Almost everyone has diarrhoea at some point in his or her life, including on holiday abroad, called traveller's diarrhoea.
Diarrhoea is having more frequent, loose, watery poo, which may be referred to as 'stools'. Some people may also have other symptoms, depending on the cause.
It affects most people from time to time and is usually nothing to worry about. However, it can be distressing and unpleasant until it passes, which normally takes a few days to a week.
The excessive loss of water in your poo can also sometimes lead to symptoms of dehydration, which can be serious if it's not recognised and treated quickly.
What are the Symptoms of Diarrhoea?
In addition to frequent, watery bowel movements, the stool may also contain mucus, pus, blood or excessive amounts of fat.
Diarrhoea can be accompanied by:
Urgency (having to go right away)
Incontinence (leakage of stools)
Lower abdominal pain or cramping
Blood or flecks of mucus in the stool
Loss of appetite, weight loss
Diarrhoea can cause dehydration, especially in young children and older people. Symptoms of dehydration in adults can include:
lack of energy;
passing less urine than normal;
dizziness or light-headedness; and
the skin on the back of your hand being slow to return to position after being pinched upwards.
Symptoms of mild to moderate dehydration in children can include:
passing less urine than usual (often noticed as fewer wet nappies in babies and toddlers);
less tears when crying.
Signs of severe dehydration in children include:
sunken eyes, cheeks or belly, or a sunken fontanelle (the soft spot on the top of the head in babies and toddlers).
People with diarrhoea, especially the very young and the very elderly, are at risk of becoming rapidly dehydrated. This requires immediate medical attention.
When to Seek Medical Advice
Seek medical advice if you have diarrhoea for more than three to four days, or if you have diarrhoea with any of the following:
Blood in your stool
Dark-black stool that looks like tar (but tell your doctor if you have been taking over-the-counter medications, which also can make the stool look darker than usual)
Mucus passed with no stools
Recent travel abroad
Recent seafood consumption
Reason to believe that you have food poisoning
Family members who have similar illness
Colleagues, associates or friends who have similar symptoms after eating in the same venue
What Causes Diarrhoea?
There are many different causes of diarrhoea, but a bowel infection (gastroenteritis) is a common cause in both adults and children.
Gastroenteritis can be caused by:
a virus – such as norovirus or rotavirus
bacteria – such as campylobacter or Escherichia coli (E. coli), which are often picked up from contaminated food
a parasite – such as the parasite that causes giardiasis, which is spread in contaminated water
These infections can sometimes be caught during travel abroad, particularly to areas with poor standards of public hygiene. This is known as travellers' diarrhoea.
Diarrhoea can also be the result of:
a food allergy
side effects from medication
drinking too much alcohol
damage to the lining of the intestines as a result of radiotherapy
a long-term condition, such as irritable bowel syndrome (IBS), inflammatory bowel disease, coeliac disease, bile acid malabsorption, chronic pancreatitis, diverticular disease, bowel cancer
Your doctor's most important tool for diagnosing the cause of your diarrhoea is the information you provide. You will need to inform the doctor about recent travel and whether other people in your family are ill. Providing details about the stools may be embarrassing to you, but they are very important, such as:
what your stools are like – for example, if they're very watery or contain blood
how often you need to go to the toilet
whether you have other symptoms, such as a high temperature (fever)
whether you've been in contact with anyone else who has diarrhoea, or have recently travelled abroad – this may mean you have picked up an infection
whether you have recently eaten out anywhere – this may mean you have food poisoning
whether you're taking medication and if it's recently changed
whether you've been stressed or anxious recently
Your GP may ask you for a stool sample so it can be analysed for signs of an infection if you have:
persistent diarrhoea that's lasted more than two weeks
blood or pus in your stools
symptoms that affect your whole body, such as a fever or dehydration
a weakened immune system – for example, because you have HIV
recently travelled abroad
recently been in hospital or been taking antibiotics
Your GP may suggest you have some blood tests if they suspect your diarrhoea is being caused by an underlying health condition.
For example, your blood can be tested for signs of inflammation, which may suggest inflammatory bowel disease.
