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Diarrhea

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Related Terms
  • Anti-diarrheals, Celiac disease, dehydration, dysentery, electrolyte imbalance, fecal incontinence, gastroenteritis, gastrointestinal disorder, IBD, IBS, inflammatory bowel disease, irritable bowel syndrome, lactose intolerance.

Background
  • Diarrhea is characterized by loose or watery stools. Diarrhea is a symptom of an underlying health problem, such as an infection, that prevents the intestines from properly absorbing nutrients from food.
  • Acute diarrhea lasts a few days and affects nearly everyone at some point in their lives. Chronic diarrhea generally lasts longer than four weeks and may be a sign of a serious condition, such as inflammatory bowel disease (IBD) or gastroenteritis. These disorders are long-term conditions that cause inflammation of the digestive tract.
  • There are many potential causes of diarrhea. Some of the most common include gastrointestinal infections, lactose intolerance, medications, artificial sweeteners, and surgery. Sometimes diarrhea is a symptom of an underlying gastrointestinal disorder, such as IBD.
  • Dehydration is a common complication of diarrhea. Dehydration is especially dangerous in infants, young children, and older adults.
  • Researchers estimate that there are nearly 100 million cases of acute diarrhea per year in adults in the United States. It is estimated that children younger than five years old experience one episode of diarrhea per year in the United States. About 222,000 people are admitted to the hospital each year for complications related to diarrhea. About 400 people die each year due to complications, such as severe dehydration, in the United States.
  • Diarrhea usually requires little to no medical treatment, but anti-diarrheal medications may help reduce symptoms. If an infection is causing diarrhea, antibiotics are prescribed to treat the infection.

Signs and symptoms
  • Symptoms of diarrhea often include frequent and loose stools, abdominal pain or cramping, bloating, and fever.
  • Other symptoms, such as nausea, vomiting, fever, and sometimes bloody stools, may occur if a patient has an infection. When a patient experiences frequent, severe, and bloody diarrhea, the condition is often called dysentery.

Diagnosis
  • Adults should visit their doctors if diarrhea continues for longer than four days, blood is present in the stool, or if they have severe signs of dehydration (dry skin, thirst, less frequent urination, light-headedness, and dark-colored urine). Infants, young children, and older adults should visit their doctors if diarrhea lasts longer than 24-48 hours, if they have high fevers, or if they have severe signs of dehydration.
  • A physical examination and detailed medical history will be performed. Patients should tell their doctors if they are taking any drugs (prescription or over-the-counter), herbs, or supplements because they may be causing diarrhea. A doctor may take a sample of the patient's blood or stool to check for an infection.

Complications
  • Dehydration: Diarrhea causes dehydration because the body loses water and salts. Infants, young children, and older adults are at risk of developing severe dehydration as a result of diarrhea. Symptoms of dehydration include dry skin, thirst, less frequent urination, light-headedness, and dark-colored urine.
  • Fecal incontinence: Patients with severe diarrhea may be unable to control the passage of stool, a condition known as fecal incontinence.

Treatment
  • General: Diarrhea usually requires little to no medical treatment, but anti-diarrheal medications may help reduce symptoms. If an infection is causing diarrhea, antibiotics are prescribed to treat the infection. If a medication is causing diarrhea, a doctor may recommend a different drug. However, patients should talk to their doctors before changing doses or stopping their medications.
  • Drink fluids: Individuals with diarrhea should drink plenty of water. Patients may also benefit from drinks that contain electrolytes, such as Pediatric Electrolyte®, Pedialyte®, or Enfalyte®.
  • Avoid diuretics: Individuals should avoid diuretics, such as caffeine, because they worsen symptoms of dehydration. These drugs help the body get rid of water, thereby increasing the amount of urine output. Certain foods, including rice, dry toast, and bananas, may help reduce symptoms of diarrhea.
  • Avoid certain foods: Certain foods, including dairy products, fatty foods, high-fiber foods, or highly seasoned foods, may worsen symptoms of diarrhea. These foods are more difficult than most foods to digest, and they may aggravate the digestive tract. Therefore, these foods should be avoided or limited until the diarrhea has gone away.
