Chronic diarrhea - why diarrhea becomes frequent and how to get rid of it. Diarrhea (diarrhea) as a symptom: causes, treatment, prevention of dehydration

Diarrhea or diarrhea is not an independent disease - it is just a symptom of many other diseases. Diarrhea is an accelerated passage of food through the intestines with a violation of the absorption of fluid in the large intestine. Sometimes the causes of diarrhea are identified very quickly, but there are times when diarrhea passes before a person goes to the doctor to look for its causes. In adults, diarrhea rarely leads to negative consequences, but in children and the elderly, this condition can lead to dehydration, which is very dangerous for health and even life.

One of the main causes of diarrhea is infection. They can be caused by bacteria, viruses, protozoa, fungi, and diarrhea can also be caused by toxins that are released by these organisms during their life.
In addition, diarrhea can be caused by disorders of the intestines and stomach, in which there is a violation of the process of splitting food and its assimilation.

There are other causes that can cause diarrhea, these include:

• the use of hard-to-digest foods that contain a lot of fat and / or vegetable fiber;
• fermentopathy, or lack of enzymes in the body, which does not allow food to be fully digested;
• violation of the natural composition of the intestinal microflora.

In most cases, there is acute diarrhea. It appears suddenly and is characterized by the release of stool more than 4-5 times a day. This condition is accompanied by bloating and rumbling in the abdomen, loss of appetite, nausea and vomiting, abdominal pain, a feeling of thirst and dryness of the skin, a feeling of weakness and fatigue, and staining of urine in a dark color.

This condition rarely lasts more than two weeks. If, during diarrhea, fever, blood in the stool, severe and sharp pains in the abdomen and darkening of the stool appear, then you should consult a doctor to exclude dangerous diseases such as dysentery, salmonellosis, cholera and others. If diarrhea continues for more than two weeks, you should also consult a doctor, as this may be a sign.

The main complications of diarrhea are dehydration, hypovitaminosis and general exhaustion of the body. Dehydration is most dangerous for children and the elderly, as their body is not able to cope with its consequences on its own. This often leads to complications and even death.

Treatment of diarrhea with diet

Treatment of diarrhea always begins with a dietary change. It should be as gentle as possible for the digestive system. With diarrhea, foods that mechanically stimulate peristalsis, such as fresh vegetables and black bread, as well as foods that stimulate peristalsis reflexively, such as spices and caffeine, are prohibited.

Disaccharides that can cause osmotic diarrhea are prohibited, such as lactose, which is contained in. It is very important to give up too fatty foods, which require a lot of enzymes to digest, as they greatly burden the already weakened intestines.

The best foods to eat during diarrhea are boiled rice, bananas, crackers and baked sour apples.

What can you eat with diarrhea? It is best to give preference to boiled pureed food without spices, fat and coarse fiber. You need to eat small portions every three hours. You can use soups on a weak broth with white bread, low-fat boiled meat or fish, low-fat cottage cheese. But sweets should be abandoned, as well as fresh milk, legumes and mushrooms. If there are signs of decay, such as belching rotten or putrid smell of feces, it is necessary to limit the protein in food and give preference to cereals and kissels. And with signs of fermentation, such as frothy feces with a sour smell, you need to reduce the amount of carbohydrates and eat more proteins, such as meat and cottage cheese.

Antidiarrheal medicines

If diarrhea needs to be stopped immediately, antidiarrheal drugs are often recommended. One such drug is loperamide, which is the active ingredient in many drugs. It inhibits the release of acetylcholine and prostaglandins, slows down peristalsis, slows secretion production, and increases the tone of the anal sphincter.

In most cases, diarrhea is a positive phenomenon, as it allows you to remove toxins from the body, so you should not stop it with medication.

Loperamide is part of the popular drug Imodium Plus. It also contains simethicone. This drug not only stops diarrhea, but also eliminates flatulence and reduces discomfort in the abdomen.

But when using drugs with loperamide, one must be as careful as possible, since it is similar to opiates and, in large doses, can lead to depression of the nervous system. Medicines based on loperamide should not be used by young children under 6 years of age, and it is not recommended to give them to children under 12. In young children, Immodium can cause intestinal muscle paralysis, which is deadly. It is forbidden to take medicines for diarrhea and in the presence of blood and pus in the stool.

But sometimes loperamide is useful, for example, in diarrhea of ​​​​nervous origin caused by stress, as well as in Crohn's disease and secretory diarrhea, in diarrhea caused by cancer chemotherapy.

Fighting dehydration as a treatment method

The main danger of any diarrhea is dehydration. That is why treatment must begin with the restoration of normal water balance. Loss of more than 20-25% of all water in the body, which is about 15% of body weight, is fatal. Most often this occurs with cholera and salmonellosis.

The risk of dehydration is much higher if the diarrhea is accompanied by nausea and vomiting and the patient is unable to drink. In such cases, it is better to go to the hospital, where the fluid will be administered intravenously.

The main signs of dehydration are: intense thirst and weakness, a small amount of dark urine, weight loss, wrinkled and flabby skin, sunken cheeks and eyes, sharpening of facial features, thickening of the blood and lowering blood pressure, as well as tachycardia, bluish skin color and convulsions.

Diarrhea requires fluid replacement or rehydration. The optimal drinks for rehydration are special preparations, such as Regidron and Gatsrolit. They help replenish lost fluids and some nutrients. You can also drink strong unsweetened tea, a decoction of rose hips, compotes and weak broths.

The use of adsorbents

These drugs have the ability to absorb toxins, poisons, some endogenous metabolites, as well as liquids and gases. They then excrete them naturally. The intake of adsorbents reduces the amount of intestinal contents and slightly slows down peristalsis. This leads to a decrease in the number of bowel movements, and also reduces intoxication and flatulence. A variety of substances are used as adsorbents, the most famous being activated carbon, it is also possible to take lignin processing products and polymer drugs based on polyvinylpyrrolidone.

