Explosive Diarrhea (Violent, Loud Bowel Movements)

What is explosive diarrhea?

Explosive diarrhea is a descriptive term to describe very frequent bowel movements that is expelled in an almost violent nature and is usually excessively loud. Although diarrhea is a common symptom from childhood to the senior years, explosive diarrhea can be very distressing. It is important to understand the mechanism behind bowel movements that appear so violent and the possible causes. Diarrhea itself is usually loud and violent when compared to normal bowel movements and the term ‘explosive diarrhea’ is subjective.

Normal vs Explosive Diarrhea

Diarrhea is not a normal occurrence. It is a symptom of some underlying disease and not a disease itself. Normally a person passes stool between 2 times a day to 3 times a week. Defecation is not painful or difficult. Based on the frequency, when a person passes stool less than 3 times a week they are said to be constipated. Passing stool more than 3 times a day is said to be diarrhea. However, there are other factors to consider in both constipation and diarrhea. For example, diarrhea is considered on the basis of the stool consistency and volume.

When diarrhea does occur, it is usually acute. A person may experience very loose stool, which is usually watery diarhea. Eating foods can worsen the diarrhea and abstaining from food eases it. There is constant urging to pass stool even after having a bowel movement. There may be some abdominal cramps or even pain. In most instances of acute diarrhea, the condition resolves spontaneously within a few days although there may be some disruption of bowel movements for days or even weeks thereafter.

Explosive diarrhea is usually acute in nature. While diarrhea may vary intensity, patients who report diarrhea as being explosive usually mean that it is very severe acute diarrhea. The term is very subjective meaning that one person’s idea of explosive diarrhea may vary from another. It is usually very forceful, which is also described as violent, and loud due to the force that stool is expelled coupled with excessive flatulence that typically accompanies the diarrhea.

Why is diarrhea explosive?

It is important to understand why diarrhea may sometimes seem explosive in nature. Normally, a thick fluid intestinal chyme enters the colon of the large intestine. It is gradually transformed from a liquid to semi-solid and then solid mass which we call stool. Water is absorbed in large quantities within the colon which is the reason why stool becomes more solid in consistency when compared to the contents of the small intestine. Normally a person’s stool is soft but firm and expelled in a long, narrow, almost sausage-shaped form.

Bacteria in the bowel consume undigested material and residual nutrients to produce gas (flatulence). Some gas also passes out of the bloodstream into the gut, enters with swallowing of air and is produced by chemical digestion. It builds up in the bowels and is eventually expelled, often quite loudly.

When the colon becomes distended with the accumulated stool, the defecation process is initiated. A person feels a strong urge to pass stool. Forceful contractions of the colon push stool into the rectum. The internal anal sphincter opens and if the external sphincter is voluntarily opened, stool is pushed out into the environment.

There are three main process that occur in most cases of diarrhea :

• The contents of the gut move too fast due to overactivity of the bowel and proper digestion with nutrient and water absorption does not occur as efficiently.
• Water is drawn out from the bowel wall and into the lumen of the intestines.
• Water is not absorbed in the colon and remains in the lumen.

In most cases of diarrhea, all three process occur to some extent. When there is significant inflammation of the bowel wall, there is also the exudation of mucus and blood.

With disorders that cause explosive diarrhea, the several circumstances that are present that causes the diarrhea to be so ‘violent’ and ‘loud’ :

• There is excessive flatulence due to gas build up beyond the normal quantity of flatus.
• The stool is of a very watery consistency.
• The contractions in the colon and rectum during defecation are unusually strong.
• The sphincters do not open fully and offers resistance to the passage of watery stool and gas.

Explosive Diarrhea Symptoms

Diarrhea is a symptom itself. In patients with very severe diarrhea that can be considered explosive there is :

• Excessive watery stool.
• Excessive and loud passage of gas.
• Forceful defecation that may propel stool, messing the toilet bowel and even soiling the buttocks.
• Excessive rumbling of the abdomen (borborygmi) with hyperactive bowel sounds.
• Anal discomfort during and after stool.
• Uncontrollable diarrhea.