  • Anti-diarrheal medications: Anti-diarrheal medications, such as bismuth subsalicylate (Pepto-bismol®, Bismatrol®, or Kaopectate®) or loperamide hydrochloride (Imodium®), may also be taken to reduce diarrhea in patients older than three years of age. Bismuth subsalicylate balances the way fluids move through the digestive tract. It also binds to harmful bacterial toxins, causing the toxins to be flushed out with the stool. Loperamide hydrochloride slows down the speed at which fluids move through the bowels.
  • In severe cases, a prescription strength anti-diarrheal medication called diphenoxylate and atropine (Lomotil®, Lofene®, or Lonox®) may be taken to reduce symptoms of diarrhea in adults. Diphenoxylate slows down the movement of fluids through the digestive tract. Because diphenoxylate may be habit-forming when taken in large doses, atropine has also been added to the medication to help reduce this risk.
  • Antibiotics: If an infection is causing symptoms, an antimicrobial medication may be prescribed. The specific type, dose, and duration of treatment depend on the severity and type of infection. However, antibiotics are not effective for viral infections.

Integrative therapies
  • Strong scientific evidence:
  • Saccharomyces boulardii: There is good evidence that concurrent use of Saccharomyces boulardii with antibiotic therapy reduces the incidence of developing antibiotic-associated diarrhea (AAD) (Clostridium difficile and other). In general, positive results occur only when Saccharomyces boulardii is continued for several days to several weeks after the course of antibiotics is stopped. Duplication of these results should be attempted to confirm these findings.
  • Avoid if allergic or hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.
  • Zinc: Multiple studies in developing countries found that zinc supplementation may reduce the severity and duration of diarrhea in children, especially those that are malnourished and with low zinc levels.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Good scientific evidence:
  • Probiotics: Lactobacillus GG may reduce the risk of nosocomial (originating in a healthcare setting) diarrhea in children and infants, particularly cases caused by rotavirus gastroenteritis. Probiotics may reduce the duration of diarrhea and related hospital stays in children. Fermented formula and formula supplemented with probiotics may reduce both the number and duration of episodes of diarrhea. There is tentative support for probiotics for diarrhea prevention in adults and children. Supplementation may benefit HIV-positive men, and yogurt containing Lactobacillus casei may help reduce incidence in healthy young adults. Children may benefit from Bifidobacterium lactis (strain Bb 12) added to their formula. Probiotics may reduce duration of symptoms in adults and children with infectious diarrhea by 17 to 30 hours. Effective forms include Lactobacillus strain GG, Lactobacillus reuteri, combination Lactobacillus rhamnosus and Lactobacillus reuteri, and combination Lactobacillus acidophilus and Lactobacillus bifidus. More studies are needed to evaluate types, dosages, duration of treatment, and relationships to specific pathogens.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Psyllium: Psyllium, also known as ispaghula, comes from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber and is the main ingredient in many commonly used laxatives, such as Metamucil® and Serutan®. Psyllium has been studied for the treatment of diarrhea, particularly in patients undergoing tube feeding. It has also been studied in addition to treatment with orlistat (a lipase inhibitor that is designed to help people lose weight) in hopes of decreasing gastrointestinal effects (diarrhea and oily discharge) of this weight loss agent. An effective stool bulking effect has generally been found in scientific studies.
  • Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantain (Plantago lanceolata). Prescription drugs should be taken one hour before or two hours after psyllium. Use cautiously if pregnant or breastfeeding because psyllium may lower blood sugar levels.
  • Saccaromyces boulardii: Saccharomyces boulardii is a non-pathogenic yeast strain that has been used to treat and prevent diarrhea that is caused by many different factors. Several trials suggest the efficacy of Saccharomyces boulardii in the treatment of diarrhea in children. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.
  • Avoid if allergic/hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.
  • Soy: Numerous studies report that infants and young children (ages two to 36 months) with diarrhea who are fed soy formula experience fewer bowel movements per day and fewer days of diarrhea. This research suggests soy to have benefits over other types of formula, including cow milk-based solutions. The addition of soy fiber to soy formula may increase the effectiveness. Better quality research is needed before a firm conclusion can be made on the use of soy for acute diarrhea in infants and young children.
