What’s normal stool and what’s diarrhea?
In order to provide a definition of acute diarrhea let’s talk about what is normal bowel movement. In fact, there is little agreement on this topic in the medical world. For instance, a “normal” range of bowel movements can be anywhere between three per day and once every three days. Most agree, however, that going once a day is necessary for proper elimination. Lack of strain, smooth and formed appearance (no lumps or cracks) are additional characteristics of normal stools. Color of the stool is important as well: too dark might be a sign of intestinal bleeding, light or gray color is a sign of bile insufficiency.
Diarrhea is a condition of abnormal increase in frequency, water content and volume of stools. Or diarrhea is watery stools more than 3 times a day.
In addition, there is acute and chronic diarrhea. Acute diarrhea lasts up to 2 weeks. If diarrhea lasts more than 4 weeks it’s chronic.
Acute diarrhea lasts no longer than two weeks and is most often results from an infection, food allergy/intolerance or intoxication. We will discuss two types of acute diarrhea: acute infectious (secretory) and acute osmotic.
Acute infectious diarrhea is one of the most common illnesses worldwide, especially in countries with poor hygiene conditions. Unfortunately, the risk of death from it is relatively high, especially among the elderly and young children, due to dehydration it causes. Infectious diarrhea is the cause of “Traveler’s” diarrhea. It usually happens when people travel from low-risk to high-risk countries. Infectious diarrhea will not be resolved by stopping food intake. There are three types of infectious diarrhea: viral, bacterial and parasitic.
More than 70% of infectious diarrhea cases are of viral origin. Rotavirus, the most common virus causing diarrhea, attacks the cell lining of the small intestine and causes about 700,000 deaths a year worldwide. Infants and young children are especially susceptible.
Parasites account for 20-25% of all cases of infectious diarrhea. Some infections can be asymptomatic and others will cause abdominal pain, diarrhea, malabsorption and over the longer term, stunted growth in children.
Bacterial infection occurs in 1.5-5.6% of all infectious cases of diarrhea. Fever and bloody stools are strongly suggestive of bacterial infection. One common hospital-acquired infectious diarrhea is caused by bacteria Clostridium difficile. Interestingly, it’s often cause by the use of antibiotics that disrupt normal gut bacteria of a patient. As a result, C. difficile, bacteria that is present in the colon in very small quantities multiples.
It’s important to note that any type of acute infectious diarrhea can linger and become persistent (more that two weeks) and even chronic, especially in cases of parasitic infections.
Osmotic diarrhea means that something makes the intestine pull water in from surrounding tissues. For example, poor digestion of sugar alcohol like sorbitol, mannitol, and xylitol can have the effect of pulling too much water into the intestine, causing diarrhea. Many “sugar free” foods, snack bars, and chewing gums use sugar alcohols as substitutes. Excessive intake of certain nutrients (vitamin C, magnesium oxide) have the same effect and cause diarrhea.
Low levels of some enzymes can also cause diarrhea. For example, people with lactose intolerance have low levels of enzyme lactase. This leads to inability or poor ability to digest lactose, which can also result in diarrhea. Other people may have difficulty digesting fructose, or gluten due to insufficient digestive enzymes. This can also cause diarrhea. Osmotic diarrhea will stop when the offending substance is removed from the diet. So try a dairy free, gluten free, or fruit free diet and see if it helps.
Treatment of acute diarrhea
The diagnosis of the causes of diarrhea is very important for the best outcome. However, it is difficult – and sometimes impossible – to correctly diagnose the cause of diarrhea. Luckily, most of the time diarrhea is self-limiting. It resolves itself once the body gets rid of the disturbing agents (virus, bacteria, parasite, toxins or food stuff).
Consult a doctor immediately if you have any of the following symptoms:
- Blood in the stool
- High fever (102F)
- More than 10 stools a day
- Traveled outside the country recently
- Stayed in the hospital and /or used antibiotics recently
- Signs of dehydration (dry mouth, little or no urination, weakness/light-headedness, excessive thirst)
- Diarrhea lasting more than 7 days (3 for children and elderly)
Otherwise, you can take the following steps at home:
- The most important step in addressing diarrhea of any type is staying hydrated. Oral Re-hydrating Solution (ORS) is easy to make at home. Combine ½ teaspoon of salt, 2 tablespoons of sugar or rice powder with 2 pints of water. The ORS is not going to treat diarrhea, but rather compensate for water and electrolyte losses.
- Drink chicken and beef broths. These are great healing foods for people with diarrhea. They are more traditional “rehydrating solutions” and, arguably, more beneficial. Not only do they replenish lost liquid and electrolytes but also provide healing compounds for intestinal lining.
- Dietary approach – BRAT diet has been historically used as a first step nutrition therapy for diarrhea. BRAT stands for Banana, Rice, Applesauce and Toast. I recommend excluding the toast or using gluten-free toast.
- Probiotic supplementation, especially Lactobacillus, is effective in treating diarrhea and supporting intestinal flora.
- Zinc supplementation, especially in zinc-deficient children, is effective in both the treatment and prevention of acute diarrhea.
Prevention of acute diarrhea
- Hand washing especially after using the bathroom
- Safe food preparation and storage
- Access to clean water
- Probiotics supplementation for healthy intestinal microflora
- Ensure adequate stomach acidity by stopping antacid medication and taking digestive bitters
- Optimize immune system functioning, support vitality