How To Manage Diarrhoea

What is Diarrhoea?

Diarrhoea is a relatively common digestive issue that most people will experience at some stage throughout their lives. Diarrhoea is when we pass loose or watery stools more than 3 times a day, or more often than what is normal for you. It can range from being mild to severe and is some cases even life-threatening due to dehydration. Diarrhoea related illnesses are one on the highest causes of death worldwide. There are a few factors that can contribute to the occurrence of diarrhoea including changes to diet and lifestyle, medical conditions, stress and anxiety, infection and some medications.


Diarrhoea occurs when our intestines are unable to properly absorb the nutrients and fluid during digestion. The nutrients in the food that we eat are absorbed in our small intestine. The undigestible parts of our food then pass through to the large intestine, or colon, which absorbs most of the remaining fluid. The remaining waste is then formed into stools and collects in the end of the colon and rectum and passed out of the body during a bowel movement.


Diarrhoea can be described as being either acute or chronic. So, what’s the difference?


Acute diarrhoea: This occurs suddenly and is when we experience 3 or more loose watery stools a day which lasts for less than 2 weeks. Most of the time acute diarrhoea will resolve itself after 1-2 days. It is usually treated by replacing any fluid or electrolytes that have been lost.


Chronic diarrhoea: This is when we have had diarrhoea lasting more than 4 weeks. Chronic diarrhoea may be caused by an underlying condition such as inflammatory bowel disease (IBD), coeliac disease or irritable bowel syndrome (IBS).


What is Functional Diarrhoea?

What this means is that there is not a physical or physiological cause for your diarrhoea. A person may be otherwise healthy, however despite this, is still having trouble with experiencing a normal bowel movement. Although the prevalence of functional diarrhoea hasn’t been well studied, it is reported to occur in 1.5% to 17% of people. It is characterised by ongoing loose watery stools that do not meet the criteria for IBS, however you may experience abdominal pain or bloating.

Once other conditions have been ruled out a set of diagnostic criteria called the Rome IV Criteria for Diagnosing Functional Diarrhoea will be used to confirm if you have this. This includes whether you have had;

  • Loose or watery stools occurring in more than 25% of stools without predominate stomach pain or bloating.

You must also meet the following;

How Often Should I Have a Bowel Movement?

This is a question that I get asked quiet frequently by my clients. What is considered normal can be different from person to person as everyone’s gut and lifestyles are different, but it can range from multiple times per day to three times per week.


What’s important to remember is that occasional changes to your bowel habits are normal and having more frequent bowel movements does not mean that you have diarrhoea, as long as you are not experiencing any pain and are following your usual bowel habits. You only need to keep an on eye out for it if you start experiencing changes to your bowel habits. As I have mentioned, everyone is different, so if you have been having more than what’s “normal” for you, it may mean that you have diarrhoea.


How Do I Know if My Stools Are Normal?

The Bristol Stool Chart below is a great tool to use help you figure out if your stools are healthy or if there is anything to be concerned about. It shows the different types of stools that you can have.

  • Types 1 or 2 indicate that you have constipation.

  • Types 3 and 4 are healthy stools.

  • Type 5 means that your stools are progressing towards diarrhoea.

  • Type 6 or 7 indicate that you have diarrhoea.

Bristol Stool Chart

Symptoms of Diarrhoea

There are so many different symptoms that can be experienced with diarrhoea and it’s important to remember that these will vary from person to person.


Common symptoms can include;

  • Frequent loose, watery stools

  • Urgency to have a bowel movement

  • Bloating

  • Abdominal pain or cramps

  • Nausea

  • Vomiting

Serious symptoms can include;

  • Blood in your stools

  • Fever

  • Pus in your stools

  • Painful bowel movements

  • Ongoing vomiting

  • Unable to keep fluids down

Causes of Diarrhoea

Causes of Acute Diarrhoea

  • Stress and anxiety

  • Gastroenteritis

  • Food poisoning

  • Viruses such as calici virus, adenovirus and rotavirus

  • Travelling, this is sometimes referred to as “travellers’ diarrhoea”

  • Tropical diseases such as typhoid and cholera

  • Bacteria such salmonella, campylobacter and shigella

  • Parasites such as giardia lamblia, cryptosporidium and tapeworm

  • Alcohol

  • Caffeine

  • Medications such as antibiotics which have short-term use

Causes of Chronic Diarrhoea

  • Food Allergies

  • Food intolerances such as lactose intolerance

  • Irritable bowel syndrome, particularly IBS-D

  • Bile acid malabsorption

  • Coeliac disease

  • Inflammatory bowel disease (crohn’s disease or ulcerative colitis)

  • Chronic constipation

  • This can cause the bowel to become blocked with hard stools. This can lead to the bowel leaking watery stools around the blockage. This is called overflow diarrhoea.

