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| Boilerpipe Text | Diarrhea
Other names
Diarrhoea (or diarrhÅa)
An electron micrograph of
rotavirus
, the cause of nearly 40% of hospitalizations from diarrhea in children under five
[
1
]
Pronunciation
Specialty
Infectious disease
,
gastroenterology
Symptoms
Loose frequent bowel movements,
dehydration
[
2
]
Causes
Usually infection (viral, bacterial, parasitic)
[
2
]
Risk factors
Contaminated food or water
[
2
]
Prevention
Handwashing
,
rotavirus vaccination
,
breastfeeding
[
2
]
Treatment
Oral rehydration solution
,
zinc supplementation
[
2
]
Frequency
ā2.4 billion (2015)
[
3
]
Deaths
1.53 million (2019)
[
4
]
Diarrhea
(
American English
), also spelled
diarrhoea
or
diarrhÅa
(
British English
), is the condition of having at least three loose, liquid, or watery
bowel movements
in a day.
[
2
]
It often lasts for a few days and can result in
dehydration
due to fluid loss.
[
2
]
Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour.
[
2
]
This can progress to decreased
urination
,
loss of skin color
, a
fast heart rate
, and a
decrease in responsiveness
as it becomes more severe.
[
2
]
Loose but non-watery
stools
in babies who are exclusively
breastfed
, however, are normal.
[
2
]
What is diarrhea? How is it caused, treated and prevented? (see also
script
)
The most common cause is an infection of the
intestines
due to a
virus
,
bacterium
, or
parasite
āa condition also known as
gastroenteritis
.
[
2
]
These infections are often acquired from food or water that has been contaminated by
feces
, or directly from another person who is infected.
[
2
]
The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody).
[
2
]
The short duration watery diarrhea may be due to
cholera
, although this is rare in the developed world.
[
2
]
If blood is present, it is also known as
dysentery
.
[
2
]
A number of non-infectious causes can result in diarrhea.
[
5
]
These include
lactose intolerance
, side effect of
drug withdrawal
,
irritable bowel syndrome
,
non-celiac gluten sensitivity
,
celiac disease
,
inflammatory bowel disease
such as
ulcerative colitis
,
hyperthyroidism
,
bile acid diarrhea
, and a number of medications.
[
5
]
[
6
]
[
7
]
In most cases,
stool cultures
to confirm the exact cause are not required.
[
8
]
Diarrhea can be prevented by improved
sanitation
, clean
drinking water
, and
hand washing
with soap.
[
2
]
Breastfeeding
for at least six months and
vaccination against rotavirus
is also recommended.
[
2
]
Oral rehydration solution
(ORS)āclean water with modest amounts of salts and
sugar
āis the treatment of choice.
[
2
]
Zinc tablets
are also recommended.
[
2
]
These treatments have been estimated to have saved 50Ā million children in the past 25 years.
[
1
]
When people have diarrhea it is recommended that they continue to eat healthy food, and babies continue to be breastfed.
[
2
]
If commercial ORS is not available, homemade solutions may be used.
[
9
]
In those with severe dehydration,
intravenous fluids
may be required.
[
2
]
Most cases, however, can be managed well with fluids by mouth.
[
10
]
Antibiotics
, while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe
diarrhea following travelling
, and those who grow specific bacteria or parasites in their stool.
[
8
]
Loperamide
may help decrease the number of bowel movements but is not recommended in those with severe disease.
[
8
]
About 1.7 to 5Ā billion cases of diarrhea occur per year.
[
2
]
[
5
]
[
11
]
It is most common in
developing countries
, where young children get diarrhea on average three times a year.
[
2
]
Total deaths from diarrhea are estimated at 1.53Ā million in 2019ādown from 2.9 million in 1990.
[
4
]
In 2012, it was the second most common cause of
deaths in children
younger than five (0.76 million or 11%).
[
2
]
[
12
]
Frequent episodes of diarrhea are also a common cause of
malnutrition
and the most common cause in those younger than five years of age.
[
2
]
Other long term problems that can result include
stunted growth
and poor intellectual development.
[
12
]
Terminology
The word diarrhea is from the
Ancient Greek
Ī“Ī¹Ī¬ĻĻĪæĪ¹Ī±
from
Ī“Ī¹Ī¬
dia
"through" and
įæ„ĪĻ
rheo
"flow".
Diarrhea
is the spelling in
American English
, whereas
diarrhoea
is the spelling in
British English
.
Canadian English
uses both spellings.
Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain
[
13
]
), "
Hershey
squirts", "
Montezuma
's Revenge", and "the trots".
[
14
]
[
15
]
Definition
Bristol stool scale
Diarrhea is defined by the
World Health Organization
as having three or more loose or liquid
stools
per day, or as having more stools than is normal for that person.
[
2
]
Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by
World Gastroenterology Organization
.
[
16
]
Acute diarrhea that is watery may be known as AWD (Acute Watery Diarrhoea.)
[
17
]
Secretory
Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a
cholera toxin
that stimulates the secretion of
anions
, especially
chloride
ions (Cl
ā
). Therefore, to maintain a charge balance in the
gastrointestinal tract
, sodium (Na
+
) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is
isotonic
with plasma even during fasting.
[
18
]
[
19
]
It continues even when there is no oral food intake.
Osmotic
Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea.
[
20
]
[
19
]
Osmotic diarrhea can also result from maldigestion (e.g., pancreatic disease or
coeliac disease
) in which the nutrients are left in the
lumen
to pull in water. Or it can be caused by osmotic
laxatives
(which work to alleviate
constipation
by drawing water into the bowels). In healthy individuals, too much
magnesium
,
vitaminĀ C
or undigested
lactose
can produce osmotic diarrhea and distention of the bowel. A person who has
lactose intolerance
can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have
fructose malabsorption
, excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea.
Sugar alcohols
such as
sorbitol
(often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea.
[
18
]
In most of these cases, osmotic diarrhea stops when the offending agent (e.g., milk or sorbitol) is stopped.
Exudative
Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with
inflammatory bowel diseases
, such as
Crohn's disease
or
ulcerative colitis
, and other severe infections such as
E.Ā coli
or other forms of food poisoning.
[
19
]
[
18
]
Inflammatory
Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea.
[
21
]
It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.
[
19
]
Dysentery
If there is blood visible in the stools, it is also known as
dysentery
. The blood is a trace of an invasion of bowel tissue. Dysentery is a symptom of, among others,
Shigella
,
Entamoeba histolytica
, and
Salmonella
.
[
19
]
Health effects
Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults",
[
22
]
and diarrhea is a primary cause of childhood malnutrition.
[
23
]
Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for
helminth
infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on a series of tests of intelligence.
[
22
]
[
24
]
Diarrhea can cause
electrolyte imbalances
,
kidney impairment
,
dehydration
, and defective
immune system
responses. When oral drugs are administered, the efficiency of the drug is to produce a
therapeutic effect
and the lack of this effect may be due to the medication travelling too quickly through the digestive system, limiting the time that it can be absorbed. Clinicians try to treat the diarrheas by reducing the dosage of medication, changing the dosing schedule, discontinuation of the drug, and rehydration. The interventions to control the diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the leading factors for placing older adults in
long term care facilities
(nursing homes).
[
19
]
Causes
Diagram of the
human gastrointestinal tract
In the latter stages of human digestion, ingested materials are inundated with water and digestive fluids such as
gastric acid
,
bile
, and
digestive enzymes
in order to break them down into their nutrient components, which are then absorbed into the bloodstream via the
intestinal tract
in the small intestine. Prior to defecation, the large intestine reabsorbs the water and other digestive solvents in the waste product in order to maintain proper hydration and overall equilibrium.
[
25
]
Diarrhea occurs when the large intestine is prevented, for any number of reasons, from sufficiently absorbing the water or other digestive fluids from fecal matter, resulting in a liquid, or "loose", bowel movement.
[
26
]
Acute
diarrhea is most commonly due to viral
gastroenteritis
with
rotavirus
, which accounts for 40% of cases in children under five.
[
1
]
In
travelers
, however,
bacterial infections
predominate.
[
27
]
Various toxins such as
mushroom poisoning
and drugs can also cause acute diarrhea.
Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include
ulcerative colitis
,
Crohn's disease
,
microscopic colitis
,
celiac disease
,
irritable bowel syndrome
, and
bile acid malabsorption
.
[
28
]
Infections
There are many causes of infectious diarrhea, which include
viruses
,
bacteria
and parasites.
[
29
]
Infectious diarrhea is frequently referred to as
gastroenteritis
.
[
30
]
Norovirus
is the most common cause of viral diarrhea in adults,
[
31
]
but
rotavirus
is the most common cause in children under five years old.
[
32
]
Adenovirus
types 40 and 41,
[
33
]
and
astroviruses
cause a significant number of infections.
[
34
]
Shiga-toxin producing
Escherichia coli
, such as
E.Ā coli
o157:h7
, are the most common cause of infectious bloody diarrhea in the United States.
[
35
]
Campylobacter
spp.
are a common cause of bacterial diarrhea, but infections by
Salmonella
spp.,
Shigella
spp. and some strains of
Escherichia coli
are also a frequent cause.
[
36
]
In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by
Clostridioides difficile
often causes severe diarrhea.
[
37
]
Parasites, particularly
protozoa
e.g.,
Cryptosporidium
spp.,
Giardia
spp.,
Entamoeba histolytica
,
Blastocystis
spp.,
Cyclospora cayetanensis
, are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent
nitazoxanide
has shown efficacy against many diarrhea-causing parasites.
[
38
]
Other infectious agents, such as
parasites
or
bacterial
toxins, may exacerbate symptoms.
[
27
]
In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or
malnourished
individuals, diarrhea can lead to severe
dehydration
and can become life-threatening.
[
39
]
Sanitation
Poverty often leads to unhygienic living conditions, as in this community in the Indian Himalayas. Such conditions promote contraction of diarrheal diseases, as a result of poor
sanitation
and
hygiene
.
Open defecation
is a leading cause of infectious diarrhea leading to death.
[
40
]
Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste (
sanitation
), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea
Ā
... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care."
[
41
]
One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human
pathogens
.
[
42
]
Nutrition
Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system.
Zinc deficiency
, a condition often found in children in
developing countries
can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system.
[
43
]
[
44
]
Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever.
[
45
]
Similarly,
vitamin A deficiency
can cause an increase in the severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status,
[
46
]
others suggest an increase in the rate associated with deficiency.
[
47
]
Given that estimates suggest 127Ā million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction.
[
48
]
Malabsorption
Malabsorption
is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the
pancreas
.
Causes include:
[
citation needed
]
enzyme deficiencies or mucosal abnormality
, as in
food allergy
and
food intolerance
, e.g.
celiac disease
(gluten intolerance),
lactose intolerance
(intolerance to milk sugar, common in non-Europeans), and
fructose malabsorption
.
pernicious anemia
, or impaired bowel function due to the inability to absorb
vitamin B
12
,
loss of pancreatic secretions
, which may be due to
cystic fibrosis
or
pancreatitis
,
structural defects
, like
short bowel syndrome
(surgically removed bowel) and radiation fibrosis, such as usually follows cancer treatment and other drugs, including agents used in
chemotherapy
; and
certain drugs
, like
orlistat
, which inhibits the absorption of fat.
Inflammatory bowel disease
The two overlapping types here are of unknown origin:
Ulcerative colitis
is marked by chronic bloody diarrhea and inflammation mostly affects the distal
colon
near the
rectum
.
Crohn's disease
typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.
Irritable bowel syndrome
Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by
defecation
and unusual
stool
(diarrhea or
constipation
) for at least three days a week over the previous three months.
[
49
]
Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as
loperamide
or
codeine
. About 30% of patients with diarrhea-predominant IBS have
bile acid malabsorption
diagnosed with an abnormal
SeHCAT
test.
[
50
]
Other diseases
Diarrhea can be caused by other diseases and conditions, namely:
Chronic
ethanol
ingestion
[
51
]
Hyperthyroidism
[
52
]
Certain medications
[
52
]
Bile acid malabsorption
[
52
]
Ischemic
bowel disease: This usually affects older people and can be due to blocked arteries.
Microscopic colitis
, a type of
inflammatory bowel disease
where changes are seen only on histological examination of colonic biopsies.
Bile salt malabsorption
(
primary bile acid diarrhea
) where excessive
bile acids
in the
colon
produce a secretory diarrhea.
Hormone-secreting tumors: some hormones, e.g.
serotonin
, can cause diarrhea if secreted in excess (usually from a tumor).
Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is called
toddler's diarrhea
.
Environmental enteropathy
Radiation enteropathy
following treatment for pelvic and abdominal cancers.
Mast cell activation syndrome
(MCAS)
[
53
]
[
54
]
[
55
]
Drug withdrawal
side effect.
Medications
Over 700 medications, such as
penicillin
, are known to cause diarrhea.
[
56
]
[
57
]
The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements.
[
19
]
Pathophysiology
Ion transporters targeted by enteric infections
[
58
]
Function Ā
Transporter
Absorption
NHE
,
SGLT1
,
ENaC
,
DRA
Secretion
CaCC
,
NKCC1
,
CFTR
Absorption and secretion
Sodium potassium ATPase
Evolution
According to two researchers,
Nesse
and
Williams
, diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery.
[
59
]
They cite in support of this argument research published in 1973 that found that treating
Shigella
with the anti-diarrhea drug (Co-phenotrope,
Lomotil
) caused people to stay
feverish
twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".
[
60
]
Diagnostic approach
The following types of diarrhea may indicate further investigation is needed:
In infants
Moderate or severe diarrhea in young children
Associated with blood
Continues for more than two days
Associated non-cramping
abdominal pain
,
fever
,
weight loss
, etc.
In
travelers
In food handlers, because of the potential to infect others;
In institutions such as hospitals, child care centers, or geriatric and convalescent homes.
A severity score is used to aid diagnosis in children.
[
61
]
When diarrhea lasts for more than four weeks a number of further tests may be recommended including:
[
62
]
Complete blood count
and a
ferritin
if
anemia
is present
Thyroid stimulating hormone
Tissue transglutaminase
for
celiac disease
Fecal
calprotectin
to exclude
inflammatory bowel disease
Stool tests
for ova and parasites as well as for
Clostridioides difficile
A
colonoscopy
or fecal immunochemical testing for cancer, including biopsies to detect
microscopic colitis
Testing for
bile acid diarrhea
with
SeHCAT
,
7Ī±-hydroxy-4-cholesten-3-one
or fecal
bile acids
depending on availability
Hydrogen breath test
looking for
lactose intolerance
Further tests if
immunodeficiency
,
pelvic radiation disease
or
small intestinal bacterial overgrowth
suspected.
A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for
giardia
.
[
63
]
Erythrocyte sedimentation rate
(ESR) and
C-reactive protein
(CRP) were not recommended.
[
63
]
Epidemiology
Deaths due to diarrhoeal diseases per million persons in 2012
Ā
Ā 0ā2
Ā
Ā 3ā10
Ā
Ā 11ā18
Ā
Ā 19ā30
Ā
Ā 31ā46
Ā
Ā 47ā80
Ā
Ā 81ā221
Ā
Ā 222ā450
Ā
Ā 451ā606
Ā
Ā 607ā1799
Disability-adjusted life year
for diarrhea per 100,000Ā inhabitants in 2004
[
64
]
Ā
Ā no data
Ā
Ā <Ā 500
Ā
Ā 500ā1000
Ā
Ā 1000ā1500
Ā
Ā 1500ā2000
Ā
Ā 2000ā2500
Ā
Ā 2500ā3000
Ā
Ā 3000ā3500
Ā
Ā 3500ā4000
Ā
Ā 4000ā4500
Ā
Ā 4500ā5000
Ā
Ā 5000ā6000
Ā
Ā >Ā 6000
Worldwide in 2004, approximately 2.5Ā billion cases of diarrhea occurred, which resulted in 1.5Ā million deaths among children under the age of five.
[
1
]
Greater than half of these were in Africa and South Asia.
[
1
]
This is down from a death rate of 4.5 million in 1980 for gastroenteritis.
[
65
]
Diarrhea remains the second leading cause of
infant mortality
(16%) after
pneumonia
(17%) in this age group.
[
1
]
The majority of such cases occur in the developing world, with over half of the recorded cases of childhood diarrhea occurring in
Africa
and
Asia
, with 696 million and 1.2 billion cases, respectively, compared to only 480 million in the rest of the world.
[
66
]
Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days.
[
67
]
[
68
]
In the Americas, diarrheal disease accounts for a total of 10% of deaths among children aged 1ā59 months while in South East Asia, it accounts for 31.3% of deaths.
[
69
]
It is estimated that around 21% of child mortalities in developing countries are due to diarrheal disease.
[
70
]
The
World Health Organization
has reported that "deaths due to diarrhoeal diseases have dropped by 45%, from sixth leading cause of death in 2000 to thirteenth in 2021."
[
71
]
Climate change can cause
an increase in diarrhoeal diseases. Bacteria proliferate with an increase with ambient temperature, and following heavy rainfall and
flooding
events. Heavy rainfall and flooding can also affect pathogen transmission by impacting sanitation and/or drinking water treatment infrastructure, contaminating drinking water sources or food products.
[
72
]
Even though diarrhea is best known in humans, it affects many other species, notably among
primates
.
[
73
]
The
cecal appendix
, when present, appears to afford some protection against diarrhea to young primates.
[
74
]
Prevention
Sanitation
Numerous studies have shown that improvements in drinking water and sanitation (
WASH
) lead to decreased risks of diarrhoea.
[
75
]
Such improvements might include for example use of water filters, provision of high-quality
piped water
and
sewer
connections.
[
75
]
In institutions, communities, and households, interventions that promote
hand washing
with soap lead to significant reductions in the incidence of diarrhea.
[
76
]
The same applies to preventing
open defecation
at a community-wide level and providing access to
improved sanitation
.
[
67
]
[
77
]
This includes use of
toilets
and implementation of the entire
sanitation
chain connected to the toilets (collection, transport, disposal or reuse of
human excreta
).
There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease.
[
78
]
[
79
]
Hand washing
Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30ā48%.
[
80
]
[
81
]
[
76
]
Hand washing in developing countries, however, is compromised by poverty as acknowledged by the
CDC
: "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours.
[
82
]
Water
Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean
water supply
and
improved sanitation
have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene.
[
42
]
[
83
]
Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22ā27% reduction in disease incidence, and a 21ā30% reduction in mortality rate associated with diarrheal disease.
[
84
]
Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens.
[
85
]
Vaccination
Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2ā3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6ā10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease.
[
86
]
Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society.
[
87
]
[
88
]
Rotavirus vaccine
decreases the rates of diarrhea in a population.
[
1
]
[
89
]
New vaccines against rotavirus,
Shigella
,
Enterotoxigenic
Escherichia coli
(ETEC)
, and cholera are under development, as well as other causes of infectious diarrhea.
[
medical citation needed
]
Nutrition
Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group.
[
90
]
[
91
]
The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence.
[
92
]
Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective.
[
93
]
Breastfeeding
Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive
exclusive breastfeeding
during their first 6 months of life are better protected against infection with diarrheal diseases.
[
94
]
One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants.
[
95
]
Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the
WHO
,
[
96
]
[
97
]
with continued breastfeeding until at least two years of age.
[
97
]
Others
Probiotics
decrease the risk of diarrhea in those taking
antibiotics
.
[
98
]
Insecticide
spraying may reduce fly numbers and the risk of diarrhea in children in a setting where there is seasonal variations in fly numbers throughout the year.
[
99
]
Management
In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth ā
oral rehydration therapy
ā or, in severe cases,
intravenously
.
[
1
]
Diet restrictions such as the
BRAT diet
are no longer recommended.
[
100
]
Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea.
[
101
]
To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain, and that continuing to eat also speeds up recovery of normal intestinal functioning.
[
20
]
CDC recommends that children and adults with cholera also continue to eat.
[
102
]
There is no evidence that early refeeding in children can cause an increase in inappropriate use of intravenous fluid, episodes of vomiting, and risk of having persistent diarrhea.
[
103
]
Medications such as
loperamide
(Imodium) and
bismuth subsalicylate
may be beneficial; however they may be
contraindicated
in certain situations.
[
104
]
Fluids
A person consuming oral rehydration solution
Oral rehydration solution (ORS)
(a slightly sweetened and salty water) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given.
[
20
]
There are commercial solutions such as
Pedialyte
, and relief agencies such as
UNICEF
widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added
[
20
]
(approximately the "taste of tears"
[
105
]
). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness.
[
106
]
Both agree that drinks with too much sugar or salt can make dehydration worse.
[
20
]
[
106
]
Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible.
[
20
]
In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment.
[
102
]
Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly.
[
20
]
Drinks especially high in simple sugars, such as
soft drinks
and fruit juices, are not recommended in children under five as they may
increase
dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water.
[
20
]
[
107
]
Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable.
[
107
]
Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall.
[
20
]
A
nasogastric tube
can be used in young children to administer fluids if warranted.
[
108
]
Eating
The WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. The WHO states "Food should
never
be withheld and the child's usual foods should
not
be diluted. Breastfeeding should
always
be continued."
[
20
]
In the specific example of cholera, the CDC makes the same recommendation.
[
102
]
Breast-fed infants with diarrhea often choose to breastfeed more, and should be encouraged to do so.
[
20
]
In young children who are not breast-fed and live in the developed world, a lactose-free diet may be useful to speed recovery.
[
109
]
Eating food containing
soluble fibre
may help, but insoluble fibre might make it worse.
[
110
]
Medications
Antidiarrheal agents can be classified into four different groups: antimotility, antisecretory, adsorbent, and anti-infectious.
[
111
]
While
antibiotics
are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations.
[
112
]
[
113
]
There are concerns that antibiotics may increase the risk of
hemolytic uremic syndrome
in people infected with
Escherichia coli
O157:H7
.
[
114
]
In resource-poor countries, treatment with antibiotics may be beneficial.
[
113
]
However, some bacteria are developing
antibiotic resistance
, particularly
Shigella
.
[
115
]
Antibiotics can also cause diarrhea, and
antibiotic-associated diarrhea
is the most common adverse effect of treatment with general antibiotics.
While bismuth compounds (
Pepto-Bismol
) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness.
[
116
]
Anti-motility agents like
loperamide
are also effective at reducing the number of stools but not the duration of disease.
[
8
]
These agents should be used only if bloody diarrhea is not present.
[
117
]
Diosmectite
, a natural aluminomagnesium silicate clay, is effective in alleviating symptoms of acute diarrhea in children,
[
118
]
and also has some effects in chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea.
[
52
]
Another absorbent agent used for the treatment of mild diarrhea is
kaopectate
.
Racecadotril
an antisecretory medication may be used to treat diarrhea in children and adults.
[
111
]
It has better tolerability than
loperamide
, as it causes less
constipation
and
flatulence
.
[
119
]
However, it has little benefit in improving acute diarrhea in children.
[
120
]
Bile acid sequestrants
such as
cholestyramine
can be effective in chronic diarrhea due to
bile acid malabsorption
. Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as
SeHCAT
retention.
[
121
]
Alternative therapies
Green bananas improved recovery, reduced dehydration and prevented prolonged diarrhea in children with diarrhea.
[
122
]
The benefit was attributed to its production of
short-chain fatty acids
in the colon from its
resistant starch
content, which enhances colonic water and electrolyte absorption.
Zinc supplementation may benefit children over six months old with diarrhea in areas with high rates of malnourishment or zinc deficiency.
[
123
]
This supports the World Health Organization guidelines for zinc, but not in the very young.
A Cochrane Review from 2020 concludes that
probiotics
make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration.
[
124
]
The
probiotic
Lactobacillus
can help prevent
antibiotic-associated diarrhea
in adults but possibly not children.
[
125
]
For those with
lactose intolerance
, taking digestive
enzymes
containing
lactase
when consuming dairy products often improves symptoms.
See also
Climate change and infectious diseases
Mucorrhea
Ā ā Discharge of mucus
Fernando Mazariegos
Ā ā Guatemalan scientist (1938ā2018)
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Pharmacotherapy
.
30
(2):
119ā
26.
doi
:
10.1592/phco.30.2.119
.
PMID
Ā
20099986
.
S2CID
Ā
21836205
.
