Focus on Disability - For Disabled People, the Elderly and their Carers in the UK

Diarrhoea – A Guide

Focus on Disability - For Disabled People, the Elderly and their Carers in the UK

Diarrhoea is passing looser or more frequent stools than is normal for you. You may get diarrhoea after being in contact with someone else who has it, or get it after eating contaminated food or drinking contaminated water

Overview
Symptoms
Causes
Diagnosing
Treatment
Prevention

Overview

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.

What to do if you have diarrhoea

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 (small, frequent sips of water) until it passes. It’s very important that babies and small children do not become dehydrated.

Your pharmacist may suggest that you use an oral rehydration solution (ORS) if you or your child are particularly at risk of dehydration.

You should eat solid food as soon as you feel able to. If you are 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 loperamide, are available. However, these are not usually necessary, and most types should not be given to children.

When to see your GP

Contact your GP or call NHS 111 for advice if you are concerned about yourself or your child.

It’s important to see your GP if the diarrhoea is particularly frequent or severe, or is associated with other symptoms, such as:

  • blood in your or your child’s poo
  • persistent vomiting
  • a severe or continuous stomach ache
  • weight loss
  • signs of dehydration – including drowsiness, passing urine infrequently and feeling lightheaded or dizzy
  • your poo is dark or black – this may be a sign of bleeding inside your stomach

You should also contact your GP if your or your child’s diarrhoea is particularly persistent, as this may be a sign of a more serious problem. In most cases, diarrhoea should pass within about a week.



Symptoms associated with diarrhoea

Diarrhoea is where you frequently pass watery or loose poo. Some people may also have other symptoms, depending on the cause.

Associated symptoms can include:

  • stomach cramps
  • nausea and vomiting
  • headache
  • loss of appetite

The excessive loss of water in your poo can also sometimes lead to dehydration, which can be serious if not recognised and treated quickly.

Signs of dehydration

Signs of dehydration in children can include:

  • irritability or drowsiness
  • passing urine infrequently
  • pale or mottled skin
  • cold hands and feet
  • they look or feel increasingly unwell

Signs of dehydration in adults can include:

  • tiredness and a lack of energy
  • loss of appetite
  • nausea
  • feeling lightheaded
  • dizziness
  • dry tongue
  • sunken eyes
  • muscle cramps
  • rapid heartbeat

Read more about the symptoms of dehydration.

When to seek medical advice

Contact your GP or call NHS 111 for advice if you are concerned about yourself or your child.

You should also contact your GP in the situations outlined below, as they may mean that you or your child has, or is at risk of, a more serious problem.

Babies

You should contact your GP or health visitor urgently if your baby has had six or more episodes of diarrhoea in the past 24 hours, or if they have vomited three times or more in the past 24 hours.

You should also seek advice if your baby has any symptoms of dehydration.

Children

Contact your GP if your child has:

  • had six or more episodes of diarrhoea in the past 24 hours
  • diarrhoea and vomiting at the same time
  • watery poo
  • blood in their poo
  • a severe or continuous stomach ache
  • symptoms of dehydration

You should also contact your GP if your child has persistent diarrhoea. Most cases will pass in five to seven days.

Adults

Contact your GP if you have diarrhoea and:

  • there is blood in your poo
  • you are vomiting persistently
  • you’ve lost a lot of weight
  • you have passed a large amount of very watery diarrhoea
  • it occurs at night and is disturbing your sleep
  • you have recently taken antibiotics or been treated in hospital
  • you have symptoms of dehydration
  • your poo is dark or black – this may be a sign of bleeding inside your stomach

You should also contact your GP if you have persistent diarrhoea. Most cases in adults will pass in two to four days.



Causes of diarrhoea

Diarrhoea usually occurs when fluid cannot be absorbed from the contents of your bowel, or when extra fluid is secreted into your bowel, causing watery poo.

