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Diarrhea occurs when there is an increase in the number of bowel movements or bowel movements are more watery and loose than normal. When the intestines push stools through the bowel before the water in the stool can be reabsorbed, diarrhea occurs. It can also occur when inflammation of the bowel lining causes excess fluid to leak into the stool. Abdominal cramps, nausea, vomiting, or a fever may occur along with the diarrhea.
Diarrhea is one of the most commonly occurring health problems affecting all ages. Most adults will have 4 episodes of diarrhea each year. Diarrhea that comes on suddenly may last up to 14 days.
Diarrhea has many causes.
- Diarrhea is often caused by stomach flu (gastroenteritis) or food poisoning. Diarrhea is your body's way of quickly clearing viruses, bacteria, or toxins from the digestive tract. Since most cases of diarrhea are viral, they will clear up in a few days with good home treatment. E. coli is a common bacteria that causes diarrhea. E. coli infection is related to improper food preparation.
- Drinking untreated water or unpasteurized dairy products can cause viral, bacterial, or parasitic infections, such as Giardia lamblia. Giardia lamblia parasite can cause diarrhea that develops 1 to 4 weeks later. These infections can also occur when you use untreated water to brush your teeth, wash your dishes or vegetables, or make ice for drinks.
- Diarrhea can also occur from infections passed on by animals.
- Many prescription and nonprescription medicines can cause diarrhea.
- Antibiotics may cause mild diarrhea that usually clears up without treatment. A more serious type of diarrhea caused by the bacteria Clostridium difficile (sometimes called C-diff) may occur while taking an antibiotic or shortly after finishing the antibiotic.
- Laxatives, such as Correctol, Dulcolax, Ex-Lax, or bisacodyl, may cause diarrhea.
- Using too much of products that contain sorbitol (such as chewing gum) or fructose can cause diarrhea.
- Some people get infections that cause diarrhea while they are traveling (traveler's diarrhea).
- For some people, emotional stress, irritable bowel syndrome, anxiety, or food digestion problems (such as lactose intolerance) cause diarrhea.
- Repeated episodes of diarrhea may be caused by inflammatory bowel disease.
- Diarrhea may also be caused by malabsorption problems and certain types of cancer.
- Diarrhea may develop after stomach, bowel, or gallbladder surgery, or after bariatric surgery for obesity.
Many times the exact cause of diarrhea is hard to determine. Almost everyone has an occasional bout of diarrhea. Although diarrhea is annoying, most cases are not serious and will clear up with home treatment.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
If you're not sure if a fever is high, moderate, or mild, think about these issues:
With a high fever:
- You feel very hot.
- It is likely one of the highest fevers you've ever had. High fevers are not that common, especially in adults.
With a moderate fever:
- You feel warm or hot.
- You know you have a fever.
With a mild fever:
- You may feel a little warm.
- You think you might have a fever, but you're not sure.
Temperature varies a little depending on how you measure it. For adults and children age 12 and older, these are the ranges for high, moderate, and mild, according to how you took the temperature.
Oral (by mouth) temperature
- High: 104°F (40°C) and higher
- Moderate: 100.4°F (38°C) to 103.9°F (39.9°C)
- Mild: 100.3°F (37.9°C) and lower
A forehead (temporal) scanner is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.
- High: 105°F (40.6°C) and higher
- Moderate: 101.4°F (38.6°C) to 104.9°F (40.5°C)
- Mild: 101.3°F (38.5°C) and lower
Armpit (axillary) temperature
- High: 103°F (39.5°C) and higher
- Moderate: 99.4°F (37.4°C) to 102.9°F (39.4°C)
- Mild: 99.3°F (37.3°C) and lower
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it's hard for you to function).
- Shaking chills.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
- Severe diarrhea means having more than 10 loose, watery stools in a single day (24 hours).
- Moderate diarrhea means having more than a few but not more than 10 diarrhea stools in a day.
- Mild diarrhea means having a few diarrhea stools in a day.
You can get dehydrated when you lose a lot of fluids because of problems like vomiting or fever.
Symptoms of dehydration can range from mild to severe. For example:
- You may feel tired and edgy (mild dehydration), or you may feel weak, not alert, and not able to think clearly (severe dehydration).
- You may pass less urine than usual (mild dehydration), or you may not be passing urine at all (severe dehydration).
Severe dehydration means:
- Your mouth and eyes may be extremely dry.
- You may pass little or no urine for 12 or more hours.
- You may not feel alert or be able to think clearly.
- You may be too weak or dizzy to stand.
- You may pass out.
Moderate dehydration means:
- You may be a lot more thirsty than usual.
- Your mouth and eyes may be drier than usual.
- You may pass little or no urine for 8 or more hours.
- You may feel dizzy when you stand or sit up.
Mild dehydration means:
- You may be more thirsty than usual.
- You may pass less urine than usual.
Many prescription and nonprescription medicines can cause diarrhea. A few examples are:
- Proton pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid).
- Medicines used to treat cancer (chemotherapy).
It is easy for your diabetes to become out of control when you are sick. Because of an illness:
- Your blood sugar may be too high or too low.
- You may not be able take your diabetes medicine (if you are vomiting or having trouble keeping food or fluids down).
