Diarrhoea
What are the symptoms of this condition?
Diarrhoea is a disturbance in the normal functioning of the bowel. Bowel motions are more frequent; there may be a sensation of 'urgency' (the bowels must be opened very quickly); the stools may be mainly liquid in consistency, rather than solid; and there can be considerable griping pain in the abdomen.What is the cause of the condition?
Diarrhoea is the result of increased activity in the muscles that line the walls of the intestines. The intestines form the part of the digestive tract that takes partly digested food from the stomach and completes the process of breaking down the food material. The small intestine leads in turn to the much shorter large intestine (colon). The colon continues into the rectum and then the anus. During digestion, nutrients, vitamins and other essential substances are absorbed from the food mass and taken up by blood vessels which line the intestines. Some water is also absorbed along with these other substances. The digesting food mass is kept moving by the muscular action of the intestinal walls. These intestinal muscles alternately contract and expand in waves along the length of the intestine - this is called 'peristalsis'. As these waves pass through the intestine, they push the food mass slowly along, out of the small intestine and into the large intestine where more water is absorbed and the very liquid material that entered the large intestine becomes a semi-solid faecal mass. Diarrhoea occurs when the intestines are irritated by the presence of certain bacteria or foods. The response to the irritation is an increase in the 'motility' or movement and power of the intestinal muscles. Instead of slow waves of peristalsis passing through the intestines, the muscles increase the frequency and strength with which they expand and contract. Food passes through the gut more rapidly, and the digestion and absorption processes cannot take place fully. Nutrients will not be picked up from the food and, importantly, less water is absorbed from the gut contents; this accounts for the watery or liquid state of the stools in diarrhoea. The increased frequency and strength of the intestinal contractions is felt by the sufferer as colicky, griping pains in the abdomen which can be very uncomfortable. Although the digestive system as a whole is quite robust, it can be upset by bacterial contamination of food or through sensitivity to certain types of food. For tourists and visitors to countries overseas, mild diarrhoea often develops, sometimes called traveller's diarrhoea. This probably results not from food poisoning but from coming into contact with different bacteria, in the local food, to those normally encountered at home. These irritate the intestines simply because they are foreign and unknown. After a period of time the symptoms will cease, although it's important to drink plenty of fluids to prevent dehydration, and to see a doctor if the problem persists after you have returned home. Bacterial contamination of food or water can cause very rapid and unpleasant symptoms. The typhoid bacterium is a particularly potent organism, which releases toxic chemicals inside the intestines that in turn cause a severe inflammatory reaction and very bad diarrhoea. Other common bacteria that can cause diarrhoea include Campylobacter and Salmonella; these are most commonly linked to undercooked poultry, or contaminated food which is insufficiently reheated.What complications might occur?
< Further complications will depend on the severity of the diarrhoea, and how effectively it is managed. As discussed above, the main function of the intestines is to absorb nutrients and water; if this normal absorption process is disrupted then water and essential substances are excreted. The main complication that can result from diarrhoea is dehydration. Considerable quantities of fluid can be lost with each loose motion, and if the diarrhoea persists over several days, dehydration can result. Not only water is being lost; chemicals essential to the normal functioning of the body, such as sodium and potassium, are also lost in the stools. The effect this can have on an individual depends on their age and general state of health - a fit and healthy adult can tolerate these losses far more effectively than can a young child or an elderly person, who are much more likely to dehydrate very quickly. You should seek medical attention if diarrhoea persists for longer than 3 days in adults, 2 days in children and the elderly, and 1 day in infants under 1 year old.What can I do to treat myself?
