As adults, especially in the Western World, we often think of diarrhea as an unpleasant inconvenience. In some parts of the world, it is that and a whole lot more. This disorder that is a side effect of many conditions is a killer that destroys many lives every year. Can we learn to prevent diarrhea and minimize its impact? Let’ see what we can find out.
What is Diarrhea?
In common usage, diarrhea is defined as an increase in the fluid content, volume, and frequency of bowel movements. However, the technical diagnosis of diarrhea has to do with the actual weight of the bowel movements. This distinction is necessary because the average number of bowel movements (BMs) varies from culture to culture. A more accurate determination based on weight places any BMs over 300 grams in the diarrhea category. The excess weight indicates a higher than normal percentage of water content, which is typically about 60-85% in a healthy individual. True diarrhea can therefore be distinguished from simply increased numbers of BMs (hyperdefecation) or incontinence (involuntary loss of bowel contents).
Diarrhea is found in both acute and chronic forms, and can be classified into four major categories:
- Osmotic diarrhea is a type which is often triggered by lactose intolerance or excessive amounts of vitamin C.
- Secretory diarrhea can be caused by bacteria infections, tumors, poor absorption of fats, certain types of surgery, and abuse of laxatives.
- Exudative diarrhea is often the result of certain diseases of the bowel, or bacterial infections.
- Inadequate-contact diarrhea is a by-product of intestinal surgery. When the intestine is shortened, the food cannot stay in the intestine long enough in its liquid form to get properly absorbed. In layman’s terms, it moves through the gut too fast, and comes out the anus in liquid form.
In some parts of the world, mostly in undeveloped countries, diarrhea is a major public health crisis, and is estimated to be responsible for over five million deaths annually. Sadly, most of the victims are children under the age of five. Even in the United States, more that 250,000 people per year are hospitalized for diarrhea. Chronic diarrhea is an ongoing problem for some peoples, and is a much more dangerous situation for children than for adults. Chronic diarrhea causes development and immunity dysfunction in children, and malnutrition and dehydration in both kids and adults.
What Are the Signs and Symptoms of Diarrhea?
Frequent, loose, watery stools is the hallmark sign of diarrhea. Beyond that, many patients will experience:
- Bloody stools
- Abdominal pain, or abdominal cramps
Extreme bouts of acute diarrhea may trigger more than twenty bowel movements in a day for some individuals. There may also be blood or pus in the stool if the condition causing the diarrhea is severe. In addition, BMs may be of uncharacteristically low density, and difficult to flush since they will tend to float. The presence of undigested or under digested foods in the stool is also a sign of diarrhea.
What Are the Causes of Diarrhea?
Diarrhea is not a disease in and of itself. It is a symptom or side effect of other conditions. Some of the most common disorders that trigger diarrhea include:
- Food allergies: Allergic reactions to certain foods is one of the most common causes of chronic diarrhea. When you eat anything that you are allergic to, the reaction can trigger the release of substances called histamines that come from specialized white blood cells in the intestine called “mast cells.” Histamines can act as a powerful laxative and produce diarrhea.
- Viral infections: Certain viruses will often cause infected individuals to suffer attacks of diarrhea. The most common culprits are Norwalk virus (a leading cause of food-borne disease in the United States), cytomegalovirus (CMV—especially dangerous to folks with compromised immune systems), herpes simplex, viral hepatitis, and rotavirus (the number one cause of acute childhood diarrhea). Viral diarrhea is one of the most contagious types, so it is very important for children and adults to thoroughly wash their hands after using the toilet.
- Bacterial infections and parasites: Bugs such as these are often contracted via contaminated food and water. Common parasites that cause diarrhea are Giardia lamblia (most frequent cause of non-bacterial diarrhea in North America) and cryptosporidium (most often found in polluted water). Typical bacterial agents of diarrhea include E. coli, salmonella, shigella, and campylobacter. Be especially careful of these bacterium sources when traveling in underdeveloped countries (Montezuma’s Revenge!).
- Lactose intolerance: Lactose is a milk sugar found in most dairy foods. Many intestinal infections will damage the cells that line the small intestine. When this happens, the body temporarily has difficulty producing the enzyme lactase, which is necessary to properly digest lactose. This can result in diarrhea.
- Certain medications: Antibiotics are probably the worst offender in this arena. One of the problems with the over use of antibiotics, is that when they enter the gut, they destroy the “good” bacteria along with the intended victims, and leave the bacterial balance of the intestinal tract in havoc. One of the undesirable results of this imbalance is often diarrhea.
