“Expectations vs. Reality: The Hidden Struggles of Diarrhoea”

Introduction

In the medical world, diarrhoea is among the most common complaints. There is a wide range of severity, from a mild, temporary condition to a potentially life-threatening one. Each year, there are approximately 2 billion cases of diarrhoea disease worldwide. Additionally, about 1.9 million children under five die from diarrhoea yearly, mostly in developing countries. That makes it the second main reason for passing in this age group.

Symptoms and Causes

The symptoms of diarrhoea include abnormally loose stools or watery stools. Most cases of diarrhoea are due to bacteria, viruses, or parasites. Digestive system disorders can also cause chronic diarrhoea.

If an individual frequently passes stools, but they are of normal consistency, this is not diarrhoea. Similarly, breastfed babies often have sticky stools or pass loose stools. That is normal. Diarrhoea occurs when there is an increase in the looseness of stools, increased bowel movements, or both.

Diarrhoea can occur due to increased fluid secretion into the intestine, rapid passage of stool through the intestine, and reduced fluid absorption from the intestine. Symptoms associated with diarrhoea include abdominal pain, especially cramping. Other symptoms depend on the cause of diarrhoea.

Types of Diarrhoea

Diarrhoea may be either acute or chronic, with different causes and treatments. It may cause dehydration, mineral abnormalities, and anus irritation.

Absolute and Relative Diarrhoea

• Absolute diarrhoea: More than five bowel movements daily or liquid stools.
• Relative diarrhoea: An increase in daily bowel movements or the looseness of stools compared with a person’s usual bowel habit.

Acute vs Chronic Diarrhoea

• Acute diarrhoea: Lasts one to two days and usually resolves without treatment.
• Persistent diarrhoea: Continues for two to four weeks.
• Chronic diarrhoea: Lasts more than four weeks or recurs over a long period. Common causes include:
  • Irritable bowel syndrome (IBS)
  • Inflammatory bowel diseases (IBD)
  • Celiac disease

Causes of Diarrhoea

Several diseases and conditions can cause diarrhoea, including:

• Viruses: Norovirus, rotavirus, and viruses causing hepatitis or COVID-19.
• Bacteria and Parasites: Exposure to pathogens like E. coli or parasites through contaminated food or water. Clostridioides difficile (C. diff) is another bacterium causing diarrhoea, often following antibiotic use.
• Medications: Antibiotics, antacids with magnesium, and anti-cancer drugs.
• Lactose Intolerance: Difficulty digesting lactose found in milk and dairy products.
• Fructose: Found in honey, fruits, and sweetened beverages.
• Artificial Sweeteners: Sorbitol, Mannitol, and Erythritol.
• Surgery: Procedures involving the gallbladder or intestine.
• Digestive Disorders: IBS, ulcerative colitis, Crohn’s disease, microscopic colitis, and small intestinal bacterial overgrowth (SIBO).

Tests and Evaluations

Tests for evaluating diarrhoea include:

• Acute diarrhoea:
  • Stool examination for white blood cells or enzymes, parasites, and bacteria cultures.
  • Blood tests for electrolyte abnormalities.
• Chronic diarrhoea:
  • Upper gastrointestinal X-rays (UGI series).
  • Oesophagus-gastro-duodenoscopy (EGD) with biopsies.
  • Barium enema and colonoscopy with biopsies.
  • Pancreatic function tests and hydrogen breath testing.

Prevention and Treatment

Prevention

Key measures to prevent diarrhoea include:

• Access to safe drinking water.
• Improved sanitation and hygiene practices.
• Hand washing with soap.
• Rotavirus vaccination.
• Exclusive breastfeeding for the first six months.
• Health education about infection spread.

Treatment

Critical measures for treating diarrhoea include:

• Rehydration: Using oral rehydration salts (ORS), a mixture of clean water, salt, and sugar.
• Zinc supplements: Reduce duration and stool volume by 25% and 30%, respectively.
• Nutrient-rich foods: Break the cycle of malnutrition and diarrhoea by providing a nutritious diet, including breastfeeding during episodes.

Consult a health professional for chronic diarrhoea or symptoms such as blood in the stool or dehydration.

Conclusion

Diarrhoea is a symptom of the response of the large and small intestines to various factors. It remains a significant cause of morbidity and mortality, especially in children in tropical regions. Developing effective methods to maintain hydration at home through oral rehydration can save thousands of lives. The interaction of microbial and other factors with the intestinal epithelium also contributes to our understanding of gastrointestinal physiology.

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Key Phrase

Diarrhoea causes, symptoms, prevention, and treatment.

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