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Diarrhoea is a condition involving frequent loose, watery stools.
What is going on in the body?
Diarrhoea occurs when the large intestine becomes irritated. This may be caused by infection, introduction of new foods, chemical toxins, inflammation, or stress and anxiety. The bowel responds to irritation in three ways. These include:
What are the signs and symptoms of the condition?
- increasing the amount of water and mucous in the stool
- decreasing the amount of water re-absorbed from the stool
- increasing the frequency with which stools are emptied from the body
Diarrhoea in children can cause:
When severe, diarrhoea can cause dehydration. Signs of this include: What are the causes and risks of the condition?
- belly cramping or pain, which may disrupt sleep
- loss of appetite
- frequent, watery stools. In more serious situations stools may contain pus or blood.
Most of the time, diarrhoea in children is caused by the viruses that cause stomach flu or gastroenteritis. Diarrhoea is often associated with vomiting. Other causes of diarrhoea include: What can be done to prevent the condition?
Diarrhoea is very contagious if it is caused by an infection. It is important to use good hand-washing technique:
Food poisoning can also be minimised by cleaning all utensils, cleaning cooking or preparing surfaces, and cooking meat until it is cooked through and no longer pink.
- after nappy changes
- before and after handling food, especially poultry
- after cleaning aquariums, or touching pets
How is the condition diagnosed?
Diarrhoea is diagnosed by the frequency and looseness of the stools. The cause of the diarrhoea is diagnosed by considering other symptoms. These may include the presence of blood or mucous in the stool, the duration of the diarrhoea, weight loss, or other signs of illness.
A doctor will take a history of the child's symptoms. He or she will then do a physical examination. The doctor will look for signs of dehydration. Diarrhoea can be dangerous if severe dehydration occurs or if the infection spreads to the blood stream.
Laboratory tests, such as blood tests and tests on the stool may be performed. Special x-rays may be taken, as well. Occasionally, an instrument known as a colonoscope is used to view the interior of the intestine. This can help determine the cause of the diarrhoea.
What are the long-term effects of the condition?
Usually there are no serious long-term effects of diarrhoea in children with effective treatment. In countries where access to intravenous fluids and medication is limited, children may suffer from other diseases or diarrhoea may be fatal. If the illness is caused by a serious infection or the child becomes extremely dehydrated, there may be more serious long-term effects. If a child becomes severely dehydrated, the amount of fluid in the blood stream decreases. This makes it difficult for the bodily organs to get enough oxygen and nutrients. If this is severe enough, this can cause death. Diarrhoea is one of the leading causes of death in children around the world.
Diarrhoea, especially in toddlers, can last a long time. If it is accompanied by persistent loss of appetite, it can lead to nutritional problems. This, however, is unusual. Diarrhoea can sometimes cause temporary problems digesting milk products, a condition known as lactose intolerance. This usually resolves on its own. If a child is still in nappies, diarrhoea may cause severe nappy rash.
What are the risks to others?
Diarrhoea caused by a virus or bacterial infection may be contagious. It is important to wash hands well to prevent spreading germs. The elderly, young children, or others who have weakened immune systems are at increased risk. Diarrhoea can cause more serious symptoms in these individuals.
What are the treatments for the condition?
Diarrhoea in children is treated by replacing the fluid in the body. Usually this is done through oral feedings. Most of the time, the child can maintain a normal diet if the diarrhoea is mild. Some children are not able to tolerate cow's milk when they have diarrhoea. If a toddler or young child is still breastfeeding, they can continue nursing.
If the diarrhoea is moderate, a doctor may recommend clear fluids for the first 6 to 24 hours. Diarrhoea makes children very thirsty. Usually the doctor will recommend giving plenty of fluids if the child is not vomiting. The main goal in treatment of diarrhoea is to prevent dehydration. Prepared drinks such as gastrolyte or Resol can help replace water and salts, known as electrolytes, that are lost through the diarrhoea. White grape juice may be substituted instead if an electrolyte solution is not available.
After the first 6 to 24 hours of a clear liquid diet, bland foods may be added. These include bananas, rice, applesauce and dry toast. Additional foods can be added slowly. Avoiding raw fruits and vegetables, beans, fatty foods and spicy foods may also be helpful while the child has diarrhoea. Reducing the intake of milk and other milk products for the first few days with diarrhoea may also reduce stomach irritation.
If diarrhoea becomes severe, treatment with intravenous (IV) fluids may be necessary. A tube is put into a vein in the child and fluids are given through the tube. Hospitalisation is sometimes necessary in this case. If unusual symptoms are present or the child is acting very sick, the doctor may look for conditions that may require further treatment. Medications or surgery may be needed.
What are the side effects of the treatments?
There are generally few side effects to the above treatments. If medications are needed for the underlying cause of the diarrhoea, there may be side effects to the medications. These include further stomach upset or allergic reactions.
What happens after treatment for the condition?
A few days of diarrhoea generally are not a cause for concern. The exception would be if the child is not taking drinking enough fluid to compensate for the liquid lost in the diarrhoea. A doctor may recommend progressing to a regular diet slowly or may recommend staying off milk products for a limited period of time. If diarrhoea continues despite treatment, the doctor should be notified.
How is the condition monitored?
Most cases of diarrhoea last 3 to 5 days. A doctor should be called immediately if:
- diarrhoea lasts more than 5 days
- there is blood or pus in the stool
- there is a persistent high fever
- the child seems more that just a little bit sick
- there are any changes in the child's regular behaviour
- the child loses weight
- there are no tears when crying
- the child has vomiting and cannot keep fluids down
- the child is not drinking very much or has frequent diarrhoea
- the child has decreased urination
- the has abdominal distress
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 9/1/2005
Potential conflict of interest information for reviewers available on request