  • Parents are advised to speak with a qualified healthcare provider if infants experience prolonged diarrhea, become dehydrated, develop signs of infection such as fever, or experience blood in the stool. A healthcare provider should be consulted for current breastfeeding recommendations, and to suggest long-term formulas with adequate nutritional value. A doctor may recommend a specially designed soy formula, but regular soy milk should not be given to infants.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with their doctors and/or pharmacists before taking soy supplements.
  • Unclear or conflicting scientific evidence:
  • Arnica: Arnica has not been well studied for its effects on diarrhea, but early study suggests that homeopathic arnica may decrease the duration of acute diarrhea in children. Further study is needed to make a strong recommendation.
  • Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae families (sunflowers, marigolds or any related plants like daisies, ragweed or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.
  • Arrowroot: Arrowroot refers to any plant of the genus Maranta, but the term is most commonly used to describe the easily digestible starch obtained from the rhizomes of Maranta arundinacea. Arrowroot is an edible starch with proposed demulcent (soothing) effects and is a well-known traditional remedy for diarrhea. Early research suggests it may have a beneficial effect in the treatment of diarrhea in irritable bowel syndrome (IBS) patients. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to arrowroot (Marantana arundinacea), its constituents, or members of the Marantaceae family. Use cautiously with a history of constipation. Although arrowroot has been used traditionally in infants, pregnant and breastfeeding women should avoid this herb due to a lack of scientific safety evidence.
  • Art therapy: It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis (fecal incontinence associated with psychiatric disorders). In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.
  • Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.
  • Berberine: Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine has been evaluated as a treatment for infectious diarrhea, including choleric diarrhea, although the data is conflicting. Therefore, there is currently insufficient evidence regarding the efficacy of berberine in the management of infectious diarrhea.
  • Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric), or to members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and development of kernicterus. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leukopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or low blood pressure. Use cautiously in children due to a lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.
  • Bilberry: Bilberry is an herb made from the wrinkled, black berries of a small deciduous shrub. The use of bilberry fruit in traditional European medicine dates back to the 12th Century. A close relative of blueberry, bilberry is commonly used to make jams, pies, cobblers, syrups, and alcoholic/non-alcoholic beverages. Bilberry is used traditionally to treat diarrhea, but reliable research in this area is currently lacking.
  • Long-term side effects and safety of bilberry remain unknown. Avoid if allergic to bilberry, anthocyanosides (a component of bilberry), or other plants in the Ericaceae family. Do not consume bilberry leaves. Use cautiously with bleeding disorders or diabetes. Use cautiously if taking anticoagulant/anti-platelet medications or drugs that alter blood sugar levels. Stop use before surgeries or dental or diagnostic procedures that have bleeding risks. Use cautiously in doses higher than recommended. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.
  • Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum may be effective for improving gastrointestinal health. Preliminary evidence suggests that colostrum inhibits the adhesion or activity of certain bacteria to intestinal cells, which may help in the treatment of diarrhea. Additional study is needed in this area.
  • Avoid if allergic to dairy products. Use bovine colostrum cautiously because toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of, cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium®), insulin, or CNS agents (such as amphetamines, caffeine). Avoid if pregnant or breastfeeding.
  • Carob: Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Traditionally, carob has been used for the treatment of gastrointestinal conditions, especially diarrhea. Preliminary study used different types of carob products as an adjunct to oral rehydrating solution for diarrhea in children and showed promising results. Additional study is needed in this area.
  • Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, with a chromium, cobalt, copper, iron, or zinc disorder or deficiency, kidney disorders, or acute diarrhea. Avoid in underweight infants. Use cautiously in patients with anemia, known allergy to peanuts and other nuts, complications with powdered, bulk forming laxative drinks, diabetes, or hyperlipidemia (high cholesterol). Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.
  • Carrot: A carrot-rice based rehydration solution decreased the duration of acute diarrhea when compared to two conventional rehydration solutions. However, more research is needed.