  • Hormonal disorders such as hyperthyroidism & diabetes

  • Bowel Cancer

  • Medications including antibiotics, antacids that contain magnesium, laxatives and those to treat cancer

My Expert Tips to Help You Manage Diarrhoea

1. Choose foods that are high in soluble fibre.

  • These include oats, high-fibre cereals, barley, white bread, white rice, pasta and bananas.

  • Peel the skin off fruit and vegetables.

  • Soluble fibre slows digestion which helps with absorbing excess fluid in your bowel and makes your stools firmer.

2. Eat foods with protein every day.

  • Choose lean meats including chicken and beef, fish, eggs and tofu.

3. Drink plenty of fluids to avoid dehydration.

  • This can include water, diluted juice or cordial and herbal teas.

  • Drink them at room temperature.

  • If you are experiencing severe diarrhoea, oral rehydration solutions such as Hydralyte may be helpful.

4. Eat small, frequent meals throughout the day rather than large meals.

  • Try to eat every 2-3 hours.

  • Be sure to include a range of foods from all the 5 food groups including grains, proteins, dairy and alternatives, peeled fruit and vegetables.

5. Take time to relax and decrease stress and anxiety.

  • This can include relaxation tapes, yoga, or massage as these may help improve gut symptoms.

  • Try gentle exercise such as walking.

6. Avoid alcohol, juice, soft drinks and caffeinated drinks such as tea and coffee.


7. Reduce your intake of insoluble fibre.

  • Avoid unpeeled fruits and vegetables, bran, wholemeal bread, wheat-based cereals, brown rice, dried beans, nuts and seeds.

  • You can replace wholegrain breads and cereals with white versions of these.

8. Fibre supplements containing soluble fibre may also be helpful.

  • These include psyllium, oats and methylcellulose.

  • Make sure to increase your intake of these slowly.

9. Limit your intake of high fat and spicy foods.

  • Avoid take-away and deep-fried foods, pastries, cream sauces, chips, butter and sausages.

  • Avoid foods with chilli in them.

10. Avoid “sugar free” foods and those with artificial sweeteners such as chewing gum and lollies.


11. Try a probiotic. Although everyone is different and what works for one person may not work for another, there is some evidence to suggest that probiotics containing Bifidobacterium infantis 1×108 may help improve diarrhoea.


12. Manage any underlying conditions that may be contributing to your diarrhoea such as IBD or speak with your doctor about investigating and eliminating any potential medical conditions that may be causing your diarrhoea.


13. If you have IBS go back to basics by following the low FODMAP diet until your diarrhoea has improved.


14. Speak with an Accredited Practising Dietitian to get tailored advice and management strategies to improve your diarrhoea.


15. If diarrhoea is severe you may need anti-diarrhoeal medication. Make sure to speak with your doctor to see which is most suitable for you.

If you would like some support to take control of your IBS, click here to watch my program video to learn how I can help you eliminate your bloating, constipation and diarrhoea WITHOUT feeling confused or overwhelmed.

References

  1. Bijkerk CJ, Muris JWM, Knottnerus JA, et al (2004). Systematic review:the role of different types of fibre in the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 19:245–51.

  2. Chey WD, Kurlander J & Eswaran S (2015). Irritable bowel syndrome: a clinical review. The Journal of the American Medical Association. 313:949-58.

  3. Drossman DA (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology. 150:1262–1279.

  4. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 420-467.

  5. Gorbach SL (1997). Treating diarrhoea. BMJ. 314(7097):1776-7.

  6. Lacy BE, Mearin F, Chang L et al (2016). Bowel Disorders. Gastroenterology. 150:1393-1407.e5.

  7. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). Functional bowel disorders. Gastroenterology. 130: 1480–149.

  8. National Health and Medical Research Council. Eat for Health-Australian Dietary Guidelines. Canberra; 2013.

  9. National Institute for Health and Care Excellence (NICE) (2008). Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. CG61.

  10. Schmulson MJ & Drossman DA (2017). What Is New in Rome IV. Journal of Neurogastroenterology and Motility. 23(2): 2093-0879.

  11. Thomas PD, Forbes A, Green J et al (2003). Guidelines for the investigation of chronic diarrhoea, Second edition. Gut. 52(Suppl V): v1–v15.

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