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Diarrhoea

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A Complete Outline of Diarrhoea

Diarrhoea, sometimes spelt diarrhea, is a condition associated with liquid or watery bowel movements. According to the World Health Organisation, it is commonly used to express the symptoms of someone experiencing “loose” bowels at a frequency of at least three times in a single day. It often presents dehydration or low water content in the blood due to the continued loss of fluids.

Note: ‘Gastroenteritis’ is an umbrella term used to define a class of infectious diarrhoea and inflammation of the gastrointestinal tract (comprising the stomach and intestine).

Types of Diarrhoea

Diarrhoea can be further classified into three types depending on the onset and duration of symptoms:

1. Short duration watery diarrhoea refers to a sudden onset, short-lived form of diarrhoea. It is commonly seen in conjunction with cholera and is therefore rarely seen in the developed world.
2. Short duration bloody diarrhoea is a common complication of diarrhoea called dysentery.
3. Persistent or acute diarrhoea is either watery or bloody diarrhoea that lasts longer than is typically observed (usually more than two consecutive weeks).

Causes of Diarrhoea

The typical cause of infectious diarrhoea can be attributed to an intestinal infection called gastroenteritis, commonly due to certain viruses, bacteria or opportunistic parasites. These infections can be contracted from edible sources such as contaminated food and water, by faecal transmission (from exposure to the bodily waste of an infected individual, specifically faeces), or by inter-personal transmission (directly from an infected individual). Common causative agents include:

● Salmonella
● Shigella
● Campylobacter
● Norovirus
● Rotavirus (accounting for 40% of all cases in children under five years)
● Sapovirus
● Astrovirus

It is also possible to suffer from non-infectious forms as a result of:

● Lactose intolerance – inability to digest the milk sugar lactose.
● Irritable Bowel Syndrome (IBS) – spastic bowel movements.
● Inflammatory Bowel Disease (IBD) – inflammation of the colon and small intestine.
● Non-celiac gluten sensitivity (NCGS) – gluten intolerance.
● Celiac disease – an autoimmune condition affecting the brush border of the small intestine.
● Ulcerative colitis (UC) – inflammation and ulcers of the colon and rectum.
● Hyperthyroidism – excess production of thyroid hormone.
● Bile acid malabsorption – excessive bile acid production.
● Cross-reactions or side effects of certain medications – antibiotics (cefdinir, amoxicillin etc.), antidepressants (citalopram, sertraline etc.), proton pump inhibitors (omeprazole, lansoprazole etc.) or chemotherapy.

Note: Diarrhoea and diarrhoeal disorders are the second leading cause of mortality in children under the age of five worldwide as of the year 2020.

Exceptions And Early Signs

Loose or semi-watery bowel movements are common in infants who are still exclusively breastfed. You may consider this as usual in such cases. Early symptoms of diarrhoea and dehydration, in general, manifest physically as a loss of normal sketchiness of the skin and mentally as unusually increased irritable behaviour.

[Fact: Over 1.7 to 5 billion cases of diarrhoea are reported every year, most commonly in developing countries.]

Diarrhoea Symptoms

The most common diarrhoea symptom is the constant urge to relieve oneself or visit the loo. It is sometimes an unpredictable urge and may result in an uncontrollable bowel evacuation. Due to the homeostatic (self-regulating) nature of the body, the low fluid content typically reduces the frequency of urination and other related symptoms such as loss of skin colour, increased heart rate or even a decrease in conscious responsiveness in more severe cases. It may also be accompanied by secondary diarrhoea symptoms such as:

● Abdominal cramps
● Abdominal pains
● Frequency passing of watery faeces
● Blood in stool
● Mucus in stool
● Bloating
● Nausea
● Vomiting
● Fever

Treatment and Management of Diarrhoea

Rehydration therapy is the primary method to recover the amount of fluids lost due to diarrhoea. This involves administering a slightly sweet and salty fluid either orally (as in oral rehydration therapy) or intravenously in more severe cases. However, previous common forms of therapy such as BRAT (Banana, Rice, Applesauce, Toast) diets have been disproved. Accepted forms of diarrhea treatment include:

1. Treating with oral fluid replacements rich in vitamin and mineral supplements such as zinc and potassium.
2. Drinks full of simple sugars such as soft drinks or fruit juices.
3. Being on a diet consisting of foods rich in fibre.
4. Probiotics to prevent antibiotic-associated diarrhoea.

Prevention Strategies

The World Health Organisation has made various methods to prevent the contracting and subsequent spread of diarrhoea common knowledge. The primary and most reliable form of prevention is good hygiene. Basic sanitation – washing your hands thoroughly with soap and water can drastically reduce the spread and risk of contracting the disease. On the other side, the availability of sanitary water and uncontaminated foods are also vital. Some vaccines exist against diarrhoeal pathogens to further cement protection from the condition.

Fact: Two researchers, Nesse and Williams, hail that diarrhoea might have an evolutionary advantage as an expulsion mechanism. Ref: Williams G, Nesse RM “Why we get sick: the new science of Darwinian medicine.”

Treatment
The remedies and often cure for diarrhoea linked conditions can be provided through drugs and pharmaceuticals. These are aimed at the very particular source cause of the ailment. Different kinds of diarrhea medicines (called antidiarrhoeals) include:
1. Bismuth containing compounds such as Pepto-Bismol has been seen to reduce the frequency of bowel movement in patients significantly. It can be administered in most forms, but they do not affect the duration of the overall condition.
2. Anti-motility agents such as loperamide have also been effective in decreasing the frequency of bowel movements, but only if blood is not present in the stool. This is also the most commonly administered diarrhoea medicine in India.
3. Diosmectite is shown to be effective in reducing acute symptoms in children. This is a natural mineral (aluminomagnesium) clay.
4. Absorbent agents such as Kaopectate can be used for mild symptoms.
5. Racecadotril is a loperamide alternative that causes less flatulence and constipation.
6. Bile acid sequestrants such as cholestyramine can be used in the case of chronic (long-term) diarrhoea.

Conclusion
The most prominent symptoms of diarrhoea consist of a consistent loss of body fluids and frequent urge to evacuate one’s bowels. There are various treatment strategies and drugs available to treat the conditions, but the prevention strategies are simpler, following basic hygiene and sanitary water and food. There also exist vaccines to further protection. Although this condition is seldom fatal, it is still essential to address the symptoms as and when they come to avoid any complications.
FAQs
1. How does diarrhoea spread?
It is typically an infection in the GI tract that spreads via waste or direct contact with an infected individua
2. How long does diarrhoea last?
Typically for 2-3 days. If it lasts longer than a few weeks, you might want to consult a physician.
3. What cures diarrhoea fast?
Drinking plenty of fluids is the best way to make a fast recovery. Many medications are available according to the particular symptoms observed, but there is no one-size-fits-all cure.