Diarrhea (cont.)
How is diarrhea treated?
Absorbents. Absorbents are compounds that absorb water. Absorbents that are taken orally
bind water in the small intestine and colon and make diarrheal stools less
watery. They also may bind toxic chemicals produced by bacteria that cause the
small intestine to secrete fluid; however, the importance of toxin binding in
reducing diarrhea is unclear.
The two main absorbents are attapulgite
and polycarbophil, and
they are both available without prescriptions.
Examples of products
containing attapulgite are:
- Donnagel,
- Rheaban,
- Kaopectate Advanced Formula,
- Parepectolin, and
- Diasorb.
Examples of products containing
polycarbophil are:
- Equalactin,
- Konsyl Fiber,
- Mitrolan, and
- Polycarb.
Equalactin is
the antidiarrheal product containing attapulgite; however the laxative, Konsyl,
also contains attapulgite. Attapulgite and polycarbophil remain in the
intestine and, therefore, have no side effects outside of the gastrointestinal tract.
They may occasionally cause constipation and bloating. One concern is
that absorbents also can bind medications and interfere with their absorption into the body. For
this reason, it often is recommended that medications and absorbents be taken several hours
apart so that they are physically separated within the intestine.
Anti-motility medications.
Anti-motility medications are drugs that relax the muscles of the small intestine and/or the
colon. Relaxation results in slower flow of intestinal contents. Slower flow
allows more time for water to be absorbed from the intestine and colon and
reduces the water content of stool. Cramps, due to spasm of the intestinal
muscles, also are relieved by the muscular relaxation.
The two main anti-motility medications are loperamide (Imodium), which is
available without a prescription, and
diphenoxylate (Lomotil), which requires
a prescription. Both medications are related to opiates (for example, codeine ) but neither
has the pain-relieving effects of opiates.
Loperamide (Imodium), though related to
opiates, does not cause addiction.
Diphenoxylate is a man-made medication that at high doses
can be addictive because of its opiate-like, euphoric (mood-elevating) effects.
In order to prevent abuse of diphenoxylate and addiction, a second medication,
atropine, is added to loperamide in Lomotil. If too much Lomotil is ingested,
unpleasant side effects from too much atropine will occur.
Loperamide and diphenoxylate are safe and well-tolerated. There are some
precautions, however, that should be observed.
- Anti-motility medications should not be used without a doctor's
guidance to treat diarrhea caused by moderate or severe ulcerative colitis,
C.
difficile colitis, and intestinal infections by bacteria that invade the
intestine (for example, Shigella). Their use can lead to more serious inflammation
and prolong the infections.
- Diphenoxylate can cause drowsiness or dizziness, and
caution should be used if driving or performing tasks that require alertness
and coordination are required.
- Anti-motility medications should not be used in children
younger than two years of age.
- Most unimportant, acute diarrhea should improve within 72
hours. If symptoms do not improve or if they worsen, a doctor should be
consulted before continuing treatment with anti-motility medications.
Bismuth compounds. Many
bismuth-containing preparations are available around the world.
Bismuth
subsalicylate (Pepto-Bismol) is available in the United States. It contains two
potentially active ingredients, bismuth and salicylate (aspirin). It is not
clear how effective bismuth compounds are, except in traveler's diarrhea and the
treatment of H. pylori
infection of the stomach
where they have been shown to be effective. It also is not clear how bismuth
subsalicylate might work. It is thought to have some antibiotic-like properties
that affect bacteria that cause diarrhea. The salicylate is anti-inflammatory
and could reduce secretion of water by reducing inflammation. Bismuth also might
directly reduce the secretion of water by the intestine.
Pepto-Bismol is well-tolerated. Minor side effects include darkening of the
stool and tongue. There are several precautions that should be observed when
using Pepto-Bismol.
- Since it contains aspirin, patients who are allergic
to aspirin should not take Pepto-Bismol.
- Pepto-Bismol should not be used with other
aspirin-containing medications since too much aspirin may be ingested and lead to
aspirin toxicity, the most common manifestation of which is ringing in the
ears.
- The aspirin in Pepto-Bismol can accentuate the effects of
anticoagulants, particularly warfarin (Coumadin),
and lead to excessive bleeding. It also may cause abnormal bleeding in people
who have a tendency to bleed because of genetic disorders or underlying
diseases, for example, cirrhosis, that may cause abnormal bleeding.
- The aspirin in Pepto-Bismol can aggravate stomach and
duodenal ulcer disease.
- Pepto-Bismol and aspirin-containing products should not be
given to children and
teenagers with chickenpox, influenza, and
other viral infections because they may cause
Reye's syndrome. Reye's syndrome is
a serious illness affecting primarily the liver and brain that can lead to
liver failure and coma, with a mortality rate of at least 20%.
- Pepto-Bismol should not be given to infants and children
younger than two years of age.
Next: When should antibiotics be used for diarrhea? »
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