Diarrhea

Diarrhea

Finding the Cause Is the Cure

Yesterday's picnic was perfect--volleyball, close friends and an awesome feast sparkling in the hot summer sun. The potato salad tasted just like Mom's, down to the mayonnaise and celery seed dressing. No wonder you splurged on seconds.

And no wonder you're sidelined today, shuffling wearily between bathroom and bed, your bowels in an uproar. Your normally well-behaved intestines are a raging river. You call in sick at the office, then heed the gurgling down below and stumble back to the toilet, a prisoner of diarrhea.

The National Institutes of Health in Washington, D.C., estimate that Americans endure 99 million bouts of the runs every year, caused by everything from tainted drinking water to improperly handled food--like the potato salad that sat too long in the sun--to forgetting to wash your hands after changing a dirty diaper.

Add a host of other factors--including travel abroad, stress, lactose intolerance, antibiotics, antacids, caffeine and artificial sweeteners such as Sorbitol--and the number of cases soars well beyond the 100 million mark.

Women and men seem equally disposed to getting diarrhea, defined by doctors as three or more loose bowel movements a day. But researchers note that women are exposed more often to one of the most notorious transmitters of the germs and viruses that cause infectious diarrhea: little kids. One study found that parents of young children in day care were 10 to 25 percent more likely to "catch" the runs from their little ones than parents whose children weren't in day care. And doctors say day care workers face higher risks, too.

"Day care nurseries are a real problem for diarrheal disease," says Ralph Giannella, M.D., professor of medicine and director of the Division of Digestive Diseases at the University of Cincinnati College of Medicine. "You have small children who are not yet toilet-trained. They can pass bacteria or viruses to other kids and to day care workers, who are usually women. Then at home, it's usually mothers who take care of the children, changing the diapers."

Nurses and aides in nursing homes are in the same boat. "These people are usually women, and they're dealing with patients who cannot take care of their own bowels," Dr. Giannella says.

The best defense?

"Wash your hands," says Randall Reves, M.D., associate professor of medicine in the Division of Infectious Diseases at the University of Colorado Health Science Center in Denver. "The ability to get your hands thoroughly clean is the most effective way to prevent the spread of infectious diarrhea--to yourself or anybody else."

Coping When You're Out of Commission

A typical run-in with the runs lasts just two to three days and doesn't merit a trip to the doctor's office. Chances are it's a viral or bacterial infection, and the volumes of watery stool you're seeing are the result of toxins given off by the bug invading your bowels. The toxins stick to the walls of the intestine, making cells there secrete massive amounts of fluid.

While you're lying low, doctors suggest the following tips to help your body weather the thunderstorm in your gut.

Drink up. Restoring lost fluids is vital for avoiding dehydration, which can lead to weakness and dizziness. Drink plenty of water or juice, but avoid coffee, tea, colas and other caffeinated drinks. Caffeine is a diuretic and will actually pull water out of your system.

"You have to replace the fluid you're losing," says Sidney F. Phillips, M.D., professor of medicine and director of gastroenterology research at the Mayo Clinic's Gastroenterology Unit in Rochester, Minnesota. "If the problem is a prolonged one, say in the two- to three-day range, or if the infectious process produces nausea or vomiting, then fluids that contain some salt and sugar, like Gatorade, are a good idea. They help replace electrolytes."

Or consider a commercial oral rehydration solution (ORS), available as a powder to mix with water or as a ready-to-use drink. These solutions are tailor-made to replace sugar, salts and other nutrients flushed from the system during diarrhea.

"An ORS will keep you feeling better and may even help you avoid hospitalization for dehydration," says Dr. Giannella. "If the diarrhea lasts more than a day and you can't eat any regular food, I would definitely use it. Adults resist trying this, because they think only children or old people or those living in poor countries need them. But we can all benefit."

Eat, but lightly. High-fiber foods, grease and five-alarm spices will only make matters worse in your sensitive gut. Stick with easily digestible fare like white rice, dry toast, applesauce and clear soups or broths.

"The intestine will get a little boost in its function if there are some carbohydrates or simple starches," says Dr. Phillips. "Rice starch is usually thought to be one of the most digestible. And the dry toast; it's just like the dry crackers our grandmothers told us to eat when we were sick."

