Diarrhea: Causes & Therapy

diarrhea

For some people it is perfectly normal to have a bowel movement three times a day. A mushy stool doesn't have to mean diarrhea either. The range of “normal bowel movements” is broad; the consistency and frequency of the stool can vary greatly from person to person. Scientifically correct, one defines diarrhea as the increased stool weight per day.

Defecation from three times a day to every three days is perfectly normal. However, if the stool frequency increases to over three times a day and the consistency decreases, diarrhea can be assumed. A fundamental distinction is made between acute and chronic diarrhea. The limit is four weeks. Fecal incontinence, in which the frequency of the stool increases but the amount of stool is normal, must be distinguished from diarrhea.

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What are the causes of diarrhea?

Diarrhea has a wide variety of causes. These range from a pathogen infection to chronic inflammation and irritable bowel syndrome. On the one hand, there can be a disturbed absorption of water and salts in the intestine. But it is also possible that diarrhea is caused by an increased release of water and salts within the body (secretion). An interplay between the two mechanisms is also possible, e.g. in the case of inflammation of the intestine. In the case of irritable bowel syndrome, there are changes in the movements of the bowel (motility), which causes diarrhea.

The most important causes of diarrhea at a glance:

• Irritable bowel syndrome;
• Infections by bacteria, viruses and other pathogens (e.g. rotaviruses or noroviruses, Clostridium difficile, Salmonella, Shigella, Campylobacter, E. coli) or by their toxins (poisons). The infection occurs, for example, through smear infection or through the consumption of contaminated food;
• Food intolerances, such as lactose intolerance, fructose intolerance or sorbitol malabsorption;
• Gluten intolerance (celiac disease);
• chronic inflammation in the intestine, such as, for example, in Crohn's disease, ulcerative colitis or microscopic colitis;
• Medicines that affect the intestine, such as antibiotics, antidepressants, diuretics and pain relievers such as NSAIDs and many more
• exocrine pancreatic insufficiency;
• bacterial overgrowth in the small intestine.

What are the symptoms of diarrhea?

If the stool frequency increases more than three times a day and the consistency changes significantly (from pulpy to liquid), one can speak of diarrhea. The weight of the stool is also increased and is over 500 grams / day, although up to several liters are possible. Diarrhea can be accompanied by abdominal pain or cramps, and certain infections can also lead to nausea and vomiting.

How is the diagnosis made?

At the beginning, the doctor will conduct a detailed anamnesis discussion, in which it will be discussed which complaints exist and since when they have been present. Acute diarrhea usually starts suddenly. The diagnosis of diarrhea that has persisted for a long time is more difficult. The following aspects can be relevant:

• Stool: amount, color, smell, consistency and frequency;
• What happens at night and when fasting?
• Eating habits;
• Concomitant symptoms such as abdominal pain, gas, weight loss, fever;
• Other diseases;
• recent trips;
• Keeping of pets;
• Taking medication.

In the case of chronic diarrhea, the doctor can carry out or order a detailed examination of the bowel. During a colonoscopy, an endoscope is inserted into the intestine through the anus. With this device it is also possible to take painless tissue samples (biopsy), which provide further valuable information. Intravenous sedoanalgesia (anesthesia) can help to sleep through the examination painlessly. See Colonoscopy for more information.

Further possible diagnostic methods:

• Calprotectin in the stool (= leukocytes in the stool; signs of inflammation),
• Blood collection, if necessary blood culture,
• Chair culture,
• Sonography (ultrasound),
• Gastroscopy for duodenal biopsy,
• Hormone regulations.

How is diarrhea treated?

In principle, it is important to understand the underlying cause of diarrhea and treat it causally. The diarrhea itself is treated symptomatically. In the case of severe fluid losses, life-threatening dehydration (desiccation) can occur, and quick action is then particularly important.

Note Infants, small children and the elderly are particularly at risk of dehydration caused by diarrhea. Caution is also advised if the immune system is weak.

Electrolyte solutions

If you have diarrhea that has lost a lot of fluid in a short period of time, fluids and electrolytes must be replaced. Special rehydration solutions are suitable for this, which you can also prepare yourself (according to WHO). Approx. 40 ml / kg of body weight should be drunk from this drinking solution within 24 hours, which corresponds to 2.8 liters of the drinking solution for a body weight of 70 kg.

WHO rehydration solution for self-preparation:

• ½ liter of mineral water
• ½ liter of orange juice
• 8 teaspoons sugar (leveled)
• ¾ teaspoon salt

Anticonvulsants

In the case of severe abdominal cramps, antispasmodics (antispasmodics) with active ingredients such as butylscopolamine can bring relief. Under certain circumstances, drugs that increase intestinal tone and reduce the number of bowel movements (e.g. loperamide) can also be used.

Only rarely given antibiotics

Depending on the cause of the diarrhea, treatment with antibiotics may be possible. The doctor decides whether this really makes sense in a specific case - ie whether a bacterial infection became invasive or not. For example, aminopenicillins with beta-lactamase inhibitors or quinolones are used.

The administration of probiotics in the form of capsules, yoghurts, drinks etc. can shorten the duration of acute diarrhea (by about a day), but their main area of use is prevention. You can find more information about the effects of probiotics on the website www.medizin-transparent.at.

Chronic diarrhea is treated causally whenever possible. Irritable bowel syndrome is most likely to be improved by the FODMAP diet and colon-focused hypnotherapy. Food intolerance, allergies and drug-related diarrhea can be combated most effectively through parental leave. Chronic inflammatory bowel diseases respond favorably to immunosuppression, bacterial overgrowth respond well to antibiotics.

How to prevent diarrhea

In order to avoid acute diarrheal illnesses, certain hygiene and behavioral rules should be heeded. One of the most important measures is frequent hand washing! You can

find more information under Hand hygiene: Little effort, great effect!

When traveling, it also helps to avoid tap water and products made from it, such as ice cubes, squirted fruit juice, etc. Fruit and vegetables should be peeled or washed thoroughly with sterile water. The motto “cook it, peel it or leave it!” Sums it up.

For more tips on avoiding traveler's diarrhea, see Eating and Drinking Right When Traveling

Whom can I ask?

If the diarrhea is particularly severe and does not improve after two days, if there is a fever or if there is blood in the stool, you should urgently seek medical help. If you have had diarrhea (chronic) for a long time, you should definitely have the causes clarified. You can contact the following offices for this purpose:

• General Practitioner,
• Specialist in internal medicine (specializing in gastroenterology and hepatology).

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). The costs of some over-the-counter OTC preparations must be borne by the patients themselves.

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic.

For more information, see Costs and Deductibles.

Please contact your social security agency for information on the respective provisions.

You can also find out more about reimbursement on the website of the social insurance agency.

When hospitalization is required

If there is severe dehydration due to diarrhea, hospitalization may be necessary. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

For more information, see What does a hospital stay cost?