An Overview of Diarrhea

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Diarrhea is the unpleasant experience of having loose and watery stools three or more times in a day. It has a large number of causes including food poisoning, infection, medications, food allergies or intolerances, inflammatory conditions, and malabsorption syndromes.

Diarrhea can lead to complications such as dehydration or even malnutrition. While it usually goes away after a day or two, you should see your doctor for diarrhea in an infant or child, if symptoms are severe, or if it persists or is chronic. The treatment will depend on the underlying cause. On average, adults typically deal with one bout of acute diarrhea per year, while young children experience two bouts of acute diarrhea per year.

Symptoms

Diarrhea can be characterized as acute, which is of sudden onset and lasting less than two weeks; persistent, which lasts 14 to 28 days; or chronic, in which symptoms have been present for longer than four weeks.

The primary symptom of acute diarrhea is the presence of loose and watery stools. Other symptoms may include:

  • Increased frequency of bowel movements
  • Abdominal cramps
  • A sense of bowel urgency
  • Soiling accidents

If the reason behind diarrhea is an infection or toxin, the following symptoms may also be experienced:

People who have chronic diarrhea will experience episodes of loose and watery stools. In some cases, these episodes will occur intermittently. They are also likely to experience other symptoms stemming from the underlying health problem. For example, people who have celiac disease may also experience weight loss and malnutrition.

Most of the time, people who experience a bout of acute diarrhea get better on their own. However, diarrhea can become a life-threatening situation for infants, older adults, and people who have a compromised immune system from an illness such as cancer or HIV.

When to See Your Doctor

Although most cases of diarrhea resolve themselves, there are other times when medical attention is an absolute necessity in order to prevent serious illness or even death. If you see signs of diarrhea in a newborn or infant, call your doctor right away. You should also call your doctor if you or your child have any of the following symptoms:

  • Diarrhea that lasts longer than 24 hours in a child or 48 hours for an adult
  • Signs of dehydration
  • Stools that are bloody, pus-covered, black, or tarry

The following symptoms require immediate medical attention:

  • Any of the danger signs related to dehydration
  • Severe abdominal or rectal pain
  • Fever of 102 F or above
  • Signs of severe weakness or confusion

Danger signs of dehydration, which require immediate medical attention, include:

  • Extreme irritability, sleepiness, fussiness (babies), and/or confusion (adults)
  • Mouth, skin, and mucous membranes are all quite dry
  • Eyes are sunken, in infants the "soft spot" may be sunken as well
  • Crying does not produce tears
  • Little to no urination; what is passed is quite dark in color
  • Skin doesn't rebound when folded
  • Rapid breathing and heart rate
  • Low blood pressure
  • Fever
  • Delirium or unconsciousness

Causes

The symptom of diarrhea can have many causes. Diarrhea can come simply from eating too much fruit or fiber or going on a mostly-liquid diet.

Acute diarrhea is often caused by food poisoning, in which improper food handling leads to bacteria producing a toxin that causes diarrhea, nausea, and vomiting. Stomach flu (viral gastroenteritis) also causes acute diarrhea. Examples of viral infections include rotavirus, the most common form to affect children, and norovirus, sometimes called "cruise ship diarrhea." Bacterial infections causing acute diarrhea often come from consuming contaminated food or water. These include C. difficile, E. coli, Salmonella, Shigella, and Campylobacter. Parasites and amoeba such as Giardia and Entamoeba histolytica can also be contracted through contaminated food and water.

Diarrhea can be a side effect of certain types of medications, including antibiotics, antacids, chemotherapy, heart medications, antidepressants, high blood pressure medications, and diuretics. Laxatives containing magnesium can lead to diarrhea, as can the abuse of laxatives. Diarrhea may occur following bariatric surgery or gallbladder removal.

Health problems that may have chronic diarrhea as a symptom include celiac disease, the inflammatory bowel diseases of Crohn's disease and ulcerative colitis, irritable bowel syndrome (IBS), and food intolerance (such as fructose or lactose malabsorption). Less common causes of chronic diarrhea include colon cancer, ongoing parasitic infections, and radiation therapy.

Diagnosis

Your doctor may not run any tests until your diarrhea has been present for longer than 48 hours, although this might not be the case depending on your medical history and other circumstances, such as recent travel.