Activated charcoal should not be used if there is bleeding in the gastrointestinal tract, as its particles can enter the bloodstream and lead to blockage of blood vessels.

Quite popular is the drug Smecta, which can have the trade names smecta, dioctite, diosmectite, neosmectin, etc. Smecta not only absorbs and removes toxins from the body, but also gently lines the surface of the stomach and intestines, allowing cells to recover from illness. Everyone can use this drug, including children and lactating women. Another option for a good adsorbent is enterosgel. Its action is similar to smecta and patients of all ages can use it.

You can also use Polysorb, the active ingredient of which is colloidal silicon dioxide. And also Neointestopan and Kaopektat, which are not recommended for children under 6 years of age.

And how long has the well-known activated carbon? This is an inexpensive and very effective remedy, so it can also be used, but you need to remember that to achieve a real effect, you will have to eat much more than the recommended tablet per 10 kg of weight. If you are not sure that you can swallow a few handfuls of coal, it is better to choose a more modern remedy.

Identification of the causative agent and treatment of the causes of diarrhea

Very often, diarrhea is a symptom of an acute intestinal infection, which is caused by a variety of pathogens. Most often these are:

• bacteria, such as salmonella, shigella vibrios, cholera, etc.;
• viruses, for example, enteroviruses, adenoviruses, etc.;
• protozoa, such as amoeba, giardia, balantidia, trichomonads, amoeba (amoebic dysentery), cryptosporidium, etc.;
• helminths, for example, whipworm, pinworms, schistosomes, etc.

With watery diarrhea without a temperature, determining the pathogen is usually not required, since such symptoms are typical for viral diarrhea, which go away on their own with proper nutrition and timely rehydration. An exception may be cholera, which is accompanied by just such diarrhea.

It has been proven that recovery from cholera is possible without the use of antibiotics, but subject to timely rehydration, including with the help of intravenous fluids.

If pus, mucus and blood are noticeable in the feces, then you should immediately contact the infectious diseases hospital. Most likely, doctors will diagnose a bacterial infection and recommend antibiotic treatment. Most often, systemic antibiotics are used, even before the precise determination of the pathogen. To determine the pathogen, sowing on a nutrient medium is usually used, so the result of the analysis will be only after 3-5 days.

Under no circumstances should you prescribe antibiotics on your own. This is due to the fact that they are useless against viruses, but they can easily kill the beneficial intestinal microflora and further worsen the patient's condition.

Treatment with intestinal antiseptics Nifuroxazide can be produced under the name stopdiar, enterofuril, ersefuril. It effectively destroys staphylococci and streptococci, as well as some common gram-negative bacteria of the intestinal group, such as salmonella, shigella, klebsiella, E. coli.

Rifaximin is marketed under the name Alfa Normix. This drug has a wide spectrum of activity, but sometimes causes side effects such as dyspepsia, nausea, vomiting, abdominal pain, which go away on their own.

The drug Intetrix destroys not only bacteria, but also amoeba and fungi of the Candida genera. It is most often used to treat amoebiasis, as well as fungal diarrhea and traveler's diarrhea.

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There are a number of diseases about which many people who suffer from them do not like to spread and which they are even ashamed of. And diarrhea (colloquially - diarrhea) is one of them. Meanwhile, this condition is often a sign of very serious disorders in the body. Not to mention that diarrhea is dangerous in itself, and can even be fatal. However, practice shows that not all people know how to treat diarrhea properly.

What is diarrhea?

First of all, let's define this concept. Diarrhea in medicine is called the condition when a person performs an act of defecation, or emptying the intestines too often. Of course, frequent bowel movements is an inexact criterion, so it should be clarified. A person who eats normally and consumes a normal amount of water should empty the intestines from 1 time in 2 days to 2 times a day. If bowel movements occur more than twice a day, then this condition can be considered one of the characteristic signs of diarrhea.
The second determining factor is the consistency of the stool. Normally, human feces are cylindrical and fairly hard. With diarrhea, the appearance of the stool is always different from the usual one - it is a semi-liquid, liquid or mushy mass, or even just water. If these symptoms of diarrhea are frequent urge to defecate and loose stools continue for more than two weeks without interruption, then the diarrhea is considered acute. Otherwise, it should be classified as chronic.

Generally speaking, diarrhea can be a symptom of many diseases. However, by the mere fact of the occurrence of diarrhea, this disease cannot be determined. Other symptoms also play a huge role. It is extremely rare to find a case when diarrhea occurs against the background of complete health and is not accompanied by other characteristic signs.

The main symptoms that often accompany diarrhea are:

• elevated temperature;
• weakness;
• nausea;
• gas formation in the intestines,;
• pain in the lower or upper abdomen.

You should also pay attention to such a characteristic of diarrhea as the consistency of the stool. Mushy, liquid, watery diarrhea can indicate various diseases of the gastrointestinal tract. Also, with diarrhea, some additional discharge may be observed - blood, mucus, pieces of undigested food. The color of the secretions matters, their volume is plentiful or scarce, the smell is fetid or not.

Causes of diarrhea

What causes diarrhea? The reasons for this condition can be varied. It is important to know the cause of diarrhea well, otherwise treatment may not be effective.

Additional factors that contribute to the occurrence of diarrhea are:

• insufficient personal hygiene;
• insufficient chewing of food, improper eating habits;
• stress and neuroses;
• sedentary lifestyle;
• use of certain types of medicines;
• reduced immunity;
• pregnancy;
• childhood.

However, whatever the causes, diarrhea requires a serious attitude and adequate treatment.

The main viral and bacterial infections that can cause diarrhea are:

• salmonellosis,
• dysentery,
• rotavirus infection,
• enterovirus infection.

As a rule, the main symptom that indicates that diarrhea is caused by an infection is a fever. Also, infections of the gastrointestinal tract are often accompanied by nausea, vomiting, general weakness. Patients often complain that they have stomach pain or pain in the lower abdomen. Stool with infectious diarrhea is frequent. Diseases such as dysentery are characterized by very liquid feces, usually it has a fetid odor, impurities of mucus or blood.

