Diarrhea

Diarrhea is defined as the passage of frequent, loose, watery stools three or more times a day that may be accompanied by vomiting. In children, the most common cause is viral. There is, therefore, usually no need to prescribe antibiotics. Other diseases like malaria, pneumonia, ear infections, and urinary tract infections may be associated with diarrhea. Fluid loss occurs quickly, and if not corrected, it may result in dehydration, which can be fatal. 

Acute Diarrhoea: Acute diarrhea is characterized by loose, watery diarrhea that lasts less than two weeks.

Chronic Diarrhoea: Chronic diarrhea is defined as diarrhea that lasts longer than four weeks or comes and goes on a regular basis over a long period.

Acute Diarrhoea (< 2 weeks)

 Infections

• Viral: e.g. Rotavirus, norovirus
• Bacterial: e.g., Salmonella spp., Shigella, Campylobacter, E. coli, Vibrio cholerae
• Protozoal: e.g., Entamoeba histolytica (amoebiasis)
• Drug-induced: e.g., Penicillins

Chronic Diarrhoea (> 2 weeks)

• Chronic infections: e.g., Amoebiasis, tuberculosis, opportunistic infections with HIV
• Functional: e.g., Irritable bowel syndrome
• Inflammatory: e.g., Ulcerative colitis, Crohn’s disease
• Malabsorption syndromes: e.g., Chronic pancreatitis
• Malignancy: e.g., Colon cancer
• Endocrine: e.g., hyperthyroidism, diabetic autonomic neuropathy
• Drug-induced: e.g., Laxatives, NSAIDs

The signs and symptoms of diarrhea include:

• Frequent watery stools
• Blood or mucus in the stool
• Presence of fever
• Reduced urine output
• Associated vomiting

The following signs may be present in adults:

• Anemia
• Weight loss
• Anorexia
• Oral lesions e.g., Oral ulcers, candidiasis
• Skin lesions, e.g., Erythema nodosum
• Signs of dehydration (dry mucous membranes, reduction in skin turgor, tachycardia, postural hypotension)
• Enlarged thyroid
• Abdominal masses
• Rectal mass

Risk factors include travel history, food history, epidemics, outbreaks, animal contact, hospitalization, and immunosuppression.

Demographic factors: The incidence of diarrhea is higher in younger children. Boys are affected more than girls.

Socio-economic factors: According to research studies, there is a statistically significant link between socioeconomic characteristics such as inadequate housing, crowded conditions, low-income households with an increased risk of diarrhea.

Water-related factors: Water storage in widemouthed containers, use of unsafe water sources (such as rivers, pools, dams, lakes, streams, wells, and other surface water sources), and poor drinking water storage have all been identified as risk factors.

Sanitation factors: The risk of diarrhea is increased by sanitation factors such as indiscriminate or improper disposal of stool and household garbage, lack of a toilet or an unsanitary toilet, sharing bathrooms, and living in a house without a sewage system.

Hygiene practices: Not washing hands before meals or after defecation,  before feeding children or preparing foods, eating cold leftovers, dirty feeding bottles and utensils, filthy domestic locations (kitchen, living room, yard), improper food storage, the presence of animals, and flies inside the house, have all been linked to an increased risk of diarrhea.

Malnutrition: Diarrhea is more common in children whose immune systems have been weakened by malnutrition. Diarrhea, especially persistent and chronic diarrhea, depletes nutritional status, resulting in nutrient malabsorption or the inability to absorb nutrients to maintain health.

Immunodeficiency: People with innate or acquired immunodeficiency are vulnerable to microorganisms that cause infectious diseases such as diarrhea.

Seasonal distribution: According to several studies, diarrhea is more common during the rainy season than in the dry season.

Contamination: By consuming contaminated foods such as fruits, vegetables, shellfish, raw meat, water, and ice cubes, tourists visiting other countries with warm climates are at greater risk of contracting diarrhea.

Eating habits: Eating with unwashed hands, eating raw foods, or drinking unboiled water can all increase your chances of getting diarrhea.

The majority of mild diarrhea cases do not require medical intervention. These conditions are self-limited (they only last a certain period) and improve on their own.  Supportive therapy is the key to mild diarrhea, i.e., staying hydrated and eating a bland diet. More severe diarrhea may require medical intervention. Your doctor may order a few diagnostic tests in these scenarios. These tests may involve the following:

• CBC
• Blood film for malaria parasites
• Stool routine examination
• Stool for culture and sensitivity
• Blood urea and creatinine

• Food allergies
• Irritable bowel syndrome
• Inflammatory bowel disease
• Lactose intolerance
• Celiac disease
• Ischemic colitis
• Side effects of medications
• Laxative abuse
• Infections e.g., salmonella, campylobacter, shigella, E.coli, giardia, cyclospora, rotavirus, adenovirus, Entamoeba, etc. 

Diarrhea that is mild and uncomplicated can usually be treated at home. You'll usually feel better very quickly if you use an over-the-counter medication like bismuth subsalicylate.  Over-the-counter drugs, on the other hand, aren't always the best option. If you have diarrhea caused by an infection or parasite, you should consult a doctor for treatment. If you have a fever or blood in your stool, you should avoid taking over-the-counter diarrhea treatments. Consult your healthcare provider if this is the case.

When diarrhea lasts for a long time (weeks or months), your healthcare provider will treat you according to the cause. This could involve a variety of treatment options, such as:

• Antibiotics or other medications may be prescribed by your doctor to treat an infection or parasite that is causing diarrhea.
• Medication to treat a specific condition: Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis, microscopic colitis, or bacterial overgrowth are all possible causes of diarrhea.
• Diarrhea may usually be managed once the cause of diarrhea has been determined.
• Probiotics: Probiotics are groups of good bacteria that are occasionally used to re-establish a healthy biome in order to treat diarrhea. Probiotics can be beneficial in some cases, and some healthcare practitioners believe it is worth the try. Before beginning a probiotic or any other supplement, always consult with your doctor.

Usually, the treatment objectives of diarrhea include:  

• Preventing dehydration
• Replacing lost fluid
• Maintaining nutrition by ensuring adequate dietary intake during illness
• Maintaining personal hygiene
• Eliminating infecting organisms where appropriate 

Diarrhea is extremely common, but that does not rule out the possibility of it being dangerous. You can become dehydrated in severe cases of diarrhea, which can lead to serious complications. One of the most dangerous side effects of diarrhea is dehydration. This can have serious consequences in the very young (infants and small children) and the very old. When you have diarrhea, it's important to take plenty of fluids containing electrolytes. This enables your body to replenish the fluid and electrolytes lost due to diarrhea. Diarrhea can be a life-threatening condition in some parts of the world due to dehydration and electrolyte loss.

• Keep surroundings clean
• Improve personal hygiene, e.g., hand washing after toilet and when handling food.
• Adequate oral fluid intake
• Maintain adequate nutrition as can be tolerated