Diarrhoea is a term for stools which occur more than three times a day, in increased amounts and/or liquid or semi-liquid form. You can read about who is affected and possible diagnoses and treatment here.
What is diarrhoea?
Diarrhoea is determined by bowel movement frequency and form. Depending on a person’s age, bowel movement frequency varies considerably: a baby can have five bowel movements a day, but once every five days is also quite normal. Many people are convinced that they have diarrhoea, but very soft or pulpy stools do not justify a diagnosis of diarrhoea. For a diagnosis of diarrhoea, there need to be stools of reduced solidity (i.e. not shaped but runny) at least three times a day accompanied by sudden strong bowel movements. The weight and volume of stools is usually also higher.
Every year almost a third of the population suffers once from diarrhoea, although only a small proportion of them go to a doctor. Worldwide, more than two million children die every year of diarrhoea, which is often caused by infections (bacteria, viruses, fungi or parasites).
Which symptoms occur with diarrhoea?
Diarrhoea is usually accompanied by nausea, vomiting and a loss of appetite. Colic-like pain and abdominal cramps (see the section on flatulence) can additionally occur – so-called gastrointestinal flu. The intensity of the symptoms depends on the respective pathogen and on the length of time which passes between becoming infected and the appearance of the first symptoms. Although patients often feel terrible, they are usually back on their feet again soon. A day or two in bed with light meals and they are fit again.
However, there can also be more serious cases. If the diarrhoea is very severe and not enough liquids are consumed, serious dehydration can arise. This can be recognised when pinching the skin – the folds remain afterwards. The patient also urinates less, and the urine is noticeably darker and concentrated. Patients feel increasingly drowsy and dazed, and there is a danger of circulation problems and kidney damage. Babies, small children and children as well as old people are acutely threatened by the loss of liquid in severe cases of diarrhoea.
If diarrhoea lasts for longer than three days and is so severe that the patient becomes noticeably weaker, a doctor should be consulted. Due to the significant loss of water and minerals, diarrhoea can be life-threatening, especially for children, those weakened by other illnesses and older people. Severe abdominal pains, a high temperature, repeated vomiting and blood in stools and a suspicion of poisoning are alarm symptoms which require clarification by a doctor.
Types 5, 6 and 7 of the Bristol Stool Scale show the typical stool consistency in the case of diarrhoea.
What can cause diarrhoea?
Diarrhoea is not a disease, but a symptom which can be caused by various conditions. Doctors differentiate between acute and chronic diarrhoea:
Causes of acute diarrhoea:
- So-called stomach bugs are usually caused by viruses (noro or rotavirus) or bacteria
- Bacterial infection – so-called food poisoning – is primarily caused by salmonella, clostridia or staphylococci. These bacteria form toxins which attack the lining of the stomach and intestines
- Medication, e.g. antibiotics, laxatives, heart drugs such as digitalis, painkillers and cytostatics [cancer drugs], and medicines containing magnesium to neutralise the stomach acid
- The consumption of large amounts of alcohol, coffee and sugary snacks, and also excessive amounts of sugar-free sweets and chewing gum with the sweetener sorbitol
- Fear, stress
- Diarrhoea during travelling – usually infections with escherichia coli bacteria.
However, not every settlement of the bowels by bacteria is an infection. The bacteria forming the gut flora are part of the normal ecosystem of the digestive tract and protect humans from infections caused by pathogens. Treatment with antibiotics can destroy this protection and thus trigger diarrhoea.
Causes of chronic diarrhoea:
Chronic diarrhoea is related to many different illnesses, some of them severe. The beginning of these illnesses is usually also acute. The symptoms of chronic diarrhoea, however, occur for at least 3-4 weeks, either repeatedly or in flare-ups. In the meantime the symptoms can die down again:
- A chronic inflammatory bowel disease (IBD) such as ulcerative colitis or Crohn’s disease can imitate an acute bowel infection, so that a pathogen can initially be presumed to be the cause
- Misuse of laxatives
- Irritable bowel
- Inflammation of the stomach lining (gastritis)
- Inflamed bowel diverticula (diverticulitis: tissue-like inflammation in the ‘pockets’ of the intestinal wall)
- Tumours, polyps
- Diarrhoea after radiation treatment and chemotherapy for cancer (due to damage to the intestinal mucosa)
- Dysfunction in the utilisation of food (e.g. in the case of liver disorders an excess fat in stools – steatorrhoea)
- Food intolerances: gluten intolerance (celiac disease), intolerance of dairy products (lactose intolerance), fructose intolerance
- Chronic inflammation of the pancreas
- Chronic bowel infections including HIV infections and disorders of the immune system
- Mucoviscidosis (cystic fibrosis – a metabolic disorder in which an enzyme defect leads to the increased production of viscous mucus in various organs, including the pancreas and lungs) with severe functional disorders and dysfunctions in the metabolisation of food
- Metabolic illnesses (overactive thyroid, insufficiency of the adrenal gland, diabetes types 1 and 2)
Complications: Diarrhoea in babies is a sign of a nutritional disorder, infant dyspepsyia, which should be carefully monitored by a doctor as it can quickly develop into a life-threatening condition. This can, for example, occur during the changeover from breast milk to baby food or follow-on formulas.