External links
WHO fact sheet on diarrhoeal disease |
| Markdown | [Jump to content](https://en.wikipedia.org/wiki/Diarrhea#bodyContent)
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## Contents
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- [(Top)](https://en.wikipedia.org/wiki/Diarrhea)
- [1 Terminology](https://en.wikipedia.org/wiki/Diarrhea#Terminology)
- [2 Definition](https://en.wikipedia.org/wiki/Diarrhea#Definition)
Toggle Definition subsection
- [2\.1 Secretory](https://en.wikipedia.org/wiki/Diarrhea#Secretory)
- [2\.2 Osmotic](https://en.wikipedia.org/wiki/Diarrhea#Osmotic)
- [2\.3 Exudative](https://en.wikipedia.org/wiki/Diarrhea#Exudative)
- [2\.4 Inflammatory](https://en.wikipedia.org/wiki/Diarrhea#Inflammatory)
- [2\.5 Dysentery](https://en.wikipedia.org/wiki/Diarrhea#Dysentery)
- [3 Health effects](https://en.wikipedia.org/wiki/Diarrhea#Health_effects)
- [4 Causes](https://en.wikipedia.org/wiki/Diarrhea#Causes)
Toggle Causes subsection
- [4\.1 Infections](https://en.wikipedia.org/wiki/Diarrhea#Infections)
- [4\.1.1 Sanitation](https://en.wikipedia.org/wiki/Diarrhea#Sanitation)
- [4\.1.2 Nutrition](https://en.wikipedia.org/wiki/Diarrhea#Nutrition)
- [4\.2 Malabsorption](https://en.wikipedia.org/wiki/Diarrhea#Malabsorption)
- [4\.3 Inflammatory bowel disease](https://en.wikipedia.org/wiki/Diarrhea#Inflammatory_bowel_disease)
- [4\.4 Irritable bowel syndrome](https://en.wikipedia.org/wiki/Diarrhea#Irritable_bowel_syndrome)
- [4\.5 Other diseases](https://en.wikipedia.org/wiki/Diarrhea#Other_diseases)
- [4\.6 Medications](https://en.wikipedia.org/wiki/Diarrhea#Medications)
- [5 Pathophysiology](https://en.wikipedia.org/wiki/Diarrhea#Pathophysiology)
Toggle Pathophysiology subsection
- [5\.1 Evolution](https://en.wikipedia.org/wiki/Diarrhea#Evolution)
- [6 Diagnostic approach](https://en.wikipedia.org/wiki/Diarrhea#Diagnostic_approach)
- [7 Epidemiology](https://en.wikipedia.org/wiki/Diarrhea#Epidemiology)
- [8 Prevention](https://en.wikipedia.org/wiki/Diarrhea#Prevention)
Toggle Prevention subsection
- [8\.1 Sanitation](https://en.wikipedia.org/wiki/Diarrhea#Sanitation_2)
- [8\.1.1 Hand washing](https://en.wikipedia.org/wiki/Diarrhea#Hand_washing)
- [8\.1.2 Water](https://en.wikipedia.org/wiki/Diarrhea#Water)
- [8\.2 Vaccination](https://en.wikipedia.org/wiki/Diarrhea#Vaccination)
- [8\.3 Nutrition](https://en.wikipedia.org/wiki/Diarrhea#Nutrition_2)
- [8\.3.1 Breastfeeding](https://en.wikipedia.org/wiki/Diarrhea#Breastfeeding)
- [8\.4 Others](https://en.wikipedia.org/wiki/Diarrhea#Others)
- [9 Management](https://en.wikipedia.org/wiki/Diarrhea#Management)
Toggle Management subsection
- [9\.1 Fluids](https://en.wikipedia.org/wiki/Diarrhea#Fluids)
- [9\.2 Eating](https://en.wikipedia.org/wiki/Diarrhea#Eating)
- [9\.3 Medications](https://en.wikipedia.org/wiki/Diarrhea#Medications_2)
- [9\.4 Alternative therapies](https://en.wikipedia.org/wiki/Diarrhea#Alternative_therapies)
- [10 See also](https://en.wikipedia.org/wiki/Diarrhea#See_also)
- [11 References](https://en.wikipedia.org/wiki/Diarrhea#References)
- [12 External links](https://en.wikipedia.org/wiki/Diarrhea#External_links)
Toggle the table of contents
# Diarrhea
123 languages
- [Afrikaans](https://af.wikipedia.org/wiki/Diarree "Diarree ā Afrikaans")
- [Ćnglisc](https://ang.wikipedia.org/wiki/Mete%C5%ABtsiht "MeteÅ«tsiht ā Old English")
- [Ų§ŁŲ¹Ų±ŲØŁŲ©](https://ar.wikipedia.org/wiki/%D8%A5%D8%B3%D9%87%D8%A7%D9%84 "Ų„Ų³ŁŲ§Ł ā Arabic")
- [Asturianu](https://ast.wikipedia.org/wiki/Foria "Foria ā Asturian")
- [Aymar aru](https://ay.wikipedia.org/wiki/Jiphilla_jaqukipata "Jiphilla jaqukipata ā Aymara")
- [AzÉrbaycanca](https://az.wikipedia.org/wiki/Diareya "Diareya ā Azerbaijani")
- [ŲŖŪŲ±Ś©Ų¬Ł](https://azb.wikipedia.org/wiki/%D8%A7%DB%8C%D8%B3%D9%87%D8%A7%D9%84 "Ų§ŪŲ³ŁŲ§Ł ā South Azerbaijani")
- [ŠŠµŠ»Š°ŃŃŃŠŗŠ°Ń (ŃŠ°ŃŠ°ŃŠŗŠµŠ²ŃŃŠ°)](https://be-tarask.wikipedia.org/wiki/%D0%94%D1%8B%D1%8F%D1%80%D1%8D%D1%8F "ŠŃŃŃŃŃ ā Belarusian (TaraÅ”kievica orthography)")
- [ŠŠµŠ»Š°ŃŃŃŠŗŠ°Ń](https://be.wikipedia.org/wiki/%D0%94%D1%8B%D1%8F%D1%80%D1%8D%D1%8F "ŠŃŃŃŃŃ ā Belarusian")
- [ŠŃŠ»Š³Š°ŃŃŠŗŠø](https://bg.wikipedia.org/wiki/%D0%94%D0%B8%D0%B0%D1%80%D0%B8%D1%8F "ŠŠøŠ°ŃŠøŃ ā Bulgarian")
- [ą¤ą„ą¤ą¤Ŗą„ą¤°ą„](https://bh.wikipedia.org/wiki/%E0%A4%A1%E0%A4%BE%E0%A4%AF%E0%A4%B0%E0%A4%BF%E0%A4%AF%E0%A4%BE "ą¤”ą¤¾ą¤Æą¤°ą¤æą¤Æą¤¾ ā Bhojpuri")
- [ą¦¬ą¦¾ą¦ą¦²ą¦¾](https://bn.wikipedia.org/wiki/%E0%A6%89%E0%A6%A6%E0%A6%B0%E0%A6%BE%E0%A6%AE%E0%A6%AF%E0%A6%BC "ą¦ą¦¦ą¦°ą¦¾ą¦®ą¦Æą¦¼ ā Bangla")
- [Brezhoneg](https://br.wikipedia.org/wiki/Red-kof "Red-kof ā Breton")
- [Bosanski](https://bs.wikipedia.org/wiki/Dijareja "Dijareja ā Bosnian")
- [CatalĆ ](https://ca.wikipedia.org/wiki/Diarrea "Diarrea ā Catalan")
- [ŠŠ¾Ń
ŃŠøŠ¹Š½](https://ce.wikipedia.org/wiki/%D0%A7%D0%BE%D1%8C%D0%BA%D0%B0%D1%87%D0%B9%D0%B0%D0%BB%D0%B0%D1%80 "Š§Š¾ŃŠŗŠ°ŃŠ¹Š°Š»Š°Ń ā Chechen")
- [Ś©ŁŲ±ŲÆŪ](https://ckb.wikipedia.org/wiki/%D8%B3%DA%A9%DA%86%D9%88%D9%88%D9%86 "Ų³Ś©ŚŁŁŁ ā Central Kurdish")
- [ÄeÅ”tina](https://cs.wikipedia.org/wiki/Pr%C5%AFjem "PrÅÆjem ā Czech")
- [Š§ÓŠ²Š°ŃŠ»Š°](https://cv.wikipedia.org/wiki/%D0%92%D0%B0%D1%80%D0%B2%D0%B8%D1%82%D1%82%D0%B8 "ŠŠ°ŃŠ²ŠøŃŃŠø ā Chuvash")
- [Cymraeg](https://cy.wikipedia.org/wiki/Dolur_rhydd "Dolur rhydd ā Welsh")
- [Dansk](https://da.wikipedia.org/wiki/Diarr%C3%A9 "DiarrĆ© ā Danish")
- [Dagbanli](https://dag.wikipedia.org/wiki/Binsaa "Binsaa ā Dagbani")
- [Deutsch](https://de.wikipedia.org/wiki/Durchfall "Durchfall ā German")
- [ThuÉÅjƤÅ](https://din.wikipedia.org/wiki/Y%C9%9B%CC%88c "YÉĢc ā Dinka")
- [ŽŽØŽŽ¬ŽŽØŽŽ¦ŽŽ°](https://dv.wikipedia.org/wiki/%DE%84%DE%AD%DE%83%DE%A6%DE%81%DE%B0_%DE%80%DE%A8%DE%82%DE%B0%DE%8E%DE%AA%DE%82%DE%B0 "ŽŽŽŽ¦ŽŽ° ŽŽØŽŽ°ŽŽŖŽŽ° ā Divehi")
- [EŹegbe](https://ee.wikipedia.org/wiki/Mitsinyed%C9%94 "MitsinyedÉ ā Ewe")
- [ĪĪ»Ī»Ī·Ī½Ī¹ĪŗĪ¬](https://el.wikipedia.org/wiki/%CE%94%CE%B9%CE%AC%CF%81%CF%81%CE%BF%CE%B9%CE%B1 "ĪĪ¹Ī¬ĻĻĪæĪ¹Ī± ā Greek")
- [Esperanto](https://eo.wikipedia.org/wiki/Diareo "Diareo ā Esperanto")
- [EspaƱol](https://es.wikipedia.org/wiki/Diarrea "Diarrea ā Spanish")
- [Euskara](https://eu.wikipedia.org/wiki/Beherako "Beherako ā Basque")
- [ŁŲ§Ų±Ų³Ū](https://fa.wikipedia.org/wiki/%D8%A7%D8%B3%D9%87%D8%A7%D9%84 "Ų§Ų³ŁŲ§Ł ā Persian")
- [Suomi](https://fi.wikipedia.org/wiki/Ripuli "Ripuli ā Finnish")
- [Na Vosa Vakaviti](https://fj.wikipedia.org/wiki/Coka "Coka ā Fijian")
- [FranƧais](https://fr.wikipedia.org/wiki/Diarrh%C3%A9e "DiarrhĆ©e ā French")
- [Gaeilge](https://ga.wikipedia.org/wiki/Buinneach "Buinneach ā Irish")
- [GĆ idhlig](https://gd.wikipedia.org/wiki/Buinneach "Buinneach ā Scottish Gaelic")
- [Galego](https://gl.wikipedia.org/wiki/Diarrea "Diarrea ā Galician")
- [Ghanaian Pidgin](https://gpe.wikipedia.org/wiki/Diarrhea "Diarrhea ā Ghanaian Pidgin")
- [ąŖą«ąŖąŖ°ąŖ¾ąŖ¤ą«](https://gu.wikipedia.org/wiki/%E0%AA%85%E0%AA%A4%E0%AA%BF%E0%AA%B8%E0%AA%BE%E0%AA%B0 "ąŖ
ąŖ¤ąŖæąŖøąŖ¾ąŖ° ā Gujarati")
- [Hausa](https://ha.wikipedia.org/wiki/Gudawa/Zawo "Gudawa/Zawo ā Hausa")
- [×¢××Ø××Ŗ](https://he.wikipedia.org/wiki/%D7%A9%D7%9C%D7%A9%D7%95%D7%9C_\(%D7%9E%D7%A6%D7%91_%D7%A8%D7%A4%D7%95%D7%90%D7%99\) "ש×ש×× (××¦× ×Øפ×××) ā Hebrew")
- [ą¤¹ą¤æą¤Øą„ą¤¦ą„](https://hi.wikipedia.org/wiki/%E0%A4%85%E0%A4%A4%E0%A4%BF%E0%A4%B8%E0%A4%BE%E0%A4%B0 "ą¤
ą¤¤ą¤æą¤øą¤¾ą¤° ā Hindi")
- [Hrvatski](https://hr.wikipedia.org/wiki/Proljev "Proljev ā Croatian")
- [KreyĆ²l ayisyen](https://ht.wikipedia.org/wiki/Gin_diare "Gin diare ā Haitian Creole")
- [Magyar](https://hu.wikipedia.org/wiki/Hasmen%C3%A9s "HasmenĆ©s ā Hungarian")
- [ÕÕ”ÕµÕ„ÖÕ„Õ¶](https://hy.wikipedia.org/wiki/%D5%93%D5%B8%D6%80%D5%AC%D5%B8%D6%82%D5%AE%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6 "ÕÕøÖÕ¬ÕøÖÕ®ÕøÖÕ©ÕµÕøÖÕ¶ ā Armenian")
- [Ō±ÖÕ„ÖÕ“ÕæÕ”Õ°Õ”ÕµÕ„ÖÕ§Õ¶](https://hyw.wikipedia.org/wiki/%D5%93%D5%B8%D6%80%D5%B0%D5%A1%D6%80%D5%B8%D6%82%D5%A9%D5%AB%D6%82%D5%B6 "ÕÕøÖÕ°Õ”ÖÕøÖÕ©Õ«ÖÕ¶ ā Western Armenian")
- [Bahasa Indonesia](https://id.wikipedia.org/wiki/Diare "Diare ā Indonesian")
- [Igbo](https://ig.wikipedia.org/wiki/Af%E1%BB%8D_%E1%BB%8Ds%E1%BB%8Bsa "Afį» į»sį»sa ā Igbo")
- [Ido](https://io.wikipedia.org/wiki/Diareo "Diareo ā Ido")
- [Ćslenska](https://is.wikipedia.org/wiki/Ni%C3%B0urgangur "NiĆ°urgangur ā Icelandic")
- [Italiano](https://it.wikipedia.org/wiki/Diarrea "Diarrea ā Italian")
- [ę„ę¬čŖ](https://ja.wikipedia.org/wiki/%E4%B8%8B%E7%97%A2 "äøē¢ ā Japanese")
- [Jawa](https://jv.wikipedia.org/wiki/Diar%C3%A9 "DiarĆ© ā Javanese")
- [į„įį įį£įį](https://ka.wikipedia.org/wiki/%E1%83%A4%E1%83%90%E1%83%A6%E1%83%90%E1%83%A0%E1%83%90%E1%83%97%E1%83%98 "į¤įį¦įį įįį ā Georgian")
- [ŅŠ°Š·Š°ŅŃŠ°](https://kk.wikipedia.org/wiki/%D0%86%D1%88_%D3%A9%D1%82%D1%83 "ŠŃ Ó©ŃŃ ā Kazakh")
- [ą²ą²Øą³ą²Øą²”](https://kn.wikipedia.org/wiki/%E0%B2%85%E0%B2%A4%E0%B2%BF%E0%B2%B8%E0%B2%BE%E0%B2%B0 "ą²
ą²¤ą²æą²øą²¾ą²° ā Kannada")
- [ķźµģ“](https://ko.wikipedia.org/wiki/%EC%84%A4%EC%82%AC "ģ¤ģ¬ ā Korean")
- [Ś©Ł²Ų“ŁŲ±](https://ks.wikipedia.org/wiki/%DA%88%D8%A7%DB%8C%D8%B1%DB%8C%D8%A7 "ŚŲ§ŪŲ±ŪŲ§ ā Kashmiri")
- [ŠŃŃŠ³ŃŠ·ŃŠ°](https://ky.wikipedia.org/wiki/%D0%94%D0%B8%D0%B0%D1%80%D0%B5%D1%8F "ŠŠøŠ°ŃŠµŃ ā Kyrgyz")
- [Latina](https://la.wikipedia.org/wiki/Alvi_profluvium "Alvi profluvium ā Latin")
- [Lombard](https://lmo.wikipedia.org/wiki/Cagheta "Cagheta ā Lombard")
- [LingĆ”la](https://ln.wikipedia.org/wiki/Pul%C3%BApul%C3%BA "PulĆŗpulĆŗ ā Lingala")
- [Lietuvių](https://lt.wikipedia.org/wiki/Viduriavimas "Viduriavimas ā Lithuanian")
- [LatvieÅ”u](https://lv.wikipedia.org/wiki/Caureja "Caureja ā Latvian")
- [Basa Banyumasan](https://map-bms.wikipedia.org/wiki/Diare "Diare ā Banyumasan")
- [ŠŠ°ŠŗŠµŠ“Š¾Š½ŃŠŗŠø](https://mk.wikipedia.org/wiki/%D0%9F%D1%80%D0%BE%D0%BB%D0%B8%D0%B2 "ŠŃŠ¾Š»ŠøŠ² ā Macedonian")
- [ą“®ą“²ą“Æą“¾ą“³ą“](https://ml.wikipedia.org/wiki/%E0%B4%85%E0%B4%A4%E0%B4%BF%E0%B4%B8%E0%B4%BE%E0%B4%B0%E0%B4%82 "ą“
ą“¤ą“æą“øą“¾ą“°ą“ ā Malayalam")
- [ą¤®ą¤°ą¤¾ą¤ ą„](https://mr.wikipedia.org/wiki/%E0%A4%85%E0%A4%A4%E0%A4%BF%E0%A4%B8%E0%A4%BE%E0%A4%B0 "ą¤
ą¤¤ą¤æą¤øą¤¾ą¤° ā Marathi")
- [Bahasa Melayu](https://ms.wikipedia.org/wiki/Diarea "Diarea ā Malay")
- [įį¼įįŗįį¬įį¬įį¬](https://my.wikipedia.org/wiki/%E1%80%9D%E1%80%99%E1%80%BA%E1%80%B8%E1%80%9C%E1%80%BB%E1%80%BE%E1%80%B1%E1%80%AC%E1%80%81%E1%80%BC%E1%80%84%E1%80%BA%E1%80%B8 "įįįŗįøįį»į¾į±į¬įį¼įįŗįø ā Burmese")
- [ŠŃŠ·ŃŠ½Ń](https://myv.wikipedia.org/wiki/%D0%9F%D1%81%D0%BA%D0%B5%D0%B7%D1%8F%D0%BC%D0%BE "ŠŃŠŗŠµŠ·ŃŠ¼Š¾ ā Erzya")
- [ą¤Øą„ą¤Ŗą¤¾ą¤²ą„](https://ne.wikipedia.org/wiki/%E0%A4%AA%E0%A4%96%E0%A4%BE%E0%A4%B2%E0%A4%BE "ą¤Ŗą¤ą¤¾ą¤²ą¤¾ ā Nepali")
- [Nederlands](https://nl.wikipedia.org/wiki/Diarree "Diarree ā Dutch")
- [Norsk nynorsk](https://nn.wikipedia.org/wiki/Diar%C3%A9 "DiarĆ© ā Norwegian Nynorsk")
- [Norsk bokmĆ„l](https://no.wikipedia.org/wiki/Diar%C3%A9 "DiarĆ© ā Norwegian BokmĆ„l")
- [Sesotho sa Leboa](https://nso.wikipedia.org/wiki/Taerea "Taerea ā Northern Sotho")
- [Occitan](https://oc.wikipedia.org/wiki/Diarr%C3%A8a "DiarrĆØa ā Occitan")
- [ą¬ą¬”ą¬¼ą¬æą¬](https://or.wikipedia.org/wiki/%E0%AC%A4%E0%AC%B0%E0%AC%B3_%E0%AC%9D%E0%AC%BE%E0%AC%A1%E0%AC%BC%E0%AC%BE "ą¬¤ą¬°ą¬³ ą¬ą¬¾ą¬”ą¬¼ą¬¾ ā Odia")
- [Polski](https://pl.wikipedia.org/wiki/Biegunka "Biegunka ā Polish")
- [Ł¾ŚŲŖŁ](https://ps.wikipedia.org/wiki/%D9%86%D8%B3_%D9%86%D8%A7%D8%B3%D8%AA%DB%8C "ŁŲ³ ŁŲ§Ų³ŲŖŪ ā Pashto")
- [PortuguĆŖs](https://pt.wikipedia.org/wiki/Diarreia "Diarreia ā Portuguese")
- [Runa Simi](https://qu.wikipedia.org/wiki/Q%27icha "Q'icha ā Quechua")
- [RomĆ¢nÄ](https://ro.wikipedia.org/wiki/Diaree "Diaree ā Romanian")
- [Š ŃŃŃŠŗŠøŠ¹](https://ru.wikipedia.org/wiki/%D0%94%D0%B8%D0%B0%D1%80%D0%B5%D1%8F "ŠŠøŠ°ŃŠµŃ ā Russian")
- [Ikinyarwanda](https://rw.wikipedia.org/wiki/Impiswi "Impiswi ā Kinyarwanda")
- [į±„į±į±±į±į±į±²į±¤](https://sat.wikipedia.org/wiki/%E1%B1%AB%E1%B1%9F%E1%B1%9C_%E1%B1%B4%E1%B1%9F%E1%B1%BA%E1%B1%B0%E1%B1%A4 "į±«į±į± į±“į±į±ŗį±°į±¤ ā Santali")
- [Sicilianu](https://scn.wikipedia.org/wiki/Cacaredda "Cacaredda ā Sicilian")
- [Ų³ŁŚŁ](https://sd.wikipedia.org/wiki/%DA%8A%D8%A7%D8%A6%D8%B1%D9%8A%D8%A7 "ŚŲ§Ų¦Ų±ŁŲ§ ā Sindhi")
- [Srpskohrvatski / ŃŃŠæŃŠŗŠ¾Ń
ŃŠ²Š°ŃŃŠŗŠø](https://sh.wikipedia.org/wiki/Proljev "Proljev ā Serbo-Croatian")
- [ą·ą·ą¶ą·ą¶½](https://si.wikipedia.org/wiki/%E0%B6%B4%E0%B7%8F%E0%B6%A0%E0%B6%B1%E0%B6%BA "ą¶“ą·ą¶ ą¶±ą¶ŗ ā Sinhala")
- [Simple English](https://simple.wikipedia.org/wiki/Diarrhea "Diarrhea ā Simple English")
- [SlovenÄina](https://sk.wikipedia.org/wiki/Hna%C4%8Dka "HnaÄka ā Slovak")
- [SlovenÅ”Äina](https://sl.wikipedia.org/wiki/Driska "Driska ā Slovenian")
- [Soomaaliga](https://so.wikipedia.org/wiki/Shuban "Shuban ā Somali")
- [Shqip](https://sq.wikipedia.org/wiki/Diarreja "Diarreja ā Albanian")
- [Š”ŃŠæŃŠŗŠø / srpski](https://sr.wikipedia.org/wiki/%D0%9F%D1%80%D0%BE%D0%BB%D0%B8%D0%B2 "ŠŃŠ¾Š»ŠøŠ² ā Serbian")
- [Sunda](https://su.wikipedia.org/wiki/Diar%C3%A9 "DiarĆ© ā Sundanese")
- [Svenska](https://sv.wikipedia.org/wiki/Diarr%C3%A9 "DiarrĆ© ā Swedish")
- [Kiswahili](https://sw.wikipedia.org/wiki/Kuhara "Kuhara ā Swahili")
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From Wikipedia, the free encyclopedia
Loose or liquid bowel movements
For other uses, see [Diarrhea (disambiguation)](https://en.wikipedia.org/wiki/Diarrhea_\(disambiguation\) "Diarrhea (disambiguation)").
Medical condition
| Diarrhea | |
|---|---|
| Other names | Diarrhoea (or diarrhÅa) |
| [](https://en.wikipedia.org/wiki/File:Multiple_rotavirus_particles.jpg) | |
| An electron micrograph of [rotavirus](https://en.wikipedia.org/wiki/Rotavirus "Rotavirus"), the cause of nearly 40% of hospitalizations from diarrhea in children under five[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) | |
| Pronunciation | [/ĖdaÉŖÉĖriĖÉ/](https://en.wikipedia.org/wiki/Help:IPA/English "Help:IPA/English") |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Infectious disease](https://en.wikipedia.org/wiki/Infectious_disease_\(medical_specialty\) "Infectious disease (medical specialty)"), [gastroenterology](https://en.wikipedia.org/wiki/Gastroenterology "Gastroenterology") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | Loose frequent bowel movements, [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration")[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | Usually infection (viral, bacterial, parasitic)[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") | Contaminated food or water[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| Prevention | [Handwashing](https://en.wikipedia.org/wiki/Handwashing "Handwashing"), [rotavirus vaccination](https://en.wikipedia.org/wiki/Rotavirus_vaccination "Rotavirus vaccination"), [breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding")[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| Treatment | [Oral rehydration solution](https://en.wikipedia.org/wiki/Oral_rehydration_solution "Oral rehydration solution"), [zinc supplementation](https://en.wikipedia.org/wiki/Zinc_supplementation "Zinc supplementation")[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| Frequency | ā2.4 billion (2015)[\[3\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-GBD2015Pre-3) |
| Deaths | 1\.53 million (2019)[\[4\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Dadonaite_2018-4) |
**Diarrhea** ([American English](https://en.wikipedia.org/wiki/American_English "American English")), also spelled **diarrhoea** or **diarrhÅa** ([British English](https://en.wikipedia.org/wiki/British_English "British English")), is the condition of having at least three loose, liquid, or watery [bowel movements](https://en.wikipedia.org/wiki/Defecation "Defecation") in a day.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) It often lasts for a few days and can result in [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration") due to fluid loss.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) This can progress to decreased [urination](https://en.wikipedia.org/wiki/Urination "Urination"), [loss of skin color](https://en.wikipedia.org/wiki/Pallor "Pallor"), a [fast heart rate](https://en.wikipedia.org/wiki/Tachycardia "Tachycardia"), and a [decrease in responsiveness](https://en.wikipedia.org/wiki/Altered_level_of_consciousness "Altered level of consciousness") as it becomes more severe.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Loose but non-watery [stools](https://en.wikipedia.org/wiki/Feces "Feces") in babies who are exclusively [breastfed](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding"), however, are normal.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)
What is diarrhea? How is it caused, treated and prevented? (see also [script](https://en.wikipedia.org/wiki/Wikipedia:VideoWiki/Diarrhea "Wikipedia:VideoWiki/Diarrhea"))
The most common cause is an infection of the [intestines](https://en.wikipedia.org/wiki/Intestine "Intestine") due to a [virus](https://en.wikipedia.org/wiki/Virus "Virus"), [bacterium](https://en.wikipedia.org/wiki/Bacterium "Bacterium"), or [parasite](https://en.wikipedia.org/wiki/Parasite "Parasite")āa condition also known as [gastroenteritis](https://en.wikipedia.org/wiki/Gastroenteritis "Gastroenteritis").[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) These infections are often acquired from food or water that has been contaminated by [feces](https://en.wikipedia.org/wiki/Human_feces "Human feces"), or directly from another person who is infected.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody).[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) The short duration watery diarrhea may be due to [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), although this is rare in the developed world.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) If blood is present, it is also known as [dysentery](https://en.wikipedia.org/wiki/Dysentery "Dysentery").[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) A number of non-infectious causes can result in diarrhea.[\[5\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CEM2013-5) These include [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance"), side effect of [drug withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal"), [irritable bowel syndrome](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome"), [non-celiac gluten sensitivity](https://en.wikipedia.org/wiki/Non-celiac_gluten_sensitivity "Non-celiac gluten sensitivity"), [celiac disease](https://en.wikipedia.org/wiki/Coeliac_disease "Coeliac disease"), [inflammatory bowel disease](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease") such as [ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [bile acid diarrhea](https://en.wikipedia.org/wiki/Bile_acid_diarrhea "Bile acid diarrhea"), and a number of medications.[\[5\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CEM2013-5)[\[6\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-SaponeBai-6)[\[7\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-7) In most cases, [stool cultures](https://en.wikipedia.org/wiki/Stool_test "Stool test") to confirm the exact cause are not required.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8)
Diarrhea can be prevented by improved [sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation"), clean [drinking water](https://en.wikipedia.org/wiki/Drinking_water "Drinking water"), and [hand washing](https://en.wikipedia.org/wiki/Hand_washing "Hand washing") with soap.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) [Breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding") for at least six months and [vaccination against rotavirus](https://en.wikipedia.org/wiki/Rotavirus_vaccine "Rotavirus vaccine") is also recommended.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) [Oral rehydration solution](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") (ORS)āclean water with modest amounts of salts and [sugar](https://en.wikipedia.org/wiki/Sugar "Sugar")āis the treatment of choice.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) [Zinc tablets](https://en.wikipedia.org/wiki/Zinc#Dietary_supplement "Zinc") are also recommended.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) These treatments have been estimated to have saved 50 million children in the past 25 years.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) When people have diarrhea it is recommended that they continue to eat healthy food, and babies continue to be breastfed.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) If commercial ORS is not available, homemade solutions may be used.[\[9\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Prober2012-9) In those with severe dehydration, [intravenous fluids](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") may be required.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Most cases, however, can be managed well with fluids by mouth.[\[10\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-10) [Antibiotics](https://en.wikipedia.org/wiki/Antibiotic "Antibiotic"), while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe [diarrhea following travelling](https://en.wikipedia.org/wiki/Travelers_diarrhea "Travelers diarrhea"), and those who grow specific bacteria or parasites in their stool.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8) [Loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") may help decrease the number of bowel movements but is not recommended in those with severe disease.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8)
About 1.7 to 5 billion cases of diarrhea occur per year.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)[\[5\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CEM2013-5)[\[11\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-GBD2013-11) It is most common in [developing countries](https://en.wikipedia.org/wiki/Developing_countries "Developing countries"), where young children get diarrhea on average three times a year.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Total deaths from diarrhea are estimated at 1.53 million in 2019ādown from 2.9 million in 1990.[\[4\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Dadonaite_2018-4) In 2012, it was the second most common cause of [deaths in children](https://en.wikipedia.org/wiki/Infant_mortality "Infant mortality") younger than five (0.76 million or 11%).[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)[\[12\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDC2013-12) Frequent episodes of diarrhea are also a common cause of [malnutrition](https://en.wikipedia.org/wiki/Malnutrition "Malnutrition") and the most common cause in those younger than five years of age.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Other long term problems that can result include [stunted growth](https://en.wikipedia.org/wiki/Stunted_growth "Stunted growth") and poor intellectual development.[\[12\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDC2013-12)
## Terminology
The word diarrhea is from the [Ancient Greek](https://en.wikipedia.org/wiki/Ancient_Greek "Ancient Greek") [Ī“Ī¹Ī¬ĻĻĪæĪ¹Ī±](https://en.wiktionary.org/wiki/%CE%B4%CE%B9%CE%AC%CF%81%CF%81%CE%BF%CE%B9%CE%B1 "wikt:Ī“Ī¹Ī¬ĻĻĪæĪ¹Ī±") from Ī“Ī¹Ī¬ **dia** "through" and įæ„ĪĻ **rheo** "flow".
