Diarrhea: Causes, symptoms and how it is diagnosed

What is diarrhea?

Diarrhoea is defined in terms of the frequency and consistency of the passage of stools. It is therefore defined as the passage of a minimum of three loose stools in a 24 hour period. This means that, for you to be diagnosed with diarrhoea (which could be a symptom of many other diseases), there should be an increase in the frequency of passage of stools (at least three) and the nature of the stools (consistency) should be loose (watery).

Diarrhoea is usually as a result of an increased volume of fluids in the intestines which may be due to the inability of the lining of the intestines to absorb fluid, active secretion of fluids, or the presence of a substance which draws out more fluids into the intestines. There are several causes of diarrhoea which include infections or inflammatory conditions.

Some of the causes of diarrhoea are known to be self-limiting. Which means that, in those instances of diarrhoea, no specific treatment is required, the body will usually be able to correct the diarrhoea.

For all types of diarrhoea, re-hydration is essential, irrespective of the cause. This is because diarrhoea results in dehydration and the loss of fluids is also accompanied by loss of essential electrolytes which can trigger other conditions. It is therefore important to replace the lost electrolytes in order to prevent possible complications following the dehydration.

What are the symptoms of diarrhea?

As already mentioned, diarrhoea involves the frequent passage of loose stools but in addition to that, one may also have some other signs or symptoms. These additional signs and symptoms usually help clinicians to narrow down and zero in to the possible cause of the diarrhoea.

You should therefore take note of any of the following symptoms if they present with your diarrhoea. Also, anytime you report to a pharmacy or any health facility, do well to mention them to the healthcare professional who is going to take care of you to ensure that you get the optimum treatment.

The additional symptoms include:

• Presence of blood or mucus in stools
• Presence of excess fat in stools (Steatorrhoea)
• Fever
• Abdominal pain or cramps
• Vomiting or nausea
• Bloating
• Generalized weakness

Also, the presence of dehydration may bring in other symptoms which are worth noting. Some of these symptoms observed in adults include:

• Reduced urine output
• Increased thirst
• Weakness
• Dizziness or light-headedness

In children there may be some different symptoms to look out for in accessing dehydration. In mild to moderate dehydration in children the following may be observed:

• Irritability
• Dry mouth
• Less tears when crying
• Passing less urine than usual

In severe dehydration, children may have signs including very sunken and dry eyes, lethargy, unconsciousness, sunken fontanelle (which is the soft spot on the top of the head in babies and toddlers), and very dry mouth and tongue.

What are the causes of diarrhea?

Diarrhoea may be acute or chronic in nature and may be caused by a lot of different things. A diarrhoea episode is described as acute if it lasts for less than two weeks. It is, however, considered chronic if the diarrhoea lasts for more than two weeks.

For acute diarrhea:

• Infections: A viral, bacteria or parasitic infection can cause diarrhoea. The most common cause of infectious diarrhoea in children is viral infection. These can usually be passed on from one person to the other.

• Common viruses known to cause diarrhoea include: Rotavirus and norovirus
• Common bacteria known to cause diarrhea include: Salmonella spp., Shigella, Campylobacter, E.coli, Vibrio cholerae
• Common protozoan known to cause diarrhoea include: Entamoeba histolytica

• Drug-induced diarrhoea: Some medications have been found to induce diarrhoea as their side effects especially when used for long or used in combination with one another. Examples of such medications include: Penicillins, Cephalosporins, Lincosamides (Clindamycin)
• Change in diet: In some people, an abrupt change in their usual diet can result in diarrhoea.
• Food intolerance: Some people cannot tolerate certain foods and may react badly after taking such foods which usually presents as diarrhoea. An example is lactose intolerance.

For chronic diarrhea

• Chronic infections: including amoebiasis, tuberculosis, opportunistic infections with HIV
• Functional: example: irritable bowel syndrome
• Inflammatory: example: ulcerative colitis, Crohn’s disease
• Malabsorption syndromes: example: chronic pancreatitis
• Malignancy: example: colon cancer
• Endocrine: example: hyperthyroidism, diabetic autonomic neuropathy
• Drug-induced: Laxatives, NSAIDs

When to see your pharmacist or doctor about diarrhea

Diarrhoea is a common occurring condition and everybody might have experienced some in one way or the other. Most instances of diarrhoea are self-limiting. Episodes of diarrhoea usually stop when the cause is eliminated and in most cases, the body is able to do it all by itself if it is not by a continuous introduction of an external substance causing the diarrhoea.

You may not have to seek any medical advice in those instances but in the following instances, seeking medical advice is recommended.

• If you become severely dehydrated from an episode of diarrhoea
• Diarrhoea that lasts for more than five (5) days
• The presence of blood (whether bright red or dark and tarry stools)
• The stool you pass has high fat content which is observed as a pale, greasy , foul smelling and difficult to flush
• It comes with vomiting, weakness and dizziness
• Has resulted in excessive weight loss
• Diarrhoea associated with use of medications (You have to inform the healthcare professional of all the medications you are taking)
• If you have a pre-existing medical condition such as diabetes, heart failure or kidney failure.
• You have very high fever
• Severe abdominal pain (especially in children)

How is diarrhea diagnosed?

From the definition, diarrhoea is diagnosed any time one passes frequent loose stools, usually a minimum of three within 24 hours. As such your doctor or pharmacist will be interested in how many times you have been passing stools, the nature of the stools and for how long you have had the diarrhoea.

As mentioned earlier, there are additional signs or symptoms that may be present with the diarrhoea which gives a clue about the possible causes of the diarrhea. As such, your pharmacist or doctor may also be interested in those additional signs or symptoms. 

Which tests or investigations will be done for diarrhoea?

To help with the diagnosis of diarrhoea and help choose the best treatment for it, your pharmacist or doctor may require you to do some laboratory investigations or tests. Some of the commonly requested tests or investigations include:

• Full blood count
• Stool routine examination
• Stool for culture and sensitivity
• Blood urea and creatinine (usually necessary when there is severe dehydration)
• Blood film for malaria parasites (especially in Sub-saharan Africa)

How is diarrhea treated?

When it comes to treating diarrhoea, you should bear the following objectives in mind:

• Prevent dehydration as much as possible
• Replace lost fluid (based on extent of dehydration)
• Maintain nutrition by ensuring adequate dietary intake during the diarrhea episodes
• Maintain personal hygiene
• Eliminate infecting organisms where applicable 

References:

• Ghana Standards Treatment Guidelines, 2017
• https://mydr.com.au/gastrointestinal-health/diarrhoea/ (accessed July 2021)