What is diarrhea?

Diarrhea is defined as the passage of loose, liquid, or watery stools three or more than three times a day or in higher frequency than the usual ones. 

However, the recent change in consistency and character of stools is more important than the number of stools passing. 

The term “diarrhoeal diseases” includes the group of diseases in which the predominant symptom is diarrhoea. The diarrheal disease is the second most common cause of death in children under five years old and is responsible for killing around 525,000 children each year. 

Diarrhoea is a leading cause of death during emergency conditions and natural disasters. Overcrowding is often associated with water resources pollution, inadequate sanitation, poor hygiene, contaminated food as well as malnutrition.

These all are the main risk factors for the development of diarrhoea. Also, lack of adequate health services, poverty, lack of education reduces the quality of health mainly in rural areas. 

Types of diarrhoea

There are four different clinical types of diarrhoea that can be recognized on the basis of the underlying pathology and altered physiology conditions.

Acute watery diarrhoea 

It lasts for several hours to days. The main danger is dehydration & weight loss. The etiological factors include some bacteria such as V. cholerae, E. coli, and also some viruses like rotavirus. 

Acute bloody diarrhoea /dysentery

Acute bloody diarrhea is also called dysentery. The main danger includes damage to the intestinal mucosa, sepsis, malnutrition, and dehydration. In acute bloody diarrhea, blood is seen in the stools. Shigella is a bacteria which is the most common cause of acute bloody diarrhea (dysentery).

Persistent diarrhea

This occurs 14 days or longer. The main danger is malnutrition and serious non-intestinal infection, dehydration may also occur in the long term conditions. Persons with other illnesses like AIDS are more prone to develop persistent diarrhoea. 

Diarrhea with severe malnutrition (marasmus and Kwashiorkor)

In this condition, the main dangers are severe systemic infection, dehydration, heart failure, and vitamin and mineral deficiency.

Causes of diarrhea

There are various causes seen in human beings and there are following

• Infections and infestations
• Malnutrition
• Metabolic disorders (such as inborn error of metabolism like congenital enzyme deficiency)
• Some drugs (like Iatrogenic, example, broad-spectrum antibiotics destroy the gut-flora in the tract)
• Allergic conditions
• Psychological (nervous)
• Idiopathic causes
• Alcohol abuse
• Diabetes conditions
• Hyperthyroidism (thyroid gland overactive)
• Radiation therapy
• Some case was seen in running so-called runner diarrhea
• Some cancers 
• surgery on your gastrointestinal tract

Infections and infestations

There are various infectious agents are found, there are following 

Viruses

Viruses are responsible for about 50 percent of the cases. There are the following some common viruses cause diarrhea includes Rotaviruses, Astroviruses, Adenoviruses, Caliciviruses, Coronaviruses, Norwalk group viruses, Enteroviruses, Cytomegalovirus, etc. 

Bacteria

Bacteria are responsible for around 45 percent of the cases caused a various type of diarrhoea, there are some common bacteria the causes diarrhoea such as Campylobacter jejuni, Enterotoxigenic Escherichia coli, Shigella,

Salmonella, Vibrio cholera, Vibrio parahaemolyticus,  Bacillus cereus, Staphylococcus aureus, Clostridium perfringens, Enterohaemorrhagic E. coli, Clostridium difficile, Enteroinvasive E. coli, Aeromonas, Yersinia enterocolitica, Chlamydia,  Neisseria gonorrhoeae, etc. 

Protozoa

Protozoa are responsible for about 5 to 8 percent of the cases of diarrhoea. There are following protozoa such as Entamoeba histolytica, Giardia lamblia, Trichuriasis, Cryptosporidium, Cyclospora, etc that cause diarrheal disease.

Fungus

Cryptosporidium is the most important cause of diarrheal disease but diarrhoea is neither severe nor prolonged, except for immune deficiency disorder patients such as malnutrition and AIDS. 

Age group

Diarrhoea is most common in infants & especially those between 6 months to 2 years and also present in the higher aged people.

The highest incidence is seen in the age group of  6-11 months, during weaning. During this, levels of maternally acquired antibodies reduced & the lack of active immunity in the infant seen.

Especially, when a baby starts to crawl, consumption of contaminated food & water and direct contact with humans or animals are the main risk factors. In babies < 6 months of age it is due to cow’s milk or infant feeding formulas. 

If malnutrition occurs, it leads to infection and finally diarrhoea which is a well-known vicious circle. 

Risk factors of diarrhea

• Poverty
• Lack of education
• Lack of sanitation
• Malnutrition  
• Prematurity
• Reduced gastric acidity
• Immunodeficiency
• Lack of personal and domestic hygiene 
• Incorrect feeding practices etc.

Symptoms of diarrhea

You may have:

• Severe bloating
• Thin or loose stools in several times a day
• Cramps
• Watery stools
• Nausea and throwing up.
• Feeling the frequent movement of bowel

More severe symptoms include:

• Mucus or blood in your stool
• Severe weight loss
• Fever

If you have watery, thin stools three or more than three times a day and you are not properly drinking sufficient amounts of water or fluids, that’s why you become dehydrated. This is a serious complication of diarrhea so treated immediately. 