If your doctor thinks that it is indicated, you may have stool tests for bacteria or parasites, particularly if you have traveled recently, are experiencing fever, or have bloody diarrhea. You may also have blood and urine tests to rule out other diseases, infections, dehydration, electrolyte imbalance, and to check your overall health.

If you are experiencing chronic diarrhea, your doctor may do more in-depth testing to try to figure out what may be underlying your symptoms. This testing may include an upper endoscopy, sigmoidoscopy, and/or colonoscopy.

Treatment

Most of the time, acute diarrhea will clear up on its own. However, there are things that you can do to help your child or your body to heal. The most important thing to do is to make sure that the person who has diarrhea is adequately hydrated. This means that they are taking in more fluids than normal. These fluids can include:

  • Clear soups and broths
  • Clear juices
  • An electrolyte drink such as Pedialyte or sports drinks

There are foods and drinks that you will want to avoid for a few days following the onset of your diarrhea as they can make your symptoms worse. These include:

  • Milk and other dairy products
  • Heavy, fatty, greasy foods
  • Drinks containing caffeine, such as coffee, tea, and colas

You will want to eat foods that are soft and bland until your symptoms improve. Good food choices are bananas, cooked carrots, potatoes, toast, rice, and plain chicken. Don't stay on a restricted diet any longer than necessary, especially if you have chronic diarrhea, as it may not have proper nutrient content.

Be sure to get plenty of rest to help your body to fight off the underlying infection.

Over-the-counter medications, like Imodium, Pepto-Bismol, and Kaopectate, should only be used by adults who have no signs of fever or bloody diarrhea. Such medications are generally not recommended for children and thus should only be used under direction by a doctor.

If you have signs of severe dehydration, you may be hospitalized. You will be given an IV to replace lost fluids and electrolytes. Antibiotics or anti-parasitic medications may be prescribed for bacterial infections or parasitic infections.

Treatment of chronic diarrhea will be primarily aimed at treating the underlying condition. The use of an over-the-counter medication like Imodium might be recommended to directly address the symptom of diarrhea.

Prevention

The best way to deal with diarrhea is to not get it in the first place. Thorough hand-washing with soap and water can be very effective for preventing infection. This is especially crucial when cooking, after using the toilet, or when out in public.

People who are at higher risk for getting seriously sick if exposed to a disease-causing organism need to be extra vigilant to avoid getting sick. This includes infants, older adults, and people who have compromised immune systems.

Pregnant women should take extra precautions to avoid diarrhea, especially when casude by Listeria, which can cause miscarriage. Foods to avoid include:

  • Under-cooked meats and unheated deli meats
  • Raw (unpasteurized) dairy products, as well as soft cheeses
  • Raw shellfish

Everyone should maintain safe food and drink practices when traveling out of their home country so as to prevent travelers' diarrhea. This means to avoid any use of, or drinking of, tap water and avoiding all raw meats, fish, fruits, vegetables, and dairy products.

Cooked foods should only be eaten if they are served hot. You can eat raw fruit only if it has a peel that you have removed yourself. You can drink bottled water, hot drinks, and soft drinks. Before traveling, you may want to talk to your doctor about any possible need to take antibiotics before you leave or to have them on hand in case you do get sick.

A Word From Verywell

Diarrhea can be an annoyance, but sometimes it will ruin your plans or can even lead to serious complications. Simple prevention tactics such as handwashing, safe food handling, and safe eating when traveling can help reduce bouts of acute diarrhea. If you have an ongoing problem with diarrhea, talk to your doctor so the underlying condition can get diagnosed and treated.

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Barr W, Smith A. Acute diarrhea. Am Fam Physician. 2014;89(3):180-9.

  2. Schiller LR, Pardi DS, Sellin JH. Chronic Diarrhea: Diagnosis and Management. Clin Gastroenterol Hepatol. 2017;15(2):182-193.e3. doi:10.1016/j.cgh.2016.07.028

Additional Reading

  • Diarrheal Diseases – Acute and Chronic. American College of Gastroenterology.

  • Diarrhea. National Institute of Diabetes & Digestive & Kidney Diseases.

  • Minocha A, Adamec C. The Encyclopedia of the Digestive System and Digestive Disorders (2nd Ed.) New York:Facts on File. 2011.