Stool disorder - diarrhea
Diarrhea
(scientific name
diarrhea
) is a pathological condition in which frequent bowel movements are observed, and the stool becomes liquefied (from mushy to watery). The stool may contain particles of mucus, pus, undigested food and even blood, have a pungent odor and an unusual color.
In a newborn baby who is breastfed, the frequency of bowel movements on average corresponds to the number of feedings (up to 6 times a day). Gradually, the frequency of stool decreases and by 6 months it stabilizes at the level of one or two times a day. Similar regularity in bowel function is typical for an adult. Deviations in one direction or another can be considered as bowel disorders.
Prolonged or severe diarrhea is dangerous to health, as it threatens dehydration.
Acute diarrhea
A very common condition, usually resulting from eating food or water contaminated with bacteria, their toxins, viruses and protozoa. Infectious diarrhea is usually short-lived, so an infectious cause is rarely identified in patients with diarrhea for more than 10 days. Alcohol intoxication, various drugs, including antibiotics, cytotoxic drugs, non-steroidal anti-inflammatory drugs, can cause acute diarrhea.
Traveler's diarrhea is also recognized
. It develops in the first days in people traveling to exotic regions of the planet other than their own and is associated with the consumption of food and water with a different qualitative and quantitative composition of non-pathogenic microbial flora.
We can talk about the acute nature of diarrhea if the duration is no more than 3 weeks; otherwise, diarrhea is considered chronic.
Diagnostics
Diagnosis of diarrhea in adults and children begins with the collection of complaints and examination. Dehydration can result in decreased blood pressure, palpitations, muscle cramps, and dry skin. Instrumental studies are prescribed:
- colonoscopy - examination of the large intestine using an endoscope;
- gastroscopy - examination of the stomach using a gastroscope;
- sigmoidoscopy - endoscopic examination of the rectum;
- ultrasound examination of the abdominal organs;
- CT scan;
- X-ray examination of the intestines.
Laboratory methods allow you to establish a diagnosis and clarify the cause of diarrhea:
- coprogram;
- general clinical blood test;
- stool analysis for helminth eggs, Giardia cysts;
- bacteriological culture of stool (diarrhea after antibiotics);
- blood tests to identify markers of inflammation, hormones, liver and pancreas enzymes;
- blood tests for viral hepatitis.
Chronic diarrhea
Chronic diarrhea manifests itself in various diseases:
- stomach (atrophic gastritis, previous gastrectomy);
- pancreas (chronic pancreatitis);
- liver and gallbladder (bile duct obstruction);
- thin (enteritis, Crohn's disease, celiac disease, lactase deficiency);
- large intestine (nonspecific ulcerative colitis, Crohn's disease, non-infectious colitis, polyposis).
Of particular importance are tumor lesions of the digestive organs and endocrine glands, vascular diseases, including ischemic intestinal damage, diseases of the endocrine system (diabetes, thyrotoxicosis).
The most common cause of chronic diarrhea is a functional disorder called irritable bowel syndrome.
. This condition usually develops at a young age against the background of psycho-emotional stress and depression. With IBS, the frequency of bowel movements increases, and the stool may be soft, liquid, or pellet-like. Diarrhea rarely occurs at night and is most severe before and after breakfast. At other times of the day, the patient experiences constipation and other characteristic symptoms (pain, bloating, rumbling). The stool often contains mucus, but never blood, and the stool volume is less than 200 g. per day.
Causes of watery diarrhea
Faecating with water often indicates infectious or non-infectious intestinal diseases. Sometimes pregnant women complain about the appearance of liquid, unformed feces, which is caused by gestational changes in the digestive and endocrine systems. In children, watery stools can be a sign of a toxic form of dyspepsia or the initial stage of colitis. Water diarrhea with dyspeptic disorders, weakness, hemorrhages is characteristic of alimentary-toxic aleukia. Profuse diarrhea occurs in 90% of patients with toxic shock.
Bacterial infections
The entry of pathogenic intestinal microflora into the body is usually accompanied by watery diarrhea of the secretory type. Bacteria are capable of secreting a specific enterotoxin that affects the epithelial cells of the mucosa and causes the accumulation of adenylate cyclase, cAMP, in them. This contributes to an increased release of ions into the intestinal lumen with subsequent entry into the intestines along a concentration gradient of a large amount of liquid. The condition is aggravated by concomitant inflammatory lesions of the gastrointestinal tract. The following intestinal infections lead to water diarrhea:
- Cholera
. This infectious disease manifests itself with diarrhea, which quickly loses its fecal character and odor, becoming watery. After a few hours, repeated vomiting occurs, which aggravates the condition, causing severe dehydration. A distinctive feature is the complete absence of abdominal pain or moderate discomfort, detected in no more than 30% of patients. - Escherichiosis
. Watery diarrhea often develops when infected with enterotoxigenic strains of the microbe, when the disease proceeds like a mild version of cholera. In young children, water diarrhea is usually caused by enteropathogenic strains. Diarrhea is combined with vomiting, pain in the epigastrium, along the intestines. Body temperature may rise to subfebrile levels. The general condition of the patients is of moderate severity. - Salmonellosis
. Dyspeptic disorders are the main manifestations of the gastrointestinal form of infection. The first symptoms of salmonellosis are general intoxication and headache; after a few hours, severe cramping pain in the intestines occurs, profuse bowel movements, first with the release of unformed feces, and then water with food particles and mucus. Greenish foamy stools (“swamp mud”) are characteristic. - Botulism
. With the gastroenterological variant of the infection, dyspeptic symptoms come to the fore: watery diarrhea, repeated vomiting, cramping abdominal pain. Patients complain of dry mouth and a feeling of a lump in the throat. Botulism is characterized by ocular manifestations: double vision, flashing “spots” before the eyes, blurred vision. In severe cases, paresis and paralysis of facial muscles with facial asymmetry are observed. - Campylobacteriosis
. The disease begins acutely with a rise in temperature to 38° C or more, pain in muscles and joints. Repeated diarrhea immediately follows with the release of liquid, foul-smelling feces, in which streaks of mucus and blood are revealed. Patients often complain of abdominal cramps, while nausea and vomiting occur in only a quarter of patients with campylobacteriosis.
Viral infections
Dyspeptic disorders, in particular watery diarrhea, are considered the main manifestations of most viral intestinal infections. When viruses enter the gastrointestinal tract, they multiply inside epithelial cells, causing their death and desquamation from the surface of the mucosa, which leads to impaired parietal digestion and diarrhea. Pathogens also slow down the processes of reabsorption of water from the intestinal lumen, which causes profuse diarrhea. The most common viral diseases affecting the intestines:
- Rotavirus gastroenteritis
. Watery stools are the main manifestation of rotavirus infection. In the mild version, the frequency of defecation is up to 10 times per day, the stools are fecal in nature, in the severe case the leading one is profuse diarrhea with the discharge of a turbid, foul-smelling yellow-green liquid. Diarrhea is combined with cramping pain in the umbilical region, low-grade fever. - Norovirus infection
. Norovirus is characterized by simultaneous damage to the respiratory and digestive systems. The disease begins with a sore throat, nasal congestion, then dyspepsia occurs - watery bowel movements, vomiting, abdominal pain. Repeated defecation with the release of a large volume of fluid becomes a prerequisite for severe dehydration, which is manifested by dry skin and mucous membranes, decreased blood pressure, and oliguria. - Hong Kong flu
. With this type of influenza infection, symptoms from the gastrointestinal tract are combined with signs of damage to the respiratory system and general intoxication of the body. Along with headache and high fever, there is repeated diarrhea with water, moderate pain in the abdomen, nausea, and lack of appetite. Respiratory manifestations (dry cough, sore throat, nasal congestion) occur on the 2-3rd day of illness. - Marburg hemorrhagic fever.