< Self-treatment involves replacing the lost fluids, and controlling the diarrhoea itself. Replacing fluidsThis is an essential part of managing diarrhoea. Large quantities of fluid can be lost very quickly, and if no action is taken dehydration may result. There is more to fluid replacement than simply drinking water. Sodium, potassium and other chemicals (called 'electrolytes') are also being lost and need to be replaced. An effective way to do this is to use oral rehydration therapies, available from Pharmacy2U. These take the form of powder sachets which are mixed with water (use bottled or sterilised water if there is any doubt about the safety of drinking water from the tap). The powder contains sodium, potassium and glucose - this is included as it aids the absorption of sodium into the body. This should be the only method of treatment for diarrhoea in children, for whom dehydration is a much greater risk. Older children (over 12) and adults may also benefit from medicines which slow down the rate of peristalsis, such as loperamide; this offers fast relief from the symptoms, but is not a substitute for adequate fluid intake. If it is not possible to obtain an oral rehydration therapy, it is possible to make your own by dissolving a teaspoonful of salt in a pint of water (again, make sure that the water is safe to drink) with some sugar mixed in as well. While not being as comprehensive as the products that can be purchased, it is useful in an emergency and is much better at rehydrating the body than drinking plain water. Remember, the very young and the very old are much more susceptible to the dehydrating effect of diarrhoea. Controlling the diarrhoea
There are a number of medications available from Pharmacy2U that can ease the muscle cramps and reduce the severity of the diarrhoea; they work mainly by slowing down the rate of peristalsis in the gut. These will be looked at in detail in the next section. While the diarrhoea is active, solid foods are best avoided, certainly for the first 24 hours. They will further irritate the intestines and may worsen the diarrhoea. You should be able to start eating solids again, in small quantities, as the diarrhoea settles. In the short term, i.e. a day or two, the body's nutritional needs can be sustained by the use of rehydration therapies. Some foods should be avoided including dairy products, fatty foods and alcohol.
What treatments are available for me to purchase?
Treatments for diarrhoea fall into two groups - oral rehydration therapies and symptomatic treatments. Oral Rehydration Oral rehydration is discussed in detail above. It is especially important for the very young and the elderly, and is the only treatment recommended for infants. Products available to buy include Dioralyte and Dioralyte Relief. Symptomatic TreatmentsThese help to reduce the symptoms of diarrhoea. The most effective anti-diarrhoeal available to buy is loperamide (contained in Imodium, Arret and Diocalm Ultra). Loperamide helps to slow down the passage of material through the large intestine thus allowing more water to be absorbed by the body. Diocalm Dual Action tablets contain a small dose of morphine which acts in a similar way; Enterosan tablets also contain morphine and include kaolin which absorbs the toxins produced by the bacteria causing the diarrhoea; however, these are not as fast acting as loperamide-containing products. To view the full range of diarrhoea treatments available from Pharmacy2U click here.
What treatments are available from my doctor?
The treatment possibilities available from your doctor depend on the cause of the diarrhoea. In acute, self-limiting episodes of diarrhoea, the prescription-only drugs loperamide or diphenoxylate might be used to control the diarrhoea; this applies only to adults, anti-diarrhoeal drugs of this kind are not used to treat children. Oral rehydration therapy would also be prescribed for both adults and children. If the diarrhoea is the result of a more serious inflammatory disease affecting the bowels, appropriate medications can be prescribed. These will be to treat the underlying cause of the diarrhoea, not the symptoms. Otherwise, the doctor will not be able to supply medications that differ substantially from those that can be bought directly from Pharmacy2U.What additional investigations might be needed?
If, after following the self-help treatments and suggestions given above, the diarrhoea does not improve, medical advice should be sought. Chronic diarrhoea can result from conditions such as irritable bowel syndrome, severe bowel infections, inflammatory bowel diseases such as Crohn's disease or ulcerative colitis, or, on rare occasions, as one of the first signs of a malignant growth in the colon. To investigate the cause, it is likely that stool specimens will be required for laboratory analysis. In addition it may be necessary to examine the inside of the colon using an endoscope, a flexible viewing tube that can be inserted into the rectum.Any other information I should have?
Diarrhoea can be very uncomfortable and may in some instances be serious, especially in the very young or the very old. If the diarrhoea is not responding to self-treatment or appears to be worsening, or is accompanied by a high temperature, seek medical help immediately.Email Newsletter
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