*Diarrhea* is the spelling in [American English](https://en.wikipedia.org/wiki/American_English "American English"), whereas *diarrhoea* is the spelling in [British English](https://en.wikipedia.org/wiki/British_English "British English"). [Canadian English](https://en.wikipedia.org/wiki/Canadian_English "Canadian English") uses both spellings.
Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain[\[13\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-13)), "[Hershey](https://en.wikipedia.org/wiki/The_Hershey_Company "The Hershey Company") squirts", "[Montezuma](https://en.wikipedia.org/wiki/Moctezuma_II "Moctezuma II")'s Revenge", and "the trots".[\[14\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-14)[\[15\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-15)
## Definition
[](https://en.wikipedia.org/wiki/File:BristolStoolChart.png)
[Bristol stool scale](https://en.wikipedia.org/wiki/Bristol_stool_scale "Bristol stool scale")
Diarrhea is defined by the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") as having three or more loose or liquid [stools](https://en.wikipedia.org/wiki/Defecation "Defecation") per day, or as having more stools than is normal for that person.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)
Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by [World Gastroenterology Organization](https://en.wikipedia.org/wiki/World_Gastroenterology_Organisation "World Gastroenterology Organisation").[\[16\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WGO-16) Acute diarrhea that is watery may be known as AWD (Acute Watery Diarrhoea.)[\[17\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-17)
### Secretory
Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a [cholera toxin](https://en.wikipedia.org/wiki/Cholera_toxin "Cholera toxin") that stimulates the secretion of [anions](https://en.wikipedia.org/wiki/Anion "Anion"), especially [chloride](https://en.wikipedia.org/wiki/Chloride "Chloride") ions (Clā). Therefore, to maintain a charge balance in the [gastrointestinal tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract "Gastrointestinal tract"), sodium (Na\+) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is [isotonic](https://en.wikipedia.org/wiki/Tonicity#3 "Tonicity") with plasma even during fasting.[\[18\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-webmd.com-18)[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19) It continues even when there is no oral food intake.
### Osmotic
Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19) Osmotic diarrhea can also result from maldigestion (e.g., pancreatic disease or [coeliac disease](https://en.wikipedia.org/wiki/Coeliac_disease "Coeliac disease")) in which the nutrients are left in the [lumen](https://en.wikipedia.org/wiki/Lumen_\(anatomy\) "Lumen (anatomy)") to pull in water. Or it can be caused by osmotic [laxatives](https://en.wikipedia.org/wiki/Laxatives "Laxatives") (which work to alleviate [constipation](https://en.wikipedia.org/wiki/Constipation "Constipation") by drawing water into the bowels). In healthy individuals, too much [magnesium](https://en.wikipedia.org/wiki/Magnesium "Magnesium"), [vitamin C](https://en.wikipedia.org/wiki/Vitamin_C "Vitamin C") or undigested [lactose](https://en.wikipedia.org/wiki/Lactose "Lactose") can produce osmotic diarrhea and distention of the bowel. A person who has [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance") can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have [fructose malabsorption](https://en.wikipedia.org/wiki/Fructose_malabsorption "Fructose malabsorption"), excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. [Sugar alcohols](https://en.wikipedia.org/wiki/Sugar_alcohol "Sugar alcohol") such as [sorbitol](https://en.wikipedia.org/wiki/Sorbitol "Sorbitol") (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea.[\[18\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-webmd.com-18) In most of these cases, osmotic diarrhea stops when the offending agent (e.g., milk or sorbitol) is stopped.
### Exudative
Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with [inflammatory bowel diseases](https://en.wikipedia.org/wiki/Inflammatory_bowel_diseases "Inflammatory bowel diseases"), such as [Crohn's disease](https://en.wikipedia.org/wiki/Crohn%27s_disease "Crohn's disease") or [ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis"), and other severe infections such as *[E. coli](https://en.wikipedia.org/wiki/Escherichia_coli "Escherichia coli")* or other forms of food poisoning.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)[\[18\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-webmd.com-18)
### Inflammatory
Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea.[\[21\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-21) It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
### Dysentery
If there is blood visible in the stools, it is also known as [dysentery](https://en.wikipedia.org/wiki/Dysentery "Dysentery"). The blood is a trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, *[Shigella](https://en.wikipedia.org/wiki/Shigella "Shigella")*, *[Entamoeba histolytica](https://en.wikipedia.org/wiki/Entamoeba_histolytica "Entamoeba histolytica")*, and *[Salmonella](https://en.wikipedia.org/wiki/Salmonella "Salmonella")*.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
## Health effects
Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults",[\[22\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-d-22) and diarrhea is a primary cause of childhood malnutrition.[\[23\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-23) Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for [helminth](https://en.wikipedia.org/wiki/Helminth "Helminth") infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on a series of tests of intelligence.[\[22\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-d-22)[\[24\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-24)
Diarrhea can cause [electrolyte imbalances](https://en.wikipedia.org/wiki/Electrolyte_imbalance "Electrolyte imbalance"), [kidney impairment](https://en.wikipedia.org/wiki/Renal_impairment "Renal impairment"), [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration"), and defective [immune system](https://en.wikipedia.org/wiki/Immune_system "Immune system") responses. When oral drugs are administered, the efficiency of the drug is to produce a [therapeutic effect](https://en.wikipedia.org/wiki/Therapeutic_effect "Therapeutic effect") and the lack of this effect may be due to the medication travelling too quickly through the digestive system, limiting the time that it can be absorbed. Clinicians try to treat the diarrheas by reducing the dosage of medication, changing the dosing schedule, discontinuation of the drug, and rehydration. The interventions to control the diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the leading factors for placing older adults in [long term care facilities](https://en.wikipedia.org/wiki/Long_term_care_facilities "Long term care facilities") (nursing homes).[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
## Causes
[](https://en.wikipedia.org/wiki/File:Stomach_colon_rectum_diagram-en.svg)
Diagram of the [human gastrointestinal tract](https://en.wikipedia.org/wiki/Human_gastrointestinal_tract "Human gastrointestinal tract")
In the latter stages of human digestion, ingested materials are inundated with water and digestive fluids such as [gastric acid](https://en.wikipedia.org/wiki/Gastric_acid "Gastric acid"), [bile](https://en.wikipedia.org/wiki/Bile "Bile"), and [digestive enzymes](https://en.wikipedia.org/wiki/Digestive_enzyme "Digestive enzyme") in order to break them down into their nutrient components, which are then absorbed into the bloodstream via the [intestinal tract](https://en.wikipedia.org/wiki/Intestinal_epithelium "Intestinal epithelium") in the small intestine. Prior to defecation, the large intestine reabsorbs the water and other digestive solvents in the waste product in order to maintain proper hydration and overall equilibrium.[\[25\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-25) Diarrhea occurs when the large intestine is prevented, for any number of reasons, from sufficiently absorbing the water or other digestive fluids from fecal matter, resulting in a liquid, or "loose", bowel movement.[\[26\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-26)
[Acute](https://en.wikipedia.org/wiki/Acute_\(medicine\) "Acute (medicine)") diarrhea is most commonly due to viral [gastroenteritis](https://en.wikipedia.org/wiki/Gastroenteritis "Gastroenteritis") with [rotavirus](https://en.wikipedia.org/wiki/Rotavirus "Rotavirus"), which accounts for 40% of cases in children under five.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) In [travelers](https://en.wikipedia.org/wiki/Traveler%27s_diarrhea "Traveler's diarrhea"), however, [bacterial infections](https://en.wikipedia.org/wiki/Bacterial_infections "Bacterial infections") predominate.[\[27\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid16267716-27) Various toxins such as [mushroom poisoning](https://en.wikipedia.org/wiki/Amanita_phalloides#Signs_and_symptoms "Amanita phalloides") and drugs can also cause acute diarrhea.
Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include [ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis"), [Crohn's disease](https://en.wikipedia.org/wiki/Crohn%27s_disease "Crohn's disease"), [microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis"), [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease"), [irritable bowel syndrome](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome"), and [bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption").[\[28\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-28)
### Infections
Main article: [Infectious diarrhea](https://en.wikipedia.org/wiki/Infectious_diarrhea "Infectious diarrhea")
There are many causes of infectious diarrhea, which include [viruses](https://en.wikipedia.org/wiki/Virus "Virus"), [bacteria](https://en.wikipedia.org/wiki/Bacteria "Bacteria") and parasites.[\[29\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid18813221-29) Infectious diarrhea is frequently referred to as [gastroenteritis](https://en.wikipedia.org/wiki/Gastroenteritis "Gastroenteritis").[\[30\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Dav2008-30) [Norovirus](https://en.wikipedia.org/wiki/Norovirus "Norovirus") is the most common cause of viral diarrhea in adults,[\[31\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19084472-31) but [rotavirus](https://en.wikipedia.org/wiki/Rotavirus "Rotavirus") is the most common cause in children under five years old.[\[32\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19457420-32) [Adenovirus](https://en.wikipedia.org/wiki/Adenovirus "Adenovirus") types 40 and 41,[\[33\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid1962727-33) and [astroviruses](https://en.wikipedia.org/wiki/Astrovirus "Astrovirus") cause a significant number of infections.[\[34\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid12442031-34) [Shiga-toxin producing *Escherichia coli*](https://en.wikipedia.org/wiki/Shiga-toxin_producing_Escherichia_coli "Shiga-toxin producing Escherichia coli"), such as [*E. coli* o157:h7](https://en.wikipedia.org/wiki/E_coli_o157:h7 "E coli o157:h7"), are the most common cause of infectious bloody diarrhea in the United States.[\[35\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-35)
*[Campylobacter](https://en.wikipedia.org/wiki/Campylobacter "Campylobacter")* [spp.](https://en.wikipedia.org/wiki/Species "Species") are a common cause of bacterial diarrhea, but infections by *[Salmonella](https://en.wikipedia.org/wiki/Salmonella "Salmonella")* spp., *[Shigella](https://en.wikipedia.org/wiki/Shigella "Shigella")* spp. and some strains of *Escherichia coli* are also a frequent cause.[\[36\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19116615-36)
In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by *[Clostridioides difficile](https://en.wikipedia.org/wiki/Clostridioides_difficile_\(bacteria\) "Clostridioides difficile (bacteria)")* often causes severe diarrhea.[\[37\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19528959-37)
Parasites, particularly [protozoa](https://en.wikipedia.org/wiki/Protozoa "Protozoa") e.g., *[Cryptosporidium](https://en.wikipedia.org/wiki/Cryptosporidium "Cryptosporidium")* spp., *[Giardia](https://en.wikipedia.org/wiki/Giardia "Giardia")* spp., *[Entamoeba histolytica](https://en.wikipedia.org/wiki/Entamoeba_histolytica "Entamoeba histolytica")*, *[Blastocystis](https://en.wikipedia.org/wiki/Blastocystis "Blastocystis")* spp., *[Cyclospora cayetanensis](https://en.wikipedia.org/wiki/Cyclospora_cayetanensis "Cyclospora cayetanensis")*, are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent [nitazoxanide](https://en.wikipedia.org/wiki/Nitazoxanide "Nitazoxanide") has shown efficacy against many diarrhea-causing parasites.[\[38\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid22301075-38)
Other infectious agents, such as [parasites](https://en.wikipedia.org/wiki/Parasites "Parasites") or [bacterial](https://en.wikipedia.org/wiki/Bacteria "Bacteria") toxins, may exacerbate symptoms.[\[27\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid16267716-27) In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or [malnourished](https://en.wikipedia.org/wiki/Malnourished "Malnourished") individuals, diarrhea can lead to severe [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration") and can become life-threatening.[\[39\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid12608880-39)
#### Sanitation
[](https://en.wikipedia.org/wiki/File:Slum_and_dirty_river.jpg)
Poverty often leads to unhygienic living conditions, as in this community in the Indian Himalayas. Such conditions promote contraction of diarrheal diseases, as a result of poor [sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation") and [hygiene](https://en.wikipedia.org/wiki/Hygiene "Hygiene").
[Open defecation](https://en.wikipedia.org/wiki/Open_defecation "Open defecation") is a leading cause of infectious diarrhea leading to death.[\[40\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-40)
Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste ([sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation")), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea ... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care."[\[41\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-41)
One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human [pathogens](https://en.wikipedia.org/wiki/Pathogens "Pathogens").[\[42\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Brown_629%E2%80%9334-42)
#### Nutrition
Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. [Zinc deficiency](https://en.wikipedia.org/wiki/Zinc_deficiency "Zinc deficiency"), a condition often found in children in [developing countries](https://en.wikipedia.org/wiki/Developing_countries "Developing countries") can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system.[\[43\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-43)[\[44\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-44) Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever.[\[45\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-45) Similarly, [vitamin A deficiency](https://en.wikipedia.org/wiki/Vitamin_A_deficiency "Vitamin A deficiency") can cause an increase in the severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status,[\[46\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-46) others suggest an increase in the rate associated with deficiency.[\[47\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-47) Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction.[\[48\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-48)
### Malabsorption
Main article: [Malabsorption](https://en.wikipedia.org/wiki/Malabsorption "Malabsorption")
[Malabsorption](https://en.wikipedia.org/wiki/Malabsorption "Malabsorption") is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the [pancreas](https://en.wikipedia.org/wiki/Pancreas "Pancreas").
Causes include:\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
- *enzyme deficiencies or mucosal abnormality*, as in [food allergy](https://en.wikipedia.org/wiki/Food_allergy "Food allergy") and [food intolerance](https://en.wikipedia.org/wiki/Food_intolerance "Food intolerance"), e.g. [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease") (gluten intolerance), [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance") (intolerance to milk sugar, common in non-Europeans), and [fructose malabsorption](https://en.wikipedia.org/wiki/Fructose_malabsorption "Fructose malabsorption").
- *[pernicious anemia](https://en.wikipedia.org/wiki/Pernicious_anemia "Pernicious anemia")*, or impaired bowel function due to the inability to absorb [vitamin B12](https://en.wikipedia.org/wiki/Vitamin_B12 "Vitamin B12"),
- *loss of pancreatic secretions*, which may be due to [cystic fibrosis](https://en.wikipedia.org/wiki/Cystic_fibrosis "Cystic fibrosis") or [pancreatitis](https://en.wikipedia.org/wiki/Pancreatitis "Pancreatitis"),
- *structural defects*, like [short bowel syndrome](https://en.wikipedia.org/wiki/Short_bowel_syndrome "Short bowel syndrome") (surgically removed bowel) and radiation fibrosis, such as usually follows cancer treatment and other drugs, including agents used in [chemotherapy](https://en.wikipedia.org/wiki/Chemotherapy "Chemotherapy"); and
- *certain drugs*, like [orlistat](https://en.wikipedia.org/wiki/Orlistat "Orlistat"), which inhibits the absorption of fat.
### Inflammatory bowel disease
Main article: [Inflammatory bowel disease](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease")
The two overlapping types here are of unknown origin:
- [Ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis") is marked by chronic bloody diarrhea and inflammation mostly affects the distal [colon](https://en.wikipedia.org/wiki/Colon_\(anatomy\) "Colon (anatomy)") near the [rectum](https://en.wikipedia.org/wiki/Rectum "Rectum").
- [Crohn's disease](https://en.wikipedia.org/wiki/Crohn%27s_disease "Crohn's disease") typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.
### Irritable bowel syndrome
Main article: [Irritable bowel syndrome](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome")
Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by [defecation](https://en.wikipedia.org/wiki/Defecation "Defecation") and unusual [stool](https://en.wikipedia.org/wiki/Human_feces "Human feces") (diarrhea or [constipation](https://en.wikipedia.org/wiki/Constipation "Constipation")) for at least three days a week over the previous three months.[\[49\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-49) Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") or [codeine](https://en.wikipedia.org/wiki/Codeine "Codeine"). About 30% of patients with diarrhea-predominant IBS have [bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption") diagnosed with an abnormal [SeHCAT](https://en.wikipedia.org/wiki/SeHCAT "SeHCAT") test.[\[50\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-50)
### Other diseases
Diarrhea can be caused by other diseases and conditions, namely:
- Chronic [ethanol](https://en.wikipedia.org/wiki/Ethanol "Ethanol") ingestion[\[51\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Harrison-51)
- [Hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism")[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52)
- Certain medications[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52)
- [Bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption")[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52)
- [Ischemic](https://en.wikipedia.org/wiki/Ischemia "Ischemia") bowel disease: This usually affects older people and can be due to blocked arteries.
- [Microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis"), a type of [inflammatory bowel disease](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease") where changes are seen only on histological examination of colonic biopsies.
- [Bile salt malabsorption](https://en.wikipedia.org/wiki/Bile_salt_malabsorption "Bile salt malabsorption") ([primary bile acid diarrhea](https://en.wikipedia.org/wiki/Primary_bile_acid_diarrhea "Primary bile acid diarrhea")) where excessive [bile acids](https://en.wikipedia.org/wiki/Bile_acids "Bile acids") in the [colon](https://en.wikipedia.org/wiki/Colon_\(anatomy\) "Colon (anatomy)") produce a secretory diarrhea.
- Hormone-secreting tumors: some hormones, e.g. [serotonin](https://en.wikipedia.org/wiki/Serotonin "Serotonin"), can cause diarrhea if secreted in excess (usually from a tumor).
- Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is called [toddler's diarrhea](https://en.wikipedia.org/wiki/Toddler%27s_diarrhea "Toddler's diarrhea").
- [Environmental enteropathy](https://en.wikipedia.org/wiki/Environmental_enteropathy "Environmental enteropathy")
- [Radiation enteropathy](https://en.wikipedia.org/wiki/Radiation_enteropathy "Radiation enteropathy") following treatment for pelvic and abdominal cancers.
- [Mast cell activation syndrome](https://en.wikipedia.org/wiki/Mast_cell_activation_syndrome "Mast cell activation syndrome") (MCAS)[\[53\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-53)[\[54\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-54)[\[55\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-55)
- [Drug withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal") side effect.
### Medications
Over 700 medications, such as [penicillin](https://en.wikipedia.org/wiki/Side_effects_of_penicillin "Side effects of penicillin"), are known to cause diarrhea.[\[56\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-56)[\[57\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-57) The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
## Pathophysiology
| Function | Transporter |
|---|---|
| Absorption | [NHE](https://en.wikipedia.org/wiki/NHE "NHE"), [SGLT1](https://en.wikipedia.org/wiki/SGLT1 "SGLT1"), [ENaC](https://en.wikipedia.org/wiki/ENaC "ENaC"), [DRA](https://en.wikipedia.org/wiki/Downregulated-in-adenoma "Downregulated-in-adenoma") |
| Secretion | [CaCC](https://en.wikipedia.org/wiki/CaCC "CaCC"), [NKCC1](https://en.wikipedia.org/wiki/NKCC1 "NKCC1"), [CFTR](https://en.wikipedia.org/wiki/CFTR "CFTR") |
| Absorption and secretion | [Sodium potassium ATPase](https://en.wikipedia.org/wiki/Sodium_potassium_ATPase "Sodium potassium ATPase") |
### Evolution
According to two researchers, [Nesse](https://en.wikipedia.org/wiki/Randolph_M._Nesse "Randolph M. Nesse") and [Williams](https://en.wikipedia.org/wiki/George_C._Williams_\(biologist\) "George C. Williams (biologist)"), diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery.[\[59\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-59) They cite in support of this argument research published in 1973 that found that treating *[Shigella](https://en.wikipedia.org/wiki/Shigella "Shigella")* with the anti-diarrhea drug (Co-phenotrope, [Lomotil](https://en.wikipedia.org/wiki/Lomotil "Lomotil")) caused people to stay [feverish](https://en.wikipedia.org/wiki/Fever "Fever") twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".[\[60\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-60)
## Diagnostic approach
The following types of diarrhea may indicate further investigation is needed:
- In infants
- Moderate or severe diarrhea in young children
- Associated with blood
- Continues for more than two days
- Associated non-cramping [abdominal pain](https://en.wikipedia.org/wiki/Abdominal_pain "Abdominal pain"), [fever](https://en.wikipedia.org/wiki/Fever "Fever"), [weight loss](https://en.wikipedia.org/wiki/Weight_loss "Weight loss"), etc.
- In [travelers](https://en.wikipedia.org/wiki/Traveler%27s_diarrhea "Traveler's diarrhea")
- In food handlers, because of the potential to infect others;
- In institutions such as hospitals, child care centers, or geriatric and convalescent homes.
A severity score is used to aid diagnosis in children.[\[61\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid2371542-61)
When diarrhea lasts for more than four weeks a number of further tests may be recommended including:[\[62\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-62)
- [Complete blood count](https://en.wikipedia.org/wiki/Complete_blood_count "Complete blood count") and a [ferritin](https://en.wikipedia.org/wiki/Ferritin "Ferritin") if [anemia](https://en.wikipedia.org/wiki/Anemia "Anemia") is present
- [Thyroid stimulating hormone](https://en.wikipedia.org/wiki/Thyroid_stimulating_hormone "Thyroid stimulating hormone")
- [Tissue transglutaminase](https://en.wikipedia.org/wiki/Tissue_transglutaminase "Tissue transglutaminase") for [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease")
- Fecal [calprotectin](https://en.wikipedia.org/wiki/Calprotectin "Calprotectin") to exclude [inflammatory bowel disease](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease")
- [Stool tests](https://en.wikipedia.org/wiki/Stool_test "Stool test") for ova and parasites as well as for *[Clostridioides difficile](https://en.wikipedia.org/wiki/Clostridioides_difficile_\(bacteria\) "Clostridioides difficile (bacteria)")*
- A [colonoscopy](https://en.wikipedia.org/wiki/Colonoscopy "Colonoscopy") or fecal immunochemical testing for cancer, including biopsies to detect [microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis")
- Testing for [bile acid diarrhea](https://en.wikipedia.org/wiki/Bile_acid_diarrhea "Bile acid diarrhea") with [SeHCAT](https://en.wikipedia.org/wiki/SeHCAT "SeHCAT"), [7Ī±-hydroxy-4-cholesten-3-one](https://en.wikipedia.org/wiki/7%CE%B1-hydroxy-4-cholesten-3-one "7Ī±-hydroxy-4-cholesten-3-one") or fecal [bile acids](https://en.wikipedia.org/wiki/Bile_acids "Bile acids") depending on availability
- [Hydrogen breath test](https://en.wikipedia.org/wiki/Hydrogen_breath_test "Hydrogen breath test") looking for [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance")
- Further tests if [immunodeficiency](https://en.wikipedia.org/wiki/Immunodeficiency "Immunodeficiency"), [pelvic radiation disease](https://en.wikipedia.org/wiki/Pelvic_radiation_disease "Pelvic radiation disease") or [small intestinal bacterial overgrowth](https://en.wikipedia.org/wiki/Small_intestinal_bacterial_overgrowth "Small intestinal bacterial overgrowth") suspected.
