Diarrhea is clinically defined as having an increase in stool frequency, equal to or greater than three stools in a 24-hour period with a less than normal form or consistency (Grover 1). If this bout of diarrhea lasts less than four weeks, it is considered acute. A chronic bout lasts four weeks or longer.
The human body can turn to drastic measures to remove anything it perceives to be dangerous or harmful. We have an incredible internal sense of self-preservation, but it can sometimes go overboard. As our body tries to flush out a potential toxin, we can end up with a symptom like diarrhea.
Who Can Have Diarrhea
Anybody can have this symptom. There are special circumstances where an antibiotic or even expired or improperly prepared food can induce this symptom. Diarrhea can be its own standalone symptom or part of a larger disease process.
What Diarrhea Does
In most cases, an excessive amount of water is drawn into the colon/large intestine. This process, known as an osmotic shift, causes a loose bowel movement.
Associated Symptoms of Diarrhea
Depending on the cause, people can also experience cramping, bloating, flatulence, an urgency to defecate, dehydration symptoms, bloody stools, nausea, and vomiting.
Acute Diarrhea
There are a number of different causes of diarrhea, from viral or bacterial causes to a reaction to diet or medication. To help determine the cause, Dr. Brody will have a patient go to a lab for testing.
Kinds of Infections
Viral infections can cause diarrhea. The two main viruses known to cause the “stomach flu” are the norovirus (Norwalk Virus) and the rotavirus. Others include adenovirus and calicivirus.
Bacteria infections can also cause diarrhea. The bacteria in this category are the classic ones that cause acute gastroenteritis or infectious gastroenteritis. Salmonella, Shigella, Campylobacter, E. coli O157:H7, and Clostridium difficile can all cause bloody diarrhea. Different strains of E. coli, cholera, Staphylococcus aureus, and Clostridium perfringens classicly don’t cause bloody diarrhea. A stool sample can help easily access the bacteria and lead to a confirmative diagnosis.
Parasitic infections are increasingly rare in the USA but are still a common cause of diarrhea both worldwide and in more rural and rugged regions of the USA. Common parasites include Cryptosporidium, Entamoeba histolytica, and Giardia. These infections can also be identified in the stool – you can find either eggs or the parasites themselves. New tests are yielding promising results by looking at DNA fragments of parasites in the stool.
Travelers Diarrhea, also called “Deli Belly” or “Montezuma’s Revenge” depending on where you are in the world, is a common cause. This can be caused by any of the above infectious causes that get transferred from person to person, usually through food contamination.
Medications that induce diarrhea are also very common. Reading the side effect insert that comes with all medications is advisable. Classic medications to be on the lookout include antibiotics, acid modifying drugs, and lactose and magnesium-containing medication/supplements.
Chronic Diarrhea
The afore-mentioned Infections should be ruled out if diarrhea has been present for more then 4 weeks.
Food allergies and intolerances can cause long term diarrhea. The classic food intolerance in the USA is lactose intolerance. This is due to a genetic gene called LDH. The gene is responsible for many copies of lactase (the enzyme used to break down the milk sugar, lactose). This gene suffers from something called “copy number variance” which means that after some time, the body has a hard time making new copies and hence stops making lactase. This enzyme is located on the brush border of the intestinal tract, and if there is damage here symptoms can occur. Lactose is a large sugar that bacteria like to consume, and if there is an overgrowth of these bacteria it can lead to a condition known as SIBO.
Other intolerances include fructose, xylitol, and other alcohol-based sugars. Other classic food-based cases of diarrhea include citrus fruits, wheat, soy, beans, eggs, and seafood.
Surgery can cause diarrhea, especially when that surgery takes place inside the abdominal cavity. Classic surgeries such as appendectomy (removal of the appendix), cholecystectomy (removal of the gallbladder), or colectomy (removal of part of the large intestine) can all result in long term diarrhea.
Medications can cause diarrhea when used long-term. These include antibiotics, acid modifying drugs, drugs that contain lactose, SSRIs and other drugs used to treat depression, chemotherapy, High blood pressure medications such as ACE inhibitors, Classic NSAIDs, and magnesium supplements.
Digestive disorders can cause diarrhea. Small Intestinal Bowel Overgrowth (SIBO), Irritable Bowel Disease (IBS), Celiac Disease (CeD), or Inflammatory Bowel Diseases (IBD) such as Crohn’s Disease and Ulcerative Colitis are just a few of the diseases that can be responsible.
Allopathic Treatment
Treatments will be based on the underlying condition but some common treatments include antibiotics ( Fluoroquinolone or Metronidazole,), Agents that slow down intestinal transit (Loperamide or Diphenoxylate/atropine) and bismuth subsalicylate to name a few.
Natural Treatment
There are many natural treatments out there to help control diarrhea but these should be prescribed specially for the underlying cause. Probiotics (Saccharomyces boulardii and Lactobacillus rhamnosus), Herbs (Ceratonia silique (carob), Geraanium maculatum, Hamamelis virginiana, Camellia sinensis (black tea)), Supplements (Bovine Colostrum, Activated Charcoal, Bentonite clay, L-Glutamine, Po Chi Pills), or Homeopathic OTC medications (Arsenicum, Natrum Sulp, Phosphorus, Podophyllum, Sulphur, Veratrum) to name a few.
Other Treatments
Preventative measures include proper hydration, regularly washing your hands with soap and water, the BRAT Diet (Banana, Rice, Applesauce, and Toast) and making sure to close the toilet lid before flushing.
Potential Complications
Dehydration is one of the biggest side-effects. It is incredibly important that whenever someone has a potential case that they drink water and electrolytes to replenish.
Related Bacteria
Clostridium difficile, often abbreviated as C. diff, is the primary antagonist for inducing diarrhea. Depending on the contents of the stool, Dr. Brody may also check for Salmonella, Shigella, E. Coli, or Helicobacter pylori.
Campylobacter jejuni is the leading cause of diarrhea, involved in 4%-11% of all cases (Grover 1).
Citations
Grover, S. (2007). Blueprints Pocket Gastroenterology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Symptoms & Causes of Diarrhea. (2016, November 1). Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/symptoms-causes