- Other conditions that a person has can be the cause of the diarrhea. Some of the most common ones associated with diarrhea are:
ü Crohn’s disease: This inflammatory disease of the gastrointestinal tract is one of the diseases under the inflammatory bowel disease (IBD) umbrella.
ü Ulcerative colitis: Also a member of the IBD family, this condition involves inflammation of the lining of the colon and the rectal area. Can produce severe episodes of diarrhea.
ü Celiac disease: An inflammatory immune disorder that affects the small intestine and often causes malabsorption.
ü Irritable bowel syndrome (IBS): An inflammatory disorder of the large intestine.
ü Hormonal or endocrine disorders such as thyroid diseases and diabetes.
ü AIDS patients must be concerned with the effects of diarrhea, especially weight loss and dehydration.
ü Colon cancer patients often suffer from significant diarrhea.
What Complications Can Occur from Diarrhea?
The most common complications of diarrhea that you should be aware of are dehydration, malnutrition, and weight loss, with dehydration being the most acutely dangerous. Signs of dehydration include:
- Excessive thirst
- Dry skin and/or dry mouth
- Reduced urine output
- Dark colored urine
- Dizziness or lightheadedness, especially upon standing
Dehydration can escalate into a serious condition if not addressed. Further possible complications include skin problems, arthritis, kidney failure, and neurological symptoms. Dehydration can be fatal in some cases.
Dehydration in children is especially dangerous, and can occur very quickly. Anytime a young child has diarrhea, parents should be watching for signs of dehydration such as:
- No wet diapers in three hours or more
- Bloody or black stools
- Dry mouth
- Crying with the absence of tears
- Unusual sleepiness or drowsiness
- Sunken appearance in the abdomen, eyes, or cheeks
- High fever
If your child exhibits any of these signs, get medical attention for them immediately. Dehydration in children or infants can be life threatening.
How Can Diarrhea be Treated or Prevented?
In severe cases of diarrhea, nutritional deficiencies and dehydration must be treated immediately, often to save the patients life. If things get bad here, most of us have access to health care, and can go into a hospital if needed. This is not the case in many poorer countries. Therefore, the World Health Organization (WHO) came up with an inexpensive homemade recipe for an Oral Rehydration Solution that can easily be prepared by almost anyone, and should be sipped frequently throughout the day. The ingredients are as follows:
- Table salt:¾ teaspoon
- Baking powder:1 teaspoon
- Orange juice:1 cup
- Water:1 quart
It is very important that a dehydrated person gets the fluids and electrolytes replaced that have been lost. The chemistry of the body can be thrown off, and this can negatively affect every system and organ. Consumption of herbal teas, vegetable broth, watered-down fruit juices, and commercial electrolyte products (like Gatorade) are helpful in many cases. Another popular home remedy is equal parts of sauerkraut and tomato juice.
Carob is also excellent for treating diarrhea, and is especially effective in children. Mixing some in applesauce is a great way to get them to eat it. Serve it two or three times a day.
Mangos have long been used to both prevent and eliminate parasites that can be more of a problem while traveling than here in the States. Other tips to avoid diarrhea while traveling include:
- Do not drink anything that is not in a sealed bottle, such as water, juice, or alcoholic beverages.
- Do not eat any fruits or vegetables that you cannot peel and wash yourself.
- Use bottled water even for brushing your teeth and washing up.
- When showering, be careful to keep your mouth closed to avoid swallowing any water.
The use of a high quality probiotic that helps to restore the natural balance of “good” bacteria in the gut can go a long ways towards both treating existing diarrhea, and preventing future attacks. This is an especially good strategy for antibiotic-related diarrhea. Probiotic use for diarrhea has even been embraced by mainstream medical to some degree. A recent report (1996) in the Journal of the American Medical Association cited its effectiveness.
It is best to continue to take in small amounts of mild solid foods while treating diarrhea. This will help to restore your nutrients and strength. One diet that is often recommended is called the BRAT diet, and is composed of Bananas, Rice, Applesauce, and Toast. These foods provide mild forms of both soluble and insoluble fiber. Some folks even suggest burning the toast a bit so that the charcoal can pull toxins out of the body and help cure the condition that is causing the diarrhea.
Other foods that can help deal with diarrhea in a natural manner include fruits and vegetables that are high in pectin. Examples are pears, apples, grapefruit, beets, potatoes, and carrots. Fresh blueberries are also an excellent choice for fighting diarrhea. They are rich in a substance called tannins, which are known to firm up loose stools.