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Many patients have a disorder known as Lactose Intolerance. This could happen at any age. Most of the time when patients get older, the lactose intolerance becomes more apparent. Those patients can definitely have diarrhea if they have any lactose containing meals such as any type of dairy meals. Now, the benefit of lactose intolerance is that it’s easily treated if you take a pill called lactaid, which has the enzyme that assists with that deficiency. Patients are able to eat dairy products, ice cream, milk without any issues, usually.
Children with diarrhea have to be evaluated much sooner than adults with diarrhea. If you have a child that has significant diarrhea and you’re unable to keep up with their fluid intake those patients should immediately be seen by their pediatrician, especially if there’s any signs of fever, weakness, lethargy, or if the child’s mood is changing because at that point, the patient may require IV fluids and may require hospitalization. If your child has an acute diarrhea, which means that it started within 24 hours, but you’re able to maintain that child on liquids and you’re able to maintain their fluid intake, medications such as acetaminophen or other over-the-counter child medications can be used to see if the diarrhea is able to be resolved within 24 to 48 hours. If after that point, the diarrhea continues, you should definitely see a physician in order to see if there’s any underlying tests that need to be done.
The common symptoms of diarrhea include a change in the form of the stool, which is more of a watery or loose stool. Other symptoms that occur include an increase in frequency or urgency, which means that a patient needs to run to the bathroom or has a feeling that they need to rush and have a bowel movement before they have an incontinent episode. Incontinence, which means the inability to actually hold a stool and having an accident is also a common symptom of diarrhea. A lot of patients with diarrhea also exhibits symptoms of bloating, cramping, and abdominal pain as well. Diarrheal symptoms can definitely be a symptom of something that’s going significantly wrong with the internal GI system such as colon cancer or any other type of malignancy in the GI tract. Patients with pancreatic cancer, pancreatic insufficiency, small bowel disorders in which they have malabsorption or any type of gastric cancer or other gastrointestinal malignancies can definitely be first scene with a diagnosis of diarrhea. Diarrheal symptoms can be a prognostic finding for many other underlying disorders such as celiac disease, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, microscopic colitis, or even malignancy. That’s why if you do have any signs of chronic diarrhea, you should get evaluated by a physician.
There are multiple different causes of diarrhea. Diarrhea is one of the most common symptoms associated with irritable bowel syndrome. It affects more women than men. Infectious diarrhea can affect anyone that comes into contact with the bacteria that can cause the diarrhea. There are multiple different types of infections that a patient can get that can cause diarrhea. The most common infections include C Diff, which is an infection that you get after taking certain antibiotics. Parasitic infections, E-coli, these are all infections that you can get from traveling or coming into contact with someone that had that infection. Other causes of diarrhea include autoimmune disorders such as Celiac disease in which you get an autoimmune antibody to your small bowel from gluten. And that can cause a malabsorptive process, which then causes diarrhea. Increased acid production in patients can cause diarrhea. Any type of GI malignancy such as pancreatic cancer, small bowel cancer, or colon cancer can cause symptoms of diarrhea. So when a patient has diarrhea, you really need to look into the exact cause of it. Other types of autoimmune disorders such as inflammatory bowel disease, Crohn’s disease, ulcerative colitis and microscopic colitis, are all some of the common causes of new onset chronic diarrhea. If your diarrhea extends for over four to six weeks, it’s something that you definitely need to see either your primary care physician or a gastroenterologist in order to do further testing to find out the exact cause of your diarrhea and to treat it.
When it comes to diarrhea, every patient is different. Depending on what kind of symptoms the patient is having, there are multiple different types of tests that a physician can do. The number one test that most physicians do if a patient comes in with new onset diarrhea is stool studies in order to evaluate if there’s any underlying infection or any infectious cause to the patient’s diarrhea. Other possible studies, including blood tests to check for Celiac disease. Colonoscopies are a very common study which are done in anyone that has any type of alarm symptoms. What I mean by alarm symptoms is any type of bleeding, weight loss, loss of appetite, or chronic diarrhea that’s not getting better. These are all some of the tools that we have in order to help evaluate what the cause of the diarrhea is and subsequently make a plan for the treatment.
