Diarrhoea is when you have frequent loose watery bowel motions. In most cases, the symptoms resolve on their own within a couple of days without the need for medical treatment.

Diarrhoea that lasts one or two days and goes away on its own is known as acute diarrhoea, which is a common condition that affects people of all ages. Diarrhoea lasting four weeks or more (whether continuous or intermittent) is known as chronic diarrhoea and can be a symptom of an underlying chronic disease or condition.

Causes

Acute (or brief) diarrhoea is usually caused by a bacterial (eg, salmonella), viral (eg,norovirusorrotavirus), or parasitic (eg, giardia)infection of the bowels. Diarrhoea caused by any of these infections is referred to asgastroenteritis.

Travel to places where the climate or sanitary practices differ form one's home country may cause short-term gastroenteritis (eg from contaminated food or water) and is known as traveller's diarrhoea. Diarrhoeaassociated withjet lagwill usually subside in a matter of days without treatment

The most common causes of chronic diarrhoea are underlying diseases or conditions, including:

Gluten intolerance (e.g.coeliac disease)

Lactose intolerance(inability to properly digest lactose in dairy products)

Irritable bowel syndrome

Chronic bowel infection

Inflammatory bowel diseases, such asCrohn’s diseaseandulcerative colitis

Bowel cancer.

You should see your doctor if you are concerned that you might have any of these conditions.

Chronic diarrhoea can also occur when taking certain medications, e.g. some antibiotics and cancer drugs.

Signs and symptoms

The main symptom of diarrhoea is loose, watery bowel motions (stools, faeces) three or more times a day.

Accompanying signs and symptoms may include:

Urgent need to go to the toilet

Abdominal pain and cramping

Change in colour of your stools

Mucous, pus, blood, or fat in your stools

Vomiting

General body weakness and tiredness.

Diagnosis

Diarrhoea is easily diagnosed by its symptoms.

If the diarrhoea lasts longer than two or three days, or is accompanied by symptoms such as fever or bloody stools, your doctor may perform diagnostic tests to determine the cause.

These diagnostic tests could include:

Stool culture to test for infection

Blood tests to rule out other diseases

Fasting tests to reveal food intolerances

Sigmoidoscopy or colonoscopy to look for signs of inflammatory bowel diseases (these tests involve using a device with thin flexible tube and a camera and light at one end to look inside the bowel).

You should see a doctor if you or your baby / child develop any of the following signs:

Blood, pus, or mucous in stools

Arash

Diarrhoea lasting longer than one week or gets better and comes back

New or worse symptoms.

Chronic or severe diarrhoea can lead to rapiddehydration, which is the excessive loss of fluids from the body. Dehydration is particularly dangerous in infants and children, the elderly, and people with weakened immune systems (e.g. people with HIV/AIDS or undergoing chemotherapy).

A doctor should also be seen if you, or a family member, becomes dehydrated. The signs and symptoms of dehydration include:

Extreme thirst

Little or no urine passed in the last eight hours

Urine is dark in colour and smelly

Reduced saliva in the mouth, dry lips, no tears, sunken cheeks or eyes

Infants may have dry nappies (for longer than 4-6 hours) and/or have a sunken fontanelle (the soft spot on top of a baby’s head)

Dizziness, lethargy, floppiness

Rapid heart rate and breathing

Cold hands and feet

Skin that does not relax after being pinched.

Treatment

Because most cases of diarrhoea resolve on their own within a day or two, self-care to relieve symptoms is usually sufficient for treatment:

Avoid caffeine, dairy products, and greasy, high fibre, or sugary foods

Placing a hot water bottle or wheat pack on your stomach, or taking paracetamol (e.g. Panadol), may provide some relief from abdominal cramps

Apply zinc and castor oil ointment or a barrier cream to affected areas if you, or your child, develops a rash (like nappy rash) from the diarrhoea

Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or diclofenac, for pain relief as these medications can cause diarrhoea

Anti-diarrhoeal medications that slow diarrhoea (e.g. Imodium) should be avoided as these drugs prevent your body from getting rid of the bacteria or virus that may have caused the diarrhea.

To avoid dehydration, drink plenty of liquid every day, taking small, frequent sips. Ideal liquids are clear thin broths or soups, diluted non-caffeinated sports drinks (e.g. Powerade or Gatorade), and rehydration formulations (e.g. Gastrolyte) that are available without prescription from a pharmacy.

Prevention

Hand washing is one of the most effective ways of preventing the spread of viruses and bacteria that can cause diarrhoea. You should always wash your hands thoroughly after using the toilet, changing nappies, and before meals.

The following rules when preparing food can also help prevent diarrhoea:

Always put foods that could spoil in the fridge

Ensure that meat is cooked thoroughly

Avoid eating raw meats, fish, and shellfish unless you are sure that they have been freshly prepared and are from a reliable source

Never place cooked meat on surfaces or plates that have held raw meat

Disinfect bench tops, stove tops, and chopping boards with a diluted bleach solution.

A vaccine for rotavirus is available free for babies in New Zealand. The oral vaccine - Rotarix - is given in two doses at the six-week and three-month immunisation visits to reduce the incidence or severity of rotavirus infection. Rotavirusis acommon cause of diarrhoea in infants and young children.