Short-term diarrhoea

Diarrhoea is usually a symptom of gastroenteritis (a bowel infection), which can be caused by:

  • a virus – such as norovirus or rotavirus
  • bacteria – such as campylobacter, Clostridium difficile (C. difficile), Escherichia coli (E. coli), salmonella or shigella; these can all cause food poisoning
  • parasites – such as the Giardia intestinalis parasite that causes giardiasis

Other possible causes of short-term diarrhoea include:

Medicines

Diarrhoea can also sometimes be a side effect of a medication, including:

The patient information leaflet that comes with your medicine should state whether diarrhoea is a possible side effect.

Long-term diarrhoea

Conditions that can cause persistent diarrhoea include:

Persistent diarrhoea can also sometimes occur following surgery on the stomach, such as a gastrectomy. This is an operation to remove part of the stomach – for example, as a treatment for stomach cancer.

Diagnosing diarrhoea

Most cases of diarrhoea get better within a week and you may not need to visit your GP.

The information below explains what will happen if you need to see your GP.

Identifying the cause

To identify what is causing your diarrhoea, your GP may ask questions, such as:

  • what your stools are like – for example, if they are 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 have been in contact with anyone else who has diarrhoea or have recently travelled abroad, as this may mean you have picked up an infection
  • whether you have recently eaten out anywhere, as this may mean you have food poisoning
  • whether you are taking medication and if it has recently changed
  • whether you have been stressed or anxious recently

Stool sample

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 has 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

Blood tests

Your GP may suggest that you have some blood tests if they suspect that an underlying health condition is causing your diarrhoea.

For example, your blood can be tested for signs of inflammation, which may suggest inflammatory bowel disease.

Rectal examination

Your GP may recommend a digital rectal examination (DRE) if you have unexplained persistent diarrhoea, particularly if you are 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.

Further investigations

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 – an instrument called a sigmoidoscope (a thin, flexible tube with a small camera and light on one end) 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



Treating diarrhoea

Diarrhoea will usually clear up without treatment after a few days, particularly if it’s caused by an infection.

In children, diarrhoea will usually pass within five to seven days and will rarely last longer than two weeks.

In adults, diarrhoea usually improves within two to four days, although some infections can last a week or more.

While waiting for your diarrhoea to pass, you can ease your symptoms by following the advice outlined below.

Drink fluids

It’s important to drink plenty of fluids to avoid dehydration, particularly if you are also vomiting. Take small, frequent sips of water.

Ideally, adults should drink a lot of liquids that contain water, salt and sugar. Examples are water mixed with juice and soup broth. If you are drinking enough fluid, your urine will be light yellow or almost clear.

It’s also very important for babies and small children not to become dehydrated. Give your child frequent sips of water, even if they are vomiting. A small amount is better than none. Fruit juice or fizzy drinks should be avoided because they can make diarrhoea worse in children.

If you are breastfeeding or bottle feeding your baby and they have diarrhoea, you should continue to feed them as normal.

Oral rehydration solutions (ORS)

Your GP or pharmacist may suggest using an oral rehydration solution (ORS) to prevent dehydration if you are at risk – for example, if you are frail or elderly. ORS can also be used to treat dehydration that has already occurred.

Rehydration solutions usually come in sachets available from your local pharmacist without a prescription. They are dissolved in water and replace salt, glucose and other important minerals that are lost if you are dehydrated.

Children

Your GP or pharmacist may recommend giving your child an ORS if they are dehydrated or at risk of becoming dehydrated.

The usual recommendation is for your child to drink an ORS each time they have an episode of diarrhoea. The amount they should drink will depend on their size and weight. Your pharmacist can advise you about this. The manufacturer’s instructions should also give information about the recommended dose.

You may be able to give your baby an ORS if they become dehydrated, but check with your GP, pharmacist or health visitor first.

Eating

Opinion is divided over when and what you should eat if you have diarrhoea. However, most experts agree that you should eat solid food as soon as you feel able to. Eat small, light meals and avoid fatty or spicy foods.

Good examples are potatoes, rice, bananas, soup and boiled vegetables. Salty foods help the most.