Lack of digestive enzymes

Digestion is a complex chemical process. Many substances are involved in it, whose task is to break down the organic substance entering the digestive tract into those simple compounds that can be absorbed by the tissues of the body. Many of the substances necessary for digestion are produced by various organs - the liver, stomach, pancreas. Such compounds include pepsins, bile, pancreatic enzymes - protease, lipase, amylase. If one of the enzymes is missing, then this means that undigested food residues will accumulate in the intestines. This causes irritation and upset of the intestines, which provokes diarrhea.

Poisoning

Often, loose stools are a reaction of the body to toxic substances. There may well be some toxins in the food we eat. This may concern mainly stale or expired products, products treated with some chemicals or containing poisons (mushrooms, fruits and vegetables). It is also possible that drugs in large doses, chemicals get inside. This circumstance may well cause poisoning of the body, accompanied by diarrhea. As a rule, in case of poisoning, not only loose stools are observed, but also other symptoms. Usually poisoning is initially accompanied by cramps and stomach cramps. As the pathological process progresses, poisoning begins to manifest with cramping pain, vomiting, nausea, sometimes headaches, neurological symptoms, or symptoms of cardiovascular insufficiency.

One of the varieties of this type of diarrhea is the so-called "travelers' diarrhea". Although in fact this disease has a whole range of causes. It occurs in persons who try large quantities of unusual and unfamiliar food. Most often, this behavior is typical for people who travel to distant and exotic countries and want to get new sensations. However, the problem is that our gastrointestinal tract and the body as a whole are conservative in nature and, to a certain extent, are tuned to the diet to which they are accustomed since childhood. And when confronted with something new, their work is disorganized, resulting in loose stools and indigestion.

Inflammatory processes of the digestive system

Often, diarrhea accompanies inflammatory diseases of the digestive system that are not directly caused by infectious agents. With these diseases, inflammation or ulcers of the surface of the mucous membrane of the stomach and intestines are observed, which, in turn, leads to gastrointestinal disorders. In addition to stool disorders, inflammatory diseases of the stomach and duodenum are often accompanied by heartburn, characteristic belching, and an unpleasant taste in the mouth (bitter or metallic). Such diseases include:

• enteritis,
• cholecystitis,
• autoimmune diseases (for example,).

Bowel dysmotility

In diseases of this type, undigested food residues due to malfunctions in the work of the autonomic nervous system of the intestine move too quickly through it and do not have time to form solid fecal masses. Most often, diarrhea of ​​\u200b\u200bthis type is characteristic of a disease called "irritable bowel syndrome". The urge to defecate in this syndrome may appear more often than usual and be associated with moments of nervous tension. However, the total amount of feces usually does not exceed the norm, and dehydration of the body, characteristic of other types of diarrhea, as a rule, is not observed.

Dysbacteriosis

Many of the bacteria that live in our intestines are not pathogenic, but take part in the process of digestion. In the event that the number of intestinal bacteria drops dramatically, for example, in the case of taking antibiotics, then reproduction of other microorganisms can be observed, as well as malfunctions in the digestive process, which often leads to diarrhea. After restoring the balance of microflora, the stool, as a rule, returns to normal.

Diagnostics

What to do if diarrhea is chronic? To identify the causes of the pathology, you must consult a doctor. However, not all patients do this. But this is not always prudent, because it is completely unknown what pathology manifests itself due to diarrhea. It can be an accidental mild food poisoning, and a relatively harmless irritable bowel syndrome, which, in principle, can be ignored, and ulcerative colitis requiring long-term treatment, and salmonellosis, in which the patient is subject to immediate hospitalization, and extremely dangerous tumors.

As for acute diarrhea, especially if it occurs in a severe form, then, of course, here any doubts about the advisability of going to the doctor should be discarded. If diarrhea occurs in an acute form, then acute dehydration that accompanies it can often lead to death. Statistics show that more than a million children die every year from diarrhea worldwide. It must be remembered that most infectious diseases of the gastrointestinal tract are dangerous not in themselves, but in the complications associated with diarrhea.

In some cases, if we are talking about relatively mild diarrhea, the patient himself can determine the causes of diarrhea - for example, overeating or food poisoning, and draw appropriate conclusions about how to carry out treatment.

Treatment

How to treat diarrhea? It must be remembered that this is not an independent disease, but just a symptom, although quite dangerous in itself. Therefore, in order to eliminate diarrhea, it is necessary, first of all, to eliminate the pathology that caused it. However, the symptomatic treatment of diarrhea is also very important in many cases.

We will analyze the main methods that allow you to successfully treat diarrhea that has arisen. They can be both medicinal and non-pharmacological. Non-drug methods of dealing with diarrhea include diet, stomach cleansing methods, etc.

Medical treatment

First of all, medicines will help get rid of diarrhea. They can be divided into several main groups:

• sorbents,
• antibiotics and antiseptics of intra-intestinal action,
• probiotics,
• antidiarrheals,
• means for restoring fluid in the body (rehydration).

Enterosorbents are agents that absorb the contents of the stomach and intestines, bind and neutralize it, and then bring it out with feces. Thus, if loose stools are caused by some foreign agents (microorganisms or toxins), then with the help of enterosorbents they can be removed from the body.

Diarrhea is most often treated with antidiarrheals such as loperamide, which act on intestinal motility and slow down the movement of feces through it. This type of medication, however, may not be effective for all diarrhea, and sometimes they can even be harmful. Therefore, before using this type of drug, it is necessary to clarify the cause of diarrhea.

To relieve severe pain, you can use antispasmodic drugs, painkillers or anti-inflammatory drugs. However, it should be firmly understood - they can only be used if the source of pain is accurately established, the disease is diagnosed and does not threaten the patient's life. Therefore, before taking these drugs, you should consult your doctor. In some cases, painkillers can mask the development of life-threatening infectious and inflammatory processes in the gastrointestinal tract.

Fluids are a type of drug that is often not taken seriously. And it’s completely in vain, because they help the body fight dehydration. Most often, saline solutions, such as Regidron, are used for this purpose.

