What is diarrhoea?
Diarrhoea can be loosely defined as the frequent passing of loose, watery stools. It is a common illness affecting many people around the world. In most cases, diarrhoea is not severe and ends within a few days without treatment. In some cases, diarrhoea can be an indication of a more serious medical condition or as a side effect of medication.
Diarrhoea may also be referred to by other names such as “loose stool” or “passage of mucus.” The term for this condition in children is “diarrhoea.” People who are ill sometimes refer to their condition as “the runs.”
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What causes diarrhoea?
Diarrhoea is a symptom in the pathophysiology of many different diseases. It can result from infections, medications, intestinal motility disorders, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, or food allergies/intolerances.
Diarrhoea occurs when there is an increase in the frequency of bowel movements over what’s considered normal or is an increase in the unformed stool. There are several causes of diarrhoea, including infections, food that is high in fat or sugar, stress, or food allergies.
The most common causes of diarrhoea include:
- Bacterial Infections such as E. coli (“traveler’s diarrhoea”), Salmonella, Campylobacter jejuni (campylobacteriosis), and Yersinia enterocolitica (yersiniosis). Other infectious causes include rotavirus (rotavirus gastroenteritis), Norwalk virus (viral gastroenteritis), adenoviruses, astroviruses, cryptosporidium parvum (cryptosporidiosis), and microscopic parasites called microsporidia (microsporidiosis).
- Viral infections such as rotavirus, norovirus (causes gastroenteritis), and enteric adenoviruses.
- Food-borne infections from toxins or pathogens from foods prepared by an infected food handler. Such foods may be contaminated with staphylococcus aureus, salmonella, campylobacter jejuni, Shigella sp., Escherichia coli O157:H7 (“E. coli”), and others. Common agents of this type of diarrhoea include staphylococcal enterotoxin B and C; toxic strains of Escherichia coli that produce Shiga toxin; and Clostridium perfringens epsilon toxin.
- Food allergies or sensitivities, lactose intolerance, fructose intolerance, gluten-sensitive enteropathy.
- Irritable bowel syndrome, inflammatory bowel disease including Crohn’s disease and ulcerative colitis. Other causes of chronic diarrhoea include fecal incontinence, anorectal diseases such as proctitis cystica profunda, rectal prolapse, anal fissure, or stricture. Iatrogenic causes are drugs for treating other disorders that may cause diarrhoea as a side effect.
- Radiation enteritis—in this condition, the large intestine is irritated by radiation therapy.
- Changes in intestinal flora due to broad-spectrum antibiotics that disturb normal gut microbiota allowing opportunistic bacteria to overgrow, resulting in bacterial overgrowth syndrome.
- Inadequate absorption of carbohydrates such as lactose, fructose, or sorbitol due to a lack or absence of digestive enzymes that normally break these sugars down into absorbable monosaccharides. Such a deficiency can be genetic (congenital sucrase-isomaltase deficiency) or secondary to damage to the pancreas from autoimmune disease, infection, or metabolic disorder.
- Intestinal parasites such as giardia lamblia (“beaver fever”) and Strongyloides stercoralis commonly cause diarrhoea, as does ingesting food contaminated with ova of intestinal parasites. Chemical agents may also cause diarrhoea by damaging the lining of the intestine increasing peristalsis, or affecting the intestine’s nerve endings.
- Chronic laxative abuse can irritate or damage the bowel’s lining resulting in chronic diarrhoea.
- Anal fissure, anal fistula, rectal polyps, and proctitis are common causes of rectal-anorectal diarrhoea.
- Hirschsprung disease is a condition where there is the absence of ganglia cells in that section of the intestine, which results in poor muscle contractions or peristalsis.
- Amyloidosis is a group of diseases resulting from deposits of an abnormal protein called amyloid in body tissues. The most common type, primary amyloidosis, results from the buildup of disease-causing proteins made by the bone marrow and/or lymph nodes. Tissues become enlarged, stiff and may cause diarrhoea.
- Chagas’ disease (American trypanosomiasis) is caused by “Trypanosoma cruzi,” an organism transmitted to humans by blood-sucking triatomine bugs found mainly in South America. This parasitic infection can affect many organs but causing chronic colitis with bloody stools; this condition responds very well to topical antiparasitic drugs like benznidazole.
- Fulminating or c difficile colitis is an acute form of toxic megacolon (massive colon enlargement). It is caused by the bacterium “Clostridium difficile,” producing toxins A and B, which can cause severe inflammation in the lining of the large intestine. C difficile colitis must be treated promptly with aggressive antibiotic therapy to avoid complications including colon perforation, massive bleeding from ulceration, sepsis, and death.
- Crohn’s disease is a chronic inflammatory disorder that may affect any part of the gastrointestinal tract but most commonly affects the small intestine’s terminal ileum. The symptoms of Crohn’s disease may range from abdominal pain to diarrhoea, fever, and even weight loss. The pathophysiology involves a shift in the way the immune system responds to bacteria and other antigens leading to chronic inflammation.
