Diarrhea

Diarrhea is an increase in the wateriness, volume, or frequency of bowel movements. Although uncomfortable, most diarrhea is not serious and will go away in a few days without treatment. See a health care provider, however, if the feces contain blood, if the diarrhea is particularly severe, or if the diarrhea lasts more than a few days.

Signs and Symptoms

Diarrhea is a symptom of another ailment. Symptoms you might experience with diarrhea include the following.

• Frequent need to defecate
• Abdominal pain, cramping
• Fever, chills, general sick feeling
• Weight loss

What Causes It?

Most diarrhea is caused by an infection (viral, bacterial, or parasitic) or intestinal disorders such as inflammatory bowel disease. Another common cause is food poisoning. Eating local food and drinking local water during foreign travel can result in "traveler's diarrhea."

What to Expect at Your Provider's Office

Your health care provider will question you about your symptoms. Your provider will also check if you are dehydrated and may feel your abdomen to see if it is tender, listen to your abdomen with a stethoscope, and give you a rectal exam.

Treatment Options

Drug Therapies
In many cases, diarrhea will disappear on its own. However, there are various drugs to treat symptoms of diarrhea. Your health care provider may suggest the following drugs for your diarrhea:

• Opioid derivatives: diphenoxulate with atropine sulfate, and loperamide
• Adsorbents: Bismuth salt (for traveler's diarrhea) and attapulgite
• Bulk-forming medications: psyllium husk

Complementary and Alternative Therapies

Work with your provider to find remedies that are right for you.

Nutrition

• Avoid coffee, chocolate, dairy products, strong spices, and solid foods. Introduce clear soup, crackers, white bread, rice, potatoes, applesauce, and bananas as diarrhea gets better.
• Rice or barley water, fresh vegetable juices (especially carrot and celery), miso broth, or other clear broths help restore proper fluid and electrolyte balance. Make rice and barley water using 1 cup of raw grain to 1 quart of boiling water. Let steep for 20 minutes. Strain and drink throughout the day.
• Lactobacillus taken as powder or in capsules helps normalize bowel flora and may help cure your diarrhea. Take as directed.
• Glutamine (3,000 mg three times per day) is helpful in treating diarrhea that is caused by irritation of the intestinal lining rather than infection.

Herbs
Do not use herbs to treat diarrhea without talking to your health care provider first. If your diarrhea is caused by certain types of infections, herbal treatments could make it worse. The most common herbal remedies for diarrhea are described below. They are best used as teas unless otherwise noted. Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Swelling reducers:

• Quercetin (250 to 500 mg two to four times per day)
• Chamomile (Matricaria recutita)
• Marshmallow root (Althea officinalis) as cold-water tea. Soak 2 tbsp. root in 1 quart of water overnight. Strain; drink throughout the day.

Infection fighters:

• Barberry (Berberis vulgaris) 250 to 500 mg three times per day
• Goldenseal (Hydrastis canadensis) 250 to 500 mg three times per day
• Licorice root (Glycyrrhiza glabra). Do not take if you have high blood pressure.

Antidiarrheal herbs:

• Blackberry leaf (Rubus fruticosus) or raspberry leaf (Rubus idaeus) 1 heaping tsp. per cup. Drink ½ cup per hour.
• Carob powder; use 4 tsp. per 4 oz. of water or mix in applesauce. Take ½ to 1 tsp. every 30 to 60 minutes.
• Slippery elm powder (Ulmus fulva) or marshmallow root powder (Althaea officinalis); use 1 oz. powder to 1 quart of water. Make a paste with the powder and a small amount of water. Gradually add in the rest of the water and then simmer down to 1 pint. Take 1 tsp. every 30 to 60 minutes.

Homeopathy
In a recent study of children with acute diarrhea, those who received an individualized homeopathic treatment for five days had a significantly shorter duration of diarrhea than children who received placebo. Some of the most effective homeopathic remedies are listed below. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Arsenicum album — for foul-smelling diarrhea from food poisoning or traveler's diarrhea with burning sensation in the abdomen and around the anus; this remedy is most appropriate for individuals who feel exhausted yet restless and whose symptoms tend to worsen in the cold and improve with warmth; vomiting may also occur; Arsenicum may also be used to prevent diarrhea when traveling
• Chamomilla — for greenish, frothy stool that smells like rotten eggs; used primarily for children, especially those who are irritable, argumentative, and difficult to console; commonly recommended for colicky or teething infants
• Calcarea carbonica — for children who fear being in the dark or alone and who perspire heavily while sleeping; stools have a sour odor
• Mercurius — for foul-smelling diarrhea that may have streaks of blood accompanied by a sensation of incomplete emptying; this remedy is most appropriate for individuals who tend to feel exhausted following bowel movements, experience extreme changes in body temperatures, perspire heavily, and have a thirst for cold fluids
• Podophyllum —for explosive, gushing, painless diarrhea that becomes worse after eating or drinking; exhaustion often follows bowel movements and the individual for whom this remedy is appropriate may experience painful cramps in lower extremities; often used in infants for diarrhea experienced from teething
• Pulsatilla — for diarrhea that occurs after consuming too much fruit or rich, greasy food; stools are greenish in infants and of changing consistencies in older children
• Sulphur — for irritable and weepy children; may have a red ring around the anus and diarrhea with the odor of rotten eggs
• Veratrum album — for profuse, watery diarrhea accompanied by stomach cramps, bloated abdomen, vomiting, exhaustion, and chills; the diarrhea is worsened by fruit, and the individual craves cold liquids