If a patient comes in and they’ve had one or two days of diarrhea, this could just be acute viral gastroenteritis or a food poisoning episode or acute diarrhea that will pass on its own. If the diarrhea continues for a prolonged period of time, it is usually at that point that we start doing tests to see if it’s something that needs to be treated. But most episodes of diarrhea that lasts within 24 hours and pass usually don’t need a full workup and can be thought of to be secondary to an acute insult that your body has cleared. Diarrhea is a very common disorder. It can mean that you have many different possible diagnoses from autoimmune diagnoses all the way to a run-of-the-mill viral infection. If your diarrhea lasts for more than 48 hours or if you have any alarm signs associated with your diarrhea such as weight loss, bleeding, or any worsening of your symptoms, you should definitely see a physician in order to get evaluated and find out the exact cause of your diarrhea and get the proper treatment. So if you do have diarrhea that has lasted more than 24 to 48 hours, if you’re having fevers, if there’s any evidence of any bleeding with your diarrhea, if there’s any cramping or significant abdominal pain, you definitely need to see a physician. And they are able to do stool samples, which means they’re able to take a collection of your stool and send it for analysis. And that will let you know what bacteria or parasite is involved in which antibiotic or antiparasitic will improve. If the diarrhea lasts for a longer period of time, such as more than three or four days, it’s at that point that you should definitely see a physician because you don’t want to wait until it’s become very severe and the patient is very dehydrated because then you can end up in a hospital setting.
Diarrhea can occur at any age. Obviously, patients that are slightly elderly or patients that have immune system issues or if they’re immunocompromised or if they’re on any type of chemotherapy, those are patients that can get diarrheal infections much more commonly. But in general, any age, any, demographic and get chronic diarrhea or acute diarrhea.
Diarrhea should be treated if there is any side of chronicity or if there’s any specific diagnosis that gives you a reason to treat. What I mean by that is if the patient has a specific infection that shows up in their stool, if the patient has been around anyone that has a specific infection and you have a high suspicion that they have that infection. If the patient is having significant symptomatology and the workup shows that there’s a specific medication that you can treat, all of these patients could be treated. It depends on a case-by-case basis. And the treatment also can vary depending on the diagnosis that you make.
When it comes to over-the-counter products that a person can buy in order to help with their diarrhea, you have to be very careful about when to start these medications. Some medications can actually make diarrhea worse. What I mean by that is if you have a C Diff infection or a bacterial infection, and you take some of these over the counter medications, it actually makes things worse because it doesn’t allow your body to clear the toxin. Therefore, if you do have severe diarrhea, speak to your physician before using any of these over-the-counter medications. But some of the more common ones that are out there are Imodium or Pepto-Bismol. These are medications that help bind and absorb a lot of the fluid in your GI tract and slow down the motility and the contraction of the bowl. And they helped with the symptoms, but they really don’t treat any underlying etiology to what’s causing the diarrhea.
Many medications cause diarrheal side effects. Antibiotics are one of the most common causes of diarrhea. They affect the flora and the bacteria in the GI tract, and that can subsequently allow patients to have diarrhea. The good thing about many medications that have that diarrheal side effect is that once you stop the medication, those symptoms usually go away. Some antibiotics cause a disorder called C diff infection, which is when your bacteria in your GI tract, the flora gets altered and a specific bacteria called C diff starts growing more than the surrounding bacteria, and that can end up having a diarrhea that requires subsequent antibiotic therapy.
In regards to restrictions for patients with diarrhea, it all depends on what the underlying cause of your diarrhea is. If the cause of your diarrhea is secondary to Celiac disease, obviously you have to avoid everything that has gluten. If you’re a diarrhea is secondary to some underlying Colitis, you have to make sure that your diet coincides with that disorder and you’re on the proper diet in order to reduce the risk of exacerbating your symptoms. Everyone is different and every reason for your diarrhea is different. That’s why you have to take every patient on a case-by-case basis.
Any fluid that has electrolytes is usually the best thing. Water is obviously good, but sometimes with patients with diarrhea, you’re also losing a significant amount of your electrolytes. So any of the over-the-counter sports drinks or anything with electrolytes, is that usually some of the best drinks when it comes to diarrhea. Food? It all depends. You know, when people have acute diarrhea, we recommend patients being on a bland diet. You know, anything with any type of seasoning or any type of spices can definitely exacerbate the contractions and inflammation in the bowel, which can then lead to worsening diarrhea. So most patients that have diarrhea, we tell them, you know, in the acute setting, to take two things that are like bananas, apples, toast, very bland meals that won’t affect the GI tract significantly.
There are multiple different types of home remedies and different types of therapies that people use for diarrhea. One of the most common is fiber. If you do have diarrhea, fiber is able to help bulk up your stool and absorb a lot of that water that’s coming out, if it’s an osmotic diarrhea and can really help with your diarrhea. There’s multiple different types of herbal concoctions that people do take for diarrhea. But most of the time, if it’s an acute diarrhea and if it’s like a viral infection, it’ll pass on its own. And if it’s a chronic diarrhea, you should definitely get it checked out before just taking over-the-counter medications or any home concoctions.
