Find the Cause of Diarrhea from Symptoms

In this article, typical symptoms are paralleled with common causes of diarrhea. The cause of diarrhea can be also found by tests for diarrhea.

Causes of Diarrhea in Newborns

A newborn normally poops 8-10 times a day.

  • Fever, vomiting, diarrhea: rotavirus, rarely other microbes;
  • Mild diarrhea: overfeeding, neonatal drug withdrawal;
  • Skin rash, strain to vomiting (gagging), irritability, diarrhea: allergy to cow’s milk or soy formula;
  • Diarrhea in first 3 days of life: congenital diseases of the liver, pancreas, biliary tract, small or large intestine.

Infant and Toddler Diarrhea

ACUTE DIARRHEA:

  • Fever, vomiting, diarrhea: rotavirus; less commonly: bacteria, parasites, middle ear and urinary tract infections, intusussception, hemolytic-uremic syndrome;
  • mild diarrhea: newly introduced food, liquid starvation diet, food allergies, antibiotics.

CHRONIC DIARRHEA:

  • Diarrhea with undigested food particles, the toddler looks healthy: excessive drinking of fruit juices (toddler’s diarrhea);
  • Constipation, alternating with diarrhea: post-infectious irritable bowel syndrome;
  • Coughing, hives, face flushing, watery/bloody diarrhea: food allergy;
  • Skin rash, underweight, watery/bloody diarrhea: intestinal parasites, including intestinal worms, celiac disease, autoimmune enteropathy; rarely: Crohn’s disease, ulcerative colitis, tuberculosis, AIDS, cystic fibrosis, congenital diseases of biliary tract, liver, pancreas or intestine, surgery of small intestine, marasmus, kwashiorkor, zinc deficiency.
  • Diarrhea faked by child’s caregiver (usually mother): factitious diarrhea, Munchausen by Proxy Syndrome (1).

Diarrhea in Older Children and Adults

ACUTE DIARRHEA:

  • Sudden diarrhea: bacteria; rare: pesticides or heavy metals poisoning, pseudomembranous colitis;
  • Mild (recurrent) diarrhea: stress, medications, bowel investigation or surgery, parasites, appendicitis, diarrhea in pregnancy;
  • Diarrhea after eating, vomiting: food poisoning (staph, mushrooms, tropical fish, alcohol), plant poisoning.

CHRONIC DIARRHEA:

  • Diarrhea after eating: IBS, lactose intolerance, food allergies, rapid gastric emptying (dumping syndrome), carcinoid syndrome;
  • Mild chronic diarrhea: fructose malabsorption, diabetes, alcoholism, pregnancy; rarely: collagenous/lymphocytic colitis, neuroendocrine tumors;
  • Weight loss, bloody diarrhea, recurrent fever, skin rash: Crohn’s disease, ulcerative colitis, typhoid fever, chronic infection (tuberculosis, AIDS, HSV, CMV);
  • Weight loss, bloating, pale loose stool: malabsorption due to gallbladder, liver or pancreatic disease, Crohn’s disease, celiac disease, small intestinal bacterial overgrowth (SIBO) , chronic infection, or laxative abuse; rare: tropical sprue, Whipple disease, intestinal lymphoma, systemic sclerosis, amyloidosis.
  • Mucus in the bowel movement: IBS, parasites
  • White coated tongue, fatigue, sugar craving, anal itching: candida (see other candida symptoms);
  • Diarrhea after travel: parasites, tropical sprue;
  • Constipation/diarrhea in children: encopresis, post-infectious irritable bowel syndrome;
  • Weakness, dizziness, salt craving: dehydration or Addison’s disease;
  • Irritability, sweating, bulging eyes, enlarged thyroid, weight loss, diarrhea: hyperthyroidism;
  • Leg swelling, mucous diarrhea: protein-losing enteropathy (in ulcerations of the esophagus, stomach or duodenum, Crohn’s disease, intestinal lymphangiectasia, tuberculosis, lymphoma, congestive heart failure, carcinoid syndrome etc), (2).

Typical Causes of Diarrhea in Old People

CHRONIC DIARRHEA:

  • Constipation and/or diarrhea: diverticulitis, ischemic colitis, partial obstruction of the colon or small intestine (fecal impaction, polyps, cancer, adhesions);
  • Pins and needles sensations in hands and feet, early satiety, diarrhea, blurred vision, difficult swallowing, urine retention/incontinence, fainting, etc: autonomic neuropathy (in diabetes, alcoholism, Parkinson’s disease, vit B12/folate deficiency, Sjögren syndrome, SLE, amyloidosis);
  • Diarrhea after eating: carcinoid, VIPoma;
  • Mild constant diarrhea: small intestinal bacterial overgrowth, intestinal lymphoma, systemic sclerosis.

Abdominal Pain and Diarrhea

Exact location of abdominal pain may help in finding the cause of diarrhea.

  • Upper right quadrant: gallbladder, biliary tract, liver disease; rarely: duodenal, pancreatic disease;
  • Upper middle abdomen: gastric, duodenal, pancreatic disease;
  • Upper left quadrant (rarely): gastric, pancreatic disease;
  • Lower right quadrant: Crohn’s disease, appendicitis;
  • Lower left quadrant: Ulcerative colitis, diverticulitis, ischemic colitis; rarely: colorectal cancer.

Causes of right side and left side abdominal pain.

How Can a Doctor Find the Cause of Diarrhea?

History. A doctor may ask you:

  • When did diarrhea start?
  • Color and consistency of the stool, any blood or mucus?
  • Is diarrhea related to meals, stress, or daytime? Any recent travel in tropics?
  • Fever, abdominal pain or other symptoms?
  • Diet, alcohol intake?
  • Chronic disease, medications, recent investigation or surgery?
  • Family members: anyone has diarrhea or chronic disease?

Physical examination. Doctor will look for signs of underlying disease:

  • Skin: rash, jaundice, pale skin, scaling, turgor;
  • Abdomen: distension or lumps, enlarged liver or spleen, painful spots;
  • Neck: enlarged thyroid, lymph nodes;
  • Rectal examination: internal hemorrhoids, polyps, inflamed skin around the anus, fistula.

Related Articles:

References:

  1. Munchousen by proxy syndrome  (kidshealth.org)
  2. Protein losing enteropathy  (emedicine.com)

Article reviewed by Dr. Greg. Last updated on February 17, 2010