Preparations - probiotics are usually used if diarrhea is caused by dysbacteriosis. In the case of a decrease in the amount of normal intestinal microflora, probiotics will restore balance in the gastrointestinal tract and normalize digestion. However, in most cases, the use of these drugs alone will not be able to correct the situation.

The choice of funds from any group depends on the etiology of the disease. Therefore, in order to learn how to treat diarrhea, you must first identify the source of the problem.

If frequent loose stools are caused by food or household poisoning, then the most effective treatment is gastric lavage and / or enterosorbents. It is also necessary to take funds to restore fluid in the body.

If diarrhea is caused by an infection, it is necessary to use antibiotics prescribed by a doctor, anti-inflammatory drugs as an auxiliary element of therapy, and rehydration agents.

With irritable bowel syndrome, non-infectious colitis, enteritis and gastritis, antidiarrheal and anti-inflammatory drugs will be most effective. The method of treatment of inflammatory processes of the gastrointestinal tract is quite complicated and the therapy strategy should be determined by the doctor.

How to treat diarrhea caused by a lack of digestive enzymes? It is quite simple - first of all, enzyme preparations containing pancreatic enzymes and bile should be taken. Antidiarrheals will also be helpful.

Diet

Diet is an important part of therapy. First of all, it is necessary for those who do not know how to get rid of diarrhea. Taking any drugs in most cases will be useless if the patient at the same time eats those foods that irritate the digestive organs and help prolong the disease.

Diet largely depends on the type of disease. However, there are a number of principles that must be followed when eating.

Too fatty and sweet foods, foods that provoke active fermentation and gas formation in the stomach, carbonated drinks, spicy foods, and alcohol should be excluded from the diet. Preference should be given to boiled food, and not raw, and even more so, not fried, and not smoked. Food should be easily digestible, that is, indigestible foods such as mushrooms should be excluded from the diet. Drinking is also important. With severe dehydration, it is useful to drink saline solutions, for intestinal infections - decoctions of chamomile, rose hips, strong tea.

Prevention

Prevention includes, first of all, personal hygiene, washing and proper heat treatment of food. It is also important to follow the right diet, not to eat expired or spoiled foods, products of dubious origin, to ensure that dangerous chemicals do not get into food. It is also important to monitor your eating habits, not eat on the go or dry food, avoid stress, overwork, monitor your health and treat chronic diseases in time.

Normally, the volume of feces is on average 200 g / day, and the water content in feces is 60-75%. With diarrhea, the volume of feces increases due to an increase in the proportion of water in it. The composition of the solid components of feces can also change.

Absorption and secretion of water in the intestine

During fasting, the intestines contain very little water. With a normal diet (3 meals a day), about 9 liters of fluid enter the small intestine per day. Of these, 2 liters are consumed by food and drinks, the rest are fluids secreted into the lumen of the gastrointestinal tract throughout its entire length. Of these 9 liters, 90% is absorbed in the small intestine. Of the remaining 1-2 liters, 90% is absorbed in the large intestine. Absorption of all fluid in the lumen of the colon and dehydration of feces is prevented by the presence of non-absorbable osmotically active substances contained in food (for example, some carbohydrates) and produced by the intestinal flora. Due to this, 100-200 gets into the feces. ml of water per day. Thus, approximately 98% of the water that enters the gastrointestinal tract daily is absorbed in the intestines. Feces contain an average of 100 ml of water, 40 mmol/l sodium, 90 mmol/l potassium, 16 mmol/l chlorine, 30 mmol/l bicarbonate, and organic anions formed during the fermentation of nonabsorbable carbohydrates by bacteria. There is no dilution mechanism in the gastrointestinal tract, so the fecal osmolality cannot be less than the plasma osmolality. In fact, fecal osmolality is usually higher than plasma osmolality due to the fact that bacteria continue to break down nonabsorbable carbohydrates into osmotically active substances after defecation.

The transport of water in the intestinal epithelium occurs passively due to the osmotic gradient, which is created by the active transport of electrolytes (for example, Na + ions and SG) and other substances, such as carbohydrates and amino acids. Absorption of ions occurs mainly in epithelial cells located at the ends of the intestinal villi. The secretion of ions occurs in the crypts. The main actively absorbed ion is sodium, the main secreted ion is chlorine. Active transport of sodium is carried out in the intestine through Na +, K + -ATPase in the basolateral membranes of intestinal epithelial cells. Water is absorbed along with sodium. Active secretion of chloride ions is also carried out through Na + ,K + -ATPase, but located in the basolateral membranes of crypt cells. Water is secreted into the intestinal lumen along with chloride ions.

If, for any reason, the absorption of sodium and water ions or increased secretion of chlorine and water ions into the intestinal lumen occurs, diarrhea occurs.

Causes of diarrhea

Diarrhea is based on four main mechanisms.

• Osmotic diarrhea. In the intestinal lumen, the amount of poorly absorbed osmotically active substances is increased.
• Secretory diarrhea. Increased secretion of chlorine and water into the intestinal lumen; at the same time, the absorption of sodium and water may also be impaired.
• Inflammatory diarrhea. Mucus, blood and protein from the inflamed areas of the mucosa enter the intestinal lumen.
• peristalsis disorders. The contact of intestinal contents with the mucosa is increased or reduced.

Osmotic diarrhea

Causes of osmotic diarrhea

Osmotic diarrhea results from the entry into the gastrointestinal tract of poorly absorbed osmotically active substances, such as carbohydrates or divalent ions such as magnesium or sulfate. An increase in the osmolality of the intestinal contents leads to the flow of water through the epithelium of the duodenum and jejunum into the intestinal lumen (to dilute the chyme). Together with water, sodium enters the intestinal lumen from the plasma along a concentration gradient, which again causes an influx of water, despite the fact that the osmolality of the contents of the intestine and plasma has already leveled off. The epithelium of the ileum and colon, on the contrary, is impermeable to sodium and osmotically active substances. It has an active ion transport system, operating even at a high electrochemical gradient, due to which sodium and water are reabsorbed. Thus, after the intestinal contents enter the ileum and large intestine, part of the water is absorbed and a partial “adjustment” of the disorders occurs. Since the volume of fluid entering the large intestine still exceeds its absorption capacity, diarrhea occurs.

