2. Diarrhea is the passing of three or more loose or watery stools per day,
or a definite decrease in consistency and increase in frequency of
bowel movements based upon what is usual for the individual.
What is Diarrhea?
Bowel movements, also called stools, are body wastes passed through
the rectum and anus. Stools contain what is left after your digestive
system absorbs nutrients and fluids from what you eat and drink. If
your body does not absorb the fluids, or if your digestive system
produces extra fluids, stools will be loose and watery. Loose stools
contain more water, salts, and minerals and weigh more than solid
stools.
https://www.healthinaging.org/tools-and-tips/caregiver-guide-diarrhea
https://www.niddk.nih.gov/-/media/Files/Digestive-
Diseases/wintkadiarrhea_508.pdf&ved=2ahUKEwjx5uDO_YX6AhVDe94KHXD5AvQQFnoECAYQBg&usg=AOvVaw3ro-nYTPPzhAoPg2SlDC_T
wjx5uDO_YX6AhVDe94KHXD5AvQQFnoECAYQBg&usg=AOvVaw3ro-nYTPPzhAoPg2SlDC_T
3.
4. How does Diarrhea works?
Diarrhea occurs when the contents in your digestive system move so quickly
through the digestive system that the intestines don’t have enough time to
absorb the fluids, or when the digestive system produces extra fluid. The
result is stools that contain excess fluids, making them loose and watery.
https://www.medbroadcast.com/channel/digestive-health/diarrhea/why-people-get-
diarrhea#:~:text=Diarrhea%20occurs%20when%20the%20contents,making%20them%20loose%20and%20watery.
5. Viruses. Viruses that can cause diarrhea include Norwalk virus (also
known as norovirus), enteric adenoviruses, astrovirus, cytomegalovirus
and viral hepatitis. Rotavirus is a common cause of acute childhood
diarrhea. The virus that causes coronavirus disease 2019 (COVID-19) has
also been associated with gastrointestinal symptoms, including nausea,
vomiting and diarrhea.
What are the causes of Diarrhea?
Bacteria and parasites. Exposure to pathogenic bacteria, such as E.
coli or parasites through contaminated food or water, leads to
diarrhea. When traveling in developing countries, diarrhea caused by
bacteria and parasites is often called traveler's diarrhea.
Clostridioides difficile (also known as C. diff) is another type of
bacterium that causes diarrhea, and it can occur after a course of
antibiotics or during a hospitalization.
6. Medications. Many medications, such as antibiotics, can cause
diarrhea. Antibiotics alleviate infections by killing bad bacteria, but
they also kill good bacteria. This disturbs the natural balance of
bacteria in your intestines, leading to diarrhea or a superimposed
infection such as C. diff. Other drugs that cause diarrhea are anti-
cancer drugs and antacids with magnesium.
Lactose intolerance. Lactose is a sugar found in milk and other dairy
products. People who have difficulty digesting lactose have diarrhea
after eating dairy products. Lactose intolerance can increase with age
because levels of the enzyme that helps digest lactose drop as you get
older.
Fructose. Fructose is a sugar found naturally in fruits and honey. It’s
sometimes added as a sweetener to certain beverages. Fructose can
lead to diarrhea in people who have trouble digesting it.
7. Surgery. Partial intestine or gallbladder removal surgeries can
sometimes cause diarrhea.
Other digestive disorders. Chronic diarrhea has a number of other
causes, such as IBS, Crohn's disease, ulcerative colitis, celiac disease,
microscopic colitis and small intestinal bacterial overgrowth (SIBO).
Traveler's Diarrhea. This type of diarrhea is caused by eating food or
drinking water contaminated with bacteria, viruses, or parasites while
traveling abroad, usually in a developing country. Traveler's diarrhea is
usually acute, but certain parasites cause diarrhea to last longer.
https://www.mayoclinic.org/diseases-conditions/diarrhea/symptoms-causes/syc-
20352241#:~:text=Diarrhea%20%E2%80%94%20loose%2C%20watery%20and%20possibly,more%20than%20a%20few%20days.
https://www.everydayhealth.com/diarrhea/
8. What are the risk factors in Diarrhea?
Demographic Factor Environmental Factor Behavioral Factor
Age Type of water source Hand washing practices
Sex Presence of sanitation
facilities
Solid waste disposal
practices
Level of wealth Solid waste disposal
system
Water storage practices
Floor type of the
kitchen
Water treatment
practices
Houses shared with
domestic animals
Feeding practices
Management of leftover
foods
Vaccination status
9. Acute diarrhea. The most common, acute diarrhea is loose watery
diarrhea that lasts one to two days. This type doesn’t need treatment
and it usually goes away after a few days.
What are the types of Diarrhea?