A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for [giardia](https://en.wikipedia.org/wiki/Giardia "Giardia").[\[63\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Sma2019-63) [Erythrocyte sedimentation rate](https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate "Erythrocyte sedimentation rate") (ESR) and [C-reactive protein](https://en.wikipedia.org/wiki/C-reactive_protein "C-reactive protein") (CRP) were not recommended.[\[63\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Sma2019-63)
## Epidemiology
[](https://en.wikipedia.org/wiki/File:Diarrhoeal_diseases_world_map-Deaths_per_million_persons-WHO2012.svg)
Deaths due to diarrhoeal diseases per million persons in 2012
0ā2
3ā10
11ā18
19ā30
31ā46
47ā80
81ā221
222ā450
451ā606
607ā1799
[](https://en.wikipedia.org/wiki/File:Diarrhoeal_diseases_world_map_-_DALY_-_WHO2004.svg)
[Disability-adjusted life year](https://en.wikipedia.org/wiki/Disability-adjusted_life_year "Disability-adjusted life year") for diarrhea per 100,000 inhabitants in 2004[\[64\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-64)
no data
\< 500
500ā1000
1000ā1500
1500ā2000
2000ā2500
2500ā3000
3000ā3500
3500ā4000
4000ā4500
4500ā5000
5000ā6000
\> 6000
Worldwide in 2004, approximately 2.5 billion cases of diarrhea occurred, which resulted in 1.5 million deaths among children under the age of five.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) Greater than half of these were in Africa and South Asia.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) This is down from a death rate of 4.5 million in 1980 for gastroenteritis.[\[65\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Mandell-65) Diarrhea remains the second leading cause of [infant mortality](https://en.wikipedia.org/wiki/Infant_mortality "Infant mortality") (16%) after [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia") (17%) in this age group.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1)
The majority of such cases occur in the developing world, with over half of the recorded cases of childhood diarrhea occurring in [Africa](https://en.wikipedia.org/wiki/Africa "Africa") and [Asia](https://en.wikipedia.org/wiki/Asia "Asia"), with 696 million and 1.2 billion cases, respectively, compared to only 480 million in the rest of the world.[\[66\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-66)
Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days.[\[67\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-UN2015-67)[\[68\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-68) In the Americas, diarrheal disease accounts for a total of 10% of deaths among children aged 1ā59 months while in South East Asia, it accounts for 31.3% of deaths.[\[69\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-69) It is estimated that around 21% of child mortalities in developing countries are due to diarrheal disease.[\[70\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-c-70)
The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") has reported that "deaths due to diarrhoeal diseases have dropped by 45%, from sixth leading cause of death in 2000 to thirteenth in 2021."[\[71\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-71)
[Climate change can cause](https://en.wikipedia.org/wiki/Climate_change_and_infectious_diseases#Diarrheal_diseases "Climate change and infectious diseases") an increase in diarrhoeal diseases. Bacteria proliferate with an increase with ambient temperature, and following heavy rainfall and [flooding](https://en.wikipedia.org/wiki/Flood "Flood") events. Heavy rainfall and flooding can also affect pathogen transmission by impacting sanitation and/or drinking water treatment infrastructure, contaminating drinking water sources or food products.[\[72\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-\(Levy_et_al.,_2016\)-72)
Even though diarrhea is best known in humans, it affects many other species, notably among [primates](https://en.wikipedia.org/wiki/Primate "Primate").[\[73\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Hird_et_al._1984-73) The [cecal appendix](https://en.wikipedia.org/wiki/Appendix_\(anatomy\) "Appendix (anatomy)"), when present, appears to afford some protection against diarrhea to young primates.[\[74\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Collard_et_al._2023-74)
## Prevention
### Sanitation
Further information: [WASH Ā§ Health aspects](https://en.wikipedia.org/wiki/WASH#Health_aspects "WASH")
Numerous studies have shown that improvements in drinking water and sanitation ([WASH](https://en.wikipedia.org/wiki/WASH "WASH")) lead to decreased risks of diarrhoea.[\[75\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:0-75) Such improvements might include for example use of water filters, provision of high-quality [piped water](https://en.wikipedia.org/wiki/Drinking_water "Drinking water") and [sewer](https://en.wikipedia.org/wiki/Sanitary_sewer "Sanitary sewer") connections.[\[75\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:0-75)
In institutions, communities, and households, interventions that promote [hand washing](https://en.wikipedia.org/wiki/Hand_washing "Hand washing") with soap lead to significant reductions in the incidence of diarrhea.[\[76\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:1-76) The same applies to preventing [open defecation](https://en.wikipedia.org/wiki/Open_defecation "Open defecation") at a community-wide level and providing access to [improved sanitation](https://en.wikipedia.org/wiki/Improved_sanitation "Improved sanitation").[\[67\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-UN2015-67)[\[77\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-77) This includes use of [toilets](https://en.wikipedia.org/wiki/Toilet "Toilet") and implementation of the entire [sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation") chain connected to the toilets (collection, transport, disposal or reuse of [human excreta](https://en.wikipedia.org/wiki/Human_waste "Human waste")).
There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease.[\[78\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-78)[\[79\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-79)
#### Hand washing
Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30ā48%.[\[80\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-80)[\[81\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-81)[\[76\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:1-76) Hand washing in developing countries, however, is compromised by poverty as acknowledged by the [CDC](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention"): "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours.[\[82\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-82)
#### Water
Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean [water supply](https://en.wikipedia.org/wiki/Water_supply "Water supply") and [improved sanitation](https://en.wikipedia.org/wiki/Improved_sanitation "Improved sanitation") have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene.[\[42\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Brown_629%E2%80%9334-42)[\[83\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-83) Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22ā27% reduction in disease incidence, and a 21ā30% reduction in mortality rate associated with diarrheal disease.[\[84\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-84)
Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens.[\[85\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-85)
### Vaccination
Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2ā3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6ā10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease.[\[86\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-86) Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society.[\[87\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-87)[\[88\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-88)
[Rotavirus vaccine](https://en.wikipedia.org/wiki/Rotavirus_vaccine "Rotavirus vaccine") decreases the rates of diarrhea in a population.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1)[\[89\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-89) New vaccines against rotavirus, *Shigella*, [Enterotoxigenic *Escherichia coli* (ETEC)](https://en.wikipedia.org/wiki/Enterotoxigenic_Escherichia_coli "Enterotoxigenic Escherichia coli"), and cholera are under development, as well as other causes of infectious diarrhea.\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\]
### Nutrition
Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group.[\[90\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-90)[\[91\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-91) The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence.[\[92\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-92) Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective.[\[93\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-93)
#### Breastfeeding
Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive [exclusive breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding#Duration_and_exclusivity "Breastfeeding") during their first 6 months of life are better protected against infection with diarrheal diseases.[\[94\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-94) One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants.[\[95\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Lawrence2016-95) Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the [WHO](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization"),[\[96\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-96)[\[97\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-World_Health_Organization_2017-97) with continued breastfeeding until at least two years of age.[\[97\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-World_Health_Organization_2017-97)
### Others
[Probiotics](https://en.wikipedia.org/wiki/Probiotics "Probiotics") decrease the risk of diarrhea in those taking [antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics").[\[98\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-98) [Insecticide](https://en.wikipedia.org/wiki/Insecticide "Insecticide") spraying may reduce fly numbers and the risk of diarrhea in children in a setting where there is seasonal variations in fly numbers throughout the year.[\[99\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-99)
## Management
In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth ā [oral rehydration therapy](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") ā or, in severe cases, [intravenously](https://en.wikipedia.org/wiki/Intravenously "Intravenously").[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) Diet restrictions such as the [BRAT diet](https://en.wikipedia.org/wiki/BRAT_diet "BRAT diet") are no longer recommended.[\[100\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-100) Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea.[\[101\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-101) To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain, and that continuing to eat also speeds up recovery of normal intestinal functioning.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) CDC recommends that children and adults with cholera also continue to eat.[\[102\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDCmanualCholera-102) There is no evidence that early refeeding in children can cause an increase in inappropriate use of intravenous fluid, episodes of vomiting, and risk of having persistent diarrhea.[\[103\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-103)
Medications such as [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") (Imodium) and [bismuth subsalicylate](https://en.wikipedia.org/wiki/Bismuth_subsalicylate "Bismuth subsalicylate") may be beneficial; however they may be [contraindicated](https://en.wikipedia.org/wiki/Contraindicated "Contraindicated") in certain situations.[\[104\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid18192963-104)
### Fluids
See also: [Management of dehydration](https://en.wikipedia.org/wiki/Management_of_dehydration "Management of dehydration")
[](https://en.wikipedia.org/wiki/File:Cholera_rehydration_nurses.jpg)
A person consuming oral rehydration solution
[Oral rehydration solution (ORS)](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") (a slightly sweetened and salty water) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) There are commercial solutions such as [Pedialyte](https://en.wikipedia.org/wiki/Pedialyte "Pedialyte"), and relief agencies such as [UNICEF](https://en.wikipedia.org/wiki/UNICEF "UNICEF") widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) (approximately the "taste of tears"[\[105\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-2010WorldCupTravellersGuide-105)). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness.[\[106\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-RehydrationProject-106) Both agree that drinks with too much sugar or salt can make dehydration worse.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)[\[106\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-RehydrationProject-106)
Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment.[\[102\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDCmanualCholera-102)
Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)
Drinks especially high in simple sugars, such as [soft drinks](https://en.wikipedia.org/wiki/Soft_drinks "Soft drinks") and fruit juices, are not recommended in children under five as they may *increase* dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)[\[107\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NICE2009-107) Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable.[\[107\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NICE2009-107) Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) A [nasogastric tube](https://en.wikipedia.org/wiki/Nasogastric_tube "Nasogastric tube") can be used in young children to administer fluids if warranted.[\[108\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Webb2005-108)
### Eating
The WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. The WHO states "Food should *never* be withheld and the child's usual foods should *not* be diluted. Breastfeeding should *always* be continued."[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) In the specific example of cholera, the CDC makes the same recommendation.[\[102\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDCmanualCholera-102) Breast-fed infants with diarrhea often choose to breastfeed more, and should be encouraged to do so.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) In young children who are not breast-fed and live in the developed world, a lactose-free diet may be useful to speed recovery.[\[109\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-109) Eating food containing [soluble fibre](https://en.wikipedia.org/wiki/Soluble_fibre "Soluble fibre") may help, but insoluble fibre might make it worse.[\[110\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-110)
### Medications
Main article: [Antidiarrhoeal](https://en.wikipedia.org/wiki/Antidiarrhoeal "Antidiarrhoeal")
Antidiarrheal agents can be classified into four different groups: antimotility, antisecretory, adsorbent, and anti-infectious.[\[111\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Diosmectite2009-111) While [antibiotics](https://en.wikipedia.org/wiki/Antibiotic "Antibiotic") are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations.[\[112\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-112)[\[113\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CE08-113) There are concerns that antibiotics may increase the risk of [hemolytic uremic syndrome](https://en.wikipedia.org/wiki/Hemolytic_uremic_syndrome "Hemolytic uremic syndrome") in people infected with [*Escherichia coli* O157:H7](https://en.wikipedia.org/wiki/Escherichia_coli_O157:H7 "Escherichia coli O157:H7").[\[114\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-114) In resource-poor countries, treatment with antibiotics may be beneficial.[\[113\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CE08-113) However, some bacteria are developing [antibiotic resistance](https://en.wikipedia.org/wiki/Antibiotic_resistance "Antibiotic resistance"), particularly *Shigella*.[\[115\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-115) Antibiotics can also cause diarrhea, and [antibiotic-associated diarrhea](https://en.wikipedia.org/wiki/Antibiotic-associated_diarrhea "Antibiotic-associated diarrhea") is the most common adverse effect of treatment with general antibiotics.
While bismuth compounds ([Pepto-Bismol](https://en.wikipedia.org/wiki/Pepto-Bismol "Pepto-Bismol")) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness.[\[116\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-116) Anti-motility agents like [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") are also effective at reducing the number of stools but not the duration of disease.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8) These agents should be used only if bloody diarrhea is not present.[\[117\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-117)
[Diosmectite](https://en.wikipedia.org/wiki/Diosmectite "Diosmectite"), a natural aluminomagnesium silicate clay, is effective in alleviating symptoms of acute diarrhea in children,[\[118\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-118) and also has some effects in chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea.[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52) Another absorbent agent used for the treatment of mild diarrhea is [kaopectate](https://en.wikipedia.org/wiki/Kaopectate "Kaopectate").
[Racecadotril](https://en.wikipedia.org/wiki/Racecadotril "Racecadotril") an antisecretory medication may be used to treat diarrhea in children and adults.[\[111\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Diosmectite2009-111) It has better tolerability than [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide"), as it causes less [constipation](https://en.wikipedia.org/wiki/Constipation "Constipation") and [flatulence](https://en.wikipedia.org/wiki/Flatulence "Flatulence").[\[119\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Arzneistoff-Profile-119) However, it has little benefit in improving acute diarrhea in children.[\[120\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-120)
[Bile acid sequestrants](https://en.wikipedia.org/wiki/Bile_acid_sequestrants "Bile acid sequestrants") such as [cholestyramine](https://en.wikipedia.org/wiki/Cholestyramine "Cholestyramine") can be effective in chronic diarrhea due to [bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption"). Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as [SeHCAT](https://en.wikipedia.org/wiki/SeHCAT "SeHCAT") retention.[\[121\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-121)
### Alternative therapies
Green bananas improved recovery, reduced dehydration and prevented prolonged diarrhea in children with diarrhea.[\[122\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-122) The benefit was attributed to its production of [short-chain fatty acids](https://en.wikipedia.org/wiki/Short-chain_fatty_acids "Short-chain fatty acids") in the colon from its [resistant starch](https://en.wikipedia.org/wiki/Resistant_starch "Resistant starch") content, which enhances colonic water and electrolyte absorption.
Zinc supplementation may benefit children over six months old with diarrhea in areas with high rates of malnourishment or zinc deficiency.[\[123\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-123) This supports the World Health Organization guidelines for zinc, but not in the very young.
A Cochrane Review from 2020 concludes that [probiotics](https://en.wikipedia.org/wiki/Probiotic "Probiotic") make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration.[\[124\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid33295643-124) The [probiotic](https://en.wikipedia.org/wiki/Probiotic "Probiotic") *[Lactobacillus](https://en.wikipedia.org/wiki/Lactobacillus "Lactobacillus")* can help prevent [antibiotic-associated diarrhea](https://en.wikipedia.org/wiki/Antibiotic-associated_diarrhea "Antibiotic-associated diarrhea") in adults but possibly not children.[\[125\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-125) For those with [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance"), taking digestive [enzymes](https://en.wikipedia.org/wiki/Enzyme "Enzyme") containing [lactase](https://en.wikipedia.org/wiki/Lactase "Lactase") when consuming dairy products often improves symptoms.
## See also
- [Climate change and infectious diseases](https://en.wikipedia.org/wiki/Climate_change_and_infectious_diseases "Climate change and infectious diseases")
- [Mucorrhea](https://en.wikipedia.org/wiki/Mucorrhea "Mucorrhea") ā Discharge of mucus
- [Fernando Mazariegos](https://en.wikipedia.org/wiki/Fernando_Mazariegos "Fernando Mazariegos") ā Guatemalan scientist (1938ā2018)
## References
1. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-6) [***h***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-7)
["whqlibdoc.who.int"](http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf) (PDF). *[World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization")*. [Archived](https://web.archive.org/web/20101108051648/http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf) (PDF) from the original on 8 November 2010.
2. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-6) [***h***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-7) [***i***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-8) [***j***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-9) [***k***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-10) [***l***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-11) [***m***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-12) [***n***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-13) [***o***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-14) [***p***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-15) [***q***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-16) [***r***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-17) [***s***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-18) [***t***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-19) [***u***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-20) [***v***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-21) [***w***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-22) [***x***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-23) [***y***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-24) [***z***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-25)
["Diarrhoeal disease Factsheet"](https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease). *World Health Organization*. 2 May 2017. [Archived](https://web.archive.org/web/20201111202300/https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease) from the original on 11 November 2020. Retrieved 29 October 2020.
3. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-GBD2015Pre_3-0)**
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4. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Dadonaite_2018_4-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Dadonaite_2018_4-1)
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Abdelmalak B, Doyle J, eds. (2013). *Anesthesia for otolaryngologic surgery*. Cambridge University Press. pp. 282ā287\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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6. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-SaponeBai_6-0)**
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[](https://en.wikipedia.org/wiki/Open_access "open access publication ā free to read")
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Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD (July 2015). ["Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea"](http://eprints.whiterose.ac.uk/86190/3/MANUSCRIPT-REVISED%5B1%5D.pdf) (PDF). *Alimentary Pharmacology & Therapeutics*. **42** (1): 3ā11\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/apt.13227](https://doi.org/10.1111%2Fapt.13227). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25913530](https://pubmed.ncbi.nlm.nih.gov/25913530). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [34603226](https://api.semanticscholar.org/CorpusID:34603226). [Archived](https://web.archive.org/web/20200509035023/http://eprints.whiterose.ac.uk/86190/3/MANUSCRIPT-REVISED%5B1%5D.pdf) (PDF) from the original on 9 May 2020. Retrieved 23 September 2019.
8. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-3)
DuPont HL (April 2014). "Acute infectious diarrhea in immunocompetent adults". *The New England Journal of Medicine*. **370** (16): 1532ā40\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/nejmra1301069](https://doi.org/10.1056%2Fnejmra1301069). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24738670](https://pubmed.ncbi.nlm.nih.gov/24738670).
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Crockett ME, Keystone JS (2012). ["Protection of Travelers"](https://books.google.com/books?id=TN2Gu2Af1BIC&pg=PA82). In Fischer M, Long SS, Prober CG (eds.). *Principles and practice of pediatric infectious diseases* (4th ed.). Edinburgh: Elsevier Saunders. p. 82. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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ACEP (14 October 2013). ["Nation's Emergency Physicians Announce List of Test and Procedures to Question as Part of Choosing Wisely Campaign"](http://www.choosingwisely.org/nations-emergency-physicians-announce-list-of-test-and-procedures-to-question-as-part-of-choosing-wisely-campaign/). *Choosing Wisely*. [Archived](https://web.archive.org/web/20140517042652/http://www.choosingwisely.org/nations-emergency-physicians-announce-list-of-test-and-procedures-to-question-as-part-of-choosing-wisely-campaign/) from the original on 17 May 2014. Retrieved 18 June 2014.
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12. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CDC2013_12-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CDC2013_12-1)
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13. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-13)** [](https://en.wikipedia.org/wiki/File:Wiktionary-logo-en-v2.svg) The dictionary definition of [*squits*](https://en.wiktionary.org/wiki/squits "wiktionary:squits") at Wiktionary
14. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-14)**
[](https://en.wikipedia.org/wiki/File:Wiktionary-logo-en-v2.svg) The dictionary definition of [*runs*](https://en.wiktionary.org/wiki/runs "wiktionary:runs") at Wiktionary
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["Definition of Diarrhea by Merriam-Webster"](https://www.merriam-webster.com/dictionary/diarrhea#synonyms). *[Merriam Webster](https://en.wikipedia.org/wiki/Merriam_Webster "Merriam Webster")*. [Archived](https://web.archive.org/web/20181211052241/https://www.merriam-webster.com/dictionary/diarrhea#synonyms) from the original on 11 December 2018. Retrieved 11 December 2018.
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["The Basics of Diarrhea"](http://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea). Webmd.com. 17 February 2011. [Archived](https://web.archive.org/web/20110311010926/http://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea) from the original on 11 March 2011. Retrieved 9 March 2011.
19. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-6)
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20. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-6) [***h***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-7) [***i***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-8) [***j***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-9) [***k***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-10)
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Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, et al. (May 2012). "Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis". *JAMA: The Journal of the American Medical Association*. **307** (18): 1959ā69\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2012.3507](https://doi.org/10.1001%2Fjama.2012.3507). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22570464](https://pubmed.ncbi.nlm.nih.gov/22570464).
99. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-99)**
Das JK, Hadi YB, Salam RA, Hoda M, Lassi ZS, Bhutta ZA, et al. (Cochrane Infectious Diseases Group) (December 2018). ["Fly control to prevent diarrhoea in children"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302900). *The Cochrane Database of Systematic Reviews*. **12** (12) CD011654. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011654.pub2](https://doi.org/10.1002%2F14651858.CD011654.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6302900](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302900). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30556598](https://pubmed.ncbi.nlm.nih.gov/30556598).
100. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-100)**
King CK, Glass R, Bresee JS, Duggan C (November 2003). ["Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy"](https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm). *MMWR. Recommendations and Reports*. **52** (RR-16): 1ā16\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [14627948](https://pubmed.ncbi.nlm.nih.gov/14627948). [Archived](https://web.archive.org/web/20141028174056/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm) from the original on 28 October 2014.
101. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-101)**
["BestBets: Does Withholding milk feeds reduce the duration of diarrhoea in children with acute gastroenteritis?"](http://www.bestbets.org/bets/bet.php?id=1728). [Archived](https://web.archive.org/web/20090504105749/http://www.bestbets.org/bets/bet.php?id=1728) from the original on 4 May 2009.
102. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CDCmanualCholera_102-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CDCmanualCholera_102-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CDCmanualCholera_102-2) [Community Health Worker Training Materials for Cholera Prevention and Control](https://www.cdc.gov/haiticholera/pdf/chw_trainingmaterialsforcholera.pdf) [Archived](https://web.archive.org/web/20111020070810/http://www.cdc.gov/haiticholera/pdf/chw_trainingmaterialsforcholera.pdf) 20 October 2011 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine"), CDC, slides at back are dated 17 November 2010. Page 7 states "... Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment. Adults and older children should continue to eat frequently."
103. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-103)**
Gregorio GV, Dans LF, Silvestre MA, et al. (Cochrane Infectious Diseases Group) (July 2011). ["Early versus Delayed Refeeding for Children with Acute Diarrhoea"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532715). *The Cochrane Database of Systematic Reviews*. **2011** (7) CD007296. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD007296.pub2](https://doi.org/10.1002%2F14651858.CD007296.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6532715](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532715). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21735409](https://pubmed.ncbi.nlm.nih.gov/21735409).
104. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-pmid18192963_104-0)**
Schiller LR (2007). "Management of diarrhea in clinical practice: strategies for primary care physicians". *Reviews in Gastroenterological Disorders*. **7** (Suppl 3): S27-38. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18192963](https://pubmed.ncbi.nlm.nih.gov/18192963).
105. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-2010WorldCupTravellersGuide_105-0)** [A Guide on Safe Food for Travellers](https://www.who.int/topics/test/food_safety/safe_food_travel.pdf) [Archived](https://web.archive.org/web/20120709034248/http://www.who.int/topics/test/food_safety/safe_food_travel.pdf) 9 July 2012 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine"), Welcome to South Africa, Host to the 2010 FIFA World Cup (bottom left of page 1).
106. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-RehydrationProject_106-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-RehydrationProject_106-1)
Rehydration Project,
["Diarrhoea, Diarrhea, Dehydration, Oral Rehydration, Mother and Child Nutrition, Water, Sanitation, Hygiene ā Rehydration Project"](http://rehydrate.org/). [Archived](https://web.archive.org/web/20150608064953/http://rehydrate.org/) from the original on 8 June 2015. Retrieved 22 June 2015.
Homemade Oral Rehydration Solution Recipe.
107. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NICE2009_107-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NICE2009_107-1)
["Management of acute diarrhoea and vomiting due to gastroenteritis in children under 5"](http://guidance.nice.org.uk/CG84). *National Institute of Clinical Excellence*. April 2009. [Archived](https://web.archive.org/web/20090802094158/http://guidance.nice.org.uk/CG84) from the original on 2 August 2009.
108. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Webb2005_108-0)**
Webb A, Starr M (April 2005). "Acute gastroenteritis in children". *Australian Family Physician*. **34** (4): 227ā31\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [15861741](https://pubmed.ncbi.nlm.nih.gov/15861741).
109. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-109)**
MacGillivray S, Fahey T, McGuire W (October 2013). ["Lactose avoidance for young children with acute diarrhoea"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276385). *The Cochrane Database of Systematic Reviews*. **2013** (10) CD005433. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD005433.pub2](https://doi.org/10.1002%2F14651858.CD005433.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4276385](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276385). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24173771](https://pubmed.ncbi.nlm.nih.gov/24173771).
110. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-110)**
["The Facts About Fiber"](https://web.archive.org/web/20200727012104/https://www.webmd.com/digestive-disorders/chronic-diarrhea-16/diarrhea-more-fiber). Archived from [the original](https://www.webmd.com/digestive-disorders/chronic-diarrhea-16/diarrhea-more-fiber) on 27 July 2020. Retrieved 25 January 2020.
111. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Diosmectite2009_111-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Diosmectite2009_111-1)
Guarino A, Lo Vecchio A, Pirozzi MR (2009). "Clinical role of diosmectite in the management of diarrhea". *Expert Opin Drug Metab Toxicol*. **5** (4): 433ā440\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1517/17425250902865594](https://doi.org/10.1517%2F17425250902865594). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19379128](https://pubmed.ncbi.nlm.nih.gov/19379128). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [56519371](https://api.semanticscholar.org/CorpusID:56519371).
112. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-112)**
Dryden MS, Gabb RJ, Wright SK (June 1996). ["Empirical treatment of severe acute community-acquired gastroenteritis with ciprofloxacin"](https://doi.org/10.1093%2Fclinids%2F22.6.1019). *Clinical Infectious Diseases*. **22** (6): 1019ā25\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/clinids/22.6.1019](https://doi.org/10.1093%2Fclinids%2F22.6.1019). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [8783703](https://pubmed.ncbi.nlm.nih.gov/8783703).
113. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CE08_113-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CE08_113-1)
de Bruyn G (March 2008). ["Diarrhoea in adults (acute)"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907942). *BMJ Clinical Evidence*. **2008**: 0901. [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2907942](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907942). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19450323](https://pubmed.ncbi.nlm.nih.gov/19450323).
114. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-114)**
Wong CS, Jelacic S, Habeeb RL, Watkins SL, Tarr PI (June 2000). ["The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659814). *The New England Journal of Medicine*. **342** (26): 1930ā6\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/NEJM200006293422601](https://doi.org/10.1056%2FNEJM200006293422601). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3659814](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659814). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [10874060](https://pubmed.ncbi.nlm.nih.gov/10874060).
115. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-115)**
["Diarrhoeal Diseases"](https://web.archive.org/web/20081215123745/http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index6.html). *World Health Organization*. February 2009. Archived from [the original](https://www.who.int/vaccine_research/diseases/diarrhoeal/en/index6.html) on 15 December 2008.
116. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-116)**
DuPont HL, Ericsson CD, Farthing MJ, Gorbach S, Pickering LK, Rombo L, et al. (2009). ["Expert review of the evidence base for self-therapy of travelers' diarrhea"](https://doi.org/10.1111%2Fj.1708-8305.2009.00300.x). *Journal of Travel Medicine*. **16** (3): 161ā71\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1708-8305.2009.00300.x](https://doi.org/10.1111%2Fj.1708-8305.2009.00300.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19538576](https://pubmed.ncbi.nlm.nih.gov/19538576).
117. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-117)**
Pawlowski SW, Warren CA, Guerrant R (May 2009). ["Diagnosis and treatment of acute or persistent diarrhea"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723735). *Gastroenterology*. **136** (6): 1874ā86\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1053/j.gastro.2009.02.072](https://doi.org/10.1053%2Fj.gastro.2009.02.072). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2723735](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723735). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19457416](https://pubmed.ncbi.nlm.nih.gov/19457416).
118. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-118)**
Dupont C, Vernisse B (2009). ["Anti-diarrheal effects of diosmectite in the treatment of acute diarrhea in children: a review"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100234). *Paediatric Drugs*. **11** (2): 89ā99\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2165/00148581-200911020-00001](https://doi.org/10.2165%2F00148581-200911020-00001). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7100234](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100234). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19301931](https://pubmed.ncbi.nlm.nih.gov/19301931).
119. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Arzneistoff-Profile_119-0)**
Dinnendahl V, Fricke U, eds. (1982). *Arzneistoff-Profile* (in German). Eschborn, Germany: Govi Pharmazeutischer Verlag. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-3-7741-9846-3](https://en.wikipedia.org/wiki/Special:BookSources/978-3-7741-9846-3 "Special:BookSources/978-3-7741-9846-3")
.
120. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-120)**
Liang Y, Zhang L, Zeng L, Gordon M, Wen J, et al. (Cochrane Infectious Diseases Group) (December 2019). ["Racecadotril for acute diarrhoea in children"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923519). *The Cochrane Database of Systematic Reviews*. **2019** (12) CD009359. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD009359.pub2](https://doi.org/10.1002%2F14651858.CD009359.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6923519](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923519). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31858591](https://pubmed.ncbi.nlm.nih.gov/31858591).
121. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-121)**
Wilcox C, Turner J, Green J (May 2014). ["Systematic review: the management of chronic diarrhoea due to bile acid malabsorption"](https://doi.org/10.1111%2Fapt.12684). *Alimentary Pharmacology & Therapeutics*. **39** (9): 923ā39\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/apt.12684](https://doi.org/10.1111%2Fapt.12684). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24602022](https://pubmed.ncbi.nlm.nih.gov/24602022). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12016216](https://api.semanticscholar.org/CorpusID:12016216).
122. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-122)**
Ghitha N, Larasati A, Satari H, Maharani Indira F, Devaera Y, Gayatri P (31 August 2025). ["The role of green banana in the dietary management of children with diarrhea: a systematic review and meta analysis"](https://doi.org/10.58427%2Fapghn.4.3.2025.98-110). *Archives of Pediatric Gastroenterology, Hepatology, and Nutrition*. **4** (3): 98-110. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.58427/apghn.4.3.2025.98-110](https://doi.org/10.58427%2Fapghn.4.3.2025.98-110).
123. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-123)**
Lazzerini M, Wanzira H (December 2016). ["Oral zinc for treating diarrhoea in children"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450879). *The Cochrane Database of Systematic Reviews*. **12** (12) CD005436. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD005436.pub5](https://doi.org/10.1002%2F14651858.CD005436.pub5). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5450879](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450879). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27996088](https://pubmed.ncbi.nlm.nih.gov/27996088).
124. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-pmid33295643_124-0)**
Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, et al. (December 2020). ["Probiotics for treating acute infectious diarrhoea"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166250). *The Cochrane Database of Systematic Reviews*. **2020** (12) CD003048. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD003048.pub4](https://doi.org/10.1002%2F14651858.CD003048.pub4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8166250](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166250). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33295643](https://pubmed.ncbi.nlm.nih.gov/33295643).
125. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-125)**
Kale-Pradhan PB, Jassal HK, Wilhelm SM (February 2010). "Role of Lactobacillus in the prevention of antibiotic-associated diarrhea: a meta-analysis". *Pharmacotherapy*. **30** (2): 119ā26\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1592/phco.30.2.119](https://doi.org/10.1592%2Fphco.30.2.119). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20099986](https://pubmed.ncbi.nlm.nih.gov/20099986). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [21836205](https://api.semanticscholar.org/CorpusID:21836205).
## External links
**Diarrhea** at Wikipedia's [sister projects](https://en.wikipedia.org/wiki/Wikipedia:Wikimedia_sister_projects "Wikipedia:Wikimedia sister projects")
- [](https://en.wikipedia.org/wiki/File:Wiktionary-logo-en-v2.svg)[Definitions](https://en.wiktionary.org/wiki/Special:Search/Diarrhea "wikt:Special:Search/Diarrhea") from Wiktionary
- [](https://en.wikipedia.org/wiki/File:Commons-logo.svg)[Media](https://commons.wikimedia.org/wiki/Category:Diarrhea "c:Category:Diarrhea") from Commons
- [](https://en.wikipedia.org/wiki/File:Wikinews-logo.svg)[News](https://en.wikinews.org/wiki/Special:Search/Diarrhea "n:Special:Search/Diarrhea") from Wikinews
- [Quotations](https://en.wikiquote.org/wiki/Special:Search/Diarrhea "q:Special:Search/Diarrhea") from Wikiquote
- [](https://en.wikipedia.org/wiki/File:Wikisource-logo.svg)[Texts](https://en.wikisource.org/wiki/Special:Search/Diarrhea "s:Special:Search/Diarrhea") from Wikisource
- [](https://en.wikipedia.org/wiki/File:Wikibooks-logo.svg)[Textbooks](https://en.wikibooks.org/wiki/Special:Search/Diarrhea "b:Special:Search/Diarrhea") from Wikibooks
- [](https://en.wikipedia.org/wiki/File:Wikiversity_logo_2017.svg)[Resources](https://en.wikiversity.org/wiki/Special:Search/Diarrhea "v:Special:Search/Diarrhea") from Wikiversity
[](https://meta.wikimedia.org/wiki/Wiki_Project_Med/App "meta:Wiki Project Med/App")
Wikipedia's health care articles can be viewed offline with the **[Medical Wikipedia app](https://meta.wikimedia.org/wiki/Wiki_Project_Med/App "meta:Wiki Project Med/App")**.
- [WHO fact sheet on diarrhoeal disease](https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease)
| | |
|---|---|
| Classification | [D](https://www.wikidata.org/wiki/Q40878 "d:Q40878") **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10")**: [A09](https://icd.who.int/browse10/2019/en#/A09), [K59.1](https://icd.who.int/browse10/2019/en#/K59.1) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes")**: [787\.91](http://www.icd9data.com/getICD9Code.ashx?icd9=787.91) **[MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings")**: [D003967](https://meshb.nlm.nih.gov/record/ui?ui=D003967) **[DiseasesDB](https://en.wikipedia.org/wiki/Diseases_Database "Diseases Database")**: [3742](http://www.diseasesdatabase.com/ddb3742.htm) |
| External resources | **[MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus")**: [003126](https://www.nlm.nih.gov/medlineplus/ency/article/003126.htm) **[eMedicine](https://en.wikipedia.org/wiki/EMedicine "EMedicine")**: [ped/583](https://emedicine.medscape.com/ped/583-overview) **[Patient UK](https://en.wikipedia.org/wiki/Patient_UK "Patient UK")**: [Diarrhea](https://patient.info/doctor/acute-diarrhoea-in-adults-pro) |
| [v](https://en.wikipedia.org/wiki/Template:Digestive_system_diseases "Template:Digestive system diseases") [t](https://en.wikipedia.org/wiki/Template_talk:Digestive_system_diseases "Template talk:Digestive system diseases") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Digestive_system_diseases "Special:EditPage/Template:Digestive system diseases")Diseases of the [human digestive system](https://en.wikipedia.org/wiki/Human_digestive_system "Human digestive system") | |
|---|---|
| [Upper GI tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract#Upper_gastrointestinal_tract "Gastrointestinal tract") | |
| | |
| [Esophagus](https://en.wikipedia.org/wiki/Esophageal_disease "Esophageal disease") | [Esophagitis](https://en.wikipedia.org/wiki/Esophagitis "Esophagitis") [Candidal](https://en.wikipedia.org/wiki/Esophageal_candidiasis "Esophageal candidiasis") [Eosinophilic](https://en.wikipedia.org/wiki/Eosinophilic_esophagitis "Eosinophilic esophagitis") [Herpetiform](https://en.wikipedia.org/wiki/Herpetiform_esophagitis "Herpetiform esophagitis") *Rupture* [Boerhaave syndrome](https://en.wikipedia.org/wiki/Boerhaave_syndrome "Boerhaave syndrome") [MalloryāWeiss syndrome](https://en.wikipedia.org/wiki/Mallory%E2%80%93Weiss_syndrome "MalloryāWeiss syndrome") [Zenker's diverticulum](https://en.wikipedia.org/wiki/Zenker%27s_diverticulum "Zenker's diverticulum") [Barrett's esophagus](https://en.wikipedia.org/wiki/Barrett%27s_esophagus "Barrett's esophagus") [Esophageal motility disorder](https://en.wikipedia.org/wiki/Esophageal_motility_disorder "Esophageal motility disorder") [Nutcracker esophagus](https://en.wikipedia.org/wiki/Nutcracker_esophagus "Nutcracker esophagus") [Achalasia](https://en.wikipedia.org/wiki/Achalasia "Achalasia") [Esophagogastric junction outflow obstruction](https://en.wikipedia.org/wiki/Esophagogastric_junction_outflow_obstruction "Esophagogastric junction outflow obstruction") [Diffuse esophageal spasm](https://en.wikipedia.org/wiki/Diffuse_esophageal_spasm "Diffuse esophageal spasm") [Gastroesophageal reflux disease](https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease "Gastroesophageal reflux disease") (GERD) [Laryngopharyngeal reflux](https://en.wikipedia.org/wiki/Laryngopharyngeal_reflux "Laryngopharyngeal reflux") (LPR) [Esophageal stricture](https://en.wikipedia.org/wiki/Esophageal_stricture "Esophageal stricture") [Inlet patch](https://en.wikipedia.org/wiki/Esophageal_inlet_patch "Esophageal inlet patch") [Megaesophagus](https://en.wikipedia.org/wiki/Megaesophagus "Megaesophagus") [Esophageal intramural pseudodiverticulosis](https://en.wikipedia.org/wiki/Esophageal_intramural_pseudodiverticulosis "Esophageal intramural pseudodiverticulosis") [Acute esophageal necrosis](https://en.wikipedia.org/wiki/Acute_esophageal_necrosis "Acute esophageal necrosis") |
| [Stomach](https://en.wikipedia.org/wiki/Stomach_disease "Stomach disease") | [Gastritis](https://en.wikipedia.org/wiki/Gastritis "Gastritis") [Atrophic](https://en.wikipedia.org/wiki/Atrophic_gastritis "Atrophic gastritis") [MĆ©nĆ©trier's disease](https://en.wikipedia.org/wiki/M%C3%A9n%C3%A9trier%27s_disease "MĆ©nĆ©trier's disease") [Gastroenteritis](https://en.wikipedia.org/wiki/Gastroenteritis "Gastroenteritis") [Peptic (gastric) ulcer](https://en.wikipedia.org/wiki/Peptic_ulcer "Peptic ulcer") [Cushing ulcer](https://en.wikipedia.org/wiki/Cushing_ulcer "Cushing ulcer") [Dieulafoy's lesion](https://en.wikipedia.org/wiki/Dieulafoy%27s_lesion "Dieulafoy's lesion") [Dyspepsia](https://en.wikipedia.org/wiki/Dyspepsia "Dyspepsia") [Functional dyspepsia](https://en.wikipedia.org/wiki/Functional_dyspepsia "Functional dyspepsia") [Pyloric stenosis](https://en.wikipedia.org/wiki/Pyloric_stenosis "Pyloric stenosis") [Achlorhydria](https://en.wikipedia.org/wiki/Achlorhydria "Achlorhydria") [Gastroparesis](https://en.wikipedia.org/wiki/Gastroparesis "Gastroparesis") [Gastroptosis](https://en.wikipedia.org/wiki/Gastroptosis "Gastroptosis") [Portal hypertensive gastropathy](https://en.wikipedia.org/wiki/Portal_hypertensive_gastropathy "Portal hypertensive gastropathy") [Gastric antral vascular ectasia](https://en.wikipedia.org/wiki/Gastric_antral_vascular_ectasia "Gastric antral vascular ectasia") [Gastric dumping syndrome](https://en.wikipedia.org/wiki/Gastric_dumping_syndrome "Gastric dumping syndrome") [Gastric volvulus](https://en.wikipedia.org/wiki/Gastric_volvulus "Gastric volvulus") [Buried bumper syndrome](https://en.wikipedia.org/wiki/Buried_bumper_syndrome "Buried bumper syndrome") [Gastrinoma](https://en.wikipedia.org/wiki/Gastrinoma "Gastrinoma") [ZollingerāEllison syndrome](https://en.wikipedia.org/wiki/Zollinger%E2%80%93Ellison_syndrome "ZollingerāEllison syndrome") |
| [Lower GI tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract#Lower_gastrointestinal_tract "Gastrointestinal tract") [Enteropathy](https://en.wikipedia.org/wiki/Enteropathy "Enteropathy") | |
| | |
| [Small intestine](https://en.wikipedia.org/wiki/Small_intestine "Small intestine") ([Duodenum](https://en.wikipedia.org/wiki/Duodenum "Duodenum")/[Jejunum](https://en.wikipedia.org/wiki/Jejunum "Jejunum")/[Ileum](https://en.wikipedia.org/wiki/Ileum "Ileum")) | [Enteritis](https://en.wikipedia.org/wiki/Enteritis "Enteritis") [Duodenitis](https://en.wikipedia.org/wiki/Duodenitis "Duodenitis") [Jejunitis](https://en.wikipedia.org/wiki/Jejunitis "Jejunitis") [Ileitis](https://en.wikipedia.org/wiki/Ileitis "Ileitis") [Peptic (duodenal) ulcer](https://en.wikipedia.org/wiki/Peptic_ulcer "Peptic ulcer") [Curling's ulcer](https://en.wikipedia.org/wiki/Curling%27s_ulcer "Curling's ulcer") [Malabsorption](https://en.wikipedia.org/wiki/Malabsorption "Malabsorption"): [Coeliac](https://en.wikipedia.org/wiki/Coeliac_disease "Coeliac disease") [Tropical sprue](https://en.wikipedia.org/wiki/Tropical_sprue "Tropical sprue") [Blind loop syndrome](https://en.wikipedia.org/wiki/Blind_loop_syndrome "Blind loop syndrome") [Small intestinal bacterial overgrowth](https://en.wikipedia.org/wiki/Small_intestinal_bacterial_overgrowth "Small intestinal bacterial overgrowth") [Whipple's](https://en.wikipedia.org/wiki/Whipple%27s_disease "Whipple's disease") [Short bowel syndrome](https://en.wikipedia.org/wiki/Short_bowel_syndrome "Short bowel syndrome") [Steatorrhea](https://en.wikipedia.org/wiki/Steatorrhea "Steatorrhea") [Milroy disease](https://en.wikipedia.org/wiki/Milroy_disease "Milroy disease") [Bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption") |
| [Large intestine](https://en.wikipedia.org/wiki/Large_intestine "Large intestine") ([Appendix](https://en.wikipedia.org/wiki/Vermiform_appendix "Vermiform appendix")/[Colon](https://en.wikipedia.org/wiki/Colon_\(anatomy\) "Colon (anatomy)")) | [Appendicitis](https://en.wikipedia.org/wiki/Appendicitis "Appendicitis") [Colitis](https://en.wikipedia.org/wiki/Colitis "Colitis") [Pseudomembranous](https://en.wikipedia.org/wiki/Pseudomembranous_colitis "Pseudomembranous colitis") [Ulcerative](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis") [Ischemic](https://en.wikipedia.org/wiki/Ischemic_colitis "Ischemic colitis") [Microscopic](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis") [Collagenous](https://en.wikipedia.org/wiki/Collagenous_colitis "Collagenous colitis") [Lymphocytic](https://en.wikipedia.org/wiki/Lymphocytic_colitis "Lymphocytic colitis") [Dysentery](https://en.wikipedia.org/wiki/Dysentery "Dysentery") [Functional colonic disease](https://en.wikipedia.org/wiki/Functional_colonic_disease "Functional colonic disease") [IBS](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome") [Intestinal pseudoobstruction](https://en.wikipedia.org/wiki/Intestinal_pseudoobstruction "Intestinal pseudoobstruction") / [Ogilvie syndrome](https://en.wikipedia.org/wiki/Ogilvie_syndrome "Ogilvie syndrome") [Megacolon](https://en.wikipedia.org/wiki/Megacolon "Megacolon") / [Toxic megacolon](https://en.wikipedia.org/wiki/Toxic_megacolon "Toxic megacolon") [Diverticulitis](https://en.wikipedia.org/wiki/Diverticulitis "Diverticulitis")/[Diverticulosis](https://en.wikipedia.org/wiki/Diverticulosis "Diverticulosis")/[SCAD](https://en.wikipedia.org/wiki/Segmental_colitis_associated_with_diverticulosis "Segmental colitis associated with diverticulosis") |
| Large and/or small | [Enterocolitis](https://en.wikipedia.org/wiki/Enterocolitis "Enterocolitis") [Necrotizing](https://en.wikipedia.org/wiki/Necrotizing_enterocolitis "Necrotizing enterocolitis") [Gastroenterocolitis](https://en.wikipedia.org/wiki/Gastroenterocolitis "Gastroenterocolitis") [IBD](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease") [Crohn's disease](https://en.wikipedia.org/wiki/Crohn%27s_disease "Crohn's disease") *[Vascular](https://en.wikipedia.org/wiki/Vascular_disease "Vascular disease")*: [Abdominal angina](https://en.wikipedia.org/wiki/Abdominal_angina "Abdominal angina") [Mesenteric ischemia](https://en.wikipedia.org/wiki/Mesenteric_ischemia "Mesenteric ischemia") [Angiodysplasia](https://en.wikipedia.org/wiki/Angiodysplasia "Angiodysplasia") [Bowel obstruction](https://en.wikipedia.org/wiki/Bowel_obstruction "Bowel obstruction"): [Ileus](https://en.wikipedia.org/wiki/Ileus "Ileus") [Intussusception](https://en.wikipedia.org/wiki/Intussusception_\(medical_disorder\) "Intussusception (medical disorder)") [Volvulus](https://en.wikipedia.org/wiki/Volvulus "Volvulus") [Fecal impaction](https://en.wikipedia.org/wiki/Fecal_impaction "Fecal impaction") [Constipation](https://en.wikipedia.org/wiki/Constipation "Constipation") [Functional](https://en.wikipedia.org/wiki/Functional_constipation "Functional constipation") [Diarrhea]() [Infectious](https://en.wikipedia.org/wiki/Infectious_diarrhea "Infectious diarrhea") [Intestinal adhesions](https://en.wikipedia.org/wiki/Adhesion_\(medicine\) "Adhesion (medicine)") |
| [Rectum](https://en.wikipedia.org/wiki/Rectum "Rectum") | [Proctitis](https://en.wikipedia.org/wiki/Proctitis "Proctitis") [Radiation proctitis](https://en.wikipedia.org/wiki/Radiation_proctitis "Radiation proctitis") [Proctalgia fugax](https://en.wikipedia.org/wiki/Proctalgia_fugax "Proctalgia fugax") [Rectal prolapse](https://en.wikipedia.org/wiki/Rectal_prolapse "Rectal prolapse") ([Internal rectal prolapse](https://en.wikipedia.org/wiki/Internal_rectal_prolapse "Internal rectal prolapse")) [Anismus](https://en.wikipedia.org/wiki/Anismus "Anismus") [Solitary rectal ulcer syndrome](https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome "Solitary rectal ulcer syndrome") [Rectal stricture](https://en.wikipedia.org/wiki/Rectal_stricture "Rectal stricture") |
| [Anal canal](https://en.wikipedia.org/wiki/Anal_canal "Anal canal") | [Anal fissure](https://en.wikipedia.org/wiki/Anal_fissure "Anal fissure")/[Anal fistula](https://en.wikipedia.org/wiki/Anal_fistula "Anal fistula") [Anal abscess](https://en.wikipedia.org/wiki/Anal_abscess "Anal abscess") [Hemorrhoid](https://en.wikipedia.org/wiki/Hemorrhoid "Hemorrhoid") [Anal dysplasia](https://en.wikipedia.org/wiki/Anal_dysplasia "Anal dysplasia") [Pruritus ani](https://en.wikipedia.org/wiki/Pruritus_ani "Pruritus ani") [Anal stricture](https://en.wikipedia.org/wiki/Anal_stricture "Anal stricture") |
| [GI bleeding](https://en.wikipedia.org/wiki/Gastrointestinal_bleeding "Gastrointestinal bleeding") | [Blood in stool](https://en.wikipedia.org/wiki/Blood_in_stool "Blood in stool") [Upper](https://en.wikipedia.org/wiki/Upper_gastrointestinal_bleeding "Upper gastrointestinal bleeding") [Hematemesis](https://en.wikipedia.org/wiki/Hematemesis "Hematemesis") [Melena](https://en.wikipedia.org/wiki/Melena "Melena") [Lower](https://en.wikipedia.org/wiki/Lower_gastrointestinal_bleeding "Lower gastrointestinal bleeding") [Hematochezia](https://en.wikipedia.org/wiki/Hematochezia "Hematochezia") |
| [Accessory](https://en.wikipedia.org/wiki/Accessory_digestive_gland "Accessory digestive gland") | |
| | |
| [Liver](https://en.wikipedia.org/wiki/Liver_disease "Liver disease") | [Hepatitis](https://en.wikipedia.org/wiki/Hepatitis "Hepatitis") [Viral hepatitis](https://en.wikipedia.org/wiki/Viral_hepatitis "Viral hepatitis") [Autoimmune hepatitis](https://en.wikipedia.org/wiki/Autoimmune_hepatitis "Autoimmune hepatitis") [Alcoholic hepatitis](https://en.wikipedia.org/wiki/Alcoholic_hepatitis "Alcoholic hepatitis") [Cirrhosis](https://en.wikipedia.org/wiki/Cirrhosis "Cirrhosis") [PBC](https://en.wikipedia.org/wiki/Primary_biliary_cirrhosis "Primary biliary cirrhosis") [Fatty liver](https://en.wikipedia.org/wiki/Fatty_liver "Fatty liver") [MASLD](https://en.wikipedia.org/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease "Metabolic dysfunctionāassociated steatotic liver disease") *[Vascular](https://en.wikipedia.org/wiki/Vascular_disease "Vascular disease")* [BuddāChiari syndrome](https://en.wikipedia.org/wiki/Budd%E2%80%93Chiari_syndrome "BuddāChiari syndrome") [Hepatic veno-occlusive disease](https://en.wikipedia.org/wiki/Hepatic_veno-occlusive_disease "Hepatic veno-occlusive disease") [Portal hypertension](https://en.wikipedia.org/wiki/Portal_hypertension "Portal hypertension") [Nutmeg liver](https://en.wikipedia.org/wiki/Nutmeg_liver "Nutmeg liver") [Alcoholic liver disease](https://en.wikipedia.org/wiki/Alcoholic_liver_disease "Alcoholic liver disease") [Liver failure](https://en.wikipedia.org/wiki/Liver_failure "Liver failure") [Hepatic encephalopathy](https://en.wikipedia.org/wiki/Hepatic_encephalopathy "Hepatic encephalopathy") [Acute liver failure](https://en.wikipedia.org/wiki/Acute_liver_failure "Acute liver failure") [Liver abscess](https://en.wikipedia.org/wiki/Liver_abscess "Liver abscess") [Pyogenic](https://en.wikipedia.org/wiki/Pyogenic_liver_abscess "Pyogenic liver abscess") [Amoebic](https://en.wikipedia.org/wiki/Amoebic_liver_abscess "Amoebic liver abscess") [Hepatorenal syndrome](https://en.wikipedia.org/wiki/Hepatorenal_syndrome "Hepatorenal syndrome") [Peliosis hepatis](https://en.wikipedia.org/wiki/Peliosis_hepatis "Peliosis hepatis") [Metabolic disorders](https://en.wikipedia.org/wiki/Metabolic_disorder "Metabolic disorder") [Wilson's disease](https://en.wikipedia.org/wiki/Wilson%27s_disease "Wilson's disease") [Hemochromatosis](https://en.wikipedia.org/wiki/Hemochromatosis "Hemochromatosis") |
| [Gallbladder](https://en.wikipedia.org/wiki/Gallbladder_disease "Gallbladder disease") | [Cholecystitis](https://en.wikipedia.org/wiki/Cholecystitis "Cholecystitis") [Gallstone / Cholelithiasis](https://en.wikipedia.org/wiki/Gallstone "Gallstone") [Cholesterolosis](https://en.wikipedia.org/wiki/Cholesterolosis_of_gallbladder "Cholesterolosis of gallbladder") [Adenomyomatosis](https://en.wikipedia.org/wiki/Adenomyomatosis "Adenomyomatosis") [Postcholecystectomy syndrome](https://en.wikipedia.org/wiki/Postcholecystectomy_syndrome "Postcholecystectomy syndrome") [Porcelain gallbladder](https://en.wikipedia.org/wiki/Porcelain_gallbladder "Porcelain gallbladder") |
| [Bile duct](https://en.wikipedia.org/wiki/Bile_duct "Bile duct")/ Other [biliary tree](https://en.wikipedia.org/wiki/Biliary_tree "Biliary tree") | [Cholangitis](https://en.wikipedia.org/wiki/Cholangitis "Cholangitis") [Primary sclerosing cholangitis](https://en.wikipedia.org/wiki/Primary_sclerosing_cholangitis "Primary sclerosing cholangitis") [Secondary sclerosing cholangitis](https://en.wikipedia.org/wiki/Secondary_sclerosing_cholangitis "Secondary sclerosing cholangitis") [Ascending](https://en.wikipedia.org/wiki/Ascending_cholangitis "Ascending cholangitis") [Cholestasis](https://en.wikipedia.org/wiki/Cholestasis "Cholestasis")/[Mirizzi's syndrome](https://en.wikipedia.org/wiki/Mirizzi%27s_syndrome "Mirizzi's syndrome") [Biliary fistula](https://en.wikipedia.org/wiki/Biliary_fistula "Biliary fistula") [Haemobilia](https://en.wikipedia.org/wiki/Haemobilia "Haemobilia") *[Common bile duct](https://en.wikipedia.org/wiki/Common_bile_duct "Common bile duct")* [Choledocholithiasis](https://en.wikipedia.org/wiki/Choledocholithiasis "Choledocholithiasis") [Biliary dyskinesia](https://en.wikipedia.org/wiki/Biliary_dyskinesia "Biliary dyskinesia") [Sphincter of Oddi dysfunction](https://en.wikipedia.org/wiki/Sphincter_of_Oddi_dysfunction "Sphincter of Oddi dysfunction") |