With lactase deficiency, dietary lactose is not absorbed in the small intestine and enters the large intestine, where it is broken down by the intestinal microflora. In this case, osmotically active substances are also formed, which increases the osmotic load and causes diarrhea.

Symptoms and signs of osmotic diarrhea

Osmotic diarrhea stops with fasting. The calculated stool osmolality is less than the osmolality measured by the drop in the freezing point of the solution. This osmotic anion gap is due to the presence of poorly absorbed osmotic active substances in the feces. An anion gap greater than 50 mosm/kg indicates osmotic diarrhea. In the diagnosis of osmotic diarrhea, determining the pH of the feces can help. Carbohydrates in the composition of feces give an acidic environment, magnesium hydroxide - alkaline, and poorly absorbed salts containing magnesium ions or sulfate - neutral.

Secretory diarrhea

Causes of secretory diarrhea

Loose stools with a volume of more than a liter per day are due to increased secretion of water through the mucous membrane into the intestinal lumen. In most cases, this is due to a simultaneous increase in active secretion and a partial suppression of absorption in the intestine. The intestinal mucosa on histological examination is often normal.

Symptoms and signs of secretory diarrhea

Secretory diarrhea is characterized by the following symptoms:

1. Large volume of feces (more than 1 l / day).
2. Watery stool.
3. There is no blood or pus in the stool.
4. Diarrhea continues even if the patient does not eat anything for 24-48 hours. However, if fatty acids are malabsorbed or if laxatives are abused, diarrhea resolves with discontinuation of these substances.
5. Fecal osmolality is close to plasma osmolality; no anion gap.

Inflammatory diarrhea

With inflammation and ulceration of the mucosa, mucus, blood and pus enter the intestinal lumen and are excreted in the feces. This may increase the osmotic load. If the mucosa is affected over a large area, the absorption of ions, other solutes and water may also be impaired, which leads to an increase in stool volume. In addition, inflammation releases prostaglandins, which stimulate secretion in the intestine and may increase intestinal motility, which also contributes to the development of diarrhea. The severity of diarrhea and general symptoms depends on the degree of mucosal damage.

The cause of inflammation can be:

• Crohn's disease, ulcerative colitis (idiopathic inflammation).
• Infections caused by microorganisms penetrating the mucosa or producing cytotoxins,
• Vasculitis.
• Ionizing radiation.
• Formation of an abscess (diverticulitis, infection of a malignant tumor).

Peristalsis disorders

Both an increase and a decrease in peristalsis can lead to diarrhea.

• With increased peristalsis of the small intestine, the contact of chyme with the absorptive surface decreases. As a result, the volume of fluid entering the large intestine may exceed its capacity for absorption, and diarrhea occurs. Due to the reduced contact of chyme with the wall of the small intestine, the absorption of fats and bile acids is disrupted, as a result of which they enter the large intestine, causing secretory diarrhea. Intestinal peristalsis can increase, leading to diarrhea, for example, with thyrotoxicosis, carcinoid, dumping syndrome.
• When the peristalsis of the small intestine is weakened, it can be colonized by bacteria that live in the large intestine. In this case, the digestion and absorption of fats, carbohydrates and bile acids can be disturbed, which leads to secretory and osmotic diarrhea. This explains the diarrhea that occurs with diabetes mellitus, hypothyroidism, systemic scleroderma, amyloidosis, after stem vagotomy.
• Increased peristalsis of the colon with premature emptying of it is the main cause of diarrhea in irritable bowel syndrome.
• Dysfunction of the anal sphincters in neuromuscular diseases, as a result of inflammation, scarring, and after operations on the rectum, can lead to fecal incontinence, which patients sometimes mistake for diarrhea.

Clinical classification of diarrhea

The clinical classification of diarrhea takes into account its duration, conditions of occurrence, characteristics of the patient's sexual life. Diarrhea with a sudden onset, lasting no more than 2-3 weeks, is considered acute. If diarrhea lasts longer than 3 weeks, it is called chronic. If diarrhea develops during or after antimicrobial therapy, pseudomembranous colitis caused by Clostridium difficile should be ruled out.

Acute diarrhea

Acute diarrhea is most often caused by an infection.

Food poisoning occurs when eating food containing bacterial toxins. Reproduction in the body of the bacteria themselves is not necessary. The disease usually begins acutely, but does not last long. Food poisoning occurs in small outbreaks without further spread.

Diarrhea caused by the multiplication of microorganisms in the intestine can be divided into two groups: with and without mucosal invasion. Most often, such diarrhea develops within 1-2 days after ingestion of food or water contaminated with pathogenic microorganisms. In some cases, animals serve as a reservoir of infection.

Diarrhea that occurs during or immediately after a trip somewhere is usually of an infectious nature.

The risk of contracting intestinal infections is higher among homosexuals. They should definitely exclude amoebiasis, giardiasis, dysentery, gonococcal proctitis, damage to the rectum with syphilis, venereal lymphogranuloma (causative agent - Chlamydia trachomatis), herpetic lesions of the rectum and perianal region. In HIV-infected people, diarrhea can also be caused by cytomegalovirus, Cryptosporidium spp. and fungi of the genus Candida.

Chronic and recurrent diarrhea

With diarrhea lasting more than 3 weeks, an additional examination is necessary.

infections. Diarrhea caused by bacterial and viral infections usually lasts no more than 3 weeks and goes away on its own. For infections caused by Campylobacter spp. and Yersinia spp., diarrhea may last for several months, but rarely becomes chronic. Amoebiasis, giardiasis, and intestinal damage in tuberculosis can take a chronic form.

