Diarrhea | دست یا اسہال

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Diarrhea


Diarrhea causes bowel movement or passing of stool more often than usual. The patient passes loose watery stools 3 - 4 times a day.  Diarrhea usually last for few days (2-3 days). If patient continues to suffer with diarrhea, it could be something serious.  It is better to contact the doctor in case symptoms continue for more than 3 days.

For diarrhea in children, contact the doctor sooner.

Acute diarrhea most commonly occurs due to bowel infection caused by certain bacteria, viruses or parasites. Infectious diarrhea happens when contaminated water or food is consumed. Bowel infections in general are called as gastroenteritis.

Many people catch diarrhea while traveling to places where water and sanitary conditions are not up to the mark. It is generally advised to avoid consuming raw vegetables or fruits, which cannot be peeled. Leafy vegetables like lettuce can be easily contaminated with germs and are very hard to clean.

Diarrhea can also be caused due to side effect of drugs and food intolerance (e.g. lactose in tolerance spicy or oily food).

Some chronic intestinal diseases for e.g. irritable bowel syndrome (IBS) or Crohn’s disease may also cause frequent diarrhea. IBS and Crohn’s disease require more detailed clinical investigation.

Prevention is key to avoid these type of infections

To prevent water-borne diarrheal infections (infections spread from contaminated water) in most cities of Pakistan, it is essential to boil water before drinking. By boiling water (continue heating for at least 5 minutes after boiling), many disease-causing bacteria, viruses and parasites are killed.

Diarrhea usually occurs with the following symptoms:

  • Abdominal pain
  • Bloating
  • Nausea and Vomiting
  • Cramps
  • Need to go to washroom urgently

Due to frequent passing of stools, patient experiences severe dehydration and loss of salts and electrolytes. In case of infection, patient may suffer with fever and chills.

Children may experience:

  • Severe dehydration and loss of salts and electrolytes
  • Drowsiness and fainting in case of too much loss of water
  • Pale skin and cold hands

Adults may experience:

  • Tiredness and weakness
  • Not feeling like eating
  • Passing dark colored urine
  • Cramps in muscles

Patient should contact the doctor soon if blood is seen in the stool

Diarrhea can be caused by many factors:

1. Infection (bacteria, viral and Ameoba) – mostly viral

  • Bacteria: Many different type bacteria can cause diarrhea that includes: Salmonella, Shigella, E. Coli, Campylobacter. These bacteria enter into the body through contaminated water or food.
  • Viruses that can cause diarrhea include: Rotavirus, Norvovirus, Cytomegalovirus
  • Parasites which can cause diarrhea include: Giardia lambdia, Entameoba histolytica

2. Stress, anxiety and nervousness

3. Reaction to some medicines such as antibiotic or chemotherapy

4. Due to chronic bowel disease

5. Intestinal surgery

Some food can also cause diarrhea:

1. Fiber enriched food

2. Oily and spicy food

3. Heavy meals/ overeating

4. Milk and dairy products

5. Drinks containing too much caffeine e.g. coffee, tea, colas and chocolates

Usually, common type of diarrhea gets better itself within a week. Over the counter diarrhea medicines are helpful and mostly patient does not require to visit the doctor’s clinic.

Mostly diarrhea is diagnosed from clinical condition and medical history. The doctor may ask the following questions to diagnose the disease:

  • Frequency of loose stools?
  • How long the patient is suffering with the symptoms?
  • Appearance of stools – are they watery; colour – red or black color represent blood in the stools?
  • Symptoms of passing loose stools are continuous or occasional?
  • Any other symptoms, fever and vomiting?
  • Any possible reason that may have caused diarrhea for e.g. eating out, drinking unclean water?
  • Travel history – if patient has travelled to countries where water-borne infections are common?
  • Anything which makes the symptoms worse – for e.g. drinking milk – may be due to lactose intolerance?
  • What, if the patient is taking antibiotics or any other medicine? Many antibiotic usually cause diarrhea

Laboratory Testing:

In case of severe diarrhea continuing for more than 2 weeks, doctor may order stool test to specifically diagnose the cause.

In some diarrhea cases, blood test may be required to diagnose other underlying condition.

Some patient may require rectal examination, colonoscopy or sigmoidoscopy

Diarrhea usually gets better itself in 5-7 days.

Over the counter medicines and eating light food are helpful to manage the symptoms.  Patient is required to drink plenty of water and fluids to avoid dehydration.

ORS (Oral rehydration solution) are very helpful in maintaining the water and electrolytes balance in the body. Especially, young children suffering with diarrhea should be given regular ORS.

Eating light food for e.g. banana, yogurt, soft rice, soups, boiled vegetables in small portions are usually helpful. Don’t eat if don’t feel like, but continue drinking fluids regularly.

In case of fever, paracetamol can be used.

Over the counter anti-diarrheal medications are effective to improve the symptoms.

Antibiotics are generally not required, however if cause of diarrhea is due to bacterial infection - antibiotics are usually required. Antibiotics, don’t help if viral infection is the cause of diarrhea.

Prevention is the best strategy to stay healthy

To prevent water-borne diarrheal infections (infections spread from contaminated water) in most cities of Pakistan, it is essential to boil water before drinking. By boiling water (continue heating for at least 5 minutes after boiling), many disease-causing bacteria, viruses and parasites are killed.

Water filtration systems used in Pakistan are mostly not very effective in removing or inactivating the disease-causing organisms. The filters used in most filtration systems can stop bigger particles like dust and sand to get into the water. However, bacteria and viruses are much smaller than sand particles, therefore can easily pass through the filters and get into the water.

Avoid using ice made from raw water. Make sure ice cubes are made from boiled water.

It is generally advised to avoid consuming raw vegetables or fruits, which cannot be peeled. Leafy vegetables like lettuce can be easily contaminated with germs and are very hard to clean.

Also, it is important to eat food prepared in hygienic conditions; do not keep food outside refrigerator for longer periods in summer. Avoid buying ready to eat food items from street hawkers/ vendors or road-side restaurant, especially raw (uncooked) foods like sliced /cut fruits and juices, salads as it may be washed with unclean water, yogurt, chutneys and other uncooked dressings as in their preparation most likely un-boiled tap water is used.

Since drinking water supplies in schools, colleges and universities are not always reliable, it is safer for teenagers to carry their own water bottle and lunch box from home to avoid these types of avoidable illnesses.

Typhoid vaccine is recommended for people who are planning to travel Pakistan and other South Asian countries where it is endemic.

Rotavirus vaccine is also recommended for infants to prevent diarrhea due rotavirus infection.

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