Diarrhea - Causes, Symptoms & Diagnosis.

Diarrhea is a problem everyone is familiar with - it is one of the most common reasons for people to seek medical advice. Diarrhea is characterized by loose, watery stools or a frequent need to have a bowel movement. Diarrhea can be acute or chronic. Diarrhea that lasts less than 2 weeks is termed acute diarrhea. Chronic diarrhea lasts longer than 4 weeks.

Most cases of acute, watery diarrhea are caused by viruses. The most common ones in children are rotavirus and in adults are norovirus. Chronic bloody diarrhea may be due to inflammatory bowel disease (IBD), which is ulcerative colitis or Crohn's disease. Other less common causes include ischemia of the gut, infections, radiation therapy and colon cancer or polyps. Infections leading to chronic diarrhea are uncommon, with the exception of parasites.

Exposure to infectious agents is the major risk factor for acute diarrhea. Bacteria and viruses are often transmitted by the fecal-oral route, so hand washing and hygiene are important to prevent infection. Soap and water are better because alcohol-based hand sanitizers may not kill viruses. Medications such as antibiotics and drugs that contain magnesium products are also common offenders. Recent dietary changes can also lead to acute diarrhea. These including intake of coffee, tea, colas, dietetic foods, gums or mints that contain poorly absorbable sugars.

There are many different symptoms of diarrhea. You may experience only one of these or any combination of all of them. The symptoms depend on the cause. its common to feel one or more of the following -

• Nausea

• Abdominal pain

• Cramping

• Bloating

• Dehydration

• A fever

• Bloody stools

• A frequent urge to evacuate your bowels

• A large volume of stools

Most episodes of acute diarrhea resolve quickly without antibiotic therapy and with simple dietary modifications. See a doctor if you feel ill, have bloody diarrhea, severe abdominal pain or diarrhea lasting more than 48 hours. In patients with mild acute diarrhea, no laboratory evaluation is needed because the illness generally resolves quickly. Your doctor may perform stool tests for bacteria and parasites if your diarrhea is severe or bloody or if you traveled to an area where infections are common. If you have severe diarrhea, blood tests will be helpful to guide replacement of fluid and electrolytes and minerals such as magnesium, potassium and zinc that can become depleted.

If you have chronic diarrhea, your doctor will want to further assess etiologic factors or complications of diarrhea by obtaining several tests. These can include a blood count to look for anemia and infections, an electrolyte and kidney function panel to assess for electrolyte abnormalities and renal insufficiency, and albumin to assess your nutritional status.

It is important to take plenty of fluid with sugar and salt to avoid dehydration. Salt and sugar together in a beverage help your intestine absorb fluids. Milk and dairy products should be avoided for 24 to 48 hours as they can make diarrhea worse. Initial dietary choices when refeeding should begin with soups and broth.

Your doctor may prescribe antibiotics if you have high fever, dysentery, or moderate to severe traveler's diarrhea. Treatment of chronic diarrhea depends on the etiology of the chronic diarrhea. Often, empiric treatment can be provided for symptomatic relief, when a specific diagnosis is not reached, or when a diagnosis that is not specifically treatable is reached.

Pharmacotherapy

Vaccines (eg, rotavirus) can help increase resistance to infection. Antimicrobial and antiparasitic agents may be used to treat diarrhea caused by specific organisms and/or clinical circumstances. Such medications include the following:

• Cefixime

• Ceftriaxone

• Cefotaxime

• Erythromycin

• Furazolidone

• Iodoquinol

• Metronidazole

• Paromomycin

• Quinacrine

• Sulfamethoxazole and trimethoprim

• Vancomycin

• Tetracycline

• Nitazoxanide

• Rifaximin