Malabsorption

Diseases of the small intestine may be accompanied by diarrhea of ​​varying severity. Diarrhea in these cases, as a rule, is due to a combination of several mechanisms at once.

Diarrhea can be caused by:

1. Celiac and sprue.
2. Amyloidosis.
3. Whipple's disease.
4. Lymphomas.
5. Carcinoid.
6. Radiation enteritis.
7. Lymphangiectasia.
8. Bowel resection or anastomosis.

Zollinger-Ellison Syndrome. Increased secretion of gastrin by the tumor leads to hyperchlorhydria. The amount of hydrochloric acid exceeds the absorption capacity of the proximal small intestine, excess acid neutralizes bicarbonates and inhibits enzymes secreted by the pancreas into the duodenum.

After gastrectomy, resection of the stomach, ileo- and jejunostomy the cause of diarrhea may be a decrease in the time during which the mucous membrane is in contact with chyme, and its poor mixing with digestive juices, which leads to malabsorption.

Overgrowth of bacteria in the small intestine is observed in diabetes mellitus, systemic scleroderma, amyloidosis, blind loop syndrome, large and multiple diverticula of the small intestine. Diarrhea results from the breakdown of carbohydrates, fats, and bile acids by bacteria.

Disaccharylase Deficiency. Lactase deficiency occurs to varying degrees in many adults, especially blacks, Asians, Southern Europeans, and Jews. In such people, even a small amount of dairy products can cause diarrhea.

Endocrine diseases

• thyrotoxicosis.
• Diabetes.
• Adrenal insufficiency.
• Carcinoid.
• Medullary thyroid cancer.
• Hormonally active tumors of the pancreas.
• Tumors that secrete VIP.
• Gastrinoma.

Neoplasms. Pod wasp can develop with villous polyps, with intestinal obstruction and fecal blockages caused by colon cancer.

Medicines. When finding out the causes of chronic diarrhea, you should always remember that the patient can take laxatives and other drugs.

irritable bowel syndrome. This condition is very common and can only be manifested by intermittent diarrhea, constipation, or their alternation. Most patients also complain of cramping abdominal pain, flatulence. belching and mucus in the stool.

Fecal incontinence and frequent stools. They can be observed in violation of the function of the sphincters of the anus due to anal fissure, pararectal fistula, inflammation of the perianal tissues, ruptures of soft tissues during childbirth, anal intercourse or other trauma, diabetic neuropathy, neuromuscular diseases. Sometimes patients take these phenomena for diarrhea.

Diagnosis of diarrhea

Anamnesis

When questioning the patient, it is necessary to have a clear idea of ​​the nature of diarrhea. They find out how long the diarrhea lasts, what is the frequency, consistency, color and volume of feces, whether diarrhea is associated with eating. It is also important to find out if the patient suffers from other diseases (the exacerbation of which can cause diarrhea), whether he has general symptoms, whether he has traveled anywhere recently, what medications or drugs he is taking, and also the characteristics of his sexual life.

The collection of anamnesis helps to determine whether the pathological process is localized in the small or large intestine. If the stool is large, thin, watery, or greasy, or contains undigested food, the diarrhea is most likely caused by damage to the small intestine. The patient may complain of pain in the umbilical or right iliac region or periodic cramping pain in the abdomen.

With frequent stools in small portions with an admixture of mucus, the descending colon or rectum is most likely affected. The feces are usually mushy, brown in color, and may contain an admixture of blood and mucus. The pain is usually weak or absent at all, localized in the lower abdomen or in the sacrum. After defecation or passing gas, the pain may temporarily decrease.

Blood in the stool can indicate inflammation, vascular disease, infection, or a tumor. White blood cells in feces are a sign of inflammation.

If the diarrhea stops with fasting, it appears to be osmotic, although secretory diarrhea caused by malabsorption of fats and bile acids may also resolve with fasting. Profuse diarrhea that does not stop with fasting is most likely secretory. If the diarrhea continues at night, an organic lesion of the intestines is likely.

Food. You need to find out if diarrhea is associated with the use of milk and other dairy products, soft drinks, sweets or chewing gum containing sorbitol.

Physical examination

It is important to assess the general condition of the patient, the degree of dehydration, the presence of fever and other general symptoms of intoxication. In chronic diarrhea, a range of symptoms may be present that may indicate the cause of the diarrhea, including thyroid enlargement, rash, arthritis, neuropathy, orthostatic hypotension, vascular murmurs on abdominal auscultation; with digital rectal examination - signs of paraproctitis (pain, fluctuation), fistulous tract, volumetric formation in the rectum or fecal stones.

Laboratory and instrumental research

They begin with a complete blood count with the calculation of the leukocyte formula for determining the levels of electrolytes, BUN and creatinine. Biochemical blood tests and urinalysis also help to identify the cause of diarrhea.

Rectoromano- and colonoscopy carried out without preliminary preparation of the intestine. In this case, stool samples can be obtained by aspiration for microscopic examination and culture. In acute diarrhea or travelers' diarrhea, sigmoidoscopy is most often not needed.

• bloody diarrhea:
• diarrhea of ​​unknown etiology;
• chronic inflammatory bowel disease, pseudomembranous colitis, pancreatic disease, laxative abuse (colon melanosis).

3. X-ray examination. As a rule, the studies described above are sufficient to identify the causes of diarrhea. But in chronic or recurrent diarrhea, radiopaque examination of the small and large intestine can help identify the location and extent of intestinal damage. At the same time, it must be remembered that after barium suspension enters the intestine, a study of feces for the presence of protozoa, helminths and their eggs, as well as sowing feces for several weeks will not give results, since barium suspension affects the intestinal microflora.

4. Other studies. At. Chronic diarrhea may require other tests to evaluate malabsorption, bacterial overgrowth in the gut, or hormonal disorders.

Diarrhea treatment

Acute diarrhea with dehydration and electrolyte disturbances is one of the most important causes of death, especially in children in developing countries. To prevent the death of the patient allows rehydration by the introduction of fluids inside or in / in. For oral rehydration, a simple solution containing sodium, potassium and glucose salts is suitable. Water in the small intestine is absorbed along with sodium and glucose, the cotransport of which is not disturbed even with the most severe diarrhea.

