Diarrhea is a common symptom that we all experience several times in our life. In most instances it is acute, meaning that it lasts for a few days, and then eases. It may not even require medical treatment and does not tend to recur shortly after stopping. However, there are instances where diarrhea can be persistent and despite our best efforts, it may not stop without medical treatment. There are also various causes of chronic diarrhea which may be a symptom of some underlying chronic disease. Chronic diarrhea needs to be addressed by treating and managing the underlying causative condition. For acute and persistent diarrhea (not chronic), however, there are several measures that can be taken within the home.
The information in this article is not intended to replace the advice and treatment by a medical professional. If you are experiencing diarrhea you should seek medical attention, particularly if the diarrhea is severe and persisting.
Facts About Diarrhea
Before delving further into the diet, remedies and medication that can help ease diarrhea or treat it, it is important to understand some of the facts behind diarrhea.
- Diarrhea is a symptom of some underlying disease and is not a disease on its own.
- Most instances of acute diarrhea will resolve spontaneously meaning that it will stop on its own within a few hours to days even without treatment.
- Normal bowel habit is passing stool anywhere between 2 to 3 times a day to at least 3 times a week. Diarrhea is passing out more than 200 grams of solid stool or 200 milliliters of liquid stool within 24 hours or having more than 3 bowel movements in a day. Typically the stool is loose or watery.
- Normal intestinal flora is the combination of bacterial species that are important for bowel health and habit. When these ‘good bowel bacteria’ are destroyed, diarrhea can occur.
- Most cases of acute diarrhea are due to infections, mainly viruses or bacteria, protozoa and their toxins. These viral infections are commonly referred to as the stomach flu. Bacteria, protozoa and its toxins are often responsible for the more severe cases of infectious diarrhea.
- Blood or copious amounts of mucus in the stool are very serious warning signs of severe bowel disease and need immediate medical attention.
Drugs to Stop Diarrhea
Antidiarrheal drugs are medication that can stop diarrhea. It only has a temporary effect unless the underlying cause of diarrhea is treated or resolves on its own. Two common drugs used for treating diarrhea are loperamide and bismuth subsalicylate. Loperamide works by slowing down the movement of intestinal contents. Bismuth subsalicylate regulates the amount of fluid within the bowels and can soothes inflammation of the intestinal wall.
Antidiarrheal drugs should not be used immediately once diarrhea arises. It may treat the symptom but not the underlying cause. With certain infections and toxins, it is better to let the diarrhea run its course and for the microbes and toxins to be expelled completely. By using antidiarrheals, the microbes can remain within the gut, multiply and worsen the condition. However, this does not mean that antidiarrheals should not be used. Rather it should be prescribed by a doctor and used in moderation.
Eliminate Problem Foods
Consuming certain foods may be the cause of diarrhea when the body cannot digest it (food intolerance) or absorb it (food malabsorption). Typically a person will experience diarrhea within a few minutes to hours after consuming the problem food. Other gastrointestinal symptoms are also present like excessive gas, abdominal cramps and nausea. Sometimes small amounts of a problem food may be tolerated thereby giving a false indication that it is not the cause of diarrhea. Ideally a food diary should be composed while undergoing an elimination diet to identify problem foods. Digestive enzymes can help with certain food intolerance problems but ideally the trigger food should be avoided.
Probiotics For Bowel Health
Probiotics are any supplement or food that contains the good bowel bacteria. Ideally during diarrhea, probiotics prescribed by a doctor should be used according to instructions. These probiotics contain microbes like Lactobacillus species (bacteria) and Saccharomyces boulardii (yeasts) that help restore the population of the normal intestinal flora. Another type of supplement known as a prebiotic provides vital nutrients to the healthy bowel bacteria thereby promoting its growth. It is not as useful in diarrhea if ‘bad bacteria’ (pathogenic bacteria) have already established itself in the bowels and the ‘good bacteria’ (normal intestinal flora) have been severely affected. Prebiotics cannot replace probiotics.
Apart from dairy being a problem for people with lactose intolerance, it can also worsen diarrhea in people who can normally tolerate it. The latter phenomenon is known as secondary lactose intolerance. Attempting to restore the normal intestinal flora (‘good bowel bacteria’) with dairy products such as live culture yogurt may therefore worsens the diarrhea. Instead probiotics, as prescribed by your doctor or recommended by your pharmacist, are the better options for restoring your healthy bowel bacteria. Once the diarrhea has resolved and bowel habit restored to normal, live culture yogurt can be helpful in promoting and maintaining the normal intestinal flora provided that a person is not lactose intolerant.
Foods to Eat and Avoid
Apart from dairy, it is important to continue with a normal diet as soon as possible. Ideally spicy foods should be avoided as well as processed foods that are heavily laden with preservatives, colorants and other additives. Some of these substances can worsen diarrhea. Avoiding a normal diet of solid foods can contribute to malnutrition especially if the diarrhea is prolonged. Fruits can be eaten in moderation but large amounts of fruit juices and fruits like prunes should be avoided while the diarrhea is still persisting.
The BRAT diet is often suggested for the first few meals. These foods are said to be better tolerated after vomiting and while the diarrhea is subsiding the BRAT diet constitutes :
- Banana, preferably mashed.
- Applesauce or grated apples.
- Toast, dry with no butter.
The BRAT diet does not constitute a balanced diet and therefore normal foods should be consumed if the BRAT diet can be tolerated. It is important to remember that the body is recovering from a serious state of stress after diarrhea and needs proper nutrition for recovery.
Avoid tea, coffee and alcohol. Not only can these beverages worsen the diarrhea but it also promotes dehydration.
Antibiotics Good and Bad in Diarrhea
In the event of bacterial and certain protozoal infections of the bowel that leads to diarrhea, antibiotics are needed to eliminate the microorganisms. Avoiding the use of antibiotics can lead to a protracted illness and even complicate into life threatening situations. While antibiotics are beneficial, it can sometimes contribute to diarrhea persisting even after the infection has resolved. This secondary diarrhea is known as antibiotic-associated diarrhea. It can also arise when antibiotics are used to treat infections elsewhere in the body other than the bowels.
Antibiotic associated diarrhea can be easily prevented and treated with the use of probiotics. Not all antibiotics and not every person using antibiotics may develop antibiotic associated diarrhea. It is more likely to occur when using high doses of antibiotics, especially when used over a prolonged period of time. Therefore probiotics should be used simultaneously as the antibiotics and continued for a short while thereafter. This type of diarrhea is more likely to occur when using oral antibiotics than with injectable antibiotics.
Dehydration First, Diarrhea Second
The loss of fluid and electrolytes from diarrhea, usually worsened if there is vomiting as well, can quickly lead to dehydration. This affects blood pressure, muscle and nerve function, heart activity and can even cause kidney failure. Ultimately it is the dehydration that is the life threatening aspect of diarrhea. It is therefore important to prevent and treat dehydration first. Focusing entirely on treating diarrhea while ignoring the dehydration can be very serious. With severe diarrhea like in cholera, dehydration can occur with hours and death within days.
Oral rehydration solutions (ORS) should therefore be used throughout the duration of the diarrhea and even be continued for a few days after the diarrhea subsides. Once vomiting subsides, if present, a solid diet should be continued immediately. The BRAT diet may help with slowly returning to a regular meals a without exacerbating the diarrhea severely, however, a person can return to a normal diet immediately even though there diarrhea continues. Oral rehydrating solutions should not be stopped even when a person can tolerate a normal diet of solid foods.