You don’t need to eat if you’ve lost your appetite, but you should continue to drink fluids and eat as soon as you feel able to.

Children

If your child is dehydrated, do not 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 your child is not dehydrated, offer them their normal diet. If they refuse to eat, continue to give them fluids and wait until their appetite returns.

Medication

Antidiarrhoeal medicines

Antidiarrhoeal medicines may help reduce your diarrhoea and slightly shorten how long it lasts. However, they are not usually necessary.

Loperamide is the main antidiarrhoeal medicine used, because it has been shown to be effective and causes few side effects. Loperamide slows down the muscle movements in your gut so that more water is absorbed from your stools. This makes your stools firmer and they are passed less frequently.

An alternative to loperamide is a different type of antidiarrhoeal medicine called racecadotril, which works by reducing the amount of water produced by the small intestine. Evidence suggests that this medication may be as effective as loperamide for treating diarrhoea.

Some antidiarrhoeal medicines can be bought from a pharmacy without a prescription. Check the patient information leaflet that comes with the medicine to find out whether it’s suitable for you and what dose you should take. Ask your pharmacist for advice if you are unsure.

Do not take antidiarrhoeal medicines if there is blood or mucus in your stools and/or you have a high temperature (fever). Instead, you should contact your GP for advice.

Most antidiarrhoeal medicines should not be given to children. Racecadotril can be used in children over three months old if it’s combined with oral rehydration and the other measures mentioned above, although not all doctors recommend it.

Painkillers

Painkillers will not treat diarrhoea, but paracetamol or ibuprofen can help relieve a fever and a headache.

If necessary, you can give your child liquid paracetamol or ibuprofen.

Always read the patient information leaflet that comes with the medication, to check if it’s suitable for you or your child and to find out the correct dose. Children under 16 years of age should not be given aspirin.

Antibiotics

Treatment with antibiotics is not recommended for diarrhoea if the cause is unknown. This is because antibiotics:

  • will not work if the diarrhoea is caused by a virus
  • can cause unpleasant side effects
  • can become less effective at treating more serious conditions if they are repeatedly used to treat mild conditions

Antibiotics may be recommended if you have severe diarrhoea and a specific type of bacteria has been identified as the cause.

They may also be used if you have an underlying health problem, such as a weakened immune system.

Hospital treatment

Occasionally, hospital treatment may be needed if you or your child is seriously dehydrated. Treatment will involve administering fluids and nutrients directly into a vein (intravenously).

Can probiotics help?

Probiotics are live bacteria and yeasts found in some yoghurts and food supplements.

There’s some evidence that certain probiotics can slightly shorten a period of diarrhoea, although the evidence isn’t yet strong enough to recommend them.

There’s also evidence to suggest some probiotics may reduce your chances of developing diarrhoea after taking antibiotics.



Going for surgery

If other treatment has not worked on your haemorrhoids (piles), you may be referred to a surgeon. There are several different surgical procedures you can have. These are explained in more detail below.

Haemorrhoidectomy

If injections or banding have not treated your haemorrhoids successfully, or if your haemorrhoids are large and causing you a lot of pain and discomfort, you may be referred for a haemorrhoidectomy. This is an operation to remove the haemorrhoids and is usually done under a general anaesthetic (a painkilling medication that makes you unconscious).

A traditional haemorrhoidectomy involves gently stretching the anus (the opening at the end of the digestive system where solid waste leaves the body) while the haemorrhoids are cut away.

It is less likely that the haemorrhoids will come back after surgery than it is with injections or banding, but a high-fibre diet is always recommended as a preventative measure.

This is a major operation and you will need to take a week or so off work while the wounds heal.

It is common to have pain after this procedure, but you will be given painkillers to help you deal with it. You may still have some pain for a few weeks afterwards, but this can be controlled with painkillers. If the pain goes on for longer, seek medical advice.

If you start to pass a lot of bright red blood or pass clots, go to your nearest accident and emergency (A&E) department immediately.

Alternative procedures

Some alternative surgical procedures are explained below.

