Diarrhea: causes, diagnosis, therapy

Diarrhea is a stool that occurs more than three times a day in adults, is increased in amount, and/or is thin. From acute to chronic. It affects many people and is often linked to an unstable microbiome.

What is diarrhea anyway?

Diarrhea is determined by the frequency and nature of the stool. Normally both are different from person to person. While one is constantly struggling with constipation or is happy to have a bowel movement every two days, another goes to the toilet every day for this purpose. Babies are particularly susceptible to variation: having a bowel movement five times a day to once every five days doing big business is quite normal. Although many affected people are convinced that they have diarrhea, a thin or mushy stool alone does not meet the criteria for it. The prerequisite is that stools of reduced consistency are emptied several times a day – at least three times. Most of the time, the stool volume and weight are increased. diarrhea Everyone knows thin stools. If vomiting occurs and you are generally not doing so well, the cause is often a gastrointestinal “flu” or a gastrointestinal infection. As miserable as it makes you feel, you are usually back on your feet again: a day or two of light food, plus plenty of drink, and the whole thing is over. But things can also turn out differently. In the case of severe diarrhea, the body loses large amounts of water, salts, and digestive juices through the intestines, if not counteracted. Without treatment, there is a risk of dehydration. This can happen quickly and become threatening, especially with the elderly and children.

As a rule of thumb: where in the intestine could the cause be?

Depending on how the chair is made, it is possible to roughly estimate where the source of the evil could be. Very watery and voluminous, possibly frothy stools, possibly containing still undigested food residues, suggest the small intestine. If stool repeats itself in small amounts, possibly with blood or mucus deposits and increased urge to defecate, the problem may be in the colon or rectum.

How does diarrhea occur?

Two mechanisms are essentially responsible: – Either the intestine releases more water and salts, possibly also mucus and blood, as a result of inflammation. The associated diarrhea, called secretory, does not stop with fasting. This happens, for example, when viruses or bacteria are involved. – Or substances remain in the intestine, such as starch and fat from food, which bind fluids and lead to osmotic diarrhea. Osmosis means that there is a thinning effect in the intestine. This type of diarrhea stops after fasting. The trigger here can be, for example, a disorder in the absorption of carbohydrates such as fructose or lactose (see again the chapter “Diarrhea: chronic causes (1)”).

Diarrhea: Acute or Chronic?

In the case of diarrhea, doctors differentiate between acute (up to two weeks duration), persistent (two to four weeks duration) and chronic diarrhea (duration of more than four weeks). The sudden onset of acute diarrhea, which usually lasts only a few days, is almost always due to an infection with pathogens, most often viruses or bacteria. A typical example is traveler’s diarrhea. In uncomplicated cases, medical examinations are generally unnecessary.

What is Food Poisoning?

In the case of persistent or chronic diarrhea, various, sometimes serious diseases are possible causes. Of course, a chronic diarrhea illness also starts more or less acutely at some point. However, the symptoms are usually present for more than two to four weeks, repeatedly or in attacks. In between, they can subside again. A chronic inflammatory bowel disease such as ulcerative colitis, for example, can initially mimic an acute intestinal infection. In other cases, the intestinal complaints are a matter of diet and improve when, for example, bread and rolls, cookies and muesli, pasta, pizza and beer disappear from the menu. It can be assumed that, for example, celiac disease (gluten intolerance) or wheat intolerance (more precisely: non-celiac disease-non-wheat allergy-wheat intolerance, also ATI sensitivity) is behind it. But of course these assumptions need clarification.

When to see your Practitioner

Diarrhea that is acute, persistent, or chronic (see previous section) is more than just an annoying irregularity. Specifically: If diarrhea lasts longer than three days or is very pronounced, please consult a doctor. If you have a baby, a toddler or an elderly person, call the pediatrician or doctor earlier. In the event of a fever, severe abdominal pain and vomiting, immediate or emergency medical care is required. The same applies if the stool is very bloody and of course if poisoning is suspected. In addition to questions from the doctor about the medical history (anamnesis) and the physical examination, targeted examinations are sometimes called for: stool and blood tests, a colonoscopy, other technical diagnostic procedures (see chapter “Diarrhea: Diagnosis”). standing on scales

