What is diarrhea?

Diarrhea is characterized as loose or runny stools that happen an abnormally high number of times throughout the day. Diarrhea can be linked to autoimmune diseases like Crohn’s or functional bowel disorders like irritable bowel syndrome, but is more often a sign of food intolerance (lactose is common), viral infection, food poisoning or other infectious diseases of varying severity. Diarrhea can be a serious problem in that it may cause dehydration and loss of nutrients. In people with chronic diarrhea, nutrient deficiency can be a serious issue.

What are the home remedies for diarrhea?

Many home remedies have been suggested for the treatment of diarrhea; however, few of them have been well studied. Three that have been studied and appear to be effective are:

What is the treatment for diarrhea in infants and children?

Most acute diarrhea in infants and young children is due to viral gastroenteritis and is usually short-lived. Antibiotics are not routinely prescribed for viral gastroenteritis. However, fever, vomiting, and loose stools can be symptoms of other childhood infections such as otitis media (infection of the middle ear), pneumonia, bladder infection, sepsis (bacterial infection in the blood) and meningitis. These illnesses may require early antibiotic treatment.

Infants with acute diarrhea also can quickly become severely dehydrated and therefore need early rehydration. For these reasons, sick infants with diarrhea should be evaluated by their pediatricians to identify and treat underlying infections as well as to provide instructions on the proper use of oral rehydration products.

Infants with moderate to severe dehydration usually are treated with intravenous fluids in the hospital. The pediatrician may decide to treat infants who are mildly dehydrated due to viral gastroenteritis at home with oral rehydration solutions.

Infants that are breastfed or formula-fed should continue to receive breast milk during the rehydration phase of their illness if not prevented by vomiting. During, and for a short time after recovering from viral gastroenteritis, babies can be lactose intolerant due to a temporary deficiency of the enzyme, lactase (necessary to digest the lactose in milk) in the small intestine. Infants with lactose intolerance can develop worsening diarrhea and cramps when dairy products are introduced. Therefore, after rehydration with oral rehydration solutions, an undiluted lactose-free formula and diluted juices are recommended. Milk products can be gradually increased as the infant improves.

What is the treatment for diarrhea in adults?

During mild cases of diarrhea, diluted fruit juices, soft drinks containing sugar, sports drinks such as Gatorade and water can be used to prevent dehydration. Caffeine and lactose-containing dairy products should be temporarily avoided since they can aggravate diarrhea. If there is no nausea and vomiting, solid foods should be continued. Foods that usually are well tolerated during a diarrheal illness include rice, cereal, bananas, and potatoes.

Oral rehydration solutions can be used for moderately severe diarrhea that is accompanied by dehydration in children older than 10 years of age and in adults. Directions on the solution label usually state the amounts that are appropriate. After rehydration, older children and adults should resume solid food as soon as any nausea and vomiting subside. Solid food should begin with rice, cereal, bananas, potatoes, and lactose-free and low-fat products. The variety of foods can be expanded as the diarrhea subsides.

Most episodes of diarrhea are acute and of short duration and do not require antibiotics. Antibiotics usually are not even necessary for the most common bacterial infections that cause diarrhea.

What medications treat diarrhea?

Antibiotics

Antibiotics often are used when

  • patients have more severe and persistent diarrhea,
  • patients have additional debilitating diseases such as heart failure, lung disease, and AIDS,
  • stool examination and testing discloses parasites, more serious bacterial infections (for example, Shigella), or C. difficile, and
  • traveler's diarrhea.

Absorbents

Absorbents are compounds that absorb water in the small intestine and colon to 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 (a naturally occurring complex mineral) and polycarbophil (a fiber) both available without prescriptions. Psyllium, another absorbent has been used for mild diarrhea but is primarily used for constipation.

Examples of products containing attapulgite are:

Examples of products containing polycarbophil are:

  • Equalactin
  • Konsyl Daily Fiber Therapy
  • Mitrolan
  • Polycarb

Products containing polycarbophil have been used to treat both diarrhea and constipation. 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, so it is recommended that medications and absorbents be taken several hours apart so that they are physically separated within the intestines.

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, when used as directed, 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 may lead to more serious inflammation and prolong the infections.
  • Diphenoxylate can cause drowsiness or dizziness, and caution should be used if driving or if 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 US. 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. Several precautions that should be observed when using Pepto-Bismol.

  • Since it contains salicylate, a chemical related to aspirin (acetyl salicylate), 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 salicylate in Pepto-Bismol, similar to aspirin, 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.
  • The salicylate in Pepto-Bismol can aggravate stomach and duodenal ulcer disease like asiprin.
  • Pepto-Bismol and salicylate-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.

What kind of doctor treats diarrhea?

Most cases of diarrhea are treated by your primary care doctor (internist, pediatrician, family practitioner) or if you go to an emergency room and emergency medicine specialist. Gastroenterologists are the specialists who usually manage patients with complicated cases of diarrhea and pursue the diagnosis of its cause, particularly when the diarrhea is chronic.

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Medically Reviewed on 2/11/2019
References
Guandalini, S, MD, et al. Diarrhea. Medscape. Updated: Jul 02, 2018.
<https://emedicine.medscape.com/article/928598-overview>
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