Stapling

Stapling, also known as stapled haemorrhoidopexy, is an alternative to a traditional haemorrhoidectomy. It is usually only done to treat prolapsed haemorrhoids (when the haemorrhoids are hanging out of your anus) and is carried out under general anaesthetic.

The haemorrhoids are stapled to the wall of the anal canal (the last section of the bowel), which reduces their blood supply and makes them smaller.

Stapling has a shorter recovery time than the traditional haemorrhoidectomy, and you can usually return to work in around a week. Stapling also tends to be less painful than a haemorrhoidectomy. However, after stapling, more people experience a further prolapsed haemorrhoid than after a haemorrhoidectomy.

Haemorrhoidal artery ligation

Haemorrhoidal artery ligation, also known as transanal haemorrhoidal dearterialisation (THD), is an operation to reduce the flow of blood to the haemorrhoids. It is usually carried out under general anaesthetic and uses a small ultrasound device called a Doppler probe. Ultrasound uses high-frequency sound waves to create an image of part of the inside of the body.

The Doppler probe is used to locate all the areas in the bowel where an artery (blood vessel) supplies blood to a haemorrhoid. A stitch is placed in these arteries so that the blood supply to the haemorrhoid is blocked. This causes the haemorrhoid to shrink over the following days and weeks.

Guidance from the National Institute for Health and Clinical Excellence (NICE) says that haemorrhoidal artery ligation is an effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy. It causes less pain after the operation and people have reported a high level of satisfaction with the results.

The Specialist Advisers for NICE, who are experts that provide informed opinions about medical procedures, found that haemorrhoidal artery ligation was effective for relieving symptoms such as bleeding, itching, swelling and pain. One study that looked at the progress of patients four weeks after having haemorrhoidal artery ligation found that 9 out of 10 said their symptoms had cleared up.

A review of a number of different studies looked at the results of haemorrhoidal artery ligation a year or more after the procedure. It found that about 1 in 10 people experienced:

  • bleeding
  • pain when passing stools
  • a prolapsed haemorrhoid (where the haemorrhoid hangs out of the anus)

Other treatments

A few other options are available, but only a few surgeons carry them out on the NHS or in private clinics. These include freezing and laser treatment.

Preventing diarrhoea

To prevent the spread of infections that cause diarrhoea, you should always maintain high standards of hygiene.

You should:

  • wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing food
  • 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

You or your child should also avoid swimming pools for two weeks after the last episode of diarrhoea.

Read more about preventing germs from spreading.

Food hygiene

Practising good food hygiene will help avoid getting diarrhoea as a result of food poisoning. You can do this by:

  • regularly washing your hands, surfaces and utensils with hot, soapy water
  • never storing raw and cooked foods together
  • making sure food is kept properly refrigerated
  • always cooking your food thoroughly
  • never eating food past its use-by date

Read more about preventing food poisoning.

Rotavirus vaccination

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 is dropped into a baby’s mouth. It is given in two doses, with the first given at two months and another at three months.

Read more about the rotavirus vaccine.

Travellers’ diarrhoea

There is no vaccination that can protect you from all possible causes of travellers’ diarrhoea. The best way to avoid it is to practise good food and water hygiene while abroad.

If you are travelling in a country where standards of public hygiene are low, you should avoid:

  • tap water – water should be boiled for at least one minute if you’re not sure whether it’s safe to drink
  • ice cubes and ice cream
  • raw or undercooked seafood, meat, chicken
  • foods that might contain uncooked eggs – such as mayonnaise
  • unpasteurised milk and dairy products – such as cheese
  • fruit and vegetables with damaged skins
  • salads

It’s generally safe to eat or drink:

  • food that has been thoroughly cooked and is served piping hot
  • sealed bottles or cans of water, fizzy drinks and alcohol
  • fruit and vegetables you peel yourself
  • tea or coffee

If you are planning a trip abroad, check health advice for the countries you will be travelling to. You can do this by visiting the NHS Fit for Travel website.

Read more about food and water abroad and travel vaccinations.



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