How Diarrhea Is Treated

Diarrhea is a common condition characterized by extremely loose stools. It's hardly a pleasant experience but as a health issue, it usually isn't serious.

Diarrhea can be caused by a viral or bacterial infection or could be symptomatic of more serious diseases or conditions. Most of the time, diarrhea goes away on its own after a few days, usually without any treatment. However, in some cases, treatment might be used to slow diarrhea down. 

For diarrhea that goes on for two or more days, it’s important to seek help from a physician to find out if there is an underlying cause such as irritable bowel syndrome (IBS), celiac disease, inflammatory bowel disease (IBD), or another disease or condition.

Diarrhea that goes on for several weeks may be considered chronic, and it’s important to work with a physician to get the underlying cause of diarrhea diagnosed and treated to avoid dehydration and malnutrition.

Home Remedies and Lifestyle

There is no shortage of advice on home remedies for diarrhea. Not every home remedy will work for every type of diarrhea or every person, however. It’s important to discuss dietary changes or other home remedies with a physician, especially if diarrhea is chronic.

Watery diarrhea can mean that the body is losing more fluids and electrolytes than it is taking in, which makes rehydration a priority. Some of the dietary changes that people often try at home to slow down or stop diarrhea include the BRAT diet, avoiding foods that may cause diarrhea, eating foods that may slow down diarrhea, and drinking more liquids.

BRAT Diet

The bananas, rice, applesauce, and toast (BRAT) diet has long been used as a treatment for diarrhea. The idea is that these foods are not likely to cause more diarrhea and also may help slow it down, all while keeping a person somewhat fed.

The foods in BRAT are low fiber and starchy, which may help firm up stools. They are also bland enough that they might not cause additional stomach upset. This diet is not meant to be used long-term because it is not nutritious enough, and getting back to a regular diet as soon as possible should be the goal.

However, recently experts have had concerns that the BRAT diet is not nutritious enough for children who are having diarrhea.

Some pediatricians may recommend feeding a child their regular diet or feeding them whatever foods are appetizing to them or can “stay down,” in the case of a child who is vomiting. Always check with a pediatrician to get guidance on what to feed a child with diarrhea and/or vomiting.

Hydration

Loose stools, and especially if there is also vomiting, can lead to a rapid loss of fluids in the body. Too much fluid loss in this way can lead to dehydration.

Most people, even when having both diarrhea and vomiting, don’t get seriously dehydrated. However, it’s important to keep drinking as tolerated. For someone who is vomiting too, that might mean only taking sips until more liquids are staying down.

For people who are otherwise considered healthy, drinking water can help prevent dehydration. Water can get boring which may make it hard to keep up. Drinking other types of fluids such as broths, coconut water, or sports drinks can also help because they have some taste and may contain minerals and electrolytes (such as sodium).

For children and for people who have an underlying medical condition (such as Crohn’s disease or ulcerative colitis) or have had surgery to remove parts of the intestines, dehydration may be more of a concern. This is when oral rehydration therapy can be considered.

Oral rehydration solution (ORS) is a preparation that replaces not only fluid, but also electrolytes. ORS is often sold in drugstores as a powder that can be mixed with water, but it can also be made at home with common ingredients such as sugar, salt, water, and baby cereal. For those who can keep food down, other ideas include using a commercial sports drink and blending in some bananas, sweet potatoes, avocados, yogurt, or spinach.

Check with a physician if dehydration is a concern, and for advice on which type of oral rehydration solution might be the most beneficial.

Food and Drink to Avoid

In some cases, stopping diarrhea also includes avoiding foods that can cause stomach upset. It’s important to remember that getting back to a regular, healthful diet as soon as possible when the diarrhea stops should be the goal.

Foods that some people may not be able to tolerate when experiencing diarrhea include:

• Artificial sweeteners (acesulfame potassium or Ace-K, Advantame, aspartame, saccharin, stevia, sucralose) 
• Caffeinated beverages (coffee, tea, cola)
• Carbonated beverages
• Cruciferous vegetables (such as cabbage, cauliflower, and broccoli)
• Fatty foods
• Fibrous foods (whole grains, nuts, and seeds)
• Fried foods
• Foods with added sugar
• Milk products
• Spicy foods (including those that contain onions or garlic)

Rest

Having diarrhea means that something has gone wrong in the digestive system and it’s worth resting in order to help oneself recover quicker. Taking a few days off from work and school for self-care can be an important part of treating diarrhea. In addition, if diarrhea is from an infectious cause, such as a virus, staying at home in order to avoid spreading the virus to others is also a good idea.

