Article title: Diarrhea: NIDDK
Main condition: Diarrhea
Conditions: Diarrhea, rotavirus, dehydration, Traveler's diarrhea
What Is Diarrhea?
Diarrhea--loose, watery stools occurring more
than three times in one day--is a common problem that usually lasts a day
or two and goes away on its own without any special treatment. However,
prolonged diarrhea can be a sign of other problems.
Diarrhea can cause dehydration, which means the body lacks enough fluid
to function properly. Dehydration is particularly dangerous in children
and the elderly, and it must be treated promptly to avoid serious health
Dehydration is discussed below.
People of all ages can get diarrhea. The average adult has a bout of
diarrhea about four times a year.
What Causes Diarrhea?
Diarrhea may be caused by a temporary problem,
like an infection, or a chronic problem, like an intestinal disease. A few
of the more common causes of diarrhea are
- Bacterial infections. Several types of bacteria, consumed through
contaminated food or water, can cause diarrhea. Common culprits include
Campylobacter, Salmonella, Shigella, and Escherichia coli.
- Viral infections. Many viruses cause diarrhea, including rotavirus,
Norwalk virus, cytomegalovirus, herpes simplex virus, and viral
- Food intolerances. Some people are unable to digest a component of
food, such as lactose, the sugar found in milk.
- Parasites. Parasites can enter the body through food or water and
settle in the digestive system. Parasites that cause diarrhea include
Giardia lamblia, Entamoeba histolytica, and
- Reaction to medicines, such as antibiotics, blood pressure
medications, and antacids containing magnesium.
- Intestinal diseases, like inflammatory bowel disease or celiac
- Functional bowel disorders, such as irritable bowel syndrome, in
which the intestines do not work normally.
Some people develop diarrhea after stomach surgery or removal of the
gallbladder. The reason may be a change in how quickly food moves through
the digestive system after stomach surgery or an increase in bile in the
colon that can occur after gallbladder surgery.
In many cases, the cause of diarrhea cannot be found. As long as
diarrhea goes away on its own, an extensive search for the cause is not
People who visit foreign countries are at risk for traveler's diarrhea,
which is caused by eating food or drinking water contaminated with
bacteria, viruses, or, sometimes, parasites. Traveler's diarrhea is a
particular problem for people visiting developing countries. Visitors to
the United States, Canada, most European countries, Japan, Australia, and
New Zealand do not face much risk for traveler's diarrhea.
What Are the Symptoms?
Diarrhea may be accompanied by cramping
abdominal pain, bloating, nausea, or an urgent need to use the bathroom.
Depending on the cause, a person may have a fever or bloody stools.
Diarrhea can be either acute or chronic. The acute form, which lasts
less than 3 weeks, is usually related to a bacterial, viral, or parasitic
infection. Chronic diarrhea lasts more than 3 weeks and is usually related
to functional disorders like irritable bowel syndrome or diseases like
celiac disease or inflammatory bowel disease.
Diarrhea in Children
Children can have acute (short-term) or chronic
(long-term) forms of diarrhea. Causes include bacteria, viruses,
parasites, medications, functional disorders, and food sensitivities.
Infection with the rotavirus is the most common cause of acute childhood
diarrhea. Rotavirus diarrhea usually resolves in 5 to 8 days.
Medications to treat diarrhea in adults can be dangerous to children
and should be given only under a doctor's guidance.
Diarrhea can be dangerous in newborns and infants. In small children,
severe diarrhea lasting just a day or two can lead to dehydration. Because
a child can die from dehydration within a few days, the main treatment for
diarrhea in children is rehydration.
Rehydration is discussed below.
Take your child to the doctor if any of the following symptoms appear:
- Stools containing blood or pus, or black stools
- Temperature above 101.4 degrees Fahrenheit
- No improvement after 24 hours
- Signs of dehydration (see below)
What Is Dehydration?
General signs of dehydration include
- Less frequent urination
- Dry skin
- Dark colored urine
Signs of dehydration in children include
- Dry mouth and tongue
- No tears when crying
- No wet diapers for 3 hours or more
- Sunken abdomen, eyes, or cheeks
- High fever
- Listlessness or irritability
- Skin that does not flatten when pinched and released
If you suspect that you or your child is dehydrated, call the doctor
immediately. Severe dehydration may require hospitalization.
When Should a Doctor Be Consulted?