| [Pancreatic](https://en.wikipedia.org/wiki/Pancreatic_disease "Pancreatic disease") | [Pancreatitis](https://en.wikipedia.org/wiki/Pancreatitis "Pancreatitis") [Acute](https://en.wikipedia.org/wiki/Acute_pancreatitis "Acute pancreatitis") [Chronic](https://en.wikipedia.org/wiki/Chronic_pancreatitis "Chronic pancreatitis") [Hereditary](https://en.wikipedia.org/wiki/Hereditary_pancreatitis "Hereditary pancreatitis") [Pancreatic abscess](https://en.wikipedia.org/wiki/Pancreatic_abscess "Pancreatic abscess") [Pancreatic pseudocyst](https://en.wikipedia.org/wiki/Pancreatic_pseudocyst "Pancreatic pseudocyst") [Exocrine pancreatic insufficiency](https://en.wikipedia.org/wiki/Exocrine_pancreatic_insufficiency "Exocrine pancreatic insufficiency") [Pancreatic fistula](https://en.wikipedia.org/wiki/Pancreatic_fistula "Pancreatic fistula") |
| Other | |
| | |
| [Hernia](https://en.wikipedia.org/wiki/Hernia "Hernia") | [Diaphragmatic](https://en.wikipedia.org/wiki/Diaphragmatic_hernia "Diaphragmatic hernia") [Congenital](https://en.wikipedia.org/wiki/Congenital_diaphragmatic_hernia "Congenital diaphragmatic hernia") [Hiatus](https://en.wikipedia.org/wiki/Hiatus_hernia "Hiatus hernia") [Inguinal](https://en.wikipedia.org/wiki/Inguinal_hernia "Inguinal hernia") [Indirect](https://en.wikipedia.org/wiki/Indirect_inguinal_hernia "Indirect inguinal hernia") [Direct](https://en.wikipedia.org/wiki/Direct_inguinal_hernia "Direct inguinal hernia") [Umbilical](https://en.wikipedia.org/wiki/Umbilical_hernia "Umbilical hernia") [Paraumbilical](https://en.wikipedia.org/wiki/Paraumbilical_hernia "Paraumbilical hernia") [Femoral](https://en.wikipedia.org/wiki/Femoral_hernia "Femoral hernia") [Obturator](https://en.wikipedia.org/wiki/Obturator_hernia "Obturator hernia") [Spigelian](https://en.wikipedia.org/wiki/Spigelian_hernia "Spigelian hernia") *[Lumbar](https://en.wikipedia.org/wiki/Lumbar_hernia "Lumbar hernia")* [Petit's](https://en.wikipedia.org/wiki/Petit%27s_hernia "Petit's hernia") [GrynfelttāLesshaft](https://en.wikipedia.org/wiki/Grynfeltt%E2%80%93Lesshaft_hernia "GrynfelttāLesshaft hernia") *Undefined location* [Incisional](https://en.wikipedia.org/wiki/Incisional_hernia "Incisional hernia") [Internal hernia](https://en.wikipedia.org/wiki/Internal_hernia "Internal hernia") [Richter's](https://en.wikipedia.org/wiki/Richter%27s_hernia "Richter's hernia") |
| [Peritoneal](https://en.wikipedia.org/wiki/Peritoneal_disease "Peritoneal disease") | [Peritonitis](https://en.wikipedia.org/wiki/Peritonitis "Peritonitis") [Spontaneous bacterial peritonitis](https://en.wikipedia.org/wiki/Spontaneous_bacterial_peritonitis "Spontaneous bacterial peritonitis") [Hemoperitoneum](https://en.wikipedia.org/wiki/Hemoperitoneum "Hemoperitoneum") [Pneumoperitoneum](https://en.wikipedia.org/wiki/Pneumoperitoneum "Pneumoperitoneum") |
| [v](https://en.wikipedia.org/wiki/Template:Digestive_system_and_abdomen_symptoms_and_signs "Template:Digestive system and abdomen symptoms and signs") [t](https://en.wikipedia.org/wiki/Template_talk:Digestive_system_and_abdomen_symptoms_and_signs "Template talk:Digestive system and abdomen symptoms and signs") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Digestive_system_and_abdomen_symptoms_and_signs "Special:EditPage/Template:Digestive system and abdomen symptoms and signs")[Signs and symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") relating to the [human digestive system](https://en.wikipedia.org/wiki/Human_digestive_system "Human digestive system"), including the [abdomen](https://en.wikipedia.org/wiki/Abdomen "Abdomen") and [eating disorders](https://en.wikipedia.org/wiki/Eating_disorder "Eating disorder") that are associated | |
|---|---|
| [Gastrointestinal tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract "Gastrointestinal tract") | [Nausea](https://en.wikipedia.org/wiki/Nausea "Nausea") [Vomiting](https://en.wikipedia.org/wiki/Vomiting "Vomiting") [Heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn") [Aerophagia](https://en.wikipedia.org/wiki/Aerophagia "Aerophagia") [Dysphagia](https://en.wikipedia.org/wiki/Dysphagia "Dysphagia") [oropharyngeal](https://en.wikipedia.org/wiki/Oropharyngeal_dysphagia "Oropharyngeal dysphagia") [esophageal](https://en.wikipedia.org/wiki/Esophageal_dysphagia "Esophageal dysphagia") [Odynophagia](https://en.wikipedia.org/wiki/Odynophagia "Odynophagia") [Bad breath](https://en.wikipedia.org/wiki/Bad_breath "Bad breath") [Xerostomia](https://en.wikipedia.org/wiki/Xerostomia "Xerostomia") [Hypersalivation](https://en.wikipedia.org/wiki/Hypersalivation "Hypersalivation") [Burping](https://en.wikipedia.org/wiki/Burping "Burping") [Goodsall's rule](https://en.wikipedia.org/wiki/Goodsall%27s_rule "Goodsall's rule") [Chilaiditi syndrome](https://en.wikipedia.org/wiki/Chilaiditi_syndrome "Chilaiditi syndrome") [Dance's sign](https://en.wikipedia.org/wiki/Dance%27s_sign "Dance's sign") [Aaron's sign](https://en.wikipedia.org/wiki/Aaron%27s_sign "Aaron's sign") [Arapov's sign](https://en.wikipedia.org/wiki/Arapov%27s_contracture "Arapov's contracture") [Markle's sign](https://en.wikipedia.org/wiki/Markle%27s_sign "Markle's sign") [McBurney's point](https://en.wikipedia.org/wiki/McBurney%27s_point "McBurney's point") [Sherren's triangle](https://en.wikipedia.org/wiki/Sherren%27s_triangle "Sherren's triangle") *[Radiologic signs](https://en.wikipedia.org/wiki/Radiologic_sign "Radiologic sign"):* [Hampton's line](https://en.wikipedia.org/wiki/Hampton%27s_line "Hampton's line") [Klemm's sign](https://en.wikipedia.org/wiki/Klemm%27s_sign "Klemm's sign") |
| Accessory | *[liver](https://en.wikipedia.org/wiki/Liver "Liver"):* [Councilman body](https://en.wikipedia.org/wiki/Councilman_body "Councilman body") [Mallory body](https://en.wikipedia.org/wiki/Mallory_body "Mallory body") *biliary:* [Boas' sign](https://en.wikipedia.org/wiki/Boas%27_sign "Boas' sign") [Courvoisier's law](https://en.wikipedia.org/wiki/Courvoisier%27s_law "Courvoisier's law") [Charcot's cholangitis triad](https://en.wikipedia.org/wiki/Charcot%27s_cholangitis_triad "Charcot's cholangitis triad")/[Reynolds' pentad](https://en.wikipedia.org/wiki/Reynolds%27_pentad "Reynolds' pentad") *[cholecystitis](https://en.wikipedia.org/wiki/Cholecystitis "Cholecystitis")* ([Murphy's sign](https://en.wikipedia.org/wiki/Murphy%27s_sign "Murphy's sign") [LĆ©pine's sign](https://en.wikipedia.org/wiki/L%C3%A9pine%27s_sign "LĆ©pine's sign") [Mirizzi's syndrome](https://en.wikipedia.org/wiki/Mirizzi%27s_syndrome "Mirizzi's syndrome")) [Nardi test](https://en.wikipedia.org/wiki/Nardi_test "Nardi test") |
| [Defecation](https://en.wikipedia.org/wiki/Defecation "Defecation") | [Flatulence](https://en.wikipedia.org/wiki/Flatulence "Flatulence") [Fecal incontinence](https://en.wikipedia.org/wiki/Fecal_incontinence "Fecal incontinence") and [encopresis](https://en.wikipedia.org/wiki/Encopresis "Encopresis") [Fecal urgency](https://en.wikipedia.org/wiki/Fecal_urgency "Fecal urgency") [Fecal occult blood](https://en.wikipedia.org/wiki/Fecal_occult_blood "Fecal occult blood") [Rectal tenesmus](https://en.wikipedia.org/wiki/Rectal_tenesmus "Rectal tenesmus") [Constipation](https://en.wikipedia.org/wiki/Constipation "Constipation") [Obstructed defecation](https://en.wikipedia.org/wiki/Obstructed_defecation "Obstructed defecation") [Diarrhea]() [Rectal discharge](https://en.wikipedia.org/wiki/Rectal_discharge "Rectal discharge") |
| Abdomen | |
| | |
| Pain | [Abdominal pain](https://en.wikipedia.org/wiki/Abdominal_pain "Abdominal pain") [Acute abdomen](https://en.wikipedia.org/wiki/Acute_abdomen "Acute abdomen") [Colic](https://en.wikipedia.org/wiki/Colic "Colic") [Baby colic](https://en.wikipedia.org/wiki/Baby_colic "Baby colic") [Abdominal guarding](https://en.wikipedia.org/wiki/Abdominal_guarding "Abdominal guarding") [Blumberg's sign](https://en.wikipedia.org/wiki/Blumberg%27s_sign "Blumberg's sign") |
| Distension | [Abdominal distension](https://en.wikipedia.org/wiki/Abdominal_distension "Abdominal distension") [Bloating](https://en.wikipedia.org/wiki/Bloating "Bloating") [Ascites](https://en.wikipedia.org/wiki/Ascites "Ascites") [Tympany](https://en.wikipedia.org/wiki/Tympany "Tympany") [Shifting dullness](https://en.wikipedia.org/wiki/Shifting_dullness "Shifting dullness") [Fluid wave test](https://en.wikipedia.org/wiki/Fluid_wave_test "Fluid wave test") |
| Masses | [Abdominal mass](https://en.wikipedia.org/wiki/Abdominal_mass "Abdominal mass") [Hepatosplenomegaly](https://en.wikipedia.org/wiki/Hepatosplenomegaly "Hepatosplenomegaly") [Hepatomegaly](https://en.wikipedia.org/wiki/Hepatomegaly "Hepatomegaly") [Splenomegaly](https://en.wikipedia.org/wiki/Splenomegaly "Splenomegaly") |
| Other | [Jaundice](https://en.wikipedia.org/wiki/Jaundice "Jaundice") [Mallet-Guy's sign](https://en.wikipedia.org/wiki/Mallet-Guy%27s_sign "Mallet-Guy's sign") [Puddle sign](https://en.wikipedia.org/wiki/Puddle_sign "Puddle sign") [Ballance's sign](https://en.wikipedia.org/wiki/Ballance%27s_sign "Ballance's sign") [Aortic insufficiency](https://en.wikipedia.org/wiki/Aortic_insufficiency "Aortic insufficiency") [Castell's sign](https://en.wikipedia.org/wiki/Castell%27s_sign "Castell's sign") [Kehr's sign](https://en.wikipedia.org/wiki/Kehr%27s_sign "Kehr's sign") [Cullen's sign](https://en.wikipedia.org/wiki/Cullen%27s_sign "Cullen's sign") [Grey Turner's sign](https://en.wikipedia.org/wiki/Grey_Turner%27s_sign "Grey Turner's sign") |
| [Hernia](https://en.wikipedia.org/wiki/Hernia "Hernia") | [HowshipāRomberg sign](https://en.wikipedia.org/wiki/Howship%E2%80%93Romberg_sign "HowshipāRomberg sign") [Hannington-Kiff sign](https://en.wikipedia.org/wiki/Hannington-Kiff_sign "Hannington-Kiff sign") |
| Other | [Psoas sign](https://en.wikipedia.org/wiki/Psoas_sign "Psoas sign") [Obturator sign](https://en.wikipedia.org/wiki/Obturator_sign "Obturator sign") [Rovsing's sign](https://en.wikipedia.org/wiki/Rovsing%27s_sign "Rovsing's sign") [Hamburger sign](https://en.wikipedia.org/wiki/Hamburger_sign "Hamburger sign") [Heel tap sign](https://en.wikipedia.org/wiki/Heel_tap_sign "Heel tap sign") [Aure-Rozanova's sign](https://en.wikipedia.org/wiki/Aure-Rozanova%27s_sign "Aure-Rozanova's sign") [Dunphy's sign](https://en.wikipedia.org/wiki/Dunphy%27s_sign "Dunphy's sign") [Alder's sign](https://en.wikipedia.org/wiki/Alder%27s_sign "Alder's sign") [Lockwood's sign](https://en.wikipedia.org/wiki/Lockwood%27s_sign "Lockwood's sign") [Rosenstein's sign](https://en.wikipedia.org/wiki/Rosenstein%27s_sign "Rosenstein's sign") [Cupola sign](https://en.wikipedia.org/wiki/Cupola_sign "Cupola sign") [Fothergill's sign](https://en.wikipedia.org/wiki/Fothergill%27s_sign "Fothergill's sign") [Carnett's sign](https://en.wikipedia.org/wiki/Carnett%27s_sign "Carnett's sign") [Massouh's sign](https://en.wikipedia.org/wiki/Massouh%27s_sign "Massouh's sign") [Sister Mary Joseph nodule](https://en.wikipedia.org/wiki/Sister_Mary_Joseph_nodule "Sister Mary Joseph nodule") [Blumer's shelf](https://en.wikipedia.org/wiki/Blumer%27s_shelf "Blumer's shelf") |
| Eating disorders | [Anorexia](https://en.wikipedia.org/wiki/Anorexia_\(symptom\) "Anorexia (symptom)") [Anorexia nervosa](https://en.wikipedia.org/wiki/Anorexia_nervosa "Anorexia nervosa") [Bulimia nervosa](https://en.wikipedia.org/wiki/Bulimia_nervosa "Bulimia nervosa") [Binge eating disorder](https://en.wikipedia.org/wiki/Binge_eating_disorder "Binge eating disorder") [A/RFID](https://en.wikipedia.org/wiki/Avoidant/restrictive_food_intake_disorder "Avoidant/restrictive food intake disorder") [Pica](https://en.wikipedia.org/wiki/Pica_\(disorder\) "Pica (disorder)") [Trichophagia](https://en.wikipedia.org/wiki/Trichophagia "Trichophagia") [Pagophagia](https://en.wikipedia.org/wiki/Pagophagia "Pagophagia") [Geophagia](https://en.wikipedia.org/wiki/Geophagia "Geophagia") |
| [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control") [](https://www.wikidata.org/wiki/Q40878#identifiers "Edit this at Wikidata") | |
|---|---|
| International | [GND](https://d-nb.info/gnd/4070636-9) |
| National | [United States](https://id.loc.gov/authorities/sh85037604) [France](https://catalogue.bnf.fr/ark:/12148/cb119403386) [BnF data](https://data.bnf.fr/ark:/12148/cb119403386) [Japan](https://id.ndl.go.jp/auth/ndlna/00562417) [Czech Republic](https://aleph.nkp.cz/F/?func=find-c&local_base=aut&ccl_term=ica=ph124733&CON_LNG=ENG) [Spain](https://datos.bne.es/resource/XX533003) [Israel](https://www.nli.org.il/en/authorities/987007552922005171) |
| Other | [Yale LUX](https://lux.collections.yale.edu/view/concept/4026c58a-18ce-4884-8f7e-31a89e320be2) |
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- [Diarrhea](https://en.wikipedia.org/wiki/Category:Diarrhea "Category:Diarrhea")
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Diarrhea
123 languages
[Add topic](https://en.wikipedia.org/wiki/Diarrhea) |
| Readable Markdown | | Diarrhea | |
|---|---|
| Other names | Diarrhoea (or diarrhÅa) |
| [](https://en.wikipedia.org/wiki/File:Multiple_rotavirus_particles.jpg) | |
| An electron micrograph of [rotavirus](https://en.wikipedia.org/wiki/Rotavirus "Rotavirus"), the cause of nearly 40% of hospitalizations from diarrhea in children under five[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) | |
| Pronunciation | |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Infectious disease](https://en.wikipedia.org/wiki/Infectious_disease_\(medical_specialty\) "Infectious disease (medical specialty)"), [gastroenterology](https://en.wikipedia.org/wiki/Gastroenterology "Gastroenterology") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | Loose frequent bowel movements, [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration")[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | Usually infection (viral, bacterial, parasitic)[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") | Contaminated food or water[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| Prevention | [Handwashing](https://en.wikipedia.org/wiki/Handwashing "Handwashing"), [rotavirus vaccination](https://en.wikipedia.org/wiki/Rotavirus_vaccination "Rotavirus vaccination"), [breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding")[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| Treatment | [Oral rehydration solution](https://en.wikipedia.org/wiki/Oral_rehydration_solution "Oral rehydration solution"), [zinc supplementation](https://en.wikipedia.org/wiki/Zinc_supplementation "Zinc supplementation")[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) |
| Frequency | ā2.4 billion (2015)[\[3\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-GBD2015Pre-3) |
| Deaths | 1\.53 million (2019)[\[4\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Dadonaite_2018-4) |
**Diarrhea** ([American English](https://en.wikipedia.org/wiki/American_English "American English")), also spelled **diarrhoea** or **diarrhÅa** ([British English](https://en.wikipedia.org/wiki/British_English "British English")), is the condition of having at least three loose, liquid, or watery [bowel movements](https://en.wikipedia.org/wiki/Defecation "Defecation") in a day.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) It often lasts for a few days and can result in [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration") due to fluid loss.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) This can progress to decreased [urination](https://en.wikipedia.org/wiki/Urination "Urination"), [loss of skin color](https://en.wikipedia.org/wiki/Pallor "Pallor"), a [fast heart rate](https://en.wikipedia.org/wiki/Tachycardia "Tachycardia"), and a [decrease in responsiveness](https://en.wikipedia.org/wiki/Altered_level_of_consciousness "Altered level of consciousness") as it becomes more severe.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Loose but non-watery [stools](https://en.wikipedia.org/wiki/Feces "Feces") in babies who are exclusively [breastfed](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding"), however, are normal.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)
What is diarrhea? How is it caused, treated and prevented? (see also [script](https://en.wikipedia.org/wiki/Wikipedia:VideoWiki/Diarrhea "Wikipedia:VideoWiki/Diarrhea"))
The most common cause is an infection of the [intestines](https://en.wikipedia.org/wiki/Intestine "Intestine") due to a [virus](https://en.wikipedia.org/wiki/Virus "Virus"), [bacterium](https://en.wikipedia.org/wiki/Bacterium "Bacterium"), or [parasite](https://en.wikipedia.org/wiki/Parasite "Parasite")āa condition also known as [gastroenteritis](https://en.wikipedia.org/wiki/Gastroenteritis "Gastroenteritis").[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) These infections are often acquired from food or water that has been contaminated by [feces](https://en.wikipedia.org/wiki/Human_feces "Human feces"), or directly from another person who is infected.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody).[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) The short duration watery diarrhea may be due to [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), although this is rare in the developed world.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) If blood is present, it is also known as [dysentery](https://en.wikipedia.org/wiki/Dysentery "Dysentery").[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) A number of non-infectious causes can result in diarrhea.[\[5\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CEM2013-5) These include [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance"), side effect of [drug withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal"), [irritable bowel syndrome](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome"), [non-celiac gluten sensitivity](https://en.wikipedia.org/wiki/Non-celiac_gluten_sensitivity "Non-celiac gluten sensitivity"), [celiac disease](https://en.wikipedia.org/wiki/Coeliac_disease "Coeliac disease"), [inflammatory bowel disease](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease") such as [ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [bile acid diarrhea](https://en.wikipedia.org/wiki/Bile_acid_diarrhea "Bile acid diarrhea"), and a number of medications.[\[5\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CEM2013-5)[\[6\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-SaponeBai-6)[\[7\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-7) In most cases, [stool cultures](https://en.wikipedia.org/wiki/Stool_test "Stool test") to confirm the exact cause are not required.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8)
Diarrhea can be prevented by improved [sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation"), clean [drinking water](https://en.wikipedia.org/wiki/Drinking_water "Drinking water"), and [hand washing](https://en.wikipedia.org/wiki/Hand_washing "Hand washing") with soap.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) [Breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding") for at least six months and [vaccination against rotavirus](https://en.wikipedia.org/wiki/Rotavirus_vaccine "Rotavirus vaccine") is also recommended.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) [Oral rehydration solution](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") (ORS)āclean water with modest amounts of salts and [sugar](https://en.wikipedia.org/wiki/Sugar "Sugar")āis the treatment of choice.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) [Zinc tablets](https://en.wikipedia.org/wiki/Zinc#Dietary_supplement "Zinc") are also recommended.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) These treatments have been estimated to have saved 50 million children in the past 25 years.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) When people have diarrhea it is recommended that they continue to eat healthy food, and babies continue to be breastfed.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) If commercial ORS is not available, homemade solutions may be used.[\[9\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Prober2012-9) In those with severe dehydration, [intravenous fluids](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") may be required.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Most cases, however, can be managed well with fluids by mouth.[\[10\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-10) [Antibiotics](https://en.wikipedia.org/wiki/Antibiotic "Antibiotic"), while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe [diarrhea following travelling](https://en.wikipedia.org/wiki/Travelers_diarrhea "Travelers diarrhea"), and those who grow specific bacteria or parasites in their stool.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8) [Loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") may help decrease the number of bowel movements but is not recommended in those with severe disease.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8)
About 1.7 to 5 billion cases of diarrhea occur per year.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)[\[5\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CEM2013-5)[\[11\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-GBD2013-11) It is most common in [developing countries](https://en.wikipedia.org/wiki/Developing_countries "Developing countries"), where young children get diarrhea on average three times a year.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Total deaths from diarrhea are estimated at 1.53 million in 2019ādown from 2.9 million in 1990.[\[4\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Dadonaite_2018-4) In 2012, it was the second most common cause of [deaths in children](https://en.wikipedia.org/wiki/Infant_mortality "Infant mortality") younger than five (0.76 million or 11%).[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)[\[12\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDC2013-12) Frequent episodes of diarrhea are also a common cause of [malnutrition](https://en.wikipedia.org/wiki/Malnutrition "Malnutrition") and the most common cause in those younger than five years of age.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2) Other long term problems that can result include [stunted growth](https://en.wikipedia.org/wiki/Stunted_growth "Stunted growth") and poor intellectual development.[\[12\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDC2013-12)
Terminology
The word diarrhea is from the [Ancient Greek](https://en.wikipedia.org/wiki/Ancient_Greek "Ancient Greek") [Ī“Ī¹Ī¬ĻĻĪæĪ¹Ī±](https://en.wiktionary.org/wiki/%CE%B4%CE%B9%CE%AC%CF%81%CF%81%CE%BF%CE%B9%CE%B1 "wikt:Ī“Ī¹Ī¬ĻĻĪæĪ¹Ī±") from Ī“Ī¹Ī¬ **dia** "through" and įæ„ĪĻ **rheo** "flow".
*Diarrhea* is the spelling in [American English](https://en.wikipedia.org/wiki/American_English "American English"), whereas *diarrhoea* is the spelling in [British English](https://en.wikipedia.org/wiki/British_English "British English"). [Canadian English](https://en.wikipedia.org/wiki/Canadian_English "Canadian English") uses both spellings.
Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain[\[13\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-13)), "[Hershey](https://en.wikipedia.org/wiki/The_Hershey_Company "The Hershey Company") squirts", "[Montezuma](https://en.wikipedia.org/wiki/Moctezuma_II "Moctezuma II")'s Revenge", and "the trots".[\[14\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-14)[\[15\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-15)
Definition
[](https://en.wikipedia.org/wiki/File:BristolStoolChart.png)
[Bristol stool scale](https://en.wikipedia.org/wiki/Bristol_stool_scale "Bristol stool scale")
Diarrhea is defined by the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") as having three or more loose or liquid [stools](https://en.wikipedia.org/wiki/Defecation "Defecation") per day, or as having more stools than is normal for that person.[\[2\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2013-2)
Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by [World Gastroenterology Organization](https://en.wikipedia.org/wiki/World_Gastroenterology_Organisation "World Gastroenterology Organisation").[\[16\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WGO-16) Acute diarrhea that is watery may be known as AWD (Acute Watery Diarrhoea.)[\[17\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-17)
Secretory
Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a [cholera toxin](https://en.wikipedia.org/wiki/Cholera_toxin "Cholera toxin") that stimulates the secretion of [anions](https://en.wikipedia.org/wiki/Anion "Anion"), especially [chloride](https://en.wikipedia.org/wiki/Chloride "Chloride") ions (Clā). Therefore, to maintain a charge balance in the [gastrointestinal tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract "Gastrointestinal tract"), sodium (Na\+) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is [isotonic](https://en.wikipedia.org/wiki/Tonicity#3 "Tonicity") with plasma even during fasting.[\[18\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-webmd.com-18)[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19) It continues even when there is no oral food intake.