Over-the-Counter (OTC) Therapies for Short-Term Diarrhea

There is no shortage of anti-diarrhea medications at every drugstore. However, they should be used with caution because they are not appropriate for every case of diarrhea.

Imodium (loperamide)

Imodium works by slowing down the contractions of the muscles in the digestive tract. It is available to buy over the counter but may also be prescribed for people who have certain health conditions that cause diarrhea. Imodium can have adverse effects, including abdominal pain, dry mouth, drowsiness, dizziness. In some cases it could also cause nausea, vomiting, and even work too well and lead to constipation. People who take this medication infrequently should wait to see how it makes them feel before driving or doing physical activities because of the risk of dizziness and drowsiness.

Pepto-Bismol (Kaopectate, Bismuth Subsalicylate)

This medication can be bought over the counter. It works by slowing down the amount of water that enters the bowel. This has the effect of firming up loose stools. Some of the adverse effects can include constipation, black stools, or a black tongue. It’s important to follow directions closely with bismuth subsalicylate because it can be dangerous to take too much. It is also not appropriate for use in children.

Probiotics

Probiotics are strains of "friendly" bacteria that naturally occur in the body—particularly in the gut—but also can be found in foods such as yogurt, cottage cheese, and other fermented foods. Probiotic supplements can be bought over the counter.

An imbalance of bad bacteria in the gut often underlies diarrhea. There is an increasing amount of evidence showing probiotics can be effective for managing digestive health symptoms. The American Gastroenterology Association (AGA) recognizes certain probiotic strains as a viable adjunct treatment for managing certain gastrointestinal conditions, including treatment of pouchitis and prevention of c.difficile infection. However, these guidelines suggest against the use of probiotics for acute infectious gastroenteritis.

Of note, the AGA recommendations for probiotics are largely conditional given the quantity and quality of clinical evidence linking probiotic use directly to improved digestive health outcomes is scant. For certain conditions, including Crohn's disease and ulcerative colitis, AGA recommends probiotic use only in clinical trials. It also states it's reasonable for people who are concerned with either the cost or potential side effects of probiotics to choose not to take them.

Prebiotics

Prebiotics are fibers found in plants that encourage friendly bacteria in the digestive system to grow. Prebiotics can be found in fruits and vegetables such as asparagus, yams, bananas, leafy greens, and in foods with whole grains. There are also supplements available over the counter.

There’s also not much evidence for the use of prebiotics in treating diarrhea. Fruits and vegetables are part of a healthy diet, however. While it may be necessary to avoid any that might cause digestive upset for a bit while diarrhea is a concern, adding them back into meals as soon as possible is important.

Prescriptions for Infectious and Chronic Diarrhea

For uncomplicated diarrhea that goes away on its own, home remedies or over-the-counter medications will often be enough. However, there are some causes of diarrhea that may need treatment with a prescription from a physician.

Travelers’ Diarrhea

After recent travel, diarrhea is common. In some cases, this will go away on its own in a few days. Even so, seeing a doctor when there is diarrhea after travel is important as it may need treatment. This is especially true if there is blood in the diarrhea, because that can mean a bacterial infection. Use of antibiotics in travelers’ diarrhea will depend on a number of factors that a doctor will take into account.

Clostridioides difficile Infection

Clostridioides difficile (C. difficile) is a bacteria that can cause significant amounts of watery diarrhea. It is becoming increasingly common and spreads easily, making it a difficult problem to eradicate.

C. difficile infections are often treated with antibiotics, most commonly Flagyl (metronidazole) and Vancocin (vancomycin hydrochloride), and Dificid (fidaxomicin), though other antibiotics may also be used. Another treatment that is being used in some places is fecal microbiota transplant. In this treatment, stool from a healthy donor is taken and processed and then transplanted in one of several different ways into the colon of a person with a C. difficile infection or to prevent a future one. In November 2022, the FDA approved the first fecal microbiota product, Rebyota.

Parasitic Infections

Infections with parasites are less common in the Western world but they can occur anywhere, especially after traveling to places with less access to modern sanitation. In the United States, Giardia and Cryptosporidium are the most common protozoa that are responsible for infections. The most common types of parasitic worms in the United States are pinworms, hookworms, tapeworms, and roundworms.

Parasitic infections can cause diarrhea but often also cause other symptoms such as nausea, vomiting, fatigue, bloating/gas, and weight loss. In the case of parasitic worms, some types might pass in the stool, so worms, eggs, or worm parts might be seen with the visible eye.

No one medication is effective against all types of parasites, so the drug prescribed will depend on which parasite is found. Antibiotics (such as Flagyl or Tindamax [tinidazole]), antiparasitics (such as Alinia [nitazoxanide]), or drugs that kill worms, called anthelminthic medications (such as Albenza [albendazole] and Emverm [mebendazole]) may be used to treat parasitic infections.

Chronic Diarrhea

When diarrhea goes on for several weeks, it may be chronic. Treating chronic diarrhea will mean treating the underlying cause. Some medications may cause diarrhea as an adverse effect. If this is determined to be the cause, talking to a physician about making a change in the medication or in the dosage may be the way to find a solution.

There are several conditions that may cause chronic diarrhea, including IBS, IBD, microscopic colitisand celiac disease. These conditions are complex and, with the exception of celiac disease which is treated by removing gluten from the diet, may be treated with a variety of diet and lifestyle changes as well as medications.  

IBS-D: IBS that causes diarrhea (which is often referred to as IBS-D) is often treated with diet and lifestyle modifications, including adding more soluble fiber to the diet. A few medications have been developed specifically to treat IBD-D but, in most cases, medications that are in use for other conditions have been found to also help treat IBS.

Medications that might be used to treat IBS-D include:

• Anaspaz, Cystospaz, Levbid, Levsin (hyoscyamine): anti-spasmodics
• Bentyl (dicyclomine): an anti-spasmodic 
• Buscopan (hyoscine butylbromide): an antispasmodic
• Imodium (loperamide): an anti-diarrheal
• Lomotil (diphenoxylate and atropine): an anti-diarrheal 
• Selective serotonin reuptake inhibitors (SSRIs), medications used to treat depression and anxiety
• Tricyclic antidepressants (such as Elavil [amitriptyline]): medications for treating depression
• Viberzi (Eluxadoline): an anti-diarrheal specifically for IBS-D
• Xifaxan (Rifaximin): an antibiotic

IBD (Crohn’s Disease or Ulcerative Colitis): Diarrhea associated with IBD may be a result of inflammation in the digestive tract. Therefore, treating the diarrhea will mean controlling the inflammation.

People with IBD are usually not prescribed anti-diarrheal drugs that are meant to treat uncomplicated diarrhea, as those types of medications may not have any effect. Instead, medications that block inflammatory pathways to work directly to treat inflamed tissues are often prescribed. Keep in mind, some of these therapies can take weeks or months to have an effect.

Types of medications that are used to treat IBD include:

• Sulfa drugs (sulfasalazine) - for ulcerative colitis
• Corticosteroids (budesonide, prednisone) 
• 5-Aminosalicylates (Asacol, Apriso, Lialda, Pentasa, Rowasa, or 5-ASA) - for ulcerative colitis 
• Immunosuppressives (Imuran, 6-MP, and Methotrexate)
• Small molecules (Xeljanz, Rinvoq, Zeposia)
• Biologics (Cimzia, Entyvio, Humira, Remicade, Simponi, Stelara)

A Word From Verywell

Most cases of diarrhea will resolve on their own without us ever knowing what caused them. Waiting it out until it passes might be the only treatment that’s needed, but care should be taken to ensure that there’s not too much water being lost from the body and that some nutrition is being taken in. Reaching for an anti-diarrhea medication might seem like the best course of action, but it might not always be the best idea, and so checking with a doctor first is important.

Resting and eating bland foods may help slow down loose stools and avoid other complications. Especially in children, the biggest concern is often becoming dehydrated, which means that taking in fluids in the form of water, broth, or oral rehydration preparations is a big priority. Taking time to rest and recover is a big part of treating diarrhea, as is trying not to spread it to other people when the diarrhea is thought to be caused by an infection.

Chronic diarrhea, which goes on for more than a few weeks, may have a more serious underlying cause. Often, in these cases, the over-the-counter drugs and home remedies will not have much of an effect. Some people may get used to having loose stools all the time or on an intermittent basis, but it’s not normal to have constant diarrhea. Seeing a physician to find out why the diarrhea is happening is the beginning to getting the right treatment. Chronic diarrhea can not only lead to complications such as sore skin on the bottom and hemorrhoids, but also dehydration and malnutrition. This is why diarrhea that has gone on for more than a few days is a reason to talk to a doctor.