  • Avoid if allergic or hypersensitive to carrot, its constituents, or members of the Apiaceae family. Use cautiously with hypoglycemia (low blood sugar) or diabetes, or if taking hypoglycemics. Use cautiously with bowel obstruction, if taking oral drugs, herbs, or supplements, with hormone-sensitive conditions, and in children. Use cautiously with known allergy/hypersensitivity to carrot or birch pollen-related allergens, as cross-sensitivity has been documented. Use cautiously and only in food amounts in pregnant and breastfeeding women.
  • Chamomile: Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Preliminary study reports that chamomile with apple pectin may reduce the length of time that children experience diarrhea. There is a lack of research on this use in adults. Further research is needed before a recommendation can be made for diarrhea in children.
  • Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Clay: It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis (fecal incontinence associated with psychiatric disorders). In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.
  • There is a lack of reports of allergy to clay in the available scientific literature. However, in theory, allergy/hypersensitivity to clay, clay products, or constituents of clay may occur. Avoid if pregnant or breastfeeding.
  • Colon therapy/colonic irrigation: Preliminary study shows possible benefits of regular irrigation of the lower part of the colon in the treatment of fecal incontinence. Further study is needed before a conclusion can be made.
  • Excessive treatments may allow the body to absorb too much water, which causes electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to lack of scientific data.
  • Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. Berberine, a constituent from goldenseal, has been used as a treatment for diarrhea caused by bacterial infections (including infectious diarrhea from cholera). Due to the very small amount of berberine in most goldenseal products, it is unclear whether goldenseal contains enough berberine to have the same effects. Therefore, there is currently not enough scientific evidence to make a recommendation in this area.
  • Avoid if allergic or hypersensitive to goldenseal or any of its constituents, like berberine and hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.
  • Lactobacillus acidophilus: Lactobacilli are bacteria that normally live in the gastrointestinal tract, mouth, and vagina. A small amount of human research suggests that Lactobacillus acidophilus may not be effective when used to prevent diarrhea in travelers or in people taking antibiotics. Several studies report that the related species Lactobacillus GG may be helpful for diarrhea prevention in children and travelers. Additional study is needed in these areas before a firm conclusion can be drawn.
  • A small amount of research in children, using different forms of acidophilus, reports no improvement in diarrhea. Future studies should use a viable Lactobacillus acidophilus culture to assess effects on diarrhea. Lactobacillus GG, a different species, is suggested by multiple human studies to be a safe and effective treatment for diarrhea in otherwise healthy infants and children. Lactobacillus acidophilus may aid in the management of chronic or persistent diarrhea and bacterial-overgrowth related diarrhea. Further research is needed to determine what dose may be safe and effective for diarrhea treatment in children.
  • There is conflicting information from several human studies as to whether using Lactobacillus acidophilus by mouth improves digestion of lactose. More research is needed before a conclusion can be made on the use of Lactobacillus for lactose intolerance.
  • Lactobacillus acidophilus may be difficult to tolerate if allergic to dairy products containing L. acidophilus. Avoid with a history of an injury or illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid if taking prescription drugs (such as corticosteroids) because of the risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy Lactobacillus acidophilus.Therefore, it is recommended that Lactobacillus acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids to decrease the amount of acid in the stomach one hour before taking Lactobacillus acidophilus.
  • Probiotics: Probiotics are beneficial bacteria that are sometimes called "friendly germs." They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products.
  • Saccharomyces boulardii and a probiotic formula Escherichia coli Nissle 1917 (EcN) solution have been shown to moderately improve acute diarrhea in children. However, all probiotic preparations may not have the same effectiveness.
  • Supplementation of infant formulas with probiotics is a potential approach for the management of cow's milk allergy, but there is conflicting evidence as to whether it improves digestion of lactose. More research is needed before a conclusion can be made on the use of probiotics for lactose intolerance.
