Diarrhea

Overview

Diarrhea — loosewatery and possibly more-frequent passage of stool — is a common problem. Sometimesit's the only symptom of a condition. At other timesit may be associated with other symptomssuch as nauseavomitingabdominal pain or weight loss.

Luckilydiarrhea is usually short-livedlasting no more than a few days. But when diarrhea lasts beyond a few daysit is usually a clue to another problem — such as medicine side effectschanges in dietirritable bowel syndrome (IBS)or a more serious disorderincluding ongoing infectionceliac disease or inflammatory bowel disease (IBD).

Symptoms

Symptoms associated with loosewatery stoolsalso called diarrheamay include:

• Belly cramps or pain.
• Bloating.
• Nausea.
• Vomiting.
• Fever.
• Blood in the stool.
• Mucus in the stool.
• Urgent need to pass stool.

When to see a doctor

If you're an adultsee your doctor if:

• Your diarrhea doesn't get better or stop after two days.
• You become dehydrated.
• You have terrible abdominal or rectal pain.
• You have bloody or black stools.
• You have a fever above 101 degrees Fahrenheit (38 degrees Celsius).

In childrenparticularly young childrendiarrhea can quickly lead to dehydration. Call your doctor if your child's diarrhea doesn't improve within 24 hours or if your child:

• Becomes dehydrated.
• Has a fever above 101 degrees Fahrenheit (38 degrees Celsius).
• Has bloody or black stools.

Causes

A number of diseases and conditions can cause diarrheaincluding:

• Viruses. Viruses that can cause diarrhea include Norwalk virusalso known as norovirusenteric adenovirusesastroviruscytomegalovirus and viruses that cause hepatitis. Rotavirus is a common cause of sudden childhood diarrhea. The virus that causes coronavirus disease 2019 (COVID-19) also has been linked to gastrointestinal symptomsincluding nauseavomiting and diarrhea.
• Bacteria and parasites. Exposure to certain bacteriasuch as Escherichia colior parasites through contaminated food or water can lead to diarrhea. When traveling in developing countriesdiarrhea caused by bacteria or parasites is often called traveler's diarrhea. Clostridioides difficilealso known as C. diffis another bacterium that causes diarrheaand it can occur after a course of antibiotics or during a hospital stay.
• Medicines. Many medicinessuch as antibioticscan cause diarrhea. Antibiotics get rid of infections by killing bacteria that cause illnessbut they also kill good bacteria that are helpful in the body. This disturbs the natural balance of bacteria in the intestinesleading to diarrhea or an infection such as C. diff. Other medicines that cause diarrhea are anticancer drugs and antacids with magnesium.
• Lactose intolerance. Lactose is a sugar found in milk and other dairy products. People who have trouble digesting lactose often have diarrhea after eating dairy products. Lactose intolerance can increase with age because levels of the enzyme that helps digest lactose become lower as people get older.
• Fructose. Fructose is a sugar found naturally in fruits and honey. It's sometimes added as a sweetener to certain beverages. Fructose can lead to diarrhea in people who have trouble digesting it.
• Artificial sweeteners. Sorbitolerythritol and mannitol — nonabsorbable sugars used as artificial sweeteners in chewing gum and other sugar-free products — can cause diarrhea in some otherwise healthy people.
• Surgery. Partial intestine or gallbladder removal surgeries can sometimes cause diarrhea.
• Other digestive disorders. Chronic diarrhea has a number of other causessuch as IBSCrohn's diseaseulcerative colitisceliac diseasemicroscopic colitis and small intestinal bacterial overgrowth (SIBO).

Risk factors

Some common risk factors for diarrhea include:

• Exposure to virusesbacteria or parasites. This is a major risk factor for sudden onset of diarrhea.
• Diet. Certain foods or drinksincluding coffeeteadairy productsor foods containing artificial sweeteners can cause diarrhea in some people.
• Medicines. Some medicinessuch as antibioticslaxativesmagnesium supplementsantidepressantsNSAIDschemotherapy and immunotherapycan cause diarrhea.

Complications

Diarrhea can cause dehydrationwhich can be life-threatening if not treated. Dehydration is particularly dangerous in childrenolder adults and those with weakened immune systems.

If you have symptoms of serious dehydrationseek medical help.

Symptoms of dehydration in adults

These include:

• Excessive thirst.
• Dry mouth or skin.
• Little or no urination.
• Weaknessdizziness or lightheadedness.
• Fatigue.
• Dark-colored urine.

Symptoms of dehydration in infants and young children

These include:

• Not having a wet diaper in three or more hours.
• Dry mouth and tongue.
• Fever above 102 degrees Fahrenheit (39 degrees Celsius).
• Crying without tears.
• Drowsinessunresponsiveness or irritability.
• Sunken appearance to the bellyeyes or cheeks.

Prevention

Preventing infectious diarrhea

Wash your hands to prevent the spread of infectious diarrhea. To ensure adequate hand-washing:

• Wash frequently. Wash your hands before and after preparing food. And wash your hands after handling uncooked meatusing the toiletchanging diaperssneezingcoughing or blowing your nose.
• Lather with soap for at least 20 seconds. After putting soap on your handsrub your hands together for at least 20 seconds. This is about as long as it takes to sing "Happy Birthday" two times.
• Use hand sanitizer when washing isn't possible. Use an alcohol-based hand sanitizer when you can't get to a sink. Apply the hand sanitizer as you would hand lotionmaking sure to cover the front and back of both hands. Use a product that contains at least 60% alcohol.

Vaccination

You can help protect your infant from rotavirusthe most common cause of viral diarrhea in childrenwith one of two approved vaccines. Ask your baby's doctor about having your baby vaccinated.

Preventing traveler's diarrhea

Diarrhea commonly affects people who travel to countries with poor sanitation and contaminated food. To reduce your risk:

• Watch what you eat. Eat hotwell-cooked foods. Don't eat raw fruits and vegetables unless you can peel them yourself. Don't eat raw or undercooked meats and dairy foods.

• Watch what you drink. Drink bottled watersodabeer or wine served in its original container. Don't drink tap water or use ice cubes. Use bottled water even for brushing your teeth. Keep your mouth closed while you shower.

  Beverages made with boiled watersuch as coffee and teaare probably safe. Remember that alcohol and caffeine can aggravate diarrhea and worsen dehydration.

• Ask your health care team about antibiotics. If you're traveling to a developing country for an extended timeask a member of your healthcare team about getting antibiotics before you goespecially if you have a weakened immune system.
• Check for travel warnings. The Centers for Disease Control and Prevention maintains a travelers' health website where disease warnings are posted for various countries. If you're planning to travel outside of the United Statescheck there for warnings and tips for reducing your risk.