If you and your child have blood or black, mucus or tarry stools, high-grade fever (above 101 F) or that lasts more than 24 hours, diarrhea lasting longer than 2 day, Nausea or throwing up that prevents drinking liquids to replace lost fluids,

Severe pain in your belly, Diarrhea after traveling back from a different foreign country then you will be immediately consulting your doctors and treat diarrhea.

If you have dark urine, low volume of urine output, rapid heart rate, headache, dry skin, crankiness, confusion delirium these all are symptoms of dehydration, these symptoms are present then consult your doctors.

Environmental determinant of diarrhoea

In temperate regions, bacterial diarrhoea occurs during the warm season but viral diarrhea (mainly caused by rotavirus) peaks during the winter season.

In tropical areas, rotavirus diarrhea (viral diarrhea) occurs throughout the year but higher frequency seen during the drier & cool months.  Whereas, bacterial diarrhoeas peak during the warmer & rainy season. 

Mode of transmission of diarrhoeal disease

Most of the pathogenic organisms responsible for causing diarrhoea are transmitted mainly or exclusively by the fecal-oral route. 

Fecal-oral transmission may be either water-borne or food-borne or direct transmission via routes such as fingers or fomites or dirt which may be ingested by young children.

Diagnosis of diarrhea

First, Your doctor or consultant will ask about your medical history before diarrhea and what drugs you take, as well as what you’ve eaten or had to drink lately. The doctor or consultant will give you a physical examination to look for signs of dehydration or severe belly pain.

Some common test can help to diagnosed diarrhea, including:

• Blood tests: It is looking for certain disorders or diseases present or not.
• Colonoscopy: Rare cases, in which your doctor or consultant looks inside your colon with a special thin, flexible tube that holds a tiny camera and light. It can also use this device to take a minute sample of tissue. Or In general, your doctor might need to do only a sigmoidoscopy, which looks at just the lower part of the colon.
• Stool tests: It looks for bacteria or parasites, etc.

Management  of diarrhea

Management of diarrhoea depends on establishing the underlying cause and instituting specific therapy (if necessary). Most diarrhea is self-limiting. Therapeutic measures for management may be grouped into:

• Treatment of fluid depletion, shock, and acidosis
• Maintenance of nutrition
• Drug therapy (based on the severity and nature of diarrhoea).

Rehydration 

Rehydration can be done orally or Intravenous route.

Intravenous rehydration: 

It is needed only when fluid loss is severe which means > 10% of body weight or if the patient is losing > 10 ml/kg/ hr or is unable to take a significant amount of the oral fluids due to weakness, stupor, or vomiting. The composition of i.v. fluid (Dhaka fluid) is:

• NaCl 85 mM = 5 g
• KCl 13 mM = 1 g
• NaHCO3 48 mM = 4 g in 1L of boiled water.
• This provides 133 mM Na+, 13 mM K+, 98 mM Cl¯ and 48 mM HCO3 ¯ .

Ringer lactate (Na+ 130, Cl¯ 109, K+ 4, lactate 28 mM) recommended by WHO could also be used alternatively. Volume equivalent to 10% Bodyweight should be infused over 2–4 hours & the subsequent rate of infusion is matched with the rate of fluid loss. In most cases, oral rehydration therapy can be instituted after the initial volume replacement. 

Oral rehydration Advent of oral rehydration therapy (ORT): 

It is considered a major advance of recent times. If the fluid loss is mild (5–7% Body Weight) or moderate (7.5–10% Body Weight) oral rehydration therapy (ORT) can be instituted from the very beginning. Oral rehydration therapy is not designed to stop diarrhoea, but to restore and maintain hydration, electrolyte, and pH balance in your body until diarrhoea ceases, mostly spontaneously.

Zinc in pediatric diarrhoea

According to the WHO, it has recommended that all children <5yrs with acute diarrhea should be given Zinc supplementation (10-20) mg along with ORS and continued for the next 10–14 days. It reduces severity as well as the duration of diarrhea.  It also strengthens the immune response and helps regeneration of intestinal epithelium.

Maintenance of nutrition

Feeding during diarrhoea has been shown to increase intestinal digestive enzymes and cell proliferation in the mucosa. Simple foods like breast milk or ½ strength buffalo milk, boiled potato, rice, chicken soup, banana, sago, etc. should be given as soon as the patient can eat.

Drug therapy 

Drugs used in diarrheas may be categorized into:

• Specific antimicrobial drugs: cotrimoxazole, tetracycline, ampicillin, fluoroquinolone, azithromycin, rifaximin, etc.
• Probiotics: Lactobacillus, enterococcus, etc.
• Drugs for inflammatory bowel disease (IBD): sulfasalazine, prednisolone, infliximab, etc.
• Nonspecific antidiarrheal drugs: kaolin, pectin, racecadotril, codeine, loperamide. 

Prevention 

• Drinking safe and sufficient water;
• Improved sanitation in your environment;
• Handwashing with soap properly
• Exclusive breastfeeding for the first six months of your baby. 
• Maintain good personal and food hygiene
• Health education about how infections and spread of diarrhea
• Rotavirus vaccination.

People frequently asked questions

• How do I stop diarrhea immediately?
• What typically causes diarrhea?
• How do you stop diarrhea?
• What can I eat to harden my stool?
• What is watery diarrhea a sign of?
• Does diarrhea make you lose weight?