Hesperian Health Guides

Hesperian Health Guides

Diarrhea

"very thin and sick-looking child who has diarrhea"

Passing loose, watery stools several times a day is called diarrhea.

When a person has diarrhea, he loses fluids and nutrients very quickly. A healthy adult may have diarrhea for a day or two, and will quickly recover. But losing so much fluid and nutrition is dangerous for children, old people, and people already weak from malnutrition or another sickness.

Care for children with diarrhea is explained in Chapter 28: Caring for Children. If you are helping a baby or a child with diarrhea, or you live somewhere where children die of diarrhea, please read the section below and then read here.

Contents

Danger signs

  • A lot of watery diarrhea in a short time. This could be cholera. No matter the cause, a lot of diarrhea in a short time quickly leads to dehydration.
  • Diarrhea with blood and mucus – called dysentery.
  • Diarrhea that goes on for weeks. This kind of long-lasting diarrhea drains the body of nutrients and weakens the gut. It is usually caused by malnutrition or a long-lasting illness.

Treatment

"woman helping a small child to eat from a spoon"
  1. Treat dehydration. Dehydration is the real danger of diarrhea, and the reason people with diarrhea can die. So the most important step in caring for people who have diarrhea is drinking fluids. You can make rehydration drink at home to replace the nutrients you need. Drinking fluids does not worsen diarrhea. On the contrary, drinking fluids can save your life.
  2. Give food. At first, if the person feels nauseous, you may need to give only little bites of something mild. Yogurt and bananas are especially helpful and may help diarrhea end sooner. Give more food as the person can eat more. Children especially must eat.
  3. Decide if medicines will help (usually, they do not). To help you decide, click here.

What causes diarrhea?

"woman thinking aloud"
All I do is treat kids with diarrhea. Maybe it would be a better use of my time to work on getting a clean water system for the community.

Diarrhea has many causes. The most common are:

  • A germ (virus, bacteria, or parasite) spread by poor sanitation. Prevent diarrhea by using toilets, washing hands, and cooking food well and eating it soon after cooking (instead of letting it sit for hours). When you buy food made on the street, ask for it to be heated again. See Water and Sanitation: Keys to Staying Healthy for more advice on improving sanitation – the best way to prevent diarrhea.
  • Another infection in the body. Ear infection, bladder infection, malaria, or HIV can all cause diarrhea. The diarrhea will get better once you treat the main infection.
  • Malnutrition. Malnutrition weakens the gut, making it less able to absorb food and liquid, which pass quickly through the intestine and cause diarrhea. Better food, every day, is needed to treat malnutrition. For ideas on how to eat well with little money, click here.
  • Antibiotics. Antibiotics can cause diarrhea and stomach aches. They are used much more than they are needed and many sicknesses will get better without antibiotics. They do nothing for the common cold or other diseases caused by viruses, for example. In general, avoid antibiotics for common infections and only use them when you are fairly certain the disease you are treating requires these medicines.
"an older woman helping a young girl wash her hands in a basin, a young man washing his hands from a faucet, and a woman washing her hands at a bathroom sink."
You can prevent many cases of diarrhea by washing your hands often with soap and water.

Eating and diarrhea

A person with diarrhea should start eating again as soon as possible. For someone who is vomiting, or feels too sick to eat much, offer small amounts of food many times a day. If there is a lot of diarrhea, offer a little every hour or two to replace all the lost nutrition. Try soups or gruels of rice, maize, or potatoes. Include a little well-cooked meat, eggs, or vegetables if the person can keep that down. Fermented milk drinks or yogurts provide protein. Fried foods and raw fruit are not as good for a person with diarrhea.

For diarrhea that lasts 2 weeks or more – chronic diarrhea – eating is especially important. Chronic diarrhea is usually caused by malnutrition or a long-lasting illness, such as HIV. In either case, more food is needed to replace what was lost from diarrhea and to help the gut better absorb the food that is eaten.

Malnutrition worsens diarrhea.
Diarrhea worsens malnutrition.
Food breaks the cycle.

A malnourished child must eat more often – 6 times a day or more. Every day, she needs protein and fat, to replace lost strength and energy. Vegetables and fruits protect the body and help her fight infections – including the infections that lead to diarrhea. Click here for how to treat malnutrition.

"beans, milk, yogurt, cheese, fish, meat, eggs, nuts"
Children with chronic diarrhea need protein foods.

Medicines

For most diarrhea, using medicines will not fight the infection that caused it. They are just a waste of money and may even be dangerous.