It is also important to alleviate the patient's condition - this will improve his well-being and reduce the time spent on sick leave or the number of missed classes at school. The drugs used to treat diarrhea can be divided into the following groups according to the mechanism of action: adsorbents; drugs that inhibit the secretion of the gastrointestinal tract; opioids; M-anticholinergics; antimicrobial agents.

Adsorbents(attapulgite, aluminum hydroxide) do not affect the course of the disease, but make the stool harder. This allows the patient to better control bowel movements and reduce its frequency.

Drugs that inhibit the secretion of the gastrointestinal tract. Bismuth subsalicylate. This drug has been shown to inhibit the secretory activity of Vibrio cholerae, Shigella spp. and enterotoxigenic strains of Escherichia coli, and when taken prophylactically, it prevents infections caused by these bacteria. Bismuth subsalicylate in the form of a suspension is taken orally 30 ml every 30 minutes - a total of 8 times. The chewable tablets are just as effective as the suspension.

Opioids widely used in both acute and chronic diarrhea. By weakening peristalsis, they slow down the passage of intestinal contents, which contributes to a more complete absorption of fluid. They can be used for moderate diarrhea, but should not be used for fever and other signs of intoxication, as well as for bloody diarrhea. If the patient's condition does not improve, let alone worsens, opioids are canceled.

This group of drugs includes paregoric, loperamide and diphenoxylate/atropine. Unlike the latter, loperamide does not contain atropine and has fewer CNS side effects.

M-anticholinergics with diarrhea in most cases are useless. With irritable bowel syndrome, in some cases, dicycloverine brings relief.

Antimicrobials. In severe diarrhea with intoxication, stool culture is performed to determine pathogens. It is necessary to use the drug that is most active against this pathogen. In some cases, with severe diarrhea, if laboratory tests cannot be performed, empirical therapy is prescribed with drugs active against Shigella spp. and Campylobacter spp. (ciprofloxacin, TMP/SMK, erythromycin). Not so long ago, an antibiotic for the treatment of travelers' diarrhea, rifaximin, appeared on the pharmaceutical market. It is not absorbed in the intestines, and therefore is especially effective in intestinal infections.

The use of antibiotics in infections caused by enterohemorrhagic Escherichia coli strains is a controversial issue, since, according to some reports, the risk of hemolytic uremic syndrome increases during antibiotic therapy. However, if diarrhea is severe, antibiotics can be given with caution.

Medical prevention of traveler's diarrhea. Prophylactic use of bismuth subsalicylate, doxycycline, TMP/SMX, as well as norfloxanin and ciprofloxacin, in most cases, can prevent traveler's diarrhea. Prevention starts from the first day of the trip.

The FDA recently approved rifaximin for the treatment of travelers' diarrhea.

Medical prevention of traveler's diarrhea in most cases is not justified. All drugs have certain side effects and contribute to the development of resistance in the bacteria inhabiting the intestines. This can make it difficult to treat another condition, such as a urinary tract infection. For persons traveling on a business trip, drug prophylaxis is carried out for 2-5 days, provided that they are familiar with possible side effects. The exception is rifaximin. It is effective in preventing traveler's diarrhea when taken daily throughout a trip. At a dose of 200 mg 3 times a day orally, it is recommended for those traveling to regions where the risk of intestinal infections caused by Escherichia coli and other pathogens is high.

Chronic and recurrent diarrhea. Treatment of chronic and recurrent diarrhea is determined by the etiology and pathogenesis of the underlying disease. Occasionally, when the diagnosis cannot be established, empiric treatment is carried out. Limit the use of products containing lactose, gluten, long-chain fatty acids; prescribe pancreatic enzymes, H 2 -blockers, cholestyramine, clonidine and antimicrobial agents (eg, metronidazole). If all this does not help, opioids are prescribed with caution to alleviate the patient's condition.

Diarrhea (diarrhea) is a syndrome in which bowel movements occur more than twice a day and are accompanied by the release of loose stools.

At its core, diarrhea most often has certain disorders in the functioning of the digestive organs, but in some cases, diarrhea happens and is not associated with damage to the digestive tract.

Clinical forms:

• acute diarrhea- its duration does not exceed 3 weeks;
• chronic diarrhea - flowing longer than 20-21 days.

Main development mechanisms

• increased excretion of salts and water into the intestinal lumen;
• acceleration of intestinal peristalsis;
• violation of food digestion;
• malabsorption of digested food.

Usually, in each individual case of diarrhea, several of the listed mechanisms are involved at once.

It is difficult to find a person who has never suffered from diarrhea in his life - such a problem happens to each of us far from once. Perhaps that is why she is often treated lightly, letting things take their course and not seeking medical help in time. Meanwhile, "banal diarrhea" can be a manifestation of very serious, sometimes life-threatening diseases. With the development of diarrhea, you need to remember the main alarming symptoms that require immediate medical attention:

• the appearance in the feces of an admixture of mucus and blood;
• feces in color and consistency resemble tar (sometimes in combination with vomiting, reminiscent of coffee grounds);
• allocation of abundant watery stools more often 15-20 times a day;
• abundant light stool against the background of a drop in body temperature below normal;
• a combination of diarrhea and high fever;
• a combination of diarrhea, abdominal pain and severe vomiting;
• diarrhea lasts more than three days, despite the prescribed treatment;
• diarrhea is accompanied by impaired consciousness;
• diarrhea for more than 2 days in an elderly person or a child under one year old;
• diarrhea periodically appears for no apparent reason, accompanied by weight loss, weakness.

If you find at least one of these symptoms, you can not hesitate. But this does not mean that in other cases, seeking medical help is not necessary. Particularly serious consequences diarrhea may have in the elderly and childhood, due to the particularly rapid onset of dehydration.

