Diarrhoea

Diarrhoea is very common, though it's not everyone's favourite topic. Dr Joe Kosterich talks about diarrhoea, including how common it is, what it is, how often people experience it, what causes it, how to treat it, and when to see your doctor.

Diarrhoea is very common. In most Western countries it is a nuisance; it is occasionally fatal in young children but fortunately quite rarely. In the third world, it remains a leading cause of death, so whilst we sometimes have a chuckle about diarrhoea and "runny poos", in some parts of the world, it is no laughing matter. Obviously in this video we are going to be talking about diarrhoea in the context of the Western world.

So what do we mean by diarrhoea? One of the issues is that the term means different things to different people. The best way to describe it is as “loose” or “watery” bowel motions. Generally speaking, when we are going to the toilet and our bowels are open, motions should be soft but firm, if that makes any sense. It's one of those things that we know when we experience it but is harder to put into words. There is a range and people do have different bowel patterns and habits. To that extent, diarrhoea will be a change to the looser side from what is “normal” for you. I think we all know when it’s watery which is pretty obvious to recognise; there are shades of grey between that and what we might normally experience. Some people may have it as a once off, while others may have these loose or runny bowel motions a number of times a day.

There are a number of causes of diarrhoea and we can’t go into all of those in this video. The two most common causes of diarrhoea will be a gastroenteritis, which is generally caused by a virus, and the other common cause would be food poisoning. The symptoms are going to be pretty much the same: certainly you will experience diarrhoea; people may also have some vomiting; they may get nausea and stomach cramps; some people may get a fever, headache and aching around the body. Now if it is due to food poisoning or a virus, it will pass over the course of a few days. Treatment is very straightforward and is really directed at keeping yourself hydrated – which is really number one, two and three – and perhaps medications to help with the symptoms if needed. There is no specific cure for a viral gastro or food poisoning.

There are bacterial causes for diarrhoea and with some of those there may be a specific treatment – I would point out that that is very rare. To find that, out one may need to take a stool sample for analysis. I know that you must be thinking: "gee, that sounds like fun", and it is literally means gathering a sample of your bowel motion, putting it into a little jar and then taking it to the lab which will analyse it to figure out if there is a particular parasite or bacteria growing. One of the more common ones is a bug called Giardia and it may require a specific treatment.

There are a number of other causes of diarrhoea and that includes inflammatory bowel disease, irritable bowel syndrome and some other metabolic conditions (we can’t go into all the details of this). People often ask me, "when I have diarrhoea, what’s the best thing to eat" and unfortunately there is no absolute answer to that question. If you don’t have much of an appetite, don’t force it and don’t eat, but in general times, the better foods are likely to be starchy foods (bread, rice, potatoes, noodles, pasta). In the simplest terms, don’t eat much if you don’t want to; if you feel like eating particular foods, be guided by what your body is telling you.

So, when should you go to the doctor if you have some diarrhoea? There are a couple of pointers; if it is going on for more than a couple of days it may be worth having a check up (not that there is necessarily any treatment required, but it may be worth having a check up). If you have a high fever that is persisting for one or two days, it may be worth getting checked. Also, if you have any blood in your bowel movements, that is always worth checking. Again, none of these things absolutely mean that there is something serious but they should be signals to get it checked. If you have ongoing stomach cramps that are painful, that may also be a reason to get things checked. The key thing is if it has been dragging on. Often, quite rightly, people say, “I’ve got diarrhoea, it’s been for a couple of days, it’s not that bad, I don’t need to go to the doctor,” and 99.9% of the time that is correct. The more days it goes on for, the more you should be thinking about getting it checked and even more so if there are any of those alarm symptoms like blood, more severe pain or high temperature. This is the sort of area where one cannot be absolute and prescriptive and, to be honest, it is about using your own judgement. If you feel that it’s okay, then there is a fairly high likelihood that it is. If you have any niggles or concerns then go along and see your doctor.

As we said earlier, the most important thing when you have diarrhoea is keeping up with your fluids – you don’t want to get dehydrated. Even in third world countries, the biggest issue with people, and children in particular, dying from diarrhoea is because they get dehydrated rather than the infection itself. So keep up with the fluids. Water is great and  you can get fluid replacements from the chemist which are okay as well. If you can’t, or don’t want to, access those then something simple like juice cordial with a pinch of salt would be good. Don’t go so much with the fruit juices if you do have diarrhoea as this is one time where it may actually make it worse rather than better. Keep up with fluids. There are some over-the-counter preparations that can help with the symptoms, and again, these are not a cure but some people may find them beneficial. You can make your own mind up on that.

To sum up, diarrhoea is very common. Fortunately, in the vast majority of instances it will pass by itself and fairly quickly. If you have any concerns, or you’re not quite feeling right, you should go and see your doctor. There may not be much by way of treatment required, which is a good thing not a bad thing, but it is worth getting checked if you’re not feeling as good as you should be.