinese pharmacopoeia
The preparation Bao Ji Wan (Po Chai) is used in Traditional Chinese Medicine for the treatment of diarrhoea.
A few simple remedies
German chamomile tea (Matricaria recutita)
Make an infusion with 1 tbsp. tablespoons (= table) (3 g) of dried flowers of German chamomile in 150 ml of boiling water for 5 to 10 minutes. Drink 3 to 4 times a day.
Ginger tea (Zingiber officinale)
Ginger can be taken as an infusion, drinking 2 to 4 cups a day. Infuse 0.5 g to 1 g of powdered ginger or about 5 g of grated fresh ginger in 150 ml of boiling water for 5 to 10 minutes.
Tea (Camellia simensis)
According to traditional usage, the tannins in tea have an antidiarrheal effect. We recommend 6 to 8 cups of tea per day. Note, however, that tea is a diuretic and contains caffeine, also called theine.
It is not recommended for children as well as pregnant or breastfeeding women.
