Diarrhea: What You Need to Know Right Now

Definition

Diarrhea is loose and watery stool that happens more than three times per day. Diarrhea is common — most adults will experience it at least once a year, and children at least twice a year. 

Diarrhea has many causes, including bad food, infection, and medication side effects. It can also be related to another medical condition. Diarrhea is often short lived and resolves on its own within a few days. Other times, it’s related to a chronic (long-term) medical issue or becomes a chronic issue itself. Here’s a general breakdown of diarrhea categories by time:

• Acute diarrhea lasts several days (and not more than 2 weeks). It usually gets better on its own. Often the cause is a virus or something you ate or drank.

• Chronic diarrhea lasts more than 4 weeks. Causes include another health condition or medications you take. 

It’s important to see your healthcare provider when diarrhea is ongoing or associated with other symptoms, like dehydration, weight loss, or pain. 

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Symptoms

Everyone gets loose stools every now and then. When it’s brief and gets better, it’s likely nothing to worry about. Diarrhea can cause a range of symptoms — including loose, frequent, and watery stool. It can also cause abdominal pain, bloating, or nausea and vomiting. 

While most cases of diarrhea get better on their own, there are some warning signs to look out for. It’s very important to see a healthcare provider if you have any of the following:

• Diarrhea that doesn’t improve after 2 days

• Severe abdominal pain

• High fevers (102°F or above)

• Blood or pus in your stool

• Ongoing vomiting 

• Black, tarry stools (which can be from bleeding in the gastrointestinal tract)

• Dehydration and inability to drink fluids

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Infectious causes

Infections with bacteria, viruses, or parasites can all cause diarrhea. The most common ways to catch these infections are from contact with other people, unsanitary conditions, or contaminated water or food. Here are some common causes of infectious diarrhea:

• Viruses, such as norovirus and rotavirus (viral gastroenteritis)

• Bacteria, including Campylobacter, Escherichia coli, Salmonella, and Shigella

• Parasites, such as Giardia lamblia, Entamoeba histolytica, and Cryptosporidium enteritis

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Other causes

Medical conditions associated with diarrhea

There are many medical conditions that can cause diarrhea. These include: 

• Irritable bowel syndrome (IBS)

• Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis

• Food allergies 

• Food intolerance, such as celiac disease or lactose intolerance

• Gallbladder disease 

• Malabsorption or digestive enzyme deficiencies  

• Thyroid disorders

• Colon cancer

Medications that can cause diarrhea

Many medications may cause diarrhea, too. Common medications that can cause diarrhea as a side effect include: 

• Antibiotics: including penicillins, like amoxicillin, cephalosporins, like cephalexin and clindamycin 

• Laxatives: including senna

• Acid-blocking medications: such as proton pump inhibitors, like pantoprazole (Protonix)

• Diabetes medications: including metformin

• Antidepressants: including SSRIs, like sertraline (Zoloft) and escitalopram (Lexapro)

• Blood pressure medication: such as beta blockers, like metoprolol, and ACE inhibitors, like lisinopril

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Diagnosis

If you have ongoing diarrhea, you’ll need to see your healthcare provider to get to the bottom of the cause. They’ll first ask you questions about your symptoms and then consider additional testing.

Diarrhea can have different characteristics that help identify the underlying cause. It can be helpful to bring your healthcare provider a symptom journal that includes:

• Timing: How long have you had the diarrhea?

• Color: Is your diarrhea watery, green, yellow, bloody, or black?

• Other symptoms: Do you have any abdominal pain, fevers, weight loss, or vomiting with the diarrea?

• Consistency: Is the diarrhea very loose and watery, or is it more pebbly and formed? The Bristol Stool Scale can help describe this.

• Triggers: What other factors might contribute, such as food, medications, or stress levels? 

Your provider may order additional testing to help figure out what is causing your diarrhea, such as:

• Blood tests: to check for a thyroid disorder, anemia, or other vitamin or nutrient deficiencies

• Stool tests: to look for bacterial or parasitic causes of diarrhea

• Breath test: to look for lactose intolerance

• Imaging studies: such as an X-ray, CT scan, or MRI to evaluate organs 

• Sigmoidoscopy or colonoscopy: to look inside the intestines

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Treatments

Treatment for diarrhea often depends on the cause. Foodborne or other viral causes of diarrhea often resolve on their own within a few days. But there may be some ways to ease your symptoms. 

If your diarrhea doesn’t get better within a few days, you’ll want to talk with your healthcare provider about the cause and what treatment might be right for you. 

Treatments for diarrhea include:

• Taking antibiotics for bacterial infections

• Taking antiparasitic medication for parasitic infections

• Making diet changes to avoid fatty, fried, or fibrous foods (you can try a simple and bland BRAT diet for a short time)

• Avoiding food triggers, such as with an elimination diet 

• Taking over-the-counter treatments may help control your diarrhea, such as loperamide (Imodium), to slow down movement through the intestines

• Getting intravenous (IV) fluids if you’re dehydrated and can’t drink enough liquids

• Taking probiotics (healthy gut bacteria) for some types of diarrhea (these can help restore a healthy balance of gut microbes)

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Prevention

Since many causes of diarrhea are common viruses and bacteria, you can often prevent them with some basic healthy habits, like: 

• Washing your hands regularly

• Cooking and cleaning your food

• Drinking pasteurized milk and cheese

• Not eating foods that have been sitting out

• Not drinking tap water when traveling

• Not eating raw meat or fish

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