Diarrhea

Introduction:

Diarrhea is an increase in the wateriness, volume, or frequency of bowel movements. When you have diarrhea, foods and fluid passes too quickly or in too large an amount through your colon, and your body doesn't absorb the fluid. Almost everyone has an episode of diarrhea at some time. Acute diarrhea is uncomfortable, but usually is not serious and will go away in a few days on its own. You should see a doctor, however, if your stool contains blood, if the diarrhea is severe, or if it lasts more than a few days. Children and elderly people are more at risk of dehydration and should see their doctor sooner.

Signs and Symptoms:

Diarrhea is a symptom of another health issue, such as an infection or a virus. Chronic diarrhea -- lasting longer than 4 weeks -- can be a sign of a serious illness, such as inflammatory bowel disease.

Symptoms may include:

• Frequent and loose stools
• Abdominal pain, cramping
• Fever, chills, general sick feeling
• Thirst
• Weight loss

If your child has diarrhea, call your pediatrician if it lasts more than 24 hours or if your child seems dehydrated. For an infant, that could mean having a dry diaper for several hours or crying without tears.

What Causes It?:

Most diarrhea is caused by bacteria, parasites, or viruses, often from food or water. Eating local food and drinking local water during foreign travel can result in "traveler's diarrhea." Diarrhea can also be caused by reactions to medications (including some vitamins, minerals, and herbs) and artificial sweeteners (sorbitol and mannitol). People who are lactose-intolerant can get diarrhea when they consume milk or dairy products. Diarrhea that results in blood in the stool, accompanied by fever or abdominal pain, could be caused by intestinal disorders such as inflammatory bowel disease or Crohn's disease, and requires a doctor's care.

What to Expect at Your Provider's Office:

Your doctor will ask questions about your symptoms. Your doctor will also check to see if you are dehydrated and may feel your abdomen to see if it is tender, listen to your abdomen with a stethoscope, and give you a rectal exam. Sometimes you may be asked for a blood or stool sample to check for an infection.

Treatment Options:

Drug Therapies

In many cases, diarrhea will go away on its own. However, in severe cases your doctor may prescribe diphenoxylate and atropine (Lomotil). Your doctor also may prescribe antibiotics if the diarrhea is due to a bacterial infection.

Over the Counter

Since diarrhea is your body's way of getting rid of toxins, it's best to let it run its course. However, you may use over-the-counter anti-diarrheal remedies for convenience, including loperamide (Imodium), bismuth sub-salicylate (Pepto-Bismol), and attapulgite (Kaopectate). Do not take bismuth sub-salicylate with the herbs meadowsweet (Spirea ulmaria), white willow (Salix alba), or wintergreen (Gaultheria procumbens).

Complementary and Alternative Therapies

Work with your health care provider to find remedies that are right for you.

Nutrition and Supplements

• Rice or barley water, fresh vegetable juices (especially carrot and celery), miso broth, or other clear broths help restore proper fluid and electrolyte balance. Make rice and barley water using 1 cup of raw grain to 1 quart of boiling water. Let steep for 20 minutes. Strain and drink throughout the day.
• Probiotics -- Lactobacillus acidophilus or bifidobacteria, taken as powder or in capsules -- help maintain the "good" bacteria in your intestines. They may help cure your diarrhea, although scientific evidence is mixed. Active culture yogurt containing these probiotics may help prevent diarrhea.
• A live yeast, Saccharomyces boulardii, is often used in Europe to prevent diarrhea associated with taking antibiotic. Take 1 - 3 capsules per day (3 - 9 billion colony forming units). May be taken with other probiotics. Rare but serious cases of infection in seriously ill patients have been reported, so do not take Saccraromyces boulardii without a doctor's supervision.
• Bovine colostrum, the pre-milk fluid secreted by a cow's mammary glands just after giving birth, may help treat some kinds of infectious diarrhea (1,000 - 4,000 mg per day)
• Glutamine (3,000 mg three times per day) may help treat diarrhea caused by irritation of the intestinal lining.
• If you are lactose-intolerant, take over-the-counter lactase enzyme supplements before consuming dairy products.

Herbs

Do not use herbs to treat diarrhea without talking to your health care provider first, and always talk to your doctor before treating diarrhea in an infant. If your diarrhea is caused by certain types of infections, herbal treatments could make it worse. The most common herbal remedies for diarrhea are described below. They can be used as teas unless otherwise noted. You should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.

Astringent herbs:

• Astringent herbs, such as blackberry leaf (Rubus fruticosus) or raspberry leaf (Rubus idaeus), help "dry up" the mucous membranes in the intestine. Make a tea with 1 heaping tsp. per cup. Drink a ½ cup per hour.
• Carob powder (Ceratonia siliqua), which is rich in fiber, may be taken at the rate of 1.5 g per 2.2 pounds or 1 kg of body weight. Dissolve powder into a hydrating solution such as Pedialyte.
• Extract of bilberry (Vaccinum myrtillus) also has astringent properties (4 g, spread over several doses). Do not take bilberry if you take anticoagulants (blood-thinners).
• Agrimony (Agrimonia eupatorium) is a traditional remedy for diarrhea. Usual dosage is 3 g (about 1/2 tsp.) per day.

Inflammation reducers:

• Quercetin (250 - 500 mg two to four times per day), a plant-based flavonoid, may help to reduce inflammation.
• Chamomile (Matricaria recutita) is usually taken as a tea. Dissolve 3 - 4 g powder (about 3 tsp.) in 1 cup hot water, strain and cool. Drink three times per day.
• Marshmallow root (Althea officinalis) can be taken as cold-water tea. Soak 2 tbs. root in 1 quart of water overnight. Strain. Drink throughout the day.
• Slippery elm powder (Ulmus fulva) or marshmallow root powder (Althaea officinalis) can be soothing to the intestines. Use 1 oz. powder to 1 quart of water. Make a paste with the powder and a small amount of water. Gradually add in the rest of the water and then simmer down to 1 pint. Take 1 tsp. every 30 - 60 minutes.

Infection fighters:

• Plants containing berberine may help treat infectious diarrhea. These include barberry (Berberis vulgaris) 250 - 500 mg three times per day; goldenseal (Hydrastis canadensis) 250 - 500 mg three times per day; and Oregon grape (Berberis aquifolium ), 250 - 500 mg three times per day. Do not take berberine if you are pregnant or breastfeeding.

Bulk-forming agent:

• Psyllium, a soluble fiber that comes from the husks of the seeds of a plant called Plantago ovata, may help treat diarrhea. It is a bulk-forming agent that soaks up water in the colon, helping to firm stool.

Homeopathy

Some evidence suggests that homeopathic treatment may help diarrhea. In one study, children with acute diarrhea who received an individualized homeopathic treatment for 5 days had diarrhea for significantly less time than children who had placebo. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the most effective homeopathic remedies include:

• Arsenicum album -- for foul-smelling diarrhea from food poisoning or traveler's diarrhea with burning sensation in the abdomen and around the anus. This remedy is most appropriate for individuals who feel exhausted yet restless and whose symptoms tend to worsen in the cold and improve with warmth. Vomiting may also occur. You may also use arsenicum to prevent diarrhea when traveling.
• Chamomilla -- for greenish, frothy stool that smells like rotten eggs. Used primarily for children, especially those who are irritable, argumentative, and difficult to console. Chamomilla is commonly recommended for colicky or teething infants.
• Calcarea carbonica -- for children who fear being in the dark or alone and who perspire heavily while sleeping. Stools may have a sour odor.
• Mercurius -- for foul-smelling diarrhea that may have streaks of blood accompanied by a sensation of incomplete emptying. This remedy is most appropriate for people who tend to feel exhausted following bowel movements, experience extreme changes in body temperatures, perspire heavily, and have a thirst for cold fluids.
• Podophyllum -- for explosive, gushing, painless diarrhea that becomes worse after eating or drinking. Exhaustion often follows bowel movements and the individual for whom this remedy is appropriate may experience painful cramps in lower extremities. Podophyllum is often used in infants for diarrhea experienced from teething.
• Sulphur -- for irritable and weepy children. They may have a red ring around the anus and diarrhea with the odor of rotten eggs.
• Veratrum album -- for profuse, watery diarrhea accompanied by stomach cramps, bloated abdomen, vomiting, exhaustion, and chills. The diarrhea is worsened by fruit, and the individual craves cold liquids.

Acupuncture

Although several studies in Traditional Chinese Medicine journals have reported success in treating childhood diarrhea, acupuncturists in the United States do not generally treat this condition in children. However, acupuncture may be used when conventional treatment has failed. In this case, acupuncturists would look at both the nutritional value and the "energetic" qualities of food that might be affecting digestion.

Acupuncture is also combined with conventional medicine in treating diarrhea in adults.

Acupuncturists treat people with diarrhea based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of diarrhea, a qi deficiency is usually detected in the spleen meridian. As a result, acupuncture treatments often focus on strengthening this meridian. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is often used because it is thought to reach deeper into the body than needling alone.

Following Up:

If your diarrhea does not stop in 3 - 5 days, or if you become dehydrated, call your doctor.

Special Considerations:

If you are pregnant, tell your doctor. Dehydration can cause you to go into labor early. Also, the diarrhea-related spasms may cause you to have contractions. Do not take goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), or high doses of vitamin A if you are pregnant.

Diarrhea can be serious, even fatal, for infants and elderly people because of dehydration and the loss of electrolytes.