- Ulcerative colitis is a form of inflammatory bowel disease (IBD) that specifically affects only the large intestine (colon) and frequently, but not always, occurs in association with Crohn’s disease or indeterminate colitis. Symptoms include abdominal pain and bloody diarrhoea. The disease may be well controlled with mesalamine derivatives such as sulfasalazine, olsalazine, or balsalazide, but these drugs may cause serious side effects, including kidney damage and bone marrow suppression, so they must be used cautiously in patients at risk for developing adverse side effects.
- Lymphocytic colitis is a rare type of chronic diarrhoea that may be related to inflammatory bowel disease (IBD). About half of affected individuals have another autoimmune disorder such as irritable bowel syndrome, thyroid problems, or ulcerative colitis.
- Celiac disease is a digestive disorder that results from sensitivity to gluten in the diet. Gluten is a protein found mainly in wheat but also occurs in rye and barley. Symptoms include diarrhoea, anemia, abdominal pain, and weight loss which respond well to a life-long gluten-free diet avoiding all foods containing wheat flour.
What are the symptoms that accompany diarrhoea?
There are many types of diarrhoea. The main symptom is having loose, watery stools at least three times in one day. Other symptoms may include abdominal cramping, bloating, nausea, and/or vomiting. In some cases, a person may become dehydrated if the diarrhoea is severe or lasts for a long time.
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What are the risk factors for diarrhoea?
The risk factors for diarrhoea may vary depending on which microbe has infected the person with diarrhoea. In general, there are a number of risk factors, including:
- Viruses such as rotavirus and norovirus
- Bacteria such as shigella or salmonella
- Parasites such as cryptosporidium
The other risk factors worth mentioning include: increased intestinal motility (e.g., colon cancer), decreased intestinal water absorption (e.g., irritable bowel syndrome), and small intestine bacterial overgrowth. Other causes include food allergies, lactose intolerance, celiac disease, amyloidosis, Crohn’s disease, ulcerative colitis, amebiasis, giardiasis, antibiotic use (including C difficile enterocolitis ), heavy metal poisoning, radiation therapy, cancer chemotherapy drugs such as irinotecan and cetuximab, aloe vera juice, and bismuth subsalicylate (Pepto-Bismol).
What is the treatment for diarrhoea?
Treatment for diarrhoea depends on the underlying condition or cause of diarrhoea. For some conditions, there is no effective treatment. In other situations, effective treatments are available, which may include oral rehydration solution (ORS), medication, changes in diet, intravenous fluid, or hospitalization.
Oral rehydration solution is preferred over intravenous fluid for most people with mild to moderate dehydration from all causes, including diarrhoea. Most cases of acute diarrhoea last from one to two weeks.
A prolonged case may warrant further investigation for inflammatory bowel disease, colon cancer, C difficile, hypothyroidism, microscopic colitis, or Crohn’s disease. When a person has three or more diarrhoeal episodes in the previous month, the cause is considered chronic.
Other conditions with similar symptoms include irritable bowel syndrome and celiac disease, so these should also be ruled out. Prevention is by hand washing with soap.
This is often the only effective measure required to prevent the spread of infectious pathogens responsible for most cases of diarrhoea. Pathogens can colonize hands, so it is important to wash hands both before handling food and after the toilet.
While fecal-oral transmission is the most common route by which many diarrhoeal diseases are spread, sometimes non-fecal – oral transmission can occur. Diarrhoea caused by some food-borne illnesses can be prevented by adopting food safety practices.
Good hygiene and public health measures, such as hand washing and safe water supplies, have successfully controlled infectious diarrhoea. Antibiotics have improved the treatment of bacterial causes of diarrhoea, but they do not improve viral or parasitic disease and may cause harm to the host. They may also kill off the normal bacteria that live in people’s intestines (large intestine), leading to harmful antibiotic-resistant superbugs that will eventually cause illness even after all conventional treatments have failed.
Contact us if you have any questions about diarrhoea. We will be happy to help you find an alternative solution for your health concern. Our health specialists will answer you as quickly as possible.
Colorectal cancer is the most prevalent cancer in Singapore with around 1200 new cases every year.1 Male Chinese Singaporeans are at the highest risk of colorectal cancer.
Early screening via colonoscopies can detect them and improve the likelihood of recovery.
So, what does a colonoscopy entail and how do I prepare for it? Is it Medisave claimable? This ultimate guide will give you a detailed insight into colonoscopy in Singapore.
A colonoscopy is a medical procedure to visually image the lining of your colon in order to examine it for any irregularities. Colonoscopies are usually carried out by general surgeons or Gastroenterologists. A long and soft tube with a camera & light known as a Colonoscope is carefully inserted via the anus, carrying a live image to a screen which allows the doctor to examine the colon, all the way to the exit of the small intestine.
Have you experienced “butterflies in your stomach” or just had a strong “gut feeling” in difficult situations? There’s a good reason why these terms came about – the gastrointestinal tract is inextricably linked to the brain, and stresses from the environment can send signals from the brain to the gut and vice versa, which produces these physical symptoms of the digestive system. This is why you often feel the need to go to the toilet when you are nervous or anxious about something.