Abdominal distention, cramps or pain, loss of appetite, nausea and vomiting and profuse sweating may also be present depending on the cause.

Causes of Explosive Diarrhea

The causes of explosive diarrhea are largely the same as diarrhea that a person may not consider ‘explosive’. It is largely acute in nature or an acute exacerbation of a chronic disease.

Infections

Most cases of acute diarrhea are infectious in nature and occurs as a result of intense inflammation of the  stomach and intestines – gastroenteritis. It is more frequently caused by viruses and is therefore often referred to as a ‘stomach flu‘. It is short-lived and passes spontaneously after 2 to 3 days in most cases. No treatment is generally required apart from supportive measures to prevent complications like dehydration.

Bacterial causes of diarrhea are also common. These bacteria may directly injure the cells of the intestine or secrete toxins that cause the damage. Some bacteria may naturally be found in the bowels and does not cause any disease unless it is ingested. Other of these naturally occurring bacteria become pathogenic for several reasons. E.coli, V.cholerae, Shigella and Salmonella species are some of the bacteria that may be responsible.

A range of protozoa can cause diarrhea. It is often referred to as traveler’s diarrhea because these pathogens are commonly found in contaminated water and food in developing nations. However, bacteria and viruses may also be the cause in these instances. Giardiasis and amoebic dysentry are two types of protozoal infections that cause severe diarrhea.

Toxins

A range of toxic substances can cause diarrhea. It may include naturally occurring toxins and poisons present in the environment, from plants or animals. Some microbes like bacteria may produce toxins which can contaminate food and water and lead to diarrhea when consumed, as is the case in food poisoning. Other toxins may be synthetic, produced in factories or laboratories, and be accidentally consumed. Less often, poisoning may be intentional.

Medication

A range of medication can cause diarrhea. Laxatives are known to facilitate bowel movements and can cause explosive diarrhea when used in excess. Another drug that may be responsible is antibiotics. After being used, it can affect the normal bowel bacteria which are important for bowel health. One type of bacteria known as Clostridium difficile can multiple profusely and lead to what is known as antibiotic-associated diarrhea or pseudomembranous colitis.

Foods

Some foods can cause diarrhea when the digestive tract cannot digest it, absorb it or if it is eaten in excess. Food intolerance is due to a lack of certain digestive enzymes leading to an inability to digest certain foods, like milk and dairy in lactose intolerance. Fructose is another common food substance that may be responsible for diarrhea when there is difficulty digesting and absorbing it as is the case in fructose malabsorption. Other substances such as sorbitol and mannitol may also be a cause of diarrhea in some people.

Other causes

• Bariatric surgery for weight loss.
• Resection of a part of the entire diseased stomach or intestines.
• Inflammatory bowel disease – Crohn’s disease and ulcerative colitis
• Celiac disease
• Irritable bowel syndrome (IBS)

Explosive Diarrhea Treatment

The cause of the diarrhea should be treated rather than focusing solely on the symptom – diarrhea. Most cases of explosive diarrhea are acute and resolve spontaneously in a few days without any treatment. However, sometimes treatment is required and should be directed at the cause. Supportive measures are needed to prevent complications and limit the severity of the diarrhea. When diarrhea itself needs to be managed, there a number of conservative measures and medication that may be helpful.

• Antidiarrheal drugs like loperamide can reduce the severity or even stosp diarrhea for short periods of time. It should be used cautiously in infections and toxin-induced diarrhea.
• Oral rehydration solutions (ORS) should be used during the course of the diarrhea to minimize dehydration with water and electrolyte loss. IV fluids are needed in severe cases of dehydration.
• Bland diets with simple fresh foods may be helpful in reducing the severity of the diarrhea. The BRAT diet consisting of mashed bananas, rice, grated apple or apple sauce and plain toast may be better tolerated.
• Probiotics containing Saccharomyces boulardii and Lactobacillus casei can help restore the normal intestinal flora (‘good’ bowel bacteria). Dairy may cause secondary lactose intolerance.

 References

1. Management of acute diarrhea. CDC.gov

Last updated on September 7, 2018.