Osmotic
Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19) Osmotic diarrhea can also result from maldigestion (e.g., pancreatic disease or [coeliac disease](https://en.wikipedia.org/wiki/Coeliac_disease "Coeliac disease")) in which the nutrients are left in the [lumen](https://en.wikipedia.org/wiki/Lumen_\(anatomy\) "Lumen (anatomy)") to pull in water. Or it can be caused by osmotic [laxatives](https://en.wikipedia.org/wiki/Laxatives "Laxatives") (which work to alleviate [constipation](https://en.wikipedia.org/wiki/Constipation "Constipation") by drawing water into the bowels). In healthy individuals, too much [magnesium](https://en.wikipedia.org/wiki/Magnesium "Magnesium"), [vitamin C](https://en.wikipedia.org/wiki/Vitamin_C "Vitamin C") or undigested [lactose](https://en.wikipedia.org/wiki/Lactose "Lactose") can produce osmotic diarrhea and distention of the bowel. A person who has [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance") can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have [fructose malabsorption](https://en.wikipedia.org/wiki/Fructose_malabsorption "Fructose malabsorption"), excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. [Sugar alcohols](https://en.wikipedia.org/wiki/Sugar_alcohol "Sugar alcohol") such as [sorbitol](https://en.wikipedia.org/wiki/Sorbitol "Sorbitol") (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea.[\[18\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-webmd.com-18) In most of these cases, osmotic diarrhea stops when the offending agent (e.g., milk or sorbitol) is stopped.
Exudative
Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with [inflammatory bowel diseases](https://en.wikipedia.org/wiki/Inflammatory_bowel_diseases "Inflammatory bowel diseases"), such as [Crohn's disease](https://en.wikipedia.org/wiki/Crohn%27s_disease "Crohn's disease") or [ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis"), and other severe infections such as *[E. coli](https://en.wikipedia.org/wiki/Escherichia_coli "Escherichia coli")* or other forms of food poisoning.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)[\[18\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-webmd.com-18)
Inflammatory
Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea.[\[21\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-21) It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
Dysentery
If there is blood visible in the stools, it is also known as [dysentery](https://en.wikipedia.org/wiki/Dysentery "Dysentery"). The blood is a trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, *[Shigella](https://en.wikipedia.org/wiki/Shigella "Shigella")*, *[Entamoeba histolytica](https://en.wikipedia.org/wiki/Entamoeba_histolytica "Entamoeba histolytica")*, and *[Salmonella](https://en.wikipedia.org/wiki/Salmonella "Salmonella")*.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
Health effects
Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults",[\[22\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-d-22) and diarrhea is a primary cause of childhood malnutrition.[\[23\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-23) Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for [helminth](https://en.wikipedia.org/wiki/Helminth "Helminth") infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on a series of tests of intelligence.[\[22\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-d-22)[\[24\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-24)
Diarrhea can cause [electrolyte imbalances](https://en.wikipedia.org/wiki/Electrolyte_imbalance "Electrolyte imbalance"), [kidney impairment](https://en.wikipedia.org/wiki/Renal_impairment "Renal impairment"), [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration"), and defective [immune system](https://en.wikipedia.org/wiki/Immune_system "Immune system") responses. When oral drugs are administered, the efficiency of the drug is to produce a [therapeutic effect](https://en.wikipedia.org/wiki/Therapeutic_effect "Therapeutic effect") and the lack of this effect may be due to the medication travelling too quickly through the digestive system, limiting the time that it can be absorbed. Clinicians try to treat the diarrheas by reducing the dosage of medication, changing the dosing schedule, discontinuation of the drug, and rehydration. The interventions to control the diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the leading factors for placing older adults in [long term care facilities](https://en.wikipedia.org/wiki/Long_term_care_facilities "Long term care facilities") (nursing homes).[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
Causes
[](https://en.wikipedia.org/wiki/File:Stomach_colon_rectum_diagram-en.svg)
Diagram of the [human gastrointestinal tract](https://en.wikipedia.org/wiki/Human_gastrointestinal_tract "Human gastrointestinal tract")
In the latter stages of human digestion, ingested materials are inundated with water and digestive fluids such as [gastric acid](https://en.wikipedia.org/wiki/Gastric_acid "Gastric acid"), [bile](https://en.wikipedia.org/wiki/Bile "Bile"), and [digestive enzymes](https://en.wikipedia.org/wiki/Digestive_enzyme "Digestive enzyme") in order to break them down into their nutrient components, which are then absorbed into the bloodstream via the [intestinal tract](https://en.wikipedia.org/wiki/Intestinal_epithelium "Intestinal epithelium") in the small intestine. Prior to defecation, the large intestine reabsorbs the water and other digestive solvents in the waste product in order to maintain proper hydration and overall equilibrium.[\[25\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-25) Diarrhea occurs when the large intestine is prevented, for any number of reasons, from sufficiently absorbing the water or other digestive fluids from fecal matter, resulting in a liquid, or "loose", bowel movement.[\[26\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-26)
[Acute](https://en.wikipedia.org/wiki/Acute_\(medicine\) "Acute (medicine)") diarrhea is most commonly due to viral [gastroenteritis](https://en.wikipedia.org/wiki/Gastroenteritis "Gastroenteritis") with [rotavirus](https://en.wikipedia.org/wiki/Rotavirus "Rotavirus"), which accounts for 40% of cases in children under five.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) In [travelers](https://en.wikipedia.org/wiki/Traveler%27s_diarrhea "Traveler's diarrhea"), however, [bacterial infections](https://en.wikipedia.org/wiki/Bacterial_infections "Bacterial infections") predominate.[\[27\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid16267716-27) Various toxins such as [mushroom poisoning](https://en.wikipedia.org/wiki/Amanita_phalloides#Signs_and_symptoms "Amanita phalloides") and drugs can also cause acute diarrhea.
Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include [ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis"), [Crohn's disease](https://en.wikipedia.org/wiki/Crohn%27s_disease "Crohn's disease"), [microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis"), [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease"), [irritable bowel syndrome](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome"), and [bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption").[\[28\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-28)
Infections
There are many causes of infectious diarrhea, which include [viruses](https://en.wikipedia.org/wiki/Virus "Virus"), [bacteria](https://en.wikipedia.org/wiki/Bacteria "Bacteria") and parasites.[\[29\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid18813221-29) Infectious diarrhea is frequently referred to as [gastroenteritis](https://en.wikipedia.org/wiki/Gastroenteritis "Gastroenteritis").[\[30\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Dav2008-30) [Norovirus](https://en.wikipedia.org/wiki/Norovirus "Norovirus") is the most common cause of viral diarrhea in adults,[\[31\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19084472-31) but [rotavirus](https://en.wikipedia.org/wiki/Rotavirus "Rotavirus") is the most common cause in children under five years old.[\[32\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19457420-32) [Adenovirus](https://en.wikipedia.org/wiki/Adenovirus "Adenovirus") types 40 and 41,[\[33\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid1962727-33) and [astroviruses](https://en.wikipedia.org/wiki/Astrovirus "Astrovirus") cause a significant number of infections.[\[34\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid12442031-34) [Shiga-toxin producing *Escherichia coli*](https://en.wikipedia.org/wiki/Shiga-toxin_producing_Escherichia_coli "Shiga-toxin producing Escherichia coli"), such as [*E. coli* o157:h7](https://en.wikipedia.org/wiki/E_coli_o157:h7 "E coli o157:h7"), are the most common cause of infectious bloody diarrhea in the United States.[\[35\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-35)
*[Campylobacter](https://en.wikipedia.org/wiki/Campylobacter "Campylobacter")* [spp.](https://en.wikipedia.org/wiki/Species "Species") are a common cause of bacterial diarrhea, but infections by *[Salmonella](https://en.wikipedia.org/wiki/Salmonella "Salmonella")* spp., *[Shigella](https://en.wikipedia.org/wiki/Shigella "Shigella")* spp. and some strains of *Escherichia coli* are also a frequent cause.[\[36\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19116615-36)
In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by *[Clostridioides difficile](https://en.wikipedia.org/wiki/Clostridioides_difficile_\(bacteria\) "Clostridioides difficile (bacteria)")* often causes severe diarrhea.[\[37\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid19528959-37)
Parasites, particularly [protozoa](https://en.wikipedia.org/wiki/Protozoa "Protozoa") e.g., *[Cryptosporidium](https://en.wikipedia.org/wiki/Cryptosporidium "Cryptosporidium")* spp., *[Giardia](https://en.wikipedia.org/wiki/Giardia "Giardia")* spp., *[Entamoeba histolytica](https://en.wikipedia.org/wiki/Entamoeba_histolytica "Entamoeba histolytica")*, *[Blastocystis](https://en.wikipedia.org/wiki/Blastocystis "Blastocystis")* spp., *[Cyclospora cayetanensis](https://en.wikipedia.org/wiki/Cyclospora_cayetanensis "Cyclospora cayetanensis")*, are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent [nitazoxanide](https://en.wikipedia.org/wiki/Nitazoxanide "Nitazoxanide") has shown efficacy against many diarrhea-causing parasites.[\[38\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid22301075-38)
Other infectious agents, such as [parasites](https://en.wikipedia.org/wiki/Parasites "Parasites") or [bacterial](https://en.wikipedia.org/wiki/Bacteria "Bacteria") toxins, may exacerbate symptoms.[\[27\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid16267716-27) In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or [malnourished](https://en.wikipedia.org/wiki/Malnourished "Malnourished") individuals, diarrhea can lead to severe [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration") and can become life-threatening.[\[39\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid12608880-39)
Sanitation
[](https://en.wikipedia.org/wiki/File:Slum_and_dirty_river.jpg)
Poverty often leads to unhygienic living conditions, as in this community in the Indian Himalayas. Such conditions promote contraction of diarrheal diseases, as a result of poor [sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation") and [hygiene](https://en.wikipedia.org/wiki/Hygiene "Hygiene").
[Open defecation](https://en.wikipedia.org/wiki/Open_defecation "Open defecation") is a leading cause of infectious diarrhea leading to death.[\[40\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-40)
Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste ([sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation")), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea ... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care."[\[41\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-41)
One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human [pathogens](https://en.wikipedia.org/wiki/Pathogens "Pathogens").[\[42\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Brown_629%E2%80%9334-42)
Nutrition
Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. [Zinc deficiency](https://en.wikipedia.org/wiki/Zinc_deficiency "Zinc deficiency"), a condition often found in children in [developing countries](https://en.wikipedia.org/wiki/Developing_countries "Developing countries") can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system.[\[43\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-43)[\[44\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-44) Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever.[\[45\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-45) Similarly, [vitamin A deficiency](https://en.wikipedia.org/wiki/Vitamin_A_deficiency "Vitamin A deficiency") can cause an increase in the severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status,[\[46\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-46) others suggest an increase in the rate associated with deficiency.[\[47\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-47) Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction.[\[48\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-48)
Malabsorption
[Malabsorption](https://en.wikipedia.org/wiki/Malabsorption "Malabsorption") is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the [pancreas](https://en.wikipedia.org/wiki/Pancreas "Pancreas").
Causes include:\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
- *enzyme deficiencies or mucosal abnormality*, as in [food allergy](https://en.wikipedia.org/wiki/Food_allergy "Food allergy") and [food intolerance](https://en.wikipedia.org/wiki/Food_intolerance "Food intolerance"), e.g. [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease") (gluten intolerance), [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance") (intolerance to milk sugar, common in non-Europeans), and [fructose malabsorption](https://en.wikipedia.org/wiki/Fructose_malabsorption "Fructose malabsorption").
- *[pernicious anemia](https://en.wikipedia.org/wiki/Pernicious_anemia "Pernicious anemia")*, or impaired bowel function due to the inability to absorb [vitamin B12](https://en.wikipedia.org/wiki/Vitamin_B12 "Vitamin B12"),
- *loss of pancreatic secretions*, which may be due to [cystic fibrosis](https://en.wikipedia.org/wiki/Cystic_fibrosis "Cystic fibrosis") or [pancreatitis](https://en.wikipedia.org/wiki/Pancreatitis "Pancreatitis"),
- *structural defects*, like [short bowel syndrome](https://en.wikipedia.org/wiki/Short_bowel_syndrome "Short bowel syndrome") (surgically removed bowel) and radiation fibrosis, such as usually follows cancer treatment and other drugs, including agents used in [chemotherapy](https://en.wikipedia.org/wiki/Chemotherapy "Chemotherapy"); and
- *certain drugs*, like [orlistat](https://en.wikipedia.org/wiki/Orlistat "Orlistat"), which inhibits the absorption of fat.
Inflammatory bowel disease
The two overlapping types here are of unknown origin:
- [Ulcerative colitis](https://en.wikipedia.org/wiki/Ulcerative_colitis "Ulcerative colitis") is marked by chronic bloody diarrhea and inflammation mostly affects the distal [colon](https://en.wikipedia.org/wiki/Colon_\(anatomy\) "Colon (anatomy)") near the [rectum](https://en.wikipedia.org/wiki/Rectum "Rectum").
- [Crohn's disease](https://en.wikipedia.org/wiki/Crohn%27s_disease "Crohn's disease") typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.
Irritable bowel syndrome
Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by [defecation](https://en.wikipedia.org/wiki/Defecation "Defecation") and unusual [stool](https://en.wikipedia.org/wiki/Human_feces "Human feces") (diarrhea or [constipation](https://en.wikipedia.org/wiki/Constipation "Constipation")) for at least three days a week over the previous three months.[\[49\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-49) Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") or [codeine](https://en.wikipedia.org/wiki/Codeine "Codeine"). About 30% of patients with diarrhea-predominant IBS have [bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption") diagnosed with an abnormal [SeHCAT](https://en.wikipedia.org/wiki/SeHCAT "SeHCAT") test.[\[50\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-50)
Other diseases
Diarrhea can be caused by other diseases and conditions, namely:
- Chronic [ethanol](https://en.wikipedia.org/wiki/Ethanol "Ethanol") ingestion[\[51\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Harrison-51)
- [Hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism")[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52)
- Certain medications[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52)
- [Bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption")[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52)
- [Ischemic](https://en.wikipedia.org/wiki/Ischemia "Ischemia") bowel disease: This usually affects older people and can be due to blocked arteries.
- [Microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis"), a type of [inflammatory bowel disease](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease") where changes are seen only on histological examination of colonic biopsies.
- [Bile salt malabsorption](https://en.wikipedia.org/wiki/Bile_salt_malabsorption "Bile salt malabsorption") ([primary bile acid diarrhea](https://en.wikipedia.org/wiki/Primary_bile_acid_diarrhea "Primary bile acid diarrhea")) where excessive [bile acids](https://en.wikipedia.org/wiki/Bile_acids "Bile acids") in the [colon](https://en.wikipedia.org/wiki/Colon_\(anatomy\) "Colon (anatomy)") produce a secretory diarrhea.
- Hormone-secreting tumors: some hormones, e.g. [serotonin](https://en.wikipedia.org/wiki/Serotonin "Serotonin"), can cause diarrhea if secreted in excess (usually from a tumor).
- Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is called [toddler's diarrhea](https://en.wikipedia.org/wiki/Toddler%27s_diarrhea "Toddler's diarrhea").
- [Environmental enteropathy](https://en.wikipedia.org/wiki/Environmental_enteropathy "Environmental enteropathy")
- [Radiation enteropathy](https://en.wikipedia.org/wiki/Radiation_enteropathy "Radiation enteropathy") following treatment for pelvic and abdominal cancers.
- [Mast cell activation syndrome](https://en.wikipedia.org/wiki/Mast_cell_activation_syndrome "Mast cell activation syndrome") (MCAS)[\[53\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-53)[\[54\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-54)[\[55\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-55)
- [Drug withdrawal](https://en.wikipedia.org/wiki/Drug_withdrawal "Drug withdrawal") side effect.
Medications
Over 700 medications, such as [penicillin](https://en.wikipedia.org/wiki/Side_effects_of_penicillin "Side effects of penicillin"), are known to cause diarrhea.[\[56\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-56)[\[57\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-57) The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements.[\[19\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-MoonZhang2015-19)
Pathophysiology
| Function | Transporter |
|---|---|
| Absorption | [NHE](https://en.wikipedia.org/wiki/NHE "NHE"), [SGLT1](https://en.wikipedia.org/wiki/SGLT1 "SGLT1"), [ENaC](https://en.wikipedia.org/wiki/ENaC "ENaC"), [DRA](https://en.wikipedia.org/wiki/Downregulated-in-adenoma "Downregulated-in-adenoma") |
| Secretion | [CaCC](https://en.wikipedia.org/wiki/CaCC "CaCC"), [NKCC1](https://en.wikipedia.org/wiki/NKCC1 "NKCC1"), [CFTR](https://en.wikipedia.org/wiki/CFTR "CFTR") |
| Absorption and secretion | [Sodium potassium ATPase](https://en.wikipedia.org/wiki/Sodium_potassium_ATPase "Sodium potassium ATPase") |
Evolution
According to two researchers, [Nesse](https://en.wikipedia.org/wiki/Randolph_M._Nesse "Randolph M. Nesse") and [Williams](https://en.wikipedia.org/wiki/George_C._Williams_\(biologist\) "George C. Williams (biologist)"), diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery.[\[59\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-59) They cite in support of this argument research published in 1973 that found that treating *[Shigella](https://en.wikipedia.org/wiki/Shigella "Shigella")* with the anti-diarrhea drug (Co-phenotrope, [Lomotil](https://en.wikipedia.org/wiki/Lomotil "Lomotil")) caused people to stay [feverish](https://en.wikipedia.org/wiki/Fever "Fever") twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".[\[60\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-60)
Diagnostic approach
The following types of diarrhea may indicate further investigation is needed:
- In infants
- Moderate or severe diarrhea in young children
- Associated with blood
- Continues for more than two days
- Associated non-cramping [abdominal pain](https://en.wikipedia.org/wiki/Abdominal_pain "Abdominal pain"), [fever](https://en.wikipedia.org/wiki/Fever "Fever"), [weight loss](https://en.wikipedia.org/wiki/Weight_loss "Weight loss"), etc.
- In [travelers](https://en.wikipedia.org/wiki/Traveler%27s_diarrhea "Traveler's diarrhea")
- In food handlers, because of the potential to infect others;
- In institutions such as hospitals, child care centers, or geriatric and convalescent homes.
A severity score is used to aid diagnosis in children.[\[61\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid2371542-61)
When diarrhea lasts for more than four weeks a number of further tests may be recommended including:[\[62\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-62)
- [Complete blood count](https://en.wikipedia.org/wiki/Complete_blood_count "Complete blood count") and a [ferritin](https://en.wikipedia.org/wiki/Ferritin "Ferritin") if [anemia](https://en.wikipedia.org/wiki/Anemia "Anemia") is present
- [Thyroid stimulating hormone](https://en.wikipedia.org/wiki/Thyroid_stimulating_hormone "Thyroid stimulating hormone")
- [Tissue transglutaminase](https://en.wikipedia.org/wiki/Tissue_transglutaminase "Tissue transglutaminase") for [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease")
- Fecal [calprotectin](https://en.wikipedia.org/wiki/Calprotectin "Calprotectin") to exclude [inflammatory bowel disease](https://en.wikipedia.org/wiki/Inflammatory_bowel_disease "Inflammatory bowel disease")
- [Stool tests](https://en.wikipedia.org/wiki/Stool_test "Stool test") for ova and parasites as well as for *[Clostridioides difficile](https://en.wikipedia.org/wiki/Clostridioides_difficile_\(bacteria\) "Clostridioides difficile (bacteria)")*
- A [colonoscopy](https://en.wikipedia.org/wiki/Colonoscopy "Colonoscopy") or fecal immunochemical testing for cancer, including biopsies to detect [microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis")
- Testing for [bile acid diarrhea](https://en.wikipedia.org/wiki/Bile_acid_diarrhea "Bile acid diarrhea") with [SeHCAT](https://en.wikipedia.org/wiki/SeHCAT "SeHCAT"), [7Ī±-hydroxy-4-cholesten-3-one](https://en.wikipedia.org/wiki/7%CE%B1-hydroxy-4-cholesten-3-one "7Ī±-hydroxy-4-cholesten-3-one") or fecal [bile acids](https://en.wikipedia.org/wiki/Bile_acids "Bile acids") depending on availability
- [Hydrogen breath test](https://en.wikipedia.org/wiki/Hydrogen_breath_test "Hydrogen breath test") looking for [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance")
- Further tests if [immunodeficiency](https://en.wikipedia.org/wiki/Immunodeficiency "Immunodeficiency"), [pelvic radiation disease](https://en.wikipedia.org/wiki/Pelvic_radiation_disease "Pelvic radiation disease") or [small intestinal bacterial overgrowth](https://en.wikipedia.org/wiki/Small_intestinal_bacterial_overgrowth "Small intestinal bacterial overgrowth") suspected.
A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for [giardia](https://en.wikipedia.org/wiki/Giardia "Giardia").[\[63\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Sma2019-63) [Erythrocyte sedimentation rate](https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate "Erythrocyte sedimentation rate") (ESR) and [C-reactive protein](https://en.wikipedia.org/wiki/C-reactive_protein "C-reactive protein") (CRP) were not recommended.[\[63\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Sma2019-63)
Epidemiology
[](https://en.wikipedia.org/wiki/File:Diarrhoeal_diseases_world_map-Deaths_per_million_persons-WHO2012.svg)
Deaths due to diarrhoeal diseases per million persons in 2012
0ā2
3ā10
11ā18
19ā30
31ā46
47ā80
81ā221
222ā450
451ā606
607ā1799
[](https://en.wikipedia.org/wiki/File:Diarrhoeal_diseases_world_map_-_DALY_-_WHO2004.svg)
[Disability-adjusted life year](https://en.wikipedia.org/wiki/Disability-adjusted_life_year "Disability-adjusted life year") for diarrhea per 100,000 inhabitants in 2004[\[64\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-64)
no data
\< 500
500ā1000
1000ā1500
1500ā2000
2000ā2500
2500ā3000
3000ā3500
3500ā4000
4000ā4500
4500ā5000
5000ā6000
\> 6000
Worldwide in 2004, approximately 2.5 billion cases of diarrhea occurred, which resulted in 1.5 million deaths among children under the age of five.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) Greater than half of these were in Africa and South Asia.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) This is down from a death rate of 4.5 million in 1980 for gastroenteritis.[\[65\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Mandell-65) Diarrhea remains the second leading cause of [infant mortality](https://en.wikipedia.org/wiki/Infant_mortality "Infant mortality") (16%) after [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia") (17%) in this age group.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1)
The majority of such cases occur in the developing world, with over half of the recorded cases of childhood diarrhea occurring in [Africa](https://en.wikipedia.org/wiki/Africa "Africa") and [Asia](https://en.wikipedia.org/wiki/Asia "Asia"), with 696 million and 1.2 billion cases, respectively, compared to only 480 million in the rest of the world.[\[66\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-66)
Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days.[\[67\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-UN2015-67)[\[68\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-68) In the Americas, diarrheal disease accounts for a total of 10% of deaths among children aged 1ā59 months while in South East Asia, it accounts for 31.3% of deaths.[\[69\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-69) It is estimated that around 21% of child mortalities in developing countries are due to diarrheal disease.[\[70\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-c-70)
The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") has reported that "deaths due to diarrhoeal diseases have dropped by 45%, from sixth leading cause of death in 2000 to thirteenth in 2021."[\[71\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-71)
[Climate change can cause](https://en.wikipedia.org/wiki/Climate_change_and_infectious_diseases#Diarrheal_diseases "Climate change and infectious diseases") an increase in diarrhoeal diseases. Bacteria proliferate with an increase with ambient temperature, and following heavy rainfall and [flooding](https://en.wikipedia.org/wiki/Flood "Flood") events. Heavy rainfall and flooding can also affect pathogen transmission by impacting sanitation and/or drinking water treatment infrastructure, contaminating drinking water sources or food products.[\[72\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-\(Levy_et_al.,_2016\)-72)
Even though diarrhea is best known in humans, it affects many other species, notably among [primates](https://en.wikipedia.org/wiki/Primate "Primate").[\[73\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Hird_et_al._1984-73) The [cecal appendix](https://en.wikipedia.org/wiki/Appendix_\(anatomy\) "Appendix (anatomy)"), when present, appears to afford some protection against diarrhea to young primates.[\[74\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Collard_et_al._2023-74)
Prevention
Sanitation
Numerous studies have shown that improvements in drinking water and sanitation ([WASH](https://en.wikipedia.org/wiki/WASH "WASH")) lead to decreased risks of diarrhoea.[\[75\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:0-75) Such improvements might include for example use of water filters, provision of high-quality [piped water](https://en.wikipedia.org/wiki/Drinking_water "Drinking water") and [sewer](https://en.wikipedia.org/wiki/Sanitary_sewer "Sanitary sewer") connections.[\[75\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:0-75)
In institutions, communities, and households, interventions that promote [hand washing](https://en.wikipedia.org/wiki/Hand_washing "Hand washing") with soap lead to significant reductions in the incidence of diarrhea.[\[76\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:1-76) The same applies to preventing [open defecation](https://en.wikipedia.org/wiki/Open_defecation "Open defecation") at a community-wide level and providing access to [improved sanitation](https://en.wikipedia.org/wiki/Improved_sanitation "Improved sanitation").[\[67\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-UN2015-67)[\[77\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-77) This includes use of [toilets](https://en.wikipedia.org/wiki/Toilet "Toilet") and implementation of the entire [sanitation](https://en.wikipedia.org/wiki/Sanitation "Sanitation") chain connected to the toilets (collection, transport, disposal or reuse of [human excreta](https://en.wikipedia.org/wiki/Human_waste "Human waste")).
