Diarrhea by Rosalyn Carson-DeWitt, MD

• Acute—occurring suddenly, and lasting briefly
• Chronic—long-term
• Recurring—occurring in recurrent episodes

• Food intolerance, such as lactose intolerance
• Medications, including:
  • Antibiotics
  • Magnesium-containing antacids
  • High blood pressure medications
  • Quinine
  • Cancer chemotherapy
  • Laxatives
• Irritable bowel syndrome (episodes of diarrhea often alternate with periods of constipation )
• Injury to the bowel after radiation treatments for cancer
• Malabsorption syndromes, such as:
  • Celiac sprue
  • Tropical sprue
  • Short bowel syndrome
  • Whipple's disease
  • Intestinal lymphangiectasia
• Diseases of the pancreas and/or gallbladder
• Inflammatory bowel diseases ( ulcerative colitis , Crohn's disease )
• Chronic diseases, such as:
  • Liver disease
  • Diabetes
  • Hyperthyroidism
  • Addison's disease
  • Pellagra
  • Scleroderma
  • Amyloidosis
  • AIDS
  • Colon cancer
• Intestinal surgery
• Infections, including food poisoning, such as:
  • Bacterial: Campylobacter, Clostridium difficile, Salmonella, Shigella, and Escherichia coli
  • Viral: rotavirus , Norwalk virus , cytomegalovirus , herpes simplex virus , and viral hepatitis
  • Parasitic: Giardia lamblia , Entamoeba histolytica , Cryptosporidium,tapeworm , roundworm , flukes
  • Fungal: Candida (yeast)

• Traveling to a developing country where the water and food supply may be contaminated
• Having a severely weakened immune system, such as with AIDS or after an organ transplant
• Taking certain medications

• Frequent, loose, liquid stools
• Abdominal pain, cramping
• Urgent need to defecate
• Blood and/or mucus in stool
• Fever
• Dehydration
• Nausea, vomiting
• Muscle aches and pains
• Weight loss
• Malnutrition

• Does anyone else in your family have diarrhea?
• What kinds of food have you eaten recently?
• Do you drink well water?
• Do your children attend daycare?
• Have you traveled recently?
• Do you use laxatives?
• What medications do you take?
• Do you have any symptoms other than diarrhea (eg, fever, rash, aching joints)?
• What is your sexual history?
• Have you ever had abdominal surgery?

• Laboratory analysis of a stool sample
• Blood tests
• Fasting or food elimination tests
• Digital rectal exam—examination of the rectum with the doctor's gloved finger inserted into your rectum
• Flexible sigmoidoscopy —a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon.
• Colonoscopy —a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon
• Biopsy —removal of a sample of colon tissue for testing. This may be performed as part of a flexible sigmoidoscopy or colonoscopy
• Upper GI Series —a series of x-rays of the upper digestive system taken after drinking a barium solution (also called barium swallow)
• Barium enema —insertion of fluid into the rectum that makes the lining of your colon show up on an x-ray

Barium Enema

© 2009 Nucleus Medical Media, Inc.

• Very spicy foods
• Fatty foods
• Greasy foods
• High-fiber foods
• Dairy products in large amounts
• Caffeinated drinks

• Bismuth subsalicylate
• Codeine phosphate
• Loperamide hydrochloride
• Paregoric
• Psyllium or methylcellulose compounds
• Kaolin or pectin products
• Antibiotics may be indicated for certain bacterial causes of diarrhea.
• Probiotics (eg, lactobacillus , bifidobacterium) may be beneficial.
• Zinc supplementation may be recommended in certain cases.

• Practice good handwashing
• Practice safe food preparation and food storage
• If you have diarrhea, don't prepare food for others
• If you're traveling:
  • Drink bottled water
  • Use bottled water when brushing your teeth
  • Avoid drinks that contain ice
  • Don't eat food purchased from street vendors
  • Don't eat raw vegetables or fruits (all produce should be peeled and/or cooked)
  • Make sure meats are cooked thoroughly
  • Eat only pasteurized dairy products
  • If you eat seafood, make sure it's very hot