- You may not know how to adjust the timing or dose of your diabetes medicine.
- You may not be eating enough or drinking enough fluids.
An illness plan for people with diabetes usually covers things like:
- How often to test blood sugar and what the target range is.
- Whether and how to adjust the dose and timing of insulin or other diabetes medicines.
- What to do if you have trouble keeping food or fluids down.
- When to call your doctor.
The plan is designed to help keep your diabetes in control even though you are sick. When you have diabetes, even a minor illness can cause problems.
Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.
A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.
Certain medicines and foods can affect the color of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food coloring can turn the stool black.
If you take aspirin or some other medicine (called a blood thinner) that prevents blood clots, it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Home treatment can help you treat your diarrhea and avoid other related problems, such as dehydration.
- Take frequent, small sips of water or a rehydration drink and small bites of salty crackers.
- Try to increase your fluid intake to at least 1 qt (1 L) per hour for 1 to 2 hours, or longer if you keep having large amounts of diarrhea. Note: If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
- Begin eating mild foods the next day or sooner, depending on how you feel.
- Avoid spicy foods, fruits, alcohol, and caffeine until 48 hours after all symptoms have disappeared.
- Avoid chewing gum that contains sorbitol.
- Avoid milk for 3 days after symptoms disappear. You can eat cheese or yogurt with probiotics.
Nonprescription medicines for diarrhea
If you are pregnant, talk with your doctor before taking any medicines for diarrhea.
Nonprescription medicines may be helpful in treating your diarrhea. Follow these tips when taking a nonprescription medicine for diarrhea:
- Use nonprescription antidiarrheal medicine if you have diarrhea for longer than 6 hours. Do not use nonprescription antidiarrheal medicines if you have bloody diarrhea, a high fever, or other signs of serious illness.
- Read and follow all label directions on the nonprescription medicine bottle or box. Be sure to take the recommended dose.
- Long-term use of nonprescription antidiarrheal medicine is not recommended. To avoid constipation, stop taking antidiarrheal medicines as soon as stools thicken.
- If your child or teen gets chickenpox or flu, do not treat the symptoms with over-the-counter medicines that contain bismuth subsalicylate (such as Pepto-Bismol and Kaopectate). Subsalicylate has been linked to Reye syndrome, a rare but serious illness. If your child has taken this kind of medicine and he or she has changes in behavior with nausea and vomiting, call your doctor. These symptoms could be an early sign of Reye syndrome.
There are several types of antidiarrheal medicines: those that absorb water and thicken the stool, and those that slow intestinal spasms.
- Thickening mixtures (such as psyllium) absorb water. This helps bulk up the stool and make it more firm.
- Antispasmodic antidiarrheals, such as Imodium A-D and Pepto Diarrhea Control, slow intestinal spasms. Some products contain both thickening and antispasmodic ingredients.
- Probiotics, such as Lactobacillus, are available in either pills or powder. This bacteria occurs naturally in the intestine and may help with digestion. When diarrhea is present, the number of these bacteria is reduced.
Learn how to clean up diarrhea safely. Protect your hands with gloves while cleaning up. Wash your hands after you are done cleaning up.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
Food poisoning is a common cause of diarrhea in children and adults. Most cases of food poisoning may be prevented by taking a few precautions when preparing and storing food at home. Perishable foods, such as eggs, meats, poultry, fish, shellfish, milk, and milk products, should be treated with extra care. Also, precautions should be taken if you are pregnant, have an impaired immune system or a chronic illness, or are preparing foods for other high-risk groups, such as young children or older adults.
The U.S. Department of Agriculture (USDA) recommends the following steps to prevent food poisoning:
- Prepare foods safely.
- Shop safely.
- Cook foods to a safe temperature.
- Store foods safely.
- Follow labels on food packaging.
- Serve foods safely.
- When in doubt, throw it out.
Many counties in the United States have extension services listed in the phone book. These services can answer your question about safe home canning and food preparation.
When you travel in wilderness areas or to other countries of the world, it is common to get traveler's diarrhea from food or water because the methods of food preparation are different.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- How long have you had diarrhea?
- How many times per day are you having diarrhea?
- What does your diarrhea look like? Describe the color, consistency (watery, mushy), and other characteristics (contains blood or mucus).
- When was your last episode of diarrhea?
- Have you recently increased the amount of fiber in your diet (more fresh fruit, vegetables, or other high-fiber foods)?
- What prescription and nonprescription medicines do you take?
- Are you taking any new medicines?
- Did you recently increase the dose of a medicine?
- Have you taken any antibiotics recently?
- Did you recently receive an antibiotic while in the hospital?
- Do you routinely use laxatives or stool softeners?
- Have you been under an unusual amount of stress at home, work, or both?
- Does anyone you live with or work with have diarrhea?
- Did your diarrhea start after eating at a restaurant? Has anyone who ate there with you become ill?
- Did you drink lake or stream water or untreated well water?
- Have you recently visited a foreign country or taken a ship cruise?
- Do you have any risk factors that make you more susceptible to diarrhea, such as irritable bowel syndrome?
- What home treatment measures have you tried? Be sure to include any nonprescription medicines you have taken.
- Do you have other symptoms, such as vomiting, fever, or dehydration?
- Do you have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine