Diarrhea can range from a mild, temporary condition to a potentially life threatening one. Common causes include viruses, bacteria, and parasites.

Globally, an estimated 2 billion cases of diarrheal disease occur each year. Also, around 1.9 million children under the age of 5 years — mostly in developing countries — die from diarrhea every year. This makes it the second leading cause of death in this age group.

Diarrhea is characterized by loose or watery stools. Most cases of diarrhea are due to bacteria, viruses, or parasites. Digestive disorders can also cause chronic diarrhea.

If a person frequently passes stools but they are of a normal consistency, this is not diarrhea. Similarly, breastfed babies often pass loose, sticky stools. This is normal.

This article looks at the causes and treatments of diarrhea. It also looks at symptoms, diagnosis, prevention, and when to see a doctor.

What are the main causes of diarrhea?

Many cases of diarrhea are due to an infection in the gastrointestinal tract. The microbes responsible for this infection include:

• bacteria
• viruses
• parasitic organisms

The most commonly identified causes of acute diarrhea in the United States are the bacteria Salmonella, Campylobacter, Shigella, and Escherichia coli.

Some cases of chronic diarrhea are called “functional” because although all the digestive organs appear normal, they are not functioning as they ideally should. In the developed world, irritable bowel syndrome (IBS) is the most common cause of functional diarrhea.

IBS causes many symptoms, including cramping, abdominal pain, and altered bowel habits, which can include diarrhea, constipation, or both.

Inflammatory bowel disease (IBD) is another cause of chronic diarrhea. IBD describes either ulcerative colitis or Crohn’s disease. Both conditions can also cause blood in the stool.

Some other major causes of chronic diarrhea include:

• Microscopic colitis: This is a persistent type of diarrhea that usually affects older adults. It develops due to inflammation and occurs often during the night.
• Malabsorption and maldigestion diarrhea: The first is due to impaired nutrient absorption, and the second is due to impaired digestive function. Celiac disease is one example.
• Chronic infections: A history of travel or antibiotic use can be clues in chronic diarrhea. Various bacteria and parasites can also be the cause.
• Drug-induced diarrhea: Laxatives and other drugs, including antibiotics, can trigger diarrhea.
• Endocrine-related causes: Sometimes, hormonal factors cause diarrhea. This is the case in Addison’s disease and carcinoid tumors.
• Cancer-related causes: Neoplastic diarrhea is associated with a number of gut cancers.

Antidiarrheal medication

Over-the-counter antidiarrheal medications are also available. These include loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol).

Imodium is an antimotility drug that reduces stool passage.

Pepto-Bismol reduces diarrheal stool output in adults and children. It can also prevent traveler’s diarrhea.

There is some concern that antidiarrheal medications could prolong bacterial infection by reducing the removal of pathogens through stools.

Symptoms

Diarrhea refers to watery stools, but it may be accompanied by other symptoms. These include:

• stomach pain
• abdominal cramps
• bloating
• weight loss
• fever
• body aches
• chills

Diarrhea is also a symptom of other conditions, some of which can be serious. Other possible symptoms are:

• blood or pus in the stool
• persistent vomiting
• dehydration

If any of these accompany diarrhea, or if the diarrhea is chronic, it may indicate a more serious illness.

How long is too long for diarrhea?

If a person has diarrhea and it lasts for more than 7 days, they should consult a doctor urgently.

Also, children should see a doctor as soon as possible if they have had more than five bouts of diarrhea or vomited more than twice within 24 hours.

Prevention

The following can help prevent diarrhea:

• drinking clean and safe water only
• having good sanitation systems, such as wastewater and sewage
• having good hygiene practices, such as regularly washing the hands with soap, especially before preparing food and eating and after using the bathroom
• educating oneself on the spread of infection

There is evidence to suggest that interventions from public health bodies to promote hand-washing can reduce diarrhea rates by about one-third.

In developing countries, however, the prevention of diarrhea may be more challenging due to dirty water and poor sanitation.

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Summary

Diarrhea is a common problem with many potential causes.

In most cases, a range of home remedies and medical treatments can help. However, a person should see their doctor if they are concerned about diarrhea or other symptoms.

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