For certain cases of diarrhea, antibiotics can be of use. Antibiotics are helpful for dysentery and certain cases of cholera. But even for dysentery and cholera, drinking fluids is the most important treatment. Never give a laxative to someone with diarrhea.

“Anti-diarrhea medicines” such as bismuth or loperamide slow or stop up the bowel but do not prevent dehydration, which is the real danger of diarrhea. Even though the fluid is not leaving the body, it is leaving all the organs that need it to function. While these medicines may occasionally be useful, for example, if you will be on a bus for a long time, they slow the body’s ability to get rid of bacteria and make diarrhea last longer. Avoid these drugs when the person has fever, bloody diarrhea (dysentry), or constant liquid diarrhea (cholera). Loperamide is not safe for children.

"upside-down bottle with a plug that keeps liquid inside"
Anti-diarrhea medicines act like a plug. They keep the infection inside, instead of letting it come out.
"liquid pours from bottle after plug is removed"

Cholera

Large amounts of diarrhea that looks like rice water may be cholera. Cholera spreads very rapidly to affect many people in a community at once. Cholera quickly leads to severe dehydration that can cause death. You can save the life of a person with cholera by giving fluids.

Treatment

Treat the dehydration continuously with rehydration drink. Have the person drink as much as he can, not stopping until the diarrhea has stopped and there are no more signs of dehydration. Even though the person is likely to vomit, he must continue to drink.

Antibiotics may help for certain cases of cholera. Which antibiotic to use depends on drug resistance in your area. Check with your local health authority, and click here.

Cholera is everyone's problem

An outbreak of cholera is an emergency for the entire community. The bacteria that cause this disease are spread through the water supply and quick action must be taken to stop it.

"canvas cot with a hole cut in it, placed over a bucket on the gound"
A “cholera bed” can allow people to rest and stay fairly clean.
  • Be sure everyone knows the most important treatment for cholera: drinking as much fluid as possible. Share the recipe for rehydration drink on the radio, by telling your neighbors, and by posting notices.
  • Wash your hands often and help everyone understand the need for good hygiene to stop the spread of the infection.
  • Get people who need it to medical help. There may be a “field clinic” or somewhere to take people for IV fluids. Sometimes antibiotics help and these may be available at a clinic.
  • Organize to make the water safe. Click here.
  • Future outbreaks can be prevented by building toilets and improving sanitation for everyone. As long as people do not have safe toilets to defecate in, or sources of drinking water get contaminated with human waste, everyone will be in danger of cholera and other illness. Click here for how to build safe toilets.
  • There are vaccines that can help prevent cholera. They work best when a whole community is given the vaccine to prevent the spread of an outbreak.

Diarrhea with blood (dysentery)

Dysentery is usually caused by a bacteria called shigella, or by parasites in the intestine called amebas.

Signs

  • Many loose stools with a lot of mucus and usually blood.
  • Cramps in the belly and the feeling of needing to pass stool, even when nothing, or only mucus, comes out.
  • Pain in the anus.
  • Diarrhea alternating with constipation.

How to know the cause of dysentery

If someone has bloody diarrhea, it is best to test the stool to learn the cause. If you cannot get a lab test, these signs can help determine the cause.

Shigella, called bacterial dysentery, usually causes fever. It often starts suddenly, and causes painful cramps and watery stools with mucus or blood.

Diarrhea + mucus or blood + fever = shigella (bacterial dysentery)

Amebas, called amebic dysentery, can cause heavy bleeding. Fever is not common.

Diarrhea + blood + no fever = amebas (amebic dysentery)

Treatment

It is best to treat dysentry with antibiotics, especially young children or people who are already weak or sick.

For shigella

Shigella quickly becomes resistant to medications, so there is no one medicine that is best everywhere in the world. See Medicines, Tests, and Treatment (in development) to learn more about drug resistance. In most cases, ciprofloxacin will work, but check with your local health authority to learn the best treatment.

For amebas

For amebas, give metronidazole.

Giardia

Giardia is a tiny parasite that lives in the gut and is a common cause of diarrhea, especially in children.

Signs

  • A lot of gas. This causes a swollen, uncomfortable belly, cramps, nausea, and a lot of farts and burps. The burps have a bad taste, like sulfur or rotten eggs.
  • Bad-smelling, yellow, and frothy (full of bubbles) diarrhea, without blood or mucus.
  • There is usually no fever.
  • It can last for weeks, causing weight loss and weakness.

A mild giardia infection is uncomfortable, but will usually get better on its own within about 6 weeks. Good nutrition helps. A long-lasting case, especially in a child, is best treated with metronidazole. Quinacrine is cheaper and often works well, but causes worse side effects.


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