Diarrhoea

Diarrhoea is defined as more than three mushy or liquid bowel movements within 24 hours.

1 May 2021 | 5 Min. Reading Time

Overview

Diarrhoea is defined as more than three mushy or liquid bowel movements within 24 hours. The accompanying symptoms are dictated by the many different causes, e.g. fever, stomach pain or vomiting. Causes include gastrointestinal infections or intolerances, for example. Replacement of lost fluids and hand hygiene are important.

Symptoms

>3 mushy or liquid bowel movements within 24 hours
Sometimes also distinctly foul-smelling
Nausea, vomiting, vomiting and diarrhoea, stomach pain or cramps
Possibly accompanied by fever, cold symptoms and joint pains
Sometimes, blood in stool or on stool surface
Scope: harmless to life-threatening

Complications and consequences

Loss of fluids and electrolytes (loss of minerals)
Malnutrition
Drop in blood pressure, collapse, circulatory shock
Liver and kidney inflammation or sepsis
Emaciation and anaemia

Causes and treatment

Cause

Direct triggers
- Increased bowel activity
- Increased fluid secretion in the intestine
- Decreased re-absorption from the intestine

Different formation mechanisms and diseases:

Gastrointestinal infections:
- Often caused by viruses and bacteria (e.g. salmonella) or their toxins
- More rarely, single-celled organisms, worms or parasites
- Contagion: contaminated water, spoiled food or smear infection
- Light traveller’s diarrhoea to life-threatening cholera
Functional disorders: anxiety, stress, nervousness, irritable bowel syndrome
Allergy or intolerance:
- Food and other allergies
- Lactose or fructose intolerance
- Coeliac disease
Intestinal tumours: often alternating with phases of constipation
Chronic inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
Hormonal causes, general illnesses: overactive thyroid, renal insufficiency or adrenal fatigue, diabetes mellitus, HIV
Medication: in particular antibiotics and laxatives
Poisoning: mercury, arsenic, other heavy metals, fungi

Further treatment by your doctor / in hospital

Possible tests

Blood test
Stool analysis
Ultrasound, if necessary
Colonoscopy, if necessary

Possible therapies

Treatment of an underlying disease
Contact isolation, if necessary
Replacement of fluids (orally or via infusion)
Antibiotics
- Usually better to do without (diarrhoea helps to flush out the bacteria)
- Important for complications, however, as well as for typhus and cholera

What can I do myself?

Replace lost fluids and minerals
- Drink as much as possible, as soon as possible (in sips)
- Suitable: unsweetened or slightly sweetened tea, slightly carbonated mineral water, heavily diluted fruit juices, beverages containing electrolytes, well-salted bouillon
- Children: no sweetened drinks or isotonic solutions
- Packets of mineral salt preparations are available from the pharmacy
- Home recipe
Return to a normal diet
- Generally, food that is rich in carbohydrates but low in fat and proteins
- Don’t consume dairy products (except yoghurt), spicy foods and coffee for the first three days
- Suitable foods: grated apple, mashed potato (without milk), banana or gruel, rusks, cooked and strained or mashed carrots
- Continue to breastfeed babies during fluid replacement phase
Hand hygiene is essential (in particular in contact with persons suffering from diarrhoea)
- Wash with soap or use hand sanitisers
- Regularly change towels
Medical charcoal if food poisoning is suspected (but consult a doctor if there is no improvement after three days)
Don’t take medication which reduces bowel activity if infectious diarrhoea is suspected
Apply rules of food hygiene
- Wash vegetables and salads well
- Interrupt cold chain for as short a period as possible
- Roast meat at a high enough temperature (>70°)
Travelling in the tropics and subtropics or developing countries:
- Obtain medical advice for travellers, check vaccinations
- Only eat cooked foods, and fruit only if it has been peeled (cook it, boil it, peel it or forget it!)
- Don't drink tap water, don't put ice cubes into beverages and don't eat ice cream served in open bowls
- Boil tap water, if necessary (for 15 minutes)
- Be careful with fish and seafood dishes
- It's best to use mineral water for brushing the teeth

When to see a doctor?

Low threshold for older and weakened people, babies and small children
Diarrhoea with fever
- Emergency: in babies younger than 2 months and children between 3 months and 3 years, if fever is higher than 39°C
Blood, pus or mucus in stool
Vomiting and colic
Long-lasting or recurrent diarrhoea
Diarrhoea up to three weeks after a trip to the tropics (consult a doctor quickly)
Signs of dehydration
- Dry mucous membranes, reduced urinary output
- Rapid pulse, rapid breathing
- Dizziness
Muscle cramps, confusion, drowsiness