Skip dairy products. Your diarrhea might be the result of the sudden onset of lactose intolerance--when your stomach lacks the enzyme that digests milk sugar. If that's the case, unabsorbed liquid will back up in your intestines. Avoiding most dairy products--milk, ice cream and most cheeses--could turn the tide, says Dr. Giannella. But follow this advice even if you know you don't have this condition, because your body becomes somewhat lactose-intolerant when you've got diarrhea.

Go easy on medicines. If you must haul yourself out of bed for an important business meeting or a social event, or if your diarrhea is intolerable, try an over-the-counter drug like Imodium or Pepto-Bismol. In a milder attack, though, try to avoid taking medicine.

"The purist's point of view is, don't take any anti-diarrheal drugs. Let everything be flushed out of your intestines. Don't slow it down," says Dr. Phillips. "But the more practical approach is, we should try to give people some relief of symptoms. One of the simple anti-diarrheals like Imodium is effective. It probably even helps the intestine reabsorb into the bloodstream some of the excess fluid in the gut."

Watch those antibiotics. Antibiotics can upset the natural balance of bacteria in your intestines and give you the runs. If you suspect that's the cause, call your doctor immediately. "The earlier you can stop the antibiotics, the better, because the diarrhea will be less severe," says Dr. Giannella. He cautions patients not to stop any antibiotic treatment without their doctor's approval, however. "If you cannot stop the antibiotics, though, there's a specific treatment that will be prescribed using another antibiotic and an antimicrobial drug that's very effective. But catching it early is important. Some people end up with recurring bouts of this kind of diarrhea otherwise."

Dine on yogurt. Yogurt that contains live cultures of lactobacillus bacteria could recolonize your intestines with "good" bacteria, says Dr. Giannella. "There's some small data that suggest it might be beneficial," he says. "At the very least, yogurt is an excellent foodstuff that's nutritious and well-tolerated by people with diarrheal disease. And the lactose in it has already been broken down, so it won't be a problem."

See the doctor. Diarrhea that lasts three days or more needs a doctor's evaluation, says Nicholas Banatvala, M.D., a medical epidemiologist in the Foodborne and Diarrheal Disease Division of the Centers for Disease Control and Prevention (CDC) in Atlanta.

"Children, the elderly and anyone with a compromised immune system should also see a doctor as soon as diarrhea begins. Infectious diarrhea is often much more serious for them," he says. "Also, diarrhea which lasts more than three days, a high fever, bloody diarrhea or severe abdominal pain are all reasons to consult your physician immediately." All are signs, he says, that your diarrhea may be a more serious infection.

Reaching for Safe Foods

Do you like rare meat? Caesar salad? Chocolate mousse? You could be a candidate for food poisoning--and with it comes diarrhea.

Bacterial infections in food, most often caused by undercooked or mishandled products, account for between 6 and 81 million cases of food poisoning every year in the United States, as well as 9,000 deaths, according to the CDC. In most cases, diarrhea is one of the first symptoms to appear, as it was in the summer of 1993, when hundreds of people in the Pacific Northwest got sick after eating fast-food hamburgers tainted with bacteria. Eventually, four died.

"Food poisoning is widespread, and the sad thing is, it's so preventable," says Morris Potter, D.V.M., assistant director for foodborne diseases in the Division of Bacterial and Mycotic Diseases at the CDC. "For instance, if a hamburger is pink in the middle, or if the juice from it is red or pink, you should take it back and ask for one that's cooked through. It's important."

Eating out? Dr. Potter suggests avoiding dishes made with raw eggs, such as Caesar salad or chocolate mousse (unless they were made with pasteurized eggs), as well as raw foods like sushi, oysters and steak tartare.

Eating in? When you cook, proper food handling can make all the difference. Follow these guidelines.

Refrigerate promptly. Don't leave cooked foods out to cool before refrigerating. It invites bacterial growth. At a picnic or potluck meal, make sure protein foods--including those made with mayonnaise, which contains eggs--are not left unrefrigerated for more than two hours, advises Dr. Potter.

Cook thoroughly. Be careful not to underccok meats, says Dr. Potter. Beef, pork and lamb should be done in the middle. Joints of poultry should not be red. Fish should be flaky.

Reheat completely. "Bring foods to a boil on the stove, leave them in the oven for half an hour at 300° or so, and if you microwave your foods to reheat them, cover the bowl and let them sit afterward for several minutes to heat up any cool spots," Dr. Potter says.