Diarrhea Facts

 Diarrhea is an increase in the frequency of bowel movements, an increase in the looseness of

stool or both.
 Diarrhea is caused by increased secretion of fluid into the intestine, reduced absorption of fluid
from the intestine or rapid passage of stool through the intestine.
 Symptoms associated with diarrhea include abdominal pain, especially cramping. Other
symptoms depend on the cause of the diarrhea.
 Diarrhea can be defined absolutely or relatively. Absolute diarrhea is defined as more than five
bowel movements a day or liquid stools. Relative diarrhea is defined as an increase in the number
of bowel movements per day or an increase in the looseness of stools compared with an
individual's usual bowel habit.
 Diarrhea may be either acute or chronic, and each has different causes and treatments.
 Complications of diarrhea include dehydration, electrolyte (mineral) abnormalities, and irritation
of the anus.
 Tests that are useful in the evaluation of acute diarrhea include examination of stool for white
blood cells or enzymes that they produce, parasites, cultures of stool for bacteria, testing of stool
for the toxins of C. difficile, and blood tests for electrolyte abnormalities.
 Tests that are useful in the evaluation of chronic diarrhea include examination of stool for
parasites, upper gastrointestinal X-rays (UGI series), barium enema, esophago-gastro-
duodenoscopy (EGD) with biopsies, colonoscopy with biopsies, small intestinal endoscopy,
hydrogen breath testing, measurement of fat in the stool, and pancreatic function tests.
 Dehydration can be treated at home with home remedies, oral rehydration solutions.
 Absorbents (that absorb water in the intestine), anti-motility medications, bismuth compounds,
and IV fluids if necessary.
 Antibiotics should not be used in treating diarrhea unless there is a culture-proven bacterial
infection that requires antibiotics, severe diarrhea that is likely to be infectious in origin, or when
an individual has serious underlying diseases.

What is diarrhea?

Diarrhea is an increase in the frequency of bowel movements or a decrease in the form of stool (greater
looseness of stool). Although changes in frequency of bowel movements and looseness of stools can vary
independently of each other, changes often occur in both.

Diarrhea needs to be distinguished from four other conditions. Although these conditions may
accompany diarrhea, they often have different causes and different treatments than diarrhea. These other
conditions are:

1. Incontinence of stool, which is the inability to control (delay) bowel movements until an
appropriate time, for example, until one can get to the toilet
2. Rectal urgency, which is a sudden urge to have a bowel movement that is so strong that if a toilet
is not immediately available there will be incontinence
3. Incomplete evacuation, which is a sensation that another bowel movement is necessary soon
after a bowel movement, yet there is difficulty passing further stool the second time

What is the definition of diarrhea?

Diarrhea can be defined in absolute or relative terms based on either the frequency of bowel movements
or the consistency (looseness) of stools.

Frequency of bowel movements: Absolute diarrhea is having more bowel movements than normal. Thus,
since among healthy individuals the maximum number of daily bowel movements is approximately three,
although some consider five or more bowel movements a day diarrhea can be defined as any number of
stools greater than three, although some consider five or more bowel movements to be diarrhea.
"Relative diarrhea" is having more bowel movements than usual. Thus, if an individual who usually has
one bowel movement each day begins to have two bowel movements each day, then relative diarrhea is
present-even though there are not more than three or five bowel movements a day, that is, there is not
absolute diarrhea.

Consistency of stools: Absolute diarrhea is more difficult to define on the basis of the consistency of
stool because the consistency of stool can vary considerably in healthy individuals depending on their
diets. Thus, individuals who eat large amounts of vegetables will have looser stools than individuals who
eat few vegetables and/or fruits. Stools that are liquid or watery are always abnormal and considered
diarrheal. Relative diarrhea is easier to define based on the consistency of stool. Thus, an individual who
develops looser stools than usual has relative diarrhea--even though the stools may be within the range of
normal with respect to consistency.

Why does diarrhea develop?

With diarrhea, stools usually are looser whether or not the frequency of bowel movements is increased.
This looseness of stool--which can vary all the way from slightly soft to watery--is caused by increased
water in the stool. During normal digestion, food is kept liquid by the secretion of large amounts of water
by the stomach, upper small intestine, pancreas, and gallbladder. Food that is not digested reaches the
lower small intestine and colon in liquid form. The lower small intestine and particularly the colon absorb
the water, turning the undigested food into a more-or-less solid stool with form. Increased amounts of
water in stool can occur if the stomach and/or small intestine secrete too much fluid, the distal small
intestine and colon do not absorb enough water, or the undigested, liquid food passes too quickly
through the small intestine and colon for enough water to be removed.

Another way of looking at the reasons for diarrhea is to divide it into five types.

1. The first is referred to as secretory diarrhea because too much fluid is secreted into the intestine.
2. The second type is referred to as osmotic diarrhea in which small molecules that pass into the
colon without being digested and absorbed draw water andelectrolytes into the colon and stool.
3. The third type is referred to as motility-related diarrhea in which the intestinal muscles are
overactive and transport the intestinal contents through the intestine without enough time for
water and electrolytes to be absorbed.
4. The fourth type is unusual. It is best represented by a condition calledcollagenous colitis.
In collagenous colitis, the mechanism of the diarrhea may be the inability of the colon to absorb
fluid and electrolytes because of the extensive scarring of the intestinal lining. Inflammation also
may play a role.
5. The fifth type of diarrhea is referred to as inflammatory diarrhea and involves more than one
mechanism. For example, some viruses, bacteria, and parasites cause increased secretion of fluid,
either by invading and inflaming the lining of the small intestine (inflammation stimulates the
lining to secrete fluid) or by producing toxins (chemicals) that also stimulate the lining to secrete
fluid but without causing inflammation. Inflammation of the small intestine and/or colon from
bacteria or from non-bacterial ileitis/colitis can increase the rapidity with which food passes
through the intestines, reducing the time that is available for absorbing water.

Diarrhea generally is divided into two types, acute and chronic.

1. Acute diarrhea lasts from a few days up to a week.

2. Chronic diarrhea can be defined in several ways but almost always lasts more than three weeks.

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