Persistent diarrhea. This type of diarrhea generally persists for
several weeks – two to four weeks
https://my.clevelandclinic.org/health/diseases/4108-diarrhea
Chronic diarrhea. Diarrhea that lasts for more than four weeks or
comes and goes regularly over a long period of time is called chronic
diarrhea.
10. The main symptom of diarrhea is passing loose, watery stools three or
more times a day.
What are the signs and symptoms of Diarrhea?
People with diarrhea may also have one or more of the following
symptoms:
1. an urgent need to use the bathroom
2. cramping
3. loss of control of bowel movements
4. nausea
5. pain in the abdomen
11. People with diarrhea caused by some infections may also have one or
more of the following symptoms:
1. bloody stools
2. fever and chills
3. light-headedness and dizziness
4. vomiting
https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/symptoms-causes
12. Dehydration. Occurs when you use or lose more fluid than you take in,
and your body doesn’t have enough water and other fluids to carry out
its normal functions.
What are the complications of Diarrhea?
Symptoms of dehydration in adults may include:
1. Thirst
2. urinating less than usual
3. feeling tired
4. dark-colored urine
5. dry mouth
6. decreased skin turgor, meaning that when your skin is pinched and
released, the skin does not flatten back to normal right away
7. sunken eyes or cheeks
8. light-headedness or fainting
13. Malabsorption. A digestive disorder that prevents your body from effectively
absorbing nutrients from your food.
Symptoms of malabsorption in adults may include:
https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086
https://my.clevelandclinic.org/health/diseases/22722-malabsorption
https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/symptoms-causes
1. Bloating
2. changes in appetite
3. gas
4. loose, greasy, foul-smelling bowel movements
5. weight loss
14. Your doctor will ask about your medical history, review the medications
you take, conduct a physical exam and may order tests to determine
what’s causing your diarrhea. Possible tests include:
What tests are done to diagnose diarrhea?
Blood test. A complete blood count test, measurement of electrolytes
and kidney function tests can help indicate the severity of your
diarrhea.
Stool test. Your doctor might recommend a stool test to see if a
bacterium or parasite is causing your diarrhea.
Hydrogen breath test.This type of test can help your doctor determine
if you have a lactose intolerance. After you drink a liquid that contains
high levels of lactose, your doctor measures the amount of hydrogen in
your breath at regular intervals. Breathing out too much hydrogen
indicates that you aren’t fully digesting and absorbing lactose.
15. https://www.mayoclinic.org/diseases-conditions/diarrhea/diagnosis-treatment/drc-20352246
Flexible sigmoidoscopy or colonoscopy. Using a thin, lighted tube
that’s inserted in your rectum, your doctor can see inside your colon.
The device is also equipped with a tool that allows your doctor to take
a small sample of tissue (biopsy) from your colon. Flexible
sigmoidoscopy provides a view of the lower colon, while colonoscopy
allows the doctor to see the entire colon.
Upper endoscopy. Doctors use a long, thin tube with a camera on the
end to examine your stomach and upper small intestine. They may
remove a tissue sample (biopsy) for analysis in the laboratory.
16. In most cases, you can treat your acute diarrhea with over-the-counter
medicines such as loperamide (Imodium) and bismuth subsalicylate
(Pepto-Bismol, Kaopectate).
How is Diarrhea treated?
You should also try to do the following:
1. Rest at home
2. stay off work or school until you have not had a loose bowel motion for
24 hours
3. drink clear fluids or oral rehydration solution to replace lost fluids —
take small sips if you feel sick
4. avoid fruit juice, cordials and sugary drinks — they will prolong the
diarrhoea
5. avoid alcohol and caffeine
6. manage your diet until you get back to normal — eat bland foods, such
as rice, pasta and crackers, and avoid fatty foods or those high in
insoluble fibre
17. Oral rehydration solutions. These are available over the counter from
your pharmacist. For older people and children, oral rehydration
solutions are a better choice than plain water. They are made
specifically to replace both fluids and electrolytes (important minerals
that your body needs to function) in the right concentrations. Sports
rehydration drinks are not recommended.
Anti-diarrhoeal medicines. Your pharmacist or doctor will be able to
advise you if you are thinking of taking over-the-counter anti-
diarrhoeal medicines. They are not suitable for use in the case of
diarrhoea caused by certain specific infections. Do not take them if you
have a fever or have blood in your stool.
Remember that diarrhoea is your body’s way of getting rid of a
gastrointestinal infection, so these medicines should not be taken long
term because they slow your gut and may prolong your illness.
18. Anti-vomiting drugs. Anti-emetics may be prescribed by your doctor if
you have gastroenteritis and are having problems due to vomiting.
https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/treatment
https://www.google.com/amp/s/www.healthdirect.gov.au/amp/article/diarrhoea
Intravenous fluids. People who are not able to adequately rehydrate —
for example, because they are vomiting — may need to be given
intravenous fluids via a drip.