Your GP may recommend a digital rectal examination (DRE) if you have unexplained persistent diarrhoea, particularly if you're over 50.
During a DRE, your GP will insert a gloved finger into your bottom to feel for any abnormalities. It can be useful for diagnosing conditions that affect your rectum and bowel.
If you have persistent diarrhoea and your GP is unable to find the cause, they may refer you to your local hospital for further investigation.
You may have:
a sigmoidoscopy – a thin, flexible tube with a small camera and light on one (a sigmoidoscope) is inserted into your bottom and up into your bowel
a colonoscopy – a similar procedure that uses a larger tube called a colonoscope to examine your entire bowel
Most cases of diarrhoea clear up after a few days without treatment, and you may not need to see your GP.
However, diarrhoea can lead to dehydration, so you should drink plenty of fluids – frequent small sips of water – until it passes.
It's very important that babies and small children don't become dehydrated. Your pharmacist may suggest you use an oral rehydration solution (ORS) if you or your child is particularly at risk of dehydration.
You should eat solid food as soon as you feel able to. If you're breastfeeding or bottle feeding your baby and they have diarrhoea, you should try to feed them as normal. Stay at home until at least 48 hours after the last episode of diarrhoea to prevent spreading any infection to others.
Medications to reduce diarrhoea, such as antidiarrhoeal medicines like loperamide, which work by slowing down the muscle movements in the gut, are available over the counter for adults and children over 12. This medicine shouldn’t be used if breastfeeding. Pharmacists can advise on suitable products.
Seek medical advice before using anti-diarrhoea medicines if there is blood in the poo, a high temperature or other symptoms. Also seek medical advice in the case of severe or persistent diarrhoea in a child under 12.
In severe diarrhoea due to infectious bacteria, your doctor may advise taking antibiotics to help resolve the symptoms. However, antibiotics won't help with viral diarrhoea, which is the most common type of infectious diarrhoea.
The most important way to avoid diarrhoea is to avoid coming into contact with infectious agents that can cause it. Diarrhoea is often caused by an infection. This means that hygienic food preparation and storage techniques, and good hand washing, especially when preparing food and after using the toilet are very important.
You can reduce your risk by making sure you maintain high standards of hygiene. For example, you should:
wash your hands thoroughly with soap and warm water after going to the toilet, before eating or preparing food and changing nappies
clean the toilet, including the handle and the seat, with disinfectant after each bout of diarrhoea
avoid sharing towels, flannels, cutlery or utensils with others
wash soiled clothing and bed linen separately from other clothes and at the highest temperature possible – for example, 60C or higher for linen – after first removing any poo into the toilet
avoid returning to work or school until at least 48 hours after the last episode of diarrhoea
It's important to practise good food and water hygiene while travelling abroad, such as avoiding potentially unsafe tap water and undercooked food
Always put foods that could spoil in the fridge
Ensure that meat is washed and cooked thoroughly
Avoid eating raw meats, fish, and shellfish unless you are sure that they have been freshly prepared and are from a reliable source
Never place cooked meet on surfaces or plates that have held raw meat
Rotavirus is a virus that commonly causes diarrhoea in children. A vaccine that helps protect children against rotavirus is now part of the routine childhood vaccination schedule.
This vaccine is given as a liquid that's dropped into a baby's mouth. It's given in two doses, with the first given at two months and another at three months.
Some key facts to keep in mind are:
There are about 2 billion cases of diarrhoeal disease every year world-wide.
Diarrhoeal disease is the second leading cause of death in children under five years of age and kills about 1.5 million children every year, due to the risks of dehydration.
Diarrhoeal disease mainly affects children younger than two years of age and is a leading cause of malnutrition in children under five years of age.
WHO works with Member States and other partners to:
promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries;
conduct research to develop and test new diarrhoea prevention and control strategies in this area;
build capacity in implementing preventive interventions, including sanitation, source water improvements, and household water treatment and safe storage;
develop new health interventions, such as the rotavirus immunization; and
help to train health workers, especially at community level.