Diarrhea is distinguished by a variety of not only causes, but also manifestations. First of all, this concerns the appearance of excreted feces: their consistency, color, visible impurities. This is very important for diagnosis. Consider the most common options.

Watery diarrhea ("watery diarrhea")

It can be caused by both bacterial and viral infections. The most severe of them, of course, is cholera, but salmonellosis, acute intestinal infections of viral etiology are much more common. The small intestine is affected by toxins of pathogens, this is accompanied by the release of a large amount of water and salts dissolved in it into the intestinal lumen (the stool may resemble "rice water"), without adequate replenishment of electrolyte reserves, fatal dehydration can occur. Hospitalization in a specialized hospital (department of intestinal infections) is required.

Self-diagnosis and treatment are unacceptable. Diarrhea in intestinal infections may not always be accompanied by nausea, vomiting, abdominal pain and fever (in debilitated patients, as well as in the terminal stages of cholera, body temperature may fall below normal); treatment directly depends on the type of causative agent of the disease, which cannot be determined at home.

Diarrhea with blood (with mucus and blood)

Loose stools mixed with blood and mucus indicate damage to the intestinal mucosa and in any case is an absolute indication for hospitalization. Most often this is due to pathogenic microflora (shigella, enteropathogenic intestinal bacteria, etc.). Also, bloody diarrhea with mucus can be a symptom of Crohn's disease or ulcerative colitis.

Black diarrhea

The most serious cause that can cause black liquid stools is esophageal, gastric or intestinal bleeding (for example, with esophageal varicose veins, stomach or duodenal ulcers, tumors). Blood, coming into contact with digestive enzymes, becomes black. A tar-like stool indicates a fairly heavy bleeding. If it is localized in the stomach, sometimes there is also vomiting "coffee grounds". Quite quickly, critical blood loss can occur - the patient must be taken to a surgical hospital as soon as possible. Sometimes blackening of the stool is caused by taking certain drugs (activated charcoal, iron, bismuth, vitamin and mineral complexes).

Yellow diarrhea

Often occurs in toddlers. The causes may be digestive disorders caused by both infections (most often it is a rotavirus infection, but viral hepatitis is not excluded), and other diseases of the digestive system that make it difficult to digest food and accelerate its passage through the gastrointestinal tract. Yellow stools may also be associated with certain medications.

White diarrhea

It often occurs in children under the age of one year. In this case, it can be caused by feeding some artificial mixtures, overfeeding with milk, introducing new foods into complementary foods, an excess of indigestible carbohydrates, sometimes observed during teething.

More serious causes of white diarrhea, which can occur in both children and adults: disorders in the gallbladder (partial or complete obstruction of the biliary tract), hepatitis (jaundice).

Provoke whitening of the stool can drugs that disrupt the liver (tetracycline, aspirin, ibuprofen, paracetamol, methotrexate, oral contraceptives, anti-tuberculosis drugs).

green diarrhea

Green fetid diarrhea in an adult is often associated with an increase in fermentation processes in the intestines, which can be caused by dysbacteriosis, dysentery and other intestinal infections. Bile, supersaturated with bilirubin due to increased breakdown of red blood cells or liver pathology, can give a green color to feces.

Green feces can also be excreted with an excess of foods (drinks) with artificial dyes in the diet.

Possible Complications of Diarrhea

• dehydration (up to death): this is indirectly evidenced by such signs as dry lips, tongue, decreased turgor of the skin and eyeballs, severe thirst, rapid breathing, rare urination;
• loss of salts by the body (occurs in combination with fluid loss), can cause convulsions;
• depletion of the body, hypovitaminosis (with chronic diarrhea);
• intoxication (poisoning by bacterial or viral toxins);
• hemorrhoids, prolapse of the rectum, its ulceration and fissures.

Treatment

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For the treatment of diarrhea, it is best to turn to professionals, since the causes of diarrhea can be many, and the approaches to treating each of them are fundamentally different.

If, due to special circumstances (for example, staying in remote areas), it is impossible to immediately receive medical care, the main treatment is to replenish the loss of fluid and salts, as well as to reduce intoxication (in the presence of an infection). For this, there are special salt mixtures (for example, rehydron, oralit), which are diluted with water according to the instructions and are constantly taken orally in small portions, in small sips. To reduce intoxication, sorbents (activated carbon, etc.) are used, which do not allow microbial toxins to be absorbed.

You should be especially careful with drugs that slow down intestinal motility, since a delay in the excretion of infected feces leads to increased intoxication. It should also not be without explaining the reasons diarrhea take antibiotics.

All of these measures can only be regarded as temporary, and at the first opportunity, in any case, it is necessary to seek medical help in order to clarify the diagnosis and adjust the treatment of diarrhea.

So, for example, if the cause lies in an infection, the doctor, after conducting tests, will select a suitable antimicrobial agent. With dysbacteriosis, which can be both a cause and a consequence of diarrhea, it is advisable to take special drugs that restore normal microflora. In case of enzyme deficiency, enzyme preparations may be required.

Diet for diarrhea

Diet is one of the components of treatment. Since with any diarrhea there is irritation (and often severe inflammation) of the intestinal mucosa, food should be as gentle and easily digestible as possible. For diarrhea it is recommended:

• drink more (drinks at room temperature, warm), from drinks, plain drinking water, water-salt mixtures, warm tea, weak jelly, astringent and enveloping herbal teas and infusions are preferable. Alcohol, milk, fruit juices, carbonated drinks should be avoided;
• do not eat in the absence of appetite (this is a protective reaction of the body);
• when appetite appears, you can start with secondary broths, oatmeal or rice porridge (on water), dried white bread, mashed potatoes, boiled lean meat (a little, in pureed form). Then you can try boiled and baked vegetables and fruits. Food should be semi-liquid, homogeneous, take it often and little by little;
• until the stool is completely normalized (and preferably some time after), fresh fruits and vegetables, as well as alcohol, fatty, spicy and fried foods should be avoided.

Prevention

Prevention of diarrhea primarily comes down to observing the rules of personal hygiene and sanitary standards for cooking.