Diarrhea “plus …”: side effects, consequential problems

If the stools are massive, mushy, shiny and difficult to wash away, this is not quite the same as diarrhea. But it is by no means normal. Rather, it can be so-called fatty stools. This happens when fat digestion is disturbed and fat excretion in the stool is increased. By definition, this is the case when more than seven grams of fat are excreted daily. Doctors then speak of steatorrhea. It is not surprising that fatty stools as well as chronic, watery diarrhea can cause subsequent problems in the long term. Depending on the underlying disease, it can happen that in addition to fats, other nutrients – carbohydrates, protein, minerals, vitamins and trace elements – are insufficiently absorbed. Doctors then speak of malassimilation syndrome. A variety of complaints and disorders are possible. Growth problems in children, weight loss, fatigue, swelling, muscle weakness, paresthesia and anemia are just a few of them. Possible causes are, for example, inflammation of the pancreas, intestinal diseases such as Cohn’s disease, which also leads to the loss of bile acids, lactose intolerance or celiac disease with gluten intolerance (see chapter “Diarrhea: chronic causes (1)”). Acute, violent (vomiting) diarrhea can lead to dehydration due to the loss of fluid, especially if you have a fever. This increases the risk of circulatory disorders, thromboses and embolisms (blood clots that get into a pulmonary artery and block it, for example), kidney failure, and shock. Diarrhea can alternate with constipation. The doctor will always follow up such complaints carefully, for example, to rule out a chronic intestinal infection, such as amoeba, irritable bowel syndrome or a tumor of the intestine. In the case of irritable bowel syndrome, the bowel is generally peaceful at night, so no diarrhea at night occurs. After infectious diarrhea caused by germs such as Campylobacter, Salmonella, Shigella, or Yersinia, rheumatic-like joint inflammation can develop. Typhoid is an example of an infection that affects numerous organs. As such, it is a common infection that can become life-threatening if not properly treated. The pathogen is typhoid salmonella. A typical symptom of the intestine is the “pea-like” diarrhea. The disease is mainly acquired while traveling abroad (without vaccination protection), currently most common in India. Another problem with diarrhea: it can interfere with the absorption of the medication from the intestine. Conclusion: All of this is reason enough to see a doctor in good time

Diarrhea: what does the doctor do?

In addition to the doctor’s questions about possible sources of infection (food, diarrheal diseases in family members, in the personal environment, at work), and the medical history (anamnesis) as well as the physical examination, targeted examinations are sometimes called for: stool and blood tests, examinations of leftovers, a Ultrasound examination (sonography) of the abdomen, if necessary also a colonoscopy and other technical diagnostic procedures (see chapter “Diarrhea: Diagnosis”).

Diarrhea: the main causes at a glance

Causes of Acute Diarrhea (1):

  • Acute intestinal infections including travelers’ diarrhea
  • Food poisoning
  • Mushroom poisoning
  • Chemical poisoning

Causes of Acute Diarrhea (2):

  • Fear, stress
  • Caffeine, teine
  • Medicines (e.g. laxatives, all antibiotics, other medicines)
  • Vascular obstruction of the intestine
  • Radiation treatment (acute radiation colitis)

Causes of Chronic Diarrhea (1) *:

  • Chronic pancreatitis
  • Pancreatic cancer
  • Cystic fibrosis
  • Milk sugar intolerance (lactose intolerance)
  • Intolerance to fructose or sorbitol
  • Celiac disease (gluten intolerance, gluten-sensitive enteropathy)
  • Wheat allergies and wheat intolerance (also ATI intolerance; ATI = amylase trypsin inhibitors (see chapter “Chronic diarrhea (1)”)
  • Food allergy and intolerance (pseudo-allergy)
  • Chronic inflammatory bowel disease, including Crohn’s disease (Crohn’s disease), ulcerative colitis and what is known as microscopic colitis
  • Bile congestion (cholestasis), possibly with jaundice
  • Amyloidosis
  • Scleroderma (systemic)
  • Persistent and chronic intestinal infections including, for example, HIV infection / AIDS, Whipple’s disease, sexually transmitted rectal inflammation, worm diseases (e.g. tapeworm infestation, rarely).

Causes of Chronic Diarrhea (2) *:

  • Irritable bowel syndrome
  • Inflamed bowel diverticula (diverticulitis)
  • Chronic alcohol abuse
  • Circulatory problems in the intestine (ischemic colitis)
  • Tumors and polyps
  • Diarrhea after gastrointestinal surgery
  • Radiation treatment (chronic radiation colitis)
  • Hormonally active tumors
  • Overactive thyroid
  • Adrenal hypofunction
  • Type 1 diabetes mellitus, type 2 diabetes mellitus
  • Medicines (see chapter “Diarrhea: acute causes (2)”)

* A food utilization disorder (malassimilation syndrome), possibly with fatty stools (steatorrhea), is possible with many of the diseases and circumstances mentioned here. The list does not claim to be complete. Further chapters in this article provide more information about the causes listed here as well as about diagnosis and therapy for diarrhea. Important: This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.

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