Although usually not harmful, diarrhea can
become dangerous or signal a more serious problem. You should see the
- You have diarrhea for more than 3 days.
- You have severe pain in the abdomen or rectum.
- You have a fever of 102 degrees Fahrenheit or higher.
- You see blood in your stool or have black, tarry stools.
- You have signs of dehydration.
If your child has diarrhea, do not hesitate to call the doctor for
advice. Diarrhea can be dangerous in children if too much fluid is lost
and not replaced quickly.
What Tests Might the Doctor Do?
Diagnostic tests to find the cause of diarrhea
include the following:
- Medical history and physical examination. The doctor will need to
know about your eating habits and medication use and will examine you
for signs of illness.
- Stool culture. Lab technicians analyze a sample of stool to check
for bacteria, parasites, or other signs of disease or infection.
- Blood tests. Blood tests can be helpful in ruling out certain
- Fasting tests. To find out if a food intolerance or allergy is
causing the diarrhea, the doctor may ask you to avoid lactose (found in
milk products), carbohydrates, wheat, or other foods to see whether the
diarrhea responds to a change in diet.
- Sigmoidoscopy. For this test, the doctor uses a special instrument
to look at the inside of the rectum and lower part of the colon.
- Colonoscopy. This test is similar to sigmoidoscopy, but the doctor
looks at the entire colon.
What Is the Treatment?
In most cases, replacing lost fluid to prevent
dehydration is the only treatment necessary. (See "Preventing Dehydration"
below.) Medicines that stop diarrhea may be helpful in some cases, but
they are not recommended for people whose diarrhea is from a bacterial
infection or parasite--stopping the diarrhea traps the organism in the
intestines, prolonging the problem. Instead, doctors usually prescribe
antibiotics. Viral causes are either treated with medication or left to
run their course, depending on the severity and type of the virus.
Dehydration occurs when the body has lost too much fluid and
electrolytes (the salts potassium and sodium). The fluid and electrolytes
lost during diarrhea need to be replaced promptly--the body cannot
function properly without them. Dehydration is particularly dangerous for
children, who can die from it within a matter of days.
Although water is extremely important in preventing dehydration, it
does not contain electrolytes. To maintain electrolyte levels, you could
have broth or soups, which contain sodium, and fruit juices, soft fruits,
or vegetables, which contain potassium.
For children, doctors often recommend a special rehydration solution
that contains the nutrients they need. You can buy this solution in the
grocery store without a prescription. Examples include Pedialyte,
Ceralyte, and Infalyte.
Tips About Food
Until diarrhea subsides, try to avoid milk products and foods that are
greasy, high-fiber, or very sweet. These foods tend to aggravate diarrhea.
As you improve, you can add soft, bland foods to your diet, including
bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and
baked chicken without the skin or fat. For children, the pediatrician may
recommend what is called the BRAT diet: bananas, rice, applesauce, and
Preventing Traveler's Diarrhea
Traveler's diarrhea happens when you consume
food or water contaminated with bacteria, viruses, or parasites. You can
take the following precautions to prevent traveler's diarrhea when you go
- Do not drink any tap water, not even when brushing your teeth.
- Do not drink unpasteurized milk or dairy products.
- Do not use ice made from tap water.
- Avoid all raw fruits and vegetables (including lettuce and fruit
salad) unless they can be peeled and you peel them yourself.
- Do not eat raw or rare meat and fish.
- Do not eat meat or shellfish that is not hot when served to you.
- Do not eat food from street vendors.
You can safely drink bottled water (if you are the one to break the
seal), carbonated soft drinks, and hot drinks like coffee or tea.
Depending on where you are going and how long you are staying, your
doctor may recommend that you take antibiotics before leaving to protect
you from possible infection.
Points To Remember
- Diarrhea is a common problem that usually resolves on its own.
- Diarrhea is dangerous if a person becomes dehydrated.
Causes include viral, bacterial, or parasitic infections; food
intolerance; reactions to medicine; intestinal diseases; and functional
- Treatment involves replacing lost fluids and electrolytes. Depending
on the cause of the problem, a person might also need medication to stop
the diarrhea or treat an infection. Children may need an oral
rehydration solution to replace lost fluids and electrolytes.
- Call the doctor if a person with diarrhea has severe pain in the
abdomen or rectum, a fever of 102 degrees Fahrenheit or higher, blood in
the stool, signs of dehydration, or diarrhea for more than 3 days.
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NIH Publication No. 01-2749
Updated: January 2001