Diarrhoea

Description

Diarrhoea (diarrhoea) is a symptom that is spoken of as soon as:

• there is an urge to defecate more frequently than 3 times a day
• the stool has a changed, liquid consistency
• the quantity is above average (> 250 g/d)

If the diarrhoea lasts up to 2 weeks, doctors speak of acute diarrhoea, anything beyond this is called chronic diarrhoea.

Short-term diarrhea (a few days) is not harmful for healthy adults. Every third person is affected by diarrhoea once a year

Diarrhea can be caused by diseases that affect the function of the small and large intestines. There are 2 main causes:

• increased intestinal activity (accelerates intestinal transit)
• above-average amount of fluid in the intestine

Acute diarrhoea

• Food poisoning: bacteria (staphylococci, salmonella) attack the digestive tract and produce toxins that act within a few hours.
• Intestinal flu: Viral or bacterial infection.
• Traveler's Diarrhea: Travelers often suffer from infections of bacteria (E. Coli), less commonly viruses or parasites.
• Medications: Antibiotics and other drugs attack or destroy the intestinal flora. Normally, the symptoms subside after the medication is stopped. Due to the necessity of these drugs in certain diseases, this side effect is tolerated.
• Food intolerance: Lactose intolerance and other intolerances lead to diarrhoea because e.g. dairy products cannot be completely digested.

Chronic diarrhoea

• Irritable bowel syndrome (intestinal irritation without complications)
• Chronic intestinal inflammation (ulcerative colitis, Crohn's disease)
• Chronic intestinal infection (parasites e.g. amoebae, Clostridium difficile, lamblia)
• Drug abuse (laxatives)

Far less frequently, metabolic disorders, tumours or operations are responsible:

• Hyperthyroidism (overactive thyroid gland)
• Pancreatic carcinoma (cancer of the pancreas)
• Intestinal surgery

In diarrhoea, the stool can be watery, mushy, greasy (greyish, strong-smelling, oily) or even bloody. In addition, there may be flatulence, abdominal colic, loss of appetite and nausea to vomiting.

A doctor should be consulted as soon as they show any of the following symptoms:

• Fluid cannot be supplied or is not supplied adequately.
• Dehydration sets in (little and dark urine, lack of strength, drying of the mucous membranes).
• fever
• bloody or fatty stools
• Symptoms develop after a stay abroad
• long lasting diarrhoea
• no improvement, although antibiotics suspected as the cause were discontinued

Acute diarrhoea

In acute diarrhea, even a history (medical history) may be sufficient to make the diagnosis. In case of prolonged symptoms and/or fever, the following examinations may be informative:

• Stool examination (germs, blood)
• Blood test (signs of inflammation, germs)
• Exclusion of infectious diseases (after a stay abroad) e.g. typhoid fever, cholera, amoebic dormancy, lambiliasis, schistosomiasis

Chronic diarrhoea

Several examinations are necessary to diagnose chronic diarrhea:

• Colonoscopy (colonoscopy) with biopsy (tissue sampling), alternatively, enema with contrast medium and imaging procedures.
• Sonography of the abdomen (abdominal ultrasound)
• Gastroscopy (gastroscopy of the stomach), gastroduodenoscopy (gastroscopy of the small intestine) and biopsies
• CT (computer tomography) of the abdomen

Acute diarrhoea

• Since bacteria or viruses are usually responsible and complications are not to be expected, the following strategies are mainly pursued:
• Ensuring fluid and electrolyte intake (salts), possibly home remedies (grated carrots, apples, mashed bananas).
• Electrolyte powders and infusions for vulnerable groups such as pregnant women, children, the elderly.
• Medicines against diarrhoea should only be used in exceptional cases (bus journey, dangerous loss of water) as the pathogen then remains longer in the intestine and damages it.
• antispasmodic medicines alleviate abdominal colic
• Antibiotics are useful if the immune system is unable to cope with triggering bacteria on its own. Suitable preparations are prescribed by the doctor after a stool examination.
• In the case of food intolerances, appropriate foods should be avoided.

Chronic diarrhoea

Symptomatic treatment is not sufficient here, the cause must be cured.

Self-help

• Mild to moderate diarrhoea can be counteracted with plenty of fluids (3-4 l/d). Sugar, salt and potassium are necessary in appropriate quantities, otherwise the fluid cannot be stored.
• Cola and similar soft drinks are not suitable for treatment. They contain too much sugar, too little sodium and usually no potassium.
• Children under 5 years of age should not be supplied with home remedies, but with special electrolyte solutions (pharmacy).

For adults the following can help:

• homemade electrolyte solution: ½ tsp salt + 5 tsp dextrose + 0.5l boiled water. Flavour with orange juice.
• Ensure salt intake through clear, salted soups.
• bananas and apricots are suitable sources of potassium
• consume dairy products only to a limited extent during the first few days.
• Eat normally as soon as appetite sets in.

Caution: In case of severe diarrhoea, always consult a doctor!

Acute diarrhea usually does not last more than a week. However, the exact duration depends on the immune system, cause and any complications.

The prognosis for chronic diarrhoea depends on the underlying disease. Prolonged diarrhea and subsequent fluid loss can lead to circulatory and renal failure. Risk groups are infants, young children, pregnant women, the elderly and the immunocompromised, as well as malnourished people.

Hygiene

Since many cases of diarrhea are the result of infections with bacteria or viruses, hygiene is crucial to prevent.

• Foods that are susceptible to salmonella should be stored separately and below 10°C. These include poultry, game, fish and seafood. These should also always be prepared separately.
• Poultry, fish and meat must be cooked thoroughly. Minced meat should be consumed on the day of production.
• Dishes (including pastries) containing raw egg must be eaten immediately.

Travel

When travelling to regions where hygiene standards are low, always ensure that your food is peeled, boiled or grilled. In addition, the following precautions may be helpful:

• Timely travel vaccinations (e.g. typhoid).
• Washing your hands thoroughly before eating
• Peel fruit and vegetables
• Disinfecting drinking water (e.g. boiling)