  • Although some data support the use of probiotics for the treatment and prevention of antibiotic-associated diarrhea (AAD), other studies have found a lack of benefit. Although probiotics are considered a safe and reasonable approach for AAD, larger and better-designed studies are needed for definitive recommendations. There is limited evidence suggesting that probiotics may reduce recurrence of Clostridium difficile associated diarrhea and may help in the treatment of bacterial overgrowth-related chronic diarrhea. More studies are needed to provide guidelines for these uses.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Saccaromyces boulardii: With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For the treatment of Clostridium difficile associated recurrent diarrhea, Saccharomyces boulardii has been shown to decrease recurrences by about 50%, especially when combined with high-dose vancomycin.While only small studies have been performed, treatment with Saccharomyces boulardii may improve quality of life in chronic diarrhea in AIDS patients. As fungemia has been associated with Saccharomyces boulardii administration in patients with central lines, care should be exercised in treating these patients.Preliminary evidence supports the use of Saccharomyces boulardii for diarrhea prevention during tube feeding. However, the role of antibiotics in the results is unclear. Although evidence supports the use of Saccharomyces boulardii for other forms of diarrhea, little evidence exists to support standard treatment with Saccharomyces boulardii for traveler's diarrhea. More studies need to be performed.
  • Avoid if allergic/hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.
  • Slippery elm: Traditionally, slippery elm has been used to treat diarrhea. While theoretically the tannins found in the herb may decrease water content of stool, and the mucilage may act as a soothing agent to inflamed mucous membranes, reliable scientific evidence to support the use of slippery elm for this indication is currently lacking. Systematic research is necessary in this area before a clear conclusion can be drawn.
  • Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding.
  • Soy: Although soy has been shown to help treat acute diarrhea in children, it remains unknown if it can treat diarrhea in adults. Due to limited human study, there is not enough evidence to recommend for or against the use of soy-polysaccharide/fiber in the treatment of diarrhea in this patient population. Further research is needed before a recommendation can be made.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as an increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.
  • Vitamin A: Vitamin A is an essential fat-soluble vitamin. Vitamin A may reduce the severity and duration of diarrheal episodes in malnourished children but not in well-nourished children. Since diarrhea is a major cause of morbidity and mortality in developing countries, vitamin A supplementation may be considered in undernourished children with diarrhea.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Fair negative scientific evidence:
  • Ayurveda: Limited available study compared the three Ayurvedic preparations bel (Aegle marmelos), thankuni (Hydrocotyle asiatica), and gandhavadulia (Paederia foetida) with ampicillin in dysentery (shigellosis), and found them to have no effect.
  • Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Probiotics: Fair evidence suggests that probiotics may not be helpful in treating HIV-associated diarrhea. Probiotic therapy appears to be well tolerated for diarrhea in HIV patients on antiretroviral therapy, but may not be helpful for gastrointestinal symptoms.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Strong negative scientific evidence:
  • Bael fruit: Indian bael, an indigenous plant of India, has spread over wide areas of Southeast Asia. Indian bael has traditionally been used as a treatment for diarrhea. However, capsules of dried powder of the unripe fruit were not effective in treating diarrhea in patients with dysentery (shigellosis). Additional study investigating different preparations of bael fruit would help confirm this finding.
  • Avoid if allergic or hypersensitive to Indian bael or any of its constituents. Avoid dosages that exceed those of use in traditional medicine. Indian bael in large quantities theoretically may result in digestive complaints and constipation, given that tannins are constituents. Use cautiously if taking hypoglycemic agents or thyroid hormone, herbs for thyroid disorders, or herbs that may exacerbate or induce hyperthyroidism. Avoid if pregnant or breastfeeding as Indian bael leaves have been traditionally used to induce abortion and to sterilize women (theoretical).

Prevention
  • Patients should properly wash all produce thoroughly before eating to reduce the risk of developing gastrointestinal infections.
  • Individuals who are in areas of the world that have poor sanitation should only drink bottled water to reduce the risk of gastrointestinal infections. If this is not possible, individuals should boil their water before drinking it. This kills any disease-causing bacteria or parasites that may be living in the water.
  • People who are traveling to parts of the world that have poor sanitation can carry anti-diarrheal medications with them, such as bismuth subsalicylate (Pepto-bismol®, Bismatrol®, or Kaopectate®) or loperamide hydrochloride (Imodium®).
  • Doctors may prescribe antibiotics (such as rifamaxin) as a way to prevent traveler's diarrhea in people with certain medical conditions, such as immune deficiencies, that put them at high risk for experiencing severe complications of diarrhea.