There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease.[\[78\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-78)[\[79\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-79)
Hand washing
Basic sanitation techniques can have a profound effect on the transmission of diarrheal disease. The implementation of hand washing using soap and water, for example, has been experimentally shown to reduce the incidence of disease by approximately 30ā48%.[\[80\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-80)[\[81\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-81)[\[76\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-:1-76) Hand washing in developing countries, however, is compromised by poverty as acknowledged by the [CDC](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention"): "Handwashing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of many challenges to proper hygiene in less developed countries." Solutions to this barrier require the implementation of educational programs that encourage sanitary behaviours.[\[82\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-82)
Water
Given that water contamination is a major means of transmitting diarrheal disease, efforts to provide clean [water supply](https://en.wikipedia.org/wiki/Water_supply "Water supply") and [improved sanitation](https://en.wikipedia.org/wiki/Improved_sanitation "Improved sanitation") have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrheal disease as a result of improved water sanitation and hygiene.[\[42\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Brown_629%E2%80%9334-42)[\[83\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-83) Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22ā27% reduction in disease incidence, and a 21ā30% reduction in mortality rate associated with diarrheal disease.[\[84\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-84)
Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrheal disease, and of contamination of stored water with diarrheal pathogens.[\[85\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-85)
Vaccination
Immunization against the pathogens that cause diarrheal disease is a viable prevention strategy, however it does require targeting certain pathogens for vaccination. In the case of Rotavirus, which was responsible for around 6% of diarrheal episodes and 20% of diarrheal disease deaths in the children of developing countries, use of a Rotavirus vaccine in trials in 1985 yielded a slight (2ā3%) decrease in total diarrheal disease incidence, while reducing overall mortality by 6ā10%. Similarly, a Cholera vaccine showed a strong reduction in morbidity and mortality, though the overall impact of vaccination was minimal as Cholera is not one of the major causative pathogens of diarrheal disease.[\[86\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-86) Since this time, more effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society.[\[87\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-87)[\[88\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-88)
[Rotavirus vaccine](https://en.wikipedia.org/wiki/Rotavirus_vaccine "Rotavirus vaccine") decreases the rates of diarrhea in a population.[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1)[\[89\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-89) New vaccines against rotavirus, *Shigella*, [Enterotoxigenic *Escherichia coli* (ETEC)](https://en.wikipedia.org/wiki/Enterotoxigenic_Escherichia_coli "Enterotoxigenic Escherichia coli"), and cholera are under development, as well as other causes of infectious diarrhea.\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\]
Nutrition
Dietary deficiencies in developing countries can be combated by promoting better eating practices. Zinc supplementation proved successful showing a significant decrease in the incidence of diarrheal disease compared to a control group.[\[90\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-90)[\[91\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-91) The majority of the literature suggests that vitamin A supplementation is advantageous in reducing disease incidence.[\[92\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-92) Development of a supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective.[\[93\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-93)
Breastfeeding
Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrheal disease in poor populations. Studies across a number of developing nations have shown that those who receive [exclusive breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding#Duration_and_exclusivity "Breastfeeding") during their first 6 months of life are better protected against infection with diarrheal diseases.[\[94\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-94) One study in Brazil found that non-breastfed infants were 14 times more likely to die from diarrhea than exclusively breastfed infants.[\[95\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Lawrence2016-95) Exclusive breastfeeding is currently recommended for the first six months of an infant's life by the [WHO](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization"),[\[96\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-96)[\[97\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-World_Health_Organization_2017-97) with continued breastfeeding until at least two years of age.[\[97\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-World_Health_Organization_2017-97)
Others
[Probiotics](https://en.wikipedia.org/wiki/Probiotics "Probiotics") decrease the risk of diarrhea in those taking [antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics").[\[98\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-98) [Insecticide](https://en.wikipedia.org/wiki/Insecticide "Insecticide") spraying may reduce fly numbers and the risk of diarrhea in children in a setting where there is seasonal variations in fly numbers throughout the year.[\[99\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-99)
Management
In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth ā [oral rehydration therapy](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") ā or, in severe cases, [intravenously](https://en.wikipedia.org/wiki/Intravenously "Intravenously").[\[1\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHO2010a-1) Diet restrictions such as the [BRAT diet](https://en.wikipedia.org/wiki/BRAT_diet "BRAT diet") are no longer recommended.[\[100\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-100) Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea.[\[101\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-101) To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain, and that continuing to eat also speeds up recovery of normal intestinal functioning.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) CDC recommends that children and adults with cholera also continue to eat.[\[102\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDCmanualCholera-102) There is no evidence that early refeeding in children can cause an increase in inappropriate use of intravenous fluid, episodes of vomiting, and risk of having persistent diarrhea.[\[103\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-103)
Medications such as [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") (Imodium) and [bismuth subsalicylate](https://en.wikipedia.org/wiki/Bismuth_subsalicylate "Bismuth subsalicylate") may be beneficial; however they may be [contraindicated](https://en.wikipedia.org/wiki/Contraindicated "Contraindicated") in certain situations.[\[104\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid18192963-104)
Fluids
[](https://en.wikipedia.org/wiki/File:Cholera_rehydration_nurses.jpg)
A person consuming oral rehydration solution
[Oral rehydration solution (ORS)](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") (a slightly sweetened and salty water) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) There are commercial solutions such as [Pedialyte](https://en.wikipedia.org/wiki/Pedialyte "Pedialyte"), and relief agencies such as [UNICEF](https://en.wikipedia.org/wiki/UNICEF "UNICEF") widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) (approximately the "taste of tears"[\[105\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-2010WorldCupTravellersGuide-105)). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness.[\[106\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-RehydrationProject-106) Both agree that drinks with too much sugar or salt can make dehydration worse.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)[\[106\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-RehydrationProject-106)
Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment.[\[102\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDCmanualCholera-102)
Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)
Drinks especially high in simple sugars, such as [soft drinks](https://en.wikipedia.org/wiki/Soft_drinks "Soft drinks") and fruit juices, are not recommended in children under five as they may *increase* dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20)[\[107\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NICE2009-107) Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable.[\[107\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NICE2009-107) Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) A [nasogastric tube](https://en.wikipedia.org/wiki/Nasogastric_tube "Nasogastric tube") can be used in young children to administer fluids if warranted.[\[108\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Webb2005-108)
Eating
The WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. The WHO states "Food should *never* be withheld and the child's usual foods should *not* be diluted. Breastfeeding should *always* be continued."[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) In the specific example of cholera, the CDC makes the same recommendation.[\[102\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CDCmanualCholera-102) Breast-fed infants with diarrhea often choose to breastfeed more, and should be encouraged to do so.[\[20\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-WHOtreatmentdiarrhoea2005-20) In young children who are not breast-fed and live in the developed world, a lactose-free diet may be useful to speed recovery.[\[109\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-109) Eating food containing [soluble fibre](https://en.wikipedia.org/wiki/Soluble_fibre "Soluble fibre") may help, but insoluble fibre might make it worse.[\[110\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-110)
Medications
Antidiarrheal agents can be classified into four different groups: antimotility, antisecretory, adsorbent, and anti-infectious.[\[111\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Diosmectite2009-111) While [antibiotics](https://en.wikipedia.org/wiki/Antibiotic "Antibiotic") are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations.[\[112\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-112)[\[113\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CE08-113) There are concerns that antibiotics may increase the risk of [hemolytic uremic syndrome](https://en.wikipedia.org/wiki/Hemolytic_uremic_syndrome "Hemolytic uremic syndrome") in people infected with [*Escherichia coli* O157:H7](https://en.wikipedia.org/wiki/Escherichia_coli_O157:H7 "Escherichia coli O157:H7").[\[114\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-114) In resource-poor countries, treatment with antibiotics may be beneficial.[\[113\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-CE08-113) However, some bacteria are developing [antibiotic resistance](https://en.wikipedia.org/wiki/Antibiotic_resistance "Antibiotic resistance"), particularly *Shigella*.[\[115\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-115) Antibiotics can also cause diarrhea, and [antibiotic-associated diarrhea](https://en.wikipedia.org/wiki/Antibiotic-associated_diarrhea "Antibiotic-associated diarrhea") is the most common adverse effect of treatment with general antibiotics.
While bismuth compounds ([Pepto-Bismol](https://en.wikipedia.org/wiki/Pepto-Bismol "Pepto-Bismol")) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness.[\[116\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-116) Anti-motility agents like [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide") are also effective at reducing the number of stools but not the duration of disease.[\[8\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-NEJM2014-8) These agents should be used only if bloody diarrhea is not present.[\[117\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-117)
[Diosmectite](https://en.wikipedia.org/wiki/Diosmectite "Diosmectite"), a natural aluminomagnesium silicate clay, is effective in alleviating symptoms of acute diarrhea in children,[\[118\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-118) and also has some effects in chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea.[\[52\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid26576135-52) Another absorbent agent used for the treatment of mild diarrhea is [kaopectate](https://en.wikipedia.org/wiki/Kaopectate "Kaopectate").
[Racecadotril](https://en.wikipedia.org/wiki/Racecadotril "Racecadotril") an antisecretory medication may be used to treat diarrhea in children and adults.[\[111\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Diosmectite2009-111) It has better tolerability than [loperamide](https://en.wikipedia.org/wiki/Loperamide "Loperamide"), as it causes less [constipation](https://en.wikipedia.org/wiki/Constipation "Constipation") and [flatulence](https://en.wikipedia.org/wiki/Flatulence "Flatulence").[\[119\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-Arzneistoff-Profile-119) However, it has little benefit in improving acute diarrhea in children.[\[120\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-120)
[Bile acid sequestrants](https://en.wikipedia.org/wiki/Bile_acid_sequestrants "Bile acid sequestrants") such as [cholestyramine](https://en.wikipedia.org/wiki/Cholestyramine "Cholestyramine") can be effective in chronic diarrhea due to [bile acid malabsorption](https://en.wikipedia.org/wiki/Bile_acid_malabsorption "Bile acid malabsorption"). Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as [SeHCAT](https://en.wikipedia.org/wiki/SeHCAT "SeHCAT") retention.[\[121\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-121)
Alternative therapies
Green bananas improved recovery, reduced dehydration and prevented prolonged diarrhea in children with diarrhea.[\[122\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-122) The benefit was attributed to its production of [short-chain fatty acids](https://en.wikipedia.org/wiki/Short-chain_fatty_acids "Short-chain fatty acids") in the colon from its [resistant starch](https://en.wikipedia.org/wiki/Resistant_starch "Resistant starch") content, which enhances colonic water and electrolyte absorption.
Zinc supplementation may benefit children over six months old with diarrhea in areas with high rates of malnourishment or zinc deficiency.[\[123\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-123) This supports the World Health Organization guidelines for zinc, but not in the very young.
A Cochrane Review from 2020 concludes that [probiotics](https://en.wikipedia.org/wiki/Probiotic "Probiotic") make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration.[\[124\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-pmid33295643-124) The [probiotic](https://en.wikipedia.org/wiki/Probiotic "Probiotic") *[Lactobacillus](https://en.wikipedia.org/wiki/Lactobacillus "Lactobacillus")* can help prevent [antibiotic-associated diarrhea](https://en.wikipedia.org/wiki/Antibiotic-associated_diarrhea "Antibiotic-associated diarrhea") in adults but possibly not children.[\[125\]](https://en.wikipedia.org/wiki/Diarrhea#cite_note-125) For those with [lactose intolerance](https://en.wikipedia.org/wiki/Lactose_intolerance "Lactose intolerance"), taking digestive [enzymes](https://en.wikipedia.org/wiki/Enzyme "Enzyme") containing [lactase](https://en.wikipedia.org/wiki/Lactase "Lactase") when consuming dairy products often improves symptoms.
See also
- [Climate change and infectious diseases](https://en.wikipedia.org/wiki/Climate_change_and_infectious_diseases "Climate change and infectious diseases")
- [Mucorrhea](https://en.wikipedia.org/wiki/Mucorrhea "Mucorrhea") ā Discharge of mucus
- [Fernando Mazariegos](https://en.wikipedia.org/wiki/Fernando_Mazariegos "Fernando Mazariegos") ā Guatemalan scientist (1938ā2018)
References
1. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-6) [***h***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2010a_1-7)
["whqlibdoc.who.int"](http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf) (PDF). *[World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization")*. [Archived](https://web.archive.org/web/20101108051648/http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf) (PDF) from the original on 8 November 2010.
2. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-6) [***h***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-7) [***i***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-8) [***j***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-9) [***k***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-10) [***l***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-11) [***m***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-12) [***n***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-13) [***o***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-14) [***p***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-15) [***q***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-16) [***r***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-17) [***s***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-18) [***t***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-19) [***u***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-20) [***v***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-21) [***w***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-22) [***x***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-23) [***y***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-24) [***z***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHO2013_2-25)
["Diarrhoeal disease Factsheet"](https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease). *World Health Organization*. 2 May 2017. [Archived](https://web.archive.org/web/20201111202300/https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease) from the original on 11 November 2020. Retrieved 29 October 2020.
3. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-GBD2015Pre_3-0)**
Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). ["Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990ā2015: a systematic analysis for the Global Burden of Disease Study 2015"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). *Lancet*. **388** (10053): 1545ā1602\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(16)31678-6](https://doi.org/10.1016%2FS0140-6736%2816%2931678-6). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5055577](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27733282](https://pubmed.ncbi.nlm.nih.gov/27733282).
4. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Dadonaite_2018_4-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Dadonaite_2018_4-1)
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5. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CEM2013_5-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CEM2013_5-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CEM2013_5-2)
Abdelmalak B, Doyle J, eds. (2013). *Anesthesia for otolaryngologic surgery*. Cambridge University Press. pp. 282ā287\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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6. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-SaponeBai_6-0)**
Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. (February 2012). ["Spectrum of gluten-related disorders: consensus on new nomenclature and classification"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292448). *BMC Medicine* (Review). **10** (1) 13. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2012BMCM...10...13S](https://ui.adsabs.harvard.edu/abs/2012BMCM...10...13S). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/1741-7015-10-13](https://doi.org/10.1186%2F1741-7015-10-13). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3292448](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292448). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22313950](https://pubmed.ncbi.nlm.nih.gov/22313950).
[](https://en.wikipedia.org/wiki/Open_access "open access publication ā free to read")
7. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-7)**
Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD (July 2015). ["Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea"](http://eprints.whiterose.ac.uk/86190/3/MANUSCRIPT-REVISED%5B1%5D.pdf) (PDF). *Alimentary Pharmacology & Therapeutics*. **42** (1): 3ā11\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/apt.13227](https://doi.org/10.1111%2Fapt.13227). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25913530](https://pubmed.ncbi.nlm.nih.gov/25913530). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [34603226](https://api.semanticscholar.org/CorpusID:34603226). [Archived](https://web.archive.org/web/20200509035023/http://eprints.whiterose.ac.uk/86190/3/MANUSCRIPT-REVISED%5B1%5D.pdf) (PDF) from the original on 9 May 2020. Retrieved 23 September 2019.
8. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-NEJM2014_8-3)
DuPont HL (April 2014). "Acute infectious diarrhea in immunocompetent adults". *The New England Journal of Medicine*. **370** (16): 1532ā40\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/nejmra1301069](https://doi.org/10.1056%2Fnejmra1301069). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24738670](https://pubmed.ncbi.nlm.nih.gov/24738670).
9. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Prober2012_9-0)**
Crockett ME, Keystone JS (2012). ["Protection of Travelers"](https://books.google.com/books?id=TN2Gu2Af1BIC&pg=PA82). In Fischer M, Long SS, Prober CG (eds.). *Principles and practice of pediatric infectious diseases* (4th ed.). Edinburgh: Elsevier Saunders. p. 82. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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10. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-10)**
ACEP (14 October 2013). ["Nation's Emergency Physicians Announce List of Test and Procedures to Question as Part of Choosing Wisely Campaign"](http://www.choosingwisely.org/nations-emergency-physicians-announce-list-of-test-and-procedures-to-question-as-part-of-choosing-wisely-campaign/). *Choosing Wisely*. [Archived](https://web.archive.org/web/20140517042652/http://www.choosingwisely.org/nations-emergency-physicians-announce-list-of-test-and-procedures-to-question-as-part-of-choosing-wisely-campaign/) from the original on 17 May 2014. Retrieved 18 June 2014.
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Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. (Global Burden of Disease Study 2013 Collaborators) (August 2015). ["Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990ā2013: a systematic analysis for the Global Burden of Disease Study 2013"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561509). *Lancet*. **386** (9995): 743ā800\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/s0140-6736(15)60692-4](https://doi.org/10.1016%2Fs0140-6736%2815%2960692-4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4561509](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561509). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26063472](https://pubmed.ncbi.nlm.nih.gov/26063472).
12. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CDC2013_12-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-CDC2013_12-1)
["Global Diarrhea Burden"](https://www.cdc.gov/healthywater/global/diarrhea-burden.html). *CDC*. 24 January 2013. [Archived](https://web.archive.org/web/20140707153625/http://www.cdc.gov/healthywater/global/diarrhea-burden.html) from the original on 7 July 2014. Retrieved 18 June 2014.
13. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-13)** [](https://en.wikipedia.org/wiki/File:Wiktionary-logo-en-v2.svg) The dictionary definition of [*squits*](https://en.wiktionary.org/wiki/squits "wiktionary:squits") at Wiktionary
14. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-14)** [](https://en.wikipedia.org/wiki/File:Wiktionary-logo-en-v2.svg) The dictionary definition of [*runs*](https://en.wiktionary.org/wiki/runs "wiktionary:runs") at Wiktionary
15. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-15)**
["Definition of Diarrhea by Merriam-Webster"](https://www.merriam-webster.com/dictionary/diarrhea#synonyms). *[Merriam Webster](https://en.wikipedia.org/wiki/Merriam_Webster "Merriam Webster")*. [Archived](https://web.archive.org/web/20181211052241/https://www.merriam-webster.com/dictionary/diarrhea#synonyms) from the original on 11 December 2018. Retrieved 11 December 2018.
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["WGO Practice Guideline ā Acute diarrhea"](http://www.worldgastroenterology.org/acute-diarrhea-in-adults.html). [Archived](https://web.archive.org/web/20110222012123/http://www.worldgastroenterology.org/acute-diarrhea-in-adults.html) from the original on 22 February 2011. Retrieved 9 March 2011.
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18. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-webmd.com_18-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-webmd.com_18-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-webmd.com_18-2)
["The Basics of Diarrhea"](http://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea). Webmd.com. 17 February 2011. [Archived](https://web.archive.org/web/20110311010926/http://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea) from the original on 11 March 2011. Retrieved 9 March 2011.
19. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-MoonZhang2015_19-6)
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20. ^ [***a***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-0) [***b***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-1) [***c***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-2) [***d***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-3) [***e***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-4) [***f***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-5) [***g***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-6) [***h***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-7) [***i***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-8) [***j***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-9) [***k***](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-WHOtreatmentdiarrhoea2005_20-10)
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["Infant and young child feeding"](https://www.who.int/mediacentre/factsheets/fs342/en/). *World Health Organization*. 3 October 2017. [Archived](https://web.archive.org/web/20150208145357/http://www.who.int/mediacentre/factsheets/fs342/en/) from the original on 8 February 2015. Retrieved 5 January 2018.
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Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, et al. (May 2012). "Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis". *JAMA: The Journal of the American Medical Association*. **307** (18): 1959ā69\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2012.3507](https://doi.org/10.1001%2Fjama.2012.3507). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22570464](https://pubmed.ncbi.nlm.nih.gov/22570464).
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Das JK, Hadi YB, Salam RA, Hoda M, Lassi ZS, Bhutta ZA, et al. (Cochrane Infectious Diseases Group) (December 2018). ["Fly control to prevent diarrhoea in children"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302900). *The Cochrane Database of Systematic Reviews*. **12** (12) CD011654. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011654.pub2](https://doi.org/10.1002%2F14651858.CD011654.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6302900](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302900). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30556598](https://pubmed.ncbi.nlm.nih.gov/30556598).
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King CK, Glass R, Bresee JS, Duggan C (November 2003). ["Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy"](https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm). *MMWR. Recommendations and Reports*. **52** (RR-16): 1ā16\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [14627948](https://pubmed.ncbi.nlm.nih.gov/14627948). [Archived](https://web.archive.org/web/20141028174056/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm) from the original on 28 October 2014.
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Gregorio GV, Dans LF, Silvestre MA, et al. (Cochrane Infectious Diseases Group) (July 2011). ["Early versus Delayed Refeeding for Children with Acute Diarrhoea"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532715). *The Cochrane Database of Systematic Reviews*. **2011** (7) CD007296. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD007296.pub2](https://doi.org/10.1002%2F14651858.CD007296.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6532715](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532715). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21735409](https://pubmed.ncbi.nlm.nih.gov/21735409).
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MacGillivray S, Fahey T, McGuire W (October 2013). ["Lactose avoidance for young children with acute diarrhoea"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276385). *The Cochrane Database of Systematic Reviews*. **2013** (10) CD005433. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD005433.pub2](https://doi.org/10.1002%2F14651858.CD005433.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4276385](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276385). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24173771](https://pubmed.ncbi.nlm.nih.gov/24173771).
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["The Facts About Fiber"](https://web.archive.org/web/20200727012104/https://www.webmd.com/digestive-disorders/chronic-diarrhea-16/diarrhea-more-fiber). Archived from [the original](https://www.webmd.com/digestive-disorders/chronic-diarrhea-16/diarrhea-more-fiber) on 27 July 2020. Retrieved 25 January 2020.
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Guarino A, Lo Vecchio A, Pirozzi MR (2009). "Clinical role of diosmectite in the management of diarrhea". *Expert Opin Drug Metab Toxicol*. **5** (4): 433ā440\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1517/17425250902865594](https://doi.org/10.1517%2F17425250902865594). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19379128](https://pubmed.ncbi.nlm.nih.gov/19379128). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [56519371](https://api.semanticscholar.org/CorpusID:56519371).
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Dryden MS, Gabb RJ, Wright SK (June 1996). ["Empirical treatment of severe acute community-acquired gastroenteritis with ciprofloxacin"](https://doi.org/10.1093%2Fclinids%2F22.6.1019). *Clinical Infectious Diseases*. **22** (6): 1019ā25\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/clinids/22.6.1019](https://doi.org/10.1093%2Fclinids%2F22.6.1019). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [8783703](https://pubmed.ncbi.nlm.nih.gov/8783703).
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Wong CS, Jelacic S, Habeeb RL, Watkins SL, Tarr PI (June 2000). ["The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659814). *The New England Journal of Medicine*. **342** (26): 1930ā6\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/NEJM200006293422601](https://doi.org/10.1056%2FNEJM200006293422601). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3659814](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659814). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [10874060](https://pubmed.ncbi.nlm.nih.gov/10874060).
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DuPont HL, Ericsson CD, Farthing MJ, Gorbach S, Pickering LK, Rombo L, et al. (2009). ["Expert review of the evidence base for self-therapy of travelers' diarrhea"](https://doi.org/10.1111%2Fj.1708-8305.2009.00300.x). *Journal of Travel Medicine*. **16** (3): 161ā71\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1708-8305.2009.00300.x](https://doi.org/10.1111%2Fj.1708-8305.2009.00300.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19538576](https://pubmed.ncbi.nlm.nih.gov/19538576).
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119. **[^](https://en.wikipedia.org/wiki/Diarrhea#cite_ref-Arzneistoff-Profile_119-0)**
Dinnendahl V, Fricke U, eds. (1982). *Arzneistoff-Profile* (in German). Eschborn, Germany: Govi Pharmazeutischer Verlag. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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Liang Y, Zhang L, Zeng L, Gordon M, Wen J, et al. (Cochrane Infectious Diseases Group) (December 2019). ["Racecadotril for acute diarrhoea in children"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923519). *The Cochrane Database of Systematic Reviews*. **2019** (12) CD009359. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD009359.pub2](https://doi.org/10.1002%2F14651858.CD009359.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6923519](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923519). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31858591](https://pubmed.ncbi.nlm.nih.gov/31858591).
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Wilcox C, Turner J, Green J (May 2014). ["Systematic review: the management of chronic diarrhoea due to bile acid malabsorption"](https://doi.org/10.1111%2Fapt.12684). *Alimentary Pharmacology & Therapeutics*. **39** (9): 923ā39\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/apt.12684](https://doi.org/10.1111%2Fapt.12684). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24602022](https://pubmed.ncbi.nlm.nih.gov/24602022). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12016216](https://api.semanticscholar.org/CorpusID:12016216).
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Ghitha N, Larasati A, Satari H, Maharani Indira F, Devaera Y, Gayatri P (31 August 2025). ["The role of green banana in the dietary management of children with diarrhea: a systematic review and meta analysis"](https://doi.org/10.58427%2Fapghn.4.3.2025.98-110). *Archives of Pediatric Gastroenterology, Hepatology, and Nutrition*. **4** (3): 98-110. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.58427/apghn.4.3.2025.98-110](https://doi.org/10.58427%2Fapghn.4.3.2025.98-110).
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Lazzerini M, Wanzira H (December 2016). ["Oral zinc for treating diarrhoea in children"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450879). *The Cochrane Database of Systematic Reviews*. **12** (12) CD005436. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD005436.pub5](https://doi.org/10.1002%2F14651858.CD005436.pub5). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5450879](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450879). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27996088](https://pubmed.ncbi.nlm.nih.gov/27996088).
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Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, et al. (December 2020). ["Probiotics for treating acute infectious diarrhoea"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166250). *The Cochrane Database of Systematic Reviews*. **2020** (12) CD003048. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD003048.pub4](https://doi.org/10.1002%2F14651858.CD003048.pub4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8166250](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166250). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33295643](https://pubmed.ncbi.nlm.nih.gov/33295643).
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Kale-Pradhan PB, Jassal HK, Wilhelm SM (February 2010). "Role of Lactobacillus in the prevention of antibiotic-associated diarrhea: a meta-analysis". *Pharmacotherapy*. **30** (2): 119ā26\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1592/phco.30.2.119](https://doi.org/10.1592%2Fphco.30.2.119). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20099986](https://pubmed.ncbi.nlm.nih.gov/20099986). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [21836205](https://api.semanticscholar.org/CorpusID:21836205).
External links
- [WHO fact sheet on diarrhoeal disease](https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease) |
| Shard | 152 (laksa) |
| Root Hash | 17790707453426894952 |
| Unparsed URL | org,wikipedia!en,/wiki/Diarrhea s443 |