How can diarrhoea be diagnosed?
Every diagnosis begins with a thorough interview with a doctor (anamnesis) about the patient’s medical history. The doctor will talk to you about several points.
- Frequency of bowel movements and form of the stools
- Eating and drinking habits
- Accompanying symptoms such as pain and flatulence, vomiting and a high temperature
- Questions about other illnesses
- Questions about medication which you are taking and possible effects it could have on bowel movements (laxatives, antibiotics, etc.)
- Questions about the family history (presence of illnesses in the family)
- The presence of organic bowel diseases (e.g. chronic inflammatory bowel disease (IBD)) which are accompanied by severe diarrhoea
- Examination of the function of the thyroid gland
After this interview a physical examination takes place during which the doctor examines the rectum and palpates and listens to the abdomen. A stool sample can provide information about digestive problems and malfunctions of the bowels. In addition, the stools are examined for blood which is not visible (fecal occult blood). In the laboratory, a blood count is carried out, and thyroid gland hormones and electrolytes such as sodium, potassium and calcium are analysed.
If the symptoms are acute and accompanied by loss of weight, fever, tiredness, joint pains and/or blood in the stools, they can be caused by serious diseases which are behind the symptom of diarrhoea, and a more detailed medical investigation of the underlying condition needs to take place. Alongside a clinical examination (high temperature? abdominal pains? colics?), medical history (diet? laxatives?) and analysis of the stool composition, in the case of chronic diarrhoea imaging procedures including colonoscopy will also be proposed by the doctor to facilitate a diagnosis.
Other possible diagnostic measures:
- Ultrasound examination of the entire abdomen (sonography)
- Radiological examination of the bowels, now usually carried as a computer tomography (CT)
How can diarrhoea be treated?
Diarrhoea is unpleasant and one would like to get rid of it as soon as possible. There are a variety of causes: acute diarrhoea is often caused by tainted food (food poisoning) or viral (bacterial) infections. Diarrhoea can also occur as a side effect when taking certain medicines and during treatment with antibiotics. If the diarrhoea continues for a longer period, a doctor should be consulted. In that case, chronic bowel inflammation, metabolic disorders or food intolerance can be the cause.
- Diarrhoea is a natural reaction, self-help on the part of the body to rid itself of toxins. It is therefore important that this cleansing process is not suppressed and that the movement of the bowels is not immediately stopped by chemical medication.
- The most important aspect is to counteract dehydration. To this end, large amounts of liquids with added minerals (potassium, sodium and others) and sugar (glucose) should be consumed. Sugar helps the absorption of liquids, while tea (non-herbal) contains tannins which counteract diarrhoea (if it has brewed long enough; at least five minutes) and calm the intestinal mucosa.
- A break from food: You should begin eating again slowly. Initially no solid foods should be consumed, and milk should also be avoided. From the second day onwards, soups or thin porridge, for example, are recommended. When the bowels have calmed down again you can slowly return to a normal diet.
- Among medicinal plants, the following are particularly recommended: bloodwort, blueberries or camomile: Humic acid supplements have a detoxifying effect and support – alongside probiotic multi-species products – the regeneration of the intestinal lining.
We require a large number of probiotic bacteria in our bowels, as only they can continue the process of breaking down food in our bodies and making it available. If our gut flora has been reduced by special medication, fermentation and putrefaction processes begin which can influence bowel function or also lead to increased elimination of liquids and to increased permeability of the damaged intestinal lining due to toxins. Probiotics with highly active bacteria strains can lead to a normalisation of the frequency of bowel movements, the regeneration of the damaged intestinal mucosa and to an improvement of the consistency of stools. Stress, which additionally promotes the peristalsis of the bowels and has a damaging effect on the balance of the bowels, should be avoided. Diarrhoea is frequently a symptom of irritable bowel syndrome, which is triggered by stress, among other things.
- Absorbents such as activated charcoal, kaolin, silica dioxide and humic acids have a physical effect: they bind soluble substances such as toxins and thus combat the cause of the diarrhoea, and their minerals (potassium, sodium and others) replace the salts lost through diarrhoea.
- Antibiotics should only be used when the bacterial pathogen causing the diarrhoea is known and a specific effective antibiotic is used. Alongside antibiotics, the gut flora should be built up again with special synbiotics (OMNi-BiOTiC® 10 AAD)
- In the case of abdominal cramps, butylscopolamine can be of assistance. However, this substance should not be taken without a prescription and not for longer than a few days.
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