  • Patients should only consume dairy products that have been pasteurized. Pasteurization involves heating liquids in order to kill viruses, bacteria, molds, yeast, protozoa, and other harmful organisms. This reduces the risk of developing a gastrointestinal infection that may cause diarrhea.
  • Individuals should avoid or limit their intake of the artificial sweeteners sorbitol and mannitol because they may cause diarrhea. These artificial sweeteners are commonly found in sugar-free products and chewing gum.
  • People with infectious diarrhea should regularly wash their hands with warm water and soap, especially after going to the bathroom. They should also cover their mouths and noses when they cough or sneeze. This helps reduce the risk of passing the infection on to someone else.
  • Individuals with diarrhea should drink plenty of water to prevent dehydration. Patients may also benefit from drinks that contain electrolytes, including Pediatric Electrolyte®, Pedialyte®, or Enfalyte®.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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Causes
  • General: Diarrhea happens when the ingested foods and fluids pass too quickly or in too large an amount through the colon. The body does not properly absorb the fluids. As a result, the patient experiences loose or watery stools. There are many potential causes of diarrhea. Below are some of the most common.
  • Infection: Diarrhea is usually caused by a viral, bacterial, or parasitic infection. Diarrhea that is caused by an infection (often called infectious diarrhea) may be passed from person to person.
  • Viruses, such as the Norwalk virus, cytomegalovirus, viral hepatitis herpes simplex virus, and rotavirus are the most likely to cause diarrhea. Infants and young children are most likely to develop diarrhea as a result of a rotavirus infection. People may develop these infections if they inhale airborne droplets of mucus from someone with infectious diarrhea. These microscopic droplets may be present after an infected person coughs, sneezes, talks, or laughs. Some viruses may also spread through contaminated objects, including telephones, doorknobs, stairway railings, and elevator buttons. If a person touches a contaminated object and then touches his/her face, the virus may enter the body and cause an infection.
  • If an individual consumes food or water that is contaminated with certain bacteria or parasites, he/she may develop diarrhea. Therefore, people with infectious diarrhea should regularly wash their hands with warm water and soap, especially after using the bathroom. This type of diarrhea is often called traveler's diarrhea because it frequently occurs in people who are traveling to developing countries. The natives of these countries usually do not develop diarrhea because they have been exposed to the infectious organisms and have developed immunity to them. Common bacterial causes of diarrhea include campylobacter, salmonella, Escherichia coli (E. coli), Shigelladysenteriae, and Clostridium difficile. Common parasites that are known to cause diarrhea include Giardia lamblia and cryptosporidium.
  • Lactose intolerance: People who are lactose intolerant may experience abdominal pain, cramping, and diarrhea. This is because people who are lactose intolerance lack the enzymes necessary to break down milk sugar for digestion.
  • Medications: Medications, especially antibiotics and anti-HIV medications (called antiretrovirals), may cause diarrhea. Antibiotics kill both the good and bad bacteria in the digestive tract. This may lead to an imbalance of the bacteria in the intestines, which ultimately causes an infection to develop. The bacterium responsible for almost all cases of antibiotic-associated diarrhea is Clostridium difficile.
  • Artificial sweeteners: Artificial sweeteners, called sorbitol and mannitol, may also cause diarrhea. These artificial sweeteners are commonly found in sugar-free products and many types of chewing gum. Artificial sweeteners are absorbed slowly and incompletely by the intestine, which is why they have fewer calories than sugar. However, this property may cause diarrhea when consumed in large quantities. In general, people who consume more than 50 grams of sorbitol daily or more than 20 grams of mannitol daily are at risk of experiencing diarrhea.
  • Surgery: Some people may experience diarrhea after undergoing abdominal surgery. This usually only lasts a few weeks as the digestive system heals. Some surgeries may change how quickly food moves through the digestive system, resulting in diarrhea.
  • Other people may experience diarrhea after having their gallbladders removed. This is because the gallbladder releases stored bile salts when a person eats. When the gallbladder is removed, the liver has to make more bile salts than it used to. Sometimes the increased amount of bile salts is more than the intestines can reabsorb. As a result, the extra bile salts flood into the colon, where they act as a laxative, causing diarrhea.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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