Diarrhoea

Diarrhoea is passing loose or watery faeces more than three times a day. A common cause in both children and adults is gastroenteritis. Bouts of diarrhoea in adults may also be brought on by anxiety or drinking too much coffee or alcohol. Diarrhoea may also be a side effect of a medication. In adults, diarrhoea caused by gastroenteritis will usually clear up in two to four days when the infection has cleared.

The symptoms of travellers’ diarrhoea usually start within two to three days of travelling abroad. Over 90% of cases occur within the first two weeks of a holiday. The symptoms usually get better without medical treatment within three to five days. In around 5-10% of travellers, the diarrhoea can last for two weeks or longer. For 1-3% of travellers, the diarrhoea can last longer than a month.

Persistent Diarrhoea

Diarrhoea in adults that lasts for more than a few weeks may be a sign of a more serious condition, such as Crohn’s disease, or Irritable Bowel Syndrome. It should always be investigated by a GP - especially if a person is seeing blood or pus in their faeces. A person should see their GP if: • They have recently been treated in hospital, or with antibiotics.

• They have diarrhoea that has blood in it, or are bleeding from the rectum. • They have diarrhoea and persistent vomiting. • Experiencing unexplained weight loss. • They have passed large volumes of very watery diarrhoea, as they may be at risk of dehydration. • Their symptoms at night that are disturbing their sleep. • The diarrhoea lasts longer than a week. • A baby has had six or more episodes of diarrhoea in the past 24 hours.

Dehydration

Symptoms of dehydration in children include: • appearing to get more unwell • being irritable or drowsy • passing urine infrequently • pale or mottled skin • cold hands and feet

Symptoms of dehydration in adults include: • lacking energy or feeling tired • loss of appetite

• nausea • sunken eyes • muscle cramps • rapid heartbeat • Nausea

• Vomiting

Treating Dehydration

Oral rehydration therapy may be recommended particularly for at-risk groups, to reduce the risks of dehydration. An oral syringe may be helpful for administering fluids slowly to children. Home-made salt or sugar drinks should be avoided.

Oral rehydration products must be mixed with 200ml of fresh drinking water according to the manufacturer’s instructions. For infants where drinking water is unavailable the water should be freshly boiled and cooled. The solution should be made up immediately before use. If refrigerated, the solution may be stored for up to 24 hours, otherwise any solution remaining an hour after reconstitution should be discarded. The solution must not be boiled after reconstitution.

Daily intake may be based on a volume of 150ml/kg body weight for infants and 20-40 mg/kg body weight for adults and children. A reasonable approximation is: Infants - One to one and a half times the usual feed volume. For infants under 12 months, use only under medical advice. Children - One sachet after every loose motion. Adults including elderly- One or two sachets after every loose motion. More may be required initially to ensure early and full volume repletion. The solution can be given as 5-10ml as every 5 minutes, gradually increased until the child is able to drink normally. It is recommended not to eat in the early stages of diarrhoea. Bottle and other infant feeds should also be stopped initially, however breastfeeding can continue as normal.

Advice on Eating

Expert opinion is divided over when and what a person should eat if they have diarrhoea, but most agree that eating solid food as soon as they feel able to is advisable. They should eat small, light meals and avoid fatty, spicy or heavy foods. If a person feels they cannot eat, it should not do them any harm, but they should make sure that they continue drinking fluids, and eat as soon as they can. If a child is dehydrated, parents should be advised not to give them any solid food until they have drunk enough fluids. Once they have stopped showing signs of dehydration, they can start eating their normal diet. If the child is not dehydrated, they can be offered their normal foods. If a child refuses to eat, parents should continue to offer drinks and wait until their appetite returns.

Antidiarrhoeal Medicine

Antidiarrhoeal medicines may reduce the diarrhoea and shorten how long it lasts by around 24 hours. However, they are not usually necessary unless shortening the duration of a person’s diarrhoea helps them to get back to their essential activities sooner.

Loperamide is the preferred antidiarrhoeal medicine because it causes fewer side effects and there is more evidence of its effectiveness. Loperamide slows down muscle movements in the gut, which leads to more water being absorbed from faeces. The faeces then become firmer and are passed less frequently. Antidiarrhoeal medicines should not be taken by anyone who has blood or mucus in their stools or if they have a high temperature. Children should not be given antidiarrhoeal medicines.

WWho? Anyone

WWhat are the symptoms? Loose stools, cramps

HHow long has the patient had the symptoms? Usually gone after a few

days, if symptoms persist refer to GP

AAction already taken? Patients may be taking pain relief medication

MMedication? Children should not be given antidiarrhoeal medicines.

Oral rehydration therapy may be recommended particularly for at-risk groups, to reduce the risks of dehydration