Acupuncture
Although acupuncturists in China have reported success in treating childhood diarrhea, acupuncturists in the United States do not generally treat this condition in children. However, acupuncture may be used when conventional treatment has failed. In this case, acupuncturists would examine both the nutritional value and the "energetic" qualities of food that might be affecting digestion. Acupuncture is also combined with conventional medicine in treating diarrhea in adults.

Acupuncturists treat people with diarrhea based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of diarrhea, a qi deficiency is usually detected in the spleen meridian. As a result, acupuncture treatments often focus on strengthening this meridian. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is frequently used in the treatment of diarrhea because its effect is thought to reach deeper into the body than needling alone.

Following Up

If your diarrhea does not stop in three to five days, contact your health care provider.

Special Considerations

If you are pregnant, tell your doctor. Dehydration can cause you to go into labor early. Also, the spasms that diarrhea causes may cause you to have contractions. Do not take goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), or high doses of vitamin A if you are pregnant.

Diarrhea can be serious, even fatal, for infants and elderly people because of dehydration and the loss of electrolytes.

References

Andreoli TE, Bennett JC, Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1993:271-277.

Anti-diarrheal Medicines: OTC Relief for Diarrhea. American Academy of Family Physicians Accessed at https://familydoctor.org/ on July 2, 2018.

Antidiarrheals. NMIHI. Accessed at http://drugs.nmihi.com/antidiarrheals.htm on July 2, 2018.

Azithromycin. NMIHI. Accessed at http://www.nmihi.com/a/azithromycin.html on July 2, 2018.

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:481-491.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:147.

Bensky D, Gamble A. Chinese Herbal Medicine. Seattle, Wash: Eastland Press; 1986:47-49.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:425, 464.

Berkow R. The Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories; 1997:523-525.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Ciprofloxacin. NMIHI. Accessed at http://www.nmihi.com/c/ciprofloxacin.html on July 2, 2018.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Jacobs J, Jiménez M, Malthouse S, Chapman E, Crothers D, Masuk M, Jonas WB. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med. 2000;6(2):131-139.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 218-220.

Infectious gastroenteritis. NMIHI. Accessed at http://www.nmihi.com/d/infectious-diarrhea.htm on July 2, 2018.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Lin Y, Zhou Z, Shen W et al. Clinical and experimental studies on shallow needling technique for treating childhood diarrhea. J Tradit Chin Med. 1993;13(2):107-114.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:15, 42, 116, 246, 305.

Murray MT. Encyclopedia of Nutritional Supplements. Rocklin, Calif: Prima Publishing; 1996:431-439.

Dambro MR. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999:316-319.

Diarrhea. NMIHI. Accessed at http://www.nmihi.com/d/diarrhea.htm on July 2, 2018.

Diarrhea and vomiting. NMIHI. Accessed at http://www.nmihi.com/d/diarrhea-and-vomiting.htm on July 2, 2018.

Diarrhea Causes. MFMER. Accessed at https://www.mayoclinic.org/ on July 2, 2018.

Food Poisoning. WebMD. Accessed at https://www.webmd.com/ on July 2, 2018.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:617-618, 621-622, 763-766, 1047-1050, 1061-1063, 1078-1079, 1103-1104, 1201-1202, 1226-1227.

Stein JK, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994:436-440.

Stoller JK, Ahmad M, Longworth DL, eds. The Cleveland Clinic Intensive Review of Internal Medicine. Baltimore, Md: Williams & Wilkins; 1998:638-643.

Su Z. Acupuncture treatment of infantile diarrhea: a report of 1050 cases. J Tradit Chin Med. 1992;12(2):120-121.

Tadalafil. NMIHI. Accessed at http://www.nmihi.com/t/tadalafil.html on July 2, 2018.

Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press; 1994:51-54.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 75-77.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 243-245.

Walker LP, Brown EH. The Alternative Pharmacy. Paramus, NJ: Prentice Hall Press; 1998:147-150.

What is diarrhea? Cleveland Clinic. Accessed at https://my.clevelandclinic.org/ on July 2, 2018.