Antibiotics. Most sudden attacks of diarrhoea are caused by viruses and
so antibiotics, which are only used to treat bacterial infections, are of
no use. If your doctor determines — usually through testing a stool
sample — that your diarrhoea is due to a bacterial or parasitic
infection, then they may prescribe antibiotics
Dietary changes. If you are experiencing diarrhoea for dietary reasons
or due to irritable bowel syndrome, an accredited practising dietitian
(APD) should be able to suggest some dietary changes.
19. Practicing portion control and limiting alcohol or caffeine can have wonderful benefits for
preventing diarrhea. However, you still need food and beverages to keep healthy and it
may be difficult to choose the proper diet. Here are some foods to prevent diarrhea after
eating in the elderly:
Best Foods for Diarrhea in the Elderly
BRAT foods can alleviate diarrheal symptoms:
1. Bananas
2. Rice (white)
3. Applesauce
4. Toast
20. Other bland foods you can eat include:
1. Boiled potatoes
2. Hot cereals (i.e. oatmeal, cream of wheat)
3. Unseasoned crackers
4. Probiotics (i.e. yogurt, miso, or sauerkraut)
5. Water (especially those with electrolytes and minerals to restore the
ones you lost)
By all means, you should AVOID these foods:
1. Fried foods
2. High-fiber foods
3. Spicy foods
4. Sugary foods and artificial sweeteners
5. Caffeinated beverages and carbonated drinks
https://www.griswoldhomecare.com/blog/2020/september/how-to-stop-chronic-diarrhea-in-elderly-adults/
21. Caregiver Management
1. Encourage a liquid diet.
Diarrhea normally requires bowel rest and the healthcare provider may order an
NPO diet, but more likely a clear or full liquid diet.
2. Educate on diet changes to prevent diarrhea.
A bland diet with low fiber is needed to bulk the stools. This includes soft foods
without added sugar or spices such as white rice, white toast, crackers, and eggs.
Raw, fresh foods and caffeine are not recommended.
3. Review medications.
Medications may need to be changed if diarrhea is an intolerable side effect. Review
how a patient is taking their medications. If they are taking laxatives or stool
softeners, educate on the appropriate use and to discontinue if diarrhea develops.
4. Administer antidiarrheals as appropriate.
Once the cause of diarrhea has been determined and it is not contraindicated,
administer antidiarrheals to stop diarrhea. These should not be given if the patient
has a parasitic infection as the infectious process needs to be eliminated.
22. Caregiver Management
5. Correct electrolyte imbalances.
Dehydration is common with diarrhea. Administer IV fluids if dehydration is severe.
Replace electrolytes such as potassium if required.
7. Promote relaxation for stress or anxiety.
Stress can exacerbate an inflammatory reaction by disrupting the immune system
and intestinal microbiome which can exacerbate inflammatory bowel disease
including Crohn’s disease or ulcerative colitis.
8. Promote skin integrity.
Frequent diarrhea can cause skin breakdown to the perianal area. Educate on
proper wiping from front to back and the use of non-irritating cleansers. If the
patient is incontinent, provide frequent diaper changes and keep the perineum dry
and apply skin barrier ointments.
9. Educate on proper food handling.
Food poisoning is a common cause of diarrhea. Ensure the patient understands how
to properly handle and cook food. Prevent cross-contamination when handling raw
meats and clean produce before ingesting. Do not eat food that has not been
properly refrigerated or cooked. Always wash hands before eating.
23. Caregiver Management
10. Refer to specialists for chronic diarrhea.
Chronic diarrhea that lasts longer than four weeks requires further assessment. The
patient may need a referral to a gastroenterologist to investigate for a possible
inflammatory bowel disease or a cause of malabsorption. Procedures such as a
colonoscopy may be needed. Allergists can assist if diarrhea seems to be related to
certain foods such as gluten. Dieticians can recommend diet adjustments.
11. Lifestyle modifications.
Alcohol can be irritating to the intestines and speeds digestion. Chronic alcohol use
has been shown to increase bacterial overgrowth in the small intestine. Smoking is a
common cause of developing and exacerbating Crohn’s disease. Educate patients on
the consequences of their lifestyle behaviors and provide resources to quit.
12. Educate on post-surgical expectations.
Patients undergoing GI surgeries will likely have loose stools for days to weeks.
Dumping syndrome occurs when part of the stomach or esophagus is removed
causing food to move too quickly into the small intestine. Patients who have
ostomies, particularly ileostomies, in which the colon is completely or partially
removed, tend to have looser stools with frequent output.
https://www.nursetogether.com/diarrhea-nursing-diagnosis-care-plan/