The amount of fluid that someone needs to take varies depending on your size, depending on your weight, and depending on how much you burn off. You could have a patient that’s very sedentary that will be able to do well with three to four glasses of water a day. On the other hand, if you have a patient that’s very active, that’s burning off a lot of sweat and burning off a lot of energy on a daily basis, they would need anywhere from eight to 10 glasses a day in order to maintain their hydration. Overhydration can lead to diarrhea. So you have to be very careful, especially if you are over hydrating with very osmotic fluids such as sports drinks and fluids with a lot of sugar. Those can definitely cause an acute diarrhea in many patients. So there’s a balance in terms of when you should drink a lot and when you shouldn’t. If a patient already has diarrhea and they’re losing a lot of their fluids, those are patients that definitely need to up their baseline fluid intake in order to, number one, maintain the amount of fluid that they need on a regular basis and number two, in order to make up for all the losses that they’re having with the diarrhea. So those are patients that need to drink more fluids with electrolytes in order to make up for that. On the other hand, if a patient is not having diarrhea and they overdo their soft drinks or sports drinks or drinks with a lot of sugar, those are patients that can have something called Dumping Syndrome where they subsequently get a significant amount of osmotic diarrhea.
One very large component as a cause of diarrhea is Irritable Bowel Syndrome. And one theory behind why people get Irritable Bowel Syndrome is technically thought of as the brain-gut access, which means that anything happens that makes you nervous, anxious, worried, most patients end up feeling in their gut. They feel cramping, they feel gurgling, and a lot of patients end up with diarrhea. Many studies have been done over the years to see the exact connection between this. Many studies have seen that we have as many Serotonin receptors in our Gi tracts as we have in our brain, if not more. And the fact that anything that sets off that Serotonin, such as excitement, anxiousness, anxiety, that also sets off the motility in the bowel, which then leads to diarrhea symptoms. And that’s very common.
In terms of prevention measures for diarrhea, what are the number one things you can do is to make sure that your immune system is as strong as possible? People that don’t sleep enough, people that aren’t good with their nutrition, people that are constantly getting other type of viral infections or at high risk of getting diarrhea. Any type of chronic infections that patients can get, can lead to IBS and can lead to chronic diarrhea. So if you’re in an area where you know that it’s going to be endemic for certain types of travelers, diarrhea or infections, you just have to make sure to practice good hand washing and good sanitary practices. And make sure that if someone is sick or if someone around you has a chronic diarrhea from an infectious etiology, just to be more aware of that and practice better sanitary guidelines.
So there’s many different studies going on right now for the treatment of chronic diarrhea. There’s many studies evaluating bacterial overgrowth has a common cause of chronic diarrhea, and there’s multiple different types of antibiotics that can be used to treat that. There’s multiple studies going on with fecal transplant for patients with chronic diarrhea and recurrent infections, in which stool is actually injected into the colon and the small bowel in order to help increase the flora of the Gi tract and reduce the risk of these recurrent infections that many patients get. Other types of probiotics and therapies are also being studied for the treatment of chronic diarrhea.
Overeating of certain things can definitely cause increasing diarrhea symptoms. If you eat or consume too much sugars, carbohydrates, or if you drink excessively, all of these things can cause what’s called an osmotic diarrhea, which can lead to loose stools for a period of time while you’re doing that over eating.
Diarrhea is a change in bowel habits, in which you’re stool goes from being a formed consistency to a watery consistency. And it’s also associated with increased frequency. So any patient that has a change in the formation of the stool, as well as having more frequent stools throughout a day, can be diagnosed with diarrhea.
Traveler’s diarrhea is a condition in which you get a bacterial infection or a parasitic infection while on a trip to an outside country or somewhere where your body is not accustomed. Countries that have less sterile water. Countries like India, Africa, certain third world countries. Those are places where you want to be more careful compared to more industrial countries. You can avoid it by being very careful about the water and food that you drink and make sure that everything that you do is in a sterile fashion. If you do get traveler’s diarrhea, most patients do require antibiotic or antiparasitic therapy for their diarrhea.
Chronic diarrhea is a patient that has had diarrhea symptoms that have lasted more than six weeks. Then they fall into a category of chronic diarrhea. If it’s less than six weeks, then we diagnose it as acute diarrhea.
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