Treatment of diarrhoea, particularly the chronic form, is a significant component of the areas of care for every gastroenterologist. Given that it is common for individuals to experience acute diarrhoea from time to time, understanding the treatment options for diarrhoea, in general, can be useful.
Apart from medical treatment which includes prescription medications, there are many general lifestyle changes that can be made in order to alleviate symptoms associated with diarrhoea.
In this piece, we endeavour to look at the treatment options for patients with this condition. It must be noted that if a patient experiences chronic diarrhoea (i.e. beyond a few days), becomes dehydrated, have bloody or black stools, severe abdominal or rectal pain or develop a temperature above 39°C – they must seek urgent medical attention.
Before treatment, the cause of diarrhoea may need to be confirmed. In order to do so, a variety of methods may be used. These include:
For patients with diarrhoea, a complete blood count test may help to identify the cause of this condition.
A stool test may be used to determine whether a particular bacterium (e.g. C. difficile) or parasite (e.g. Giardia, Cryptosporidium) is the cause of diarrhoea.
A flexible sigmoidoscopy/colonoscopy is performed in those suffering from chronic diarrhoea in which the aetiology of the disorder is yet to be determined. Mucosal biopsies are taken in order to assess the histological condition of the colon. A flexible sigmoidoscopy (assesses up to the last 60cm of the colon) is indicated unless the patient is thought to have iron deficiency anaemia, in which colonoscopy is utilised to reach a section of the colon (terminal ileum) to exclude the possibility of particular autoimmune conditions.
Whilst the majority of cases of acute diarrhoea are self-limiting (i.e. resolves itself) after a few days, medication(s) and lifestyle changes may be required if symptoms persist past this point. Such treatments may include:
Antibiotics and over-the-counter medication
Antibiotics are commonly used for the treatment of bacteria or parasite-associated diarrhoea. Antibiotics are not indicated or efficacious in treating diarrhoea resulting from a virus.
Other treatment options include symptomatic therapy (i.e. anti-diarrhoea medication) such as loperamide and bismuth subsalicylate, which are over-the-counter solutions, and may reduce the frequency of watery bowel movements. This form of medication is indicated when a diagnosis has been made, but specific treatment is unavailable. Symptomatic therapy can also be used to diarrhoea associated with specific disorders.
Hydration or fluid replacement
Supplementary hydration strategies are recommended for patients with both acute and chronic diarrhoea. This will replenish fluids and electrolytes through increased hydration or fluid replacement.
For patients who are unable to tolerate oral hydration, intravenous (IV) fluids may be the next course of action. While drinking water is a good way to stay hydrated, it does not contain essential salts and electrolytes, such as sodium and potassium, which are important for a number of physiological processes. This can be rectified by drinking fruit juice (patients will need to avoid certain juices like apple juice), soups, and electrolyte filled fluids.
As previously stated above, hydration is a key factor in the treatment of diarrhoea. Drinking plenty of clear liquid including water, broths, and juices are one of the most important lifestyle changes that can be made, given that acute diarrhoea can lead to dehydration in patients. Patients are also recommended to refrain from coffee and alcohol, as these can exacerbate this condition.
Patients may also be asked to maintain a semi-solid and low-fibre diet until their bowel movements return to normal. Crackers, toast, eggs, rice or chicken are a few recommended options. In this process, dairy-based items, fatty foods, seasoned food, and high-fibre food items should be avoided until symptoms are alleviated.
Another common recommendation for patients with diarrhoea is the increased intake of probiotics. This is the addition of beneficial bacteria into the intestinal tract, that restores a healthy balance to the GI tract. This can be ingested in the form of yoghurt, capsules or in liquid form.
For treatment options for chronic/ongoing diarrhoea, consulting a trained medical professional is recommended,