The disease manifests itself acutely with the appearance of headache, myalgia, conjunctivitis, and erosions on the oral mucosa. Dyspeptic disorders in the form of watery diarrhea, vomiting, severe abdominal pain develop on the 3-4th day of hemorrhagic fever. Pathognomonic signs are maculopapular rash, uterine, nasal and gastrointestinal bleeding, appearing on days 5-6 of illness. - HIV infection
. AIDS is characterized by copious watery stools without pathological inclusions, caused by digestive disorders and the addition of a secondary infection against the background of severe immunodeficiency. In addition to loose stools, other nonspecific symptoms are determined - prolonged low-grade fever, increased sweating at night. Most patients lose more than 10% of body weight.
Protozoal and helminthic infestations
Helminths and protozoa have a direct pathogenic effect on the enterocytes of the mucous membrane, causing severe disturbances in the digestion and absorption of food components. Severe malabsorption syndrome in combination with increased secretion of water and electrolytes into the intestinal cavity provokes profuse diarrhea. With insufficient replenishment of fluid losses, dehydration syndrome of varying severity develops. Watery diarrhea is observed with infestations such as:
- Cryptosporidiosis
. Protozoa parasitize in the lumen of the small intestine, potentiating malabsorption and inhibition of the activity of digestive enzymes, resulting in watery stools with a foul odor. Diarrhea is accompanied by severe abdominal cramps, nausea, and vomiting. The disease most often affects people with immunodeficiencies. In such cases, there is a long course (up to 4 months) with severe dehydration. - Strongyloidiasis
. Intestinal manifestations are observed in the second phase of the disease, 2-3 weeks after the appearance of the first symptoms - urticaria, rashes and arthralgia. The development of diarrhea is associated with inflammatory damage to the small intestinal mucosa, the formation of hemorrhages, and erosions. In addition to diarrhea, epigastric pain, nausea, and vomiting are typical. Sometimes yellowness of the skin and pain in the right hypochondrium occur.
Non-infectious bowel diseases
Watery diarrhea often complicates the course of organic diseases of the digestive tract, especially in the initial stages. The increase in the volume of feces is due to both disturbances in the processes of parietal and cavity digestion, and the influence of various inflammatory mediators. Diarrhea can be associated with intestinal motility disorders of the hyperkinetic or hypokinetic type. With changes in stool frequency and consistency, the following non-infectious gastrointestinal pathologies occur:
- Enteritis
. Watery diarrhea is a symptom of non-infectious inflammation of the small intestine, which is allergic, drug-induced or autoimmune in nature. The appearance of liquid, foul-smelling feces is mainly caused by malabsorption and maldigestion syndromes. Stools are observed up to 10-15 times during the day, accompanied by flatulence, rumbling in the stomach, decreased appetite, nausea, and significant weight loss. - Enteropathy
. Chronic watery diarrhea occurs with non-inflammatory intestinal pathologies. A change in the consistency of stool can be caused by both fermentopathy and impaired gastrointestinal motility (for example, a hypomotor variant of diabetic enteropathy). The pain syndrome is mild; digestive disorders predominate, promoting weight loss and protein-energy deficiency. - Acute colitis
. Colitis is characterized by spasms in the left iliac region, painful urge to defecate, and the presence of pathological mucus and blood in the stool. The stool initially has a fecal character, a fetid odor, and as the disease progresses it becomes watery. The frequency of bowel movements reaches 25 times a day. Similar changes are observed in the pseudomembranous variant of colitis with exudative enteropathy.
Enzyme deficiency
In the absence of enzymes in the initial parts of the small intestine, the appearance of profuse diarrhea with water is associated with an osmotic mechanism. The presence of a large number of undigested large molecules, especially disaccharides and peptones, is a prerequisite for increased pressure in the intestinal lumen, the release of fluid and sodium ions. Diarrhea occurs with fibrosis of the pancreas and a decrease in its exocrine function by 80-90%, as a result of which the digestion of all types of food is disrupted. The condition is aggravated by the addition of the secretory mechanism of diarrhea associated with the activation of cAMP.
Watery stools are possible with gastrinoma, Zollinger-Ellison syndrome. Increased secretion of gastrin and hydrochloric acid leads to the destruction of digestive enzymes and an increase in chyme osmolarity. Diarrhea is accompanied by intense epigastric pain and sour belching. In children, defecation of water becomes a consequence of galactosemia - milk intolerance due to the congenital absence of the enzyme. The symptom appears immediately after the start of breastfeeding and is accompanied by malnutrition, jaundice, and suppressed reflexes.
Treatment of diarrhea
Treatment depends on the specific disease, and only a doctor can recommend it.
The greatest danger to the body during heavy or prolonged diarrhea is the loss of fluid and electrolytes, which can lead to serious complications. Therefore, even before seeking medical help, it is necessary to start taking special medications - saline solutions for rehydration.
It is also important to adhere to certain dietary recommendations to prevent irritation of the intestinal mucosa and fermentation processes. Sweets and baked goods, milk, anything fatty, fried, spicy, smoked, canned food, sausages, fresh vegetables and fruits, legumes, soda, coffee and alcohol are prohibited. Recommended are porridges with water (rice, oatmeal), jelly, boiled eggs or steamed omelettes, lean meat (poultry) and soups based on it, crackers, dried fruits, low-fat cottage cheese, boiled vegetables, baked apples and bananas, herbal teas.
WHO activities
WHO works with Member States and other partners on the following:
- promoting national policies and investments that support the management of diarrhea and its complications, and increasing access to safe drinking water and sanitation in developing countries;
- conducting research to develop and test new strategies for delivering health services in this area;
- building capacity for preventive interventions, including sanitation, improved water sources, and household water treatment and safe storage;
- developing new health interventions such as immunization against rotavirus;
- Promoting the training of health workers, especially at the community level.
Home Remedies
It is important that people experiencing abdominal pain and diarrhea stay hydrated. Drink plenty of clear liquids such as water, juice and broth. Avoid caffeine and alcohol. As your bowel movements become more regular, eat small amounts of diet foods such as porridge, rice and eggs. Avoid spicy, fatty and high-fiber foods. They can worsen inflammation in the digestive system. Probiotics can help your digestive system heal. Natural probiotics are found in foods such as yogurt. You can take herbal supplements that are considered beneficial:
- Blueberry;
- Melissa;
- Chamomile.
We strongly do not recommend doing treatment yourself, because you may choose the wrong method, which will only aggravate the situation and you will spend extra money on buying unnecessary expensive medications
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Prevention
To avoid diarrhea, it is extremely important to follow simple rules:
- Don’t forget about the rules of personal hygiene: wash your hands well before eating and preparing food, after visiting the toilet, walking outside, or changing your baby.
- Avoid bad habits such as sucking pens, pencils, fingers, and unlearn biting your nails, especially for children.
- Balance your diet, do not overindulge in sweet foods.
- Buy products only from trusted sellers, be sure to monitor their expiration dates, and do not eat those whose freshness is in doubt.
- After contact with meat or fish, wash all kitchen utensils well with warm water and detergent.
- Do not consume unpasteurized milk.
- Do not leave cooked food in a warm place; as a result, dangerous microflora may multiply.
- Do not prepare food for future use, it can be dangerous.
- Wash fruits and vegetables well with running water immediately before consumption.
- Drink only clean water, avoid using water from various sources, streams, wells, the quality of which may be in doubt.
It is unlikely that it will be possible to completely protect a person from diarrhea and possible infection. But these recommendations will reduce the risk of diarrhea.
Remember, self-medication can be harmful to your health!
Classification
The following types of diarrhea are distinguished: infectious (with dysentery, salmonellosis, amoebiasis, foodborne toxic infections and entroviruses), nutritional (associated with dietary disorders or allergic reactions to foods), dyspeptic (accompanies digestive disorders associated with insufficiency of the secretory functions of the digestive system organs: liver, pancreas, stomach; as well as in case of insufficiency of enzyme secretion in the small intestine), toxic (with arsenic or mercury poisoning, uremia), medicinal (caused by taking drugs, drug dysbacteriosis), neurogenic (with changes in motility due to impaired nervous regulation associated with psycho-emotional experiences).
