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When should I be worried about diarrhea?

The signs to see a doctor for acute diarrhea: Lasts longer than two days. You're dehydrated and cannot keep food or water down. Severe abdominal pain. Blood in your stool. A fever of 102 °F or higher.

houstonmethodist.org - When to See a Doctor for Diarrhea - Houston Methodist

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It keeps you tied to a bathroom, interrupting your day. It's ... unpleasant, to say the least.

It's diarrhea.

When you've got it, you want it over fast. And if it's something you've been dealing with for a while, you're looking for answers. "Diarrhea is very common and, most of the time, it's short-lived and clears up on its own," says Dr. Neeharika Kalakota, a gastroenterologist at Houston Methodist. "But it can also be severe or chronic, and that's when diarrhea becomes more concerning."

What causes diarrhea?

There are two overarching types of diarrhea — acute and chronic.

Both result in the release of loose and watery stools, usually at least three times in a single 24-hour period. Acute diarrhea is transient — lasting for just a day or two, though sometimes as long as two weeks. It also frequently presents with other symptoms, like nausea, vomiting, abdominal cramps and even fever. Chronic diarrhea, on the other hand, persists over a longer period of time — 30 days or more by true clinical definition.

The two have different underlying causes.

Causes of acute diarrhea

"Acute diarrhea is almost always the result of an intestinal infection — usually viral, often foodborne," says Dr. Kalakota. "These infections are typically self-limiting and the resulting diarrhea often doesn't last beyond 48 hours." Many of the viruses that cause foodborne illness are very contagious, making fecal-oral transmission a possibility. For instance, norovirus and rotavirus — the most common causes of diarrhea, often referred to as stomach flu — can quickly spread through homes, workplaces and other close quarters, like cruise ships. They're frequently found in day-care facilities and passed from child to parents.

Several types of bacteria can also cause acute diarrhea through foodborne illness.

"Interestingly, the SARS-CoV-2 virus that causes COVID-19 can cause a number of gastrointestinal symptoms, including acute diarrhea," Dr. Kalakota adds. "This only occurs in a subset of people, though, and it's important to note that COVID-19 isn't foodborne like the other viruses and bacteria that are the more common causes of diarrhea." Instead, COVID-19 primarily spreads through infectious respiratory droplets. And while it may also spread through fecal-oral transmission, this risk should be low if you're practicing proper bathroom etiquette.

Causes of chronic diarrhea

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Diarrhea that persists over time is typically caused by an underlying health issue or condition, such as:

Irritable bowel syndrome (IBS)

Irritable bowel disease (IBD), which can manifest as either Crohn's disease or ulcerative colitis

Lactose intolerance

Gluten sensitivity and celiac disease

Chronic pancreatitis

Small intestinal bacterial overgrowth (SIBO)

Surgical removal of the gall bladder

"Many over-the-counter and prescription medications can also cause diarrhea, including ibuprofen and certain blood pressure drugs," says Dr. Kalakota. Supplements taken in high dosages — vitamin C and magnesium, in particular — can also be sources of diarrhea.

How can you get rid of diarrhea?

Why didn't we ask this question first?

Well, how to stop diarrhea can depend on what's causing it.

Over-the-counter anti-diarrheal medications can help reduce some of the discomfort and inconvenience that comes with diarrhea, but they don't treat the underlying cause. Remember, acute diarrhea is self-limiting and typically clears up in a day or two, with or without an anti-diarrheal. "In the meantime, it's important to keep up with fluids and food as best you can, since dehydration can become a concern if the fluids and electrolytes you're losing aren't replaced," Dr. Kalakota explains. "Getting plenty of rest can help you feel better, too." She also suggests isolating to your own bathroom, if possible. As mentioned, the viruses that commonly cause acute diarrhea are very contagious. If it's chronic, getting rid of diarrhea is about finding the cause of it. "We always want someone who is experiencing ongoing diarrhea to be evaluated so we can determine the underlying cause of it and the most effective way to manage it," Dr. Kalakota explains.

When should you see a doctor for diarrhea?

Generally speaking, the occasional bout of diarrhea typically isn't a huge cause for concern.

But not always.

The signs to see a doctor for acute diarrhea:

Lasts longer than two days

You're dehydrated and cannot keep food or water down

Severe abdominal pain

Blood in your stool

A fever of 102 °F or higher

"In some cases, dehydration and severe diarrhea can be a medical emergency," Dr. Kalakota adds.

You should also consult your doctor if you're experiencing chronic diarrhea.

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"Your primary care doctor will start the blood workups and stool tests needed to help determine what might be causing diarrhea," Dr. Kalakota explains. "Depending on the results, lifestyle changes that help reduce diarrhea may be recommended." For more complex causes of chronic diarrhea, like IBD, or if it persists despite lifestyle modifications, your doctor will refer you to a gastroenterologist.

Chronic diarrhea treatment: What are the options?

"If diarrhea is caused by IBS or a food sensitivity, like lactose or gluten intolerance, diet modification is typically the first-line treatment," says Dr. Kalakota. When the body can't properly absorb a particular type of food, it leads to water collecting in the bowels — hence the watery stool.

The following steps can help:

Avoiding foods that trigger or exacerbate symptoms

Getting plenty of fiber (25 grams per day for women, 38 grams per day for men)

Eating a healthy diet that limits ultra-processed foods

"If you're having trouble identifying problem foods, keep a food-symptom journal," Dr. Kalakota recommends. "Fiber supplementation can also help ensure you're getting enough fiber to help bulk up your stool." Your doctor may also recommend diarrhea medicines — diphenoxylate or loperamide — to help manage symptoms. "If you have diarrhea no matter whether you're eating or not — even when fasting, during the middle of the night, for instance — it's approached slightly differently than diarrhea after eating," explains Dr. Kalakota. Getting plenty of fiber and eating a healthy diet remain key, and anti-diarrheal medications may be recommended. But your gastroenterologist will also take steps to treat the underlying condition causing your diarrhea — prescribing corticosteroids or anti-inflammatory medications to help manage IBD, for instance. "The steps needed to treat chronic diarrhea vary based on what exactly is causing it," Dr. Kalakota reminds. "This is why it's so important to consult your doctor — so an accurate diagnosis is made and the most effective treatment plan is recommended."

houstonmethodist.org - When to See a Doctor for Diarrhea - Houston Methodist

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