Diarrhoea

• What is diarrhoea?
• What causes diarrhoea?
• When is it best to get medical assistance?
• Prevention
• Treatment

Has someone ever told you to just “let diarrhoea work itself out” and not stop it? Some people prefer not to suppress the condition with an antidiarrhoeal, as they consider it part of our natural defence against intestinal pathogens. However, researchers have shown that pathogens trigger diarrhoea and exploit the condition simply to facilitate transmission to others. ¹

When is a runny tummy actually diarrhoea?

It is normal to experience a loose bowel movement or two every now and then. When a person passes unusually loose or watery stools at least three times in a 24-hour period, specialists define it as diarrhoea. ²

South Africans, on average and of all ages, have 1 to 2 incidences of diarrhoea every year. Studies found that households in which children between 5 and 15 years old were part of the family experienced significantly more incidences in a year.³ Children below three years of age are reported to have three episodes of diarrhoea a year on average. ²

When a person has diarrhoea, they may have other symptoms that accompany the loose stools, which could include: ⁴

• nausea (feeling sick)
• vomiting
• fever
• headache
• bloating and flatulence
• abdominal cramps and pains
• loss of appetite
• weakness
• dehydration

Of these symptoms, one of the most deadly yet easy to prevent or treat is dehydration. ²

It happens when insufficient water is removed from your stool, or too much fluid is secreted into it, making it loose. ⁴

There are several reasons why you could experience the condition. Some cause only short-lived episodes (acute diarrhoea), while others may cause episodes on a more ongoing basis (chronic diarrhoea). ⁴

Some signs that could indicate that you may need medical attention include the following: ⁵

• Particularly frequent or severe diarrhoea
• There is blood in your or your child’s stool
• Persistent vomiting
• A severe or continuous bowel ache
• Weight loss
• Signs of dehydration. For instance, drowsiness, passing urine infrequently, and feeling lightheaded or dizzy
• Stool is dark or black – this may be a sign of bleeding inside your stomach

An infection by a virus, bacteria or parasite is often the cause of diarrhoea. The best way to prevent it would be to pay close attention to everyday hygiene practices around you and your family. ⁵

• Wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing food. Furthermore, check that all family members, including children, do the same.
• Additionally, clean the toilet, including the handle and the seat, with disinfectant after each bout of diarrhoea
• Avoid sharing towels, cutlery, or utensils with other household members ⁵

While travelling, take special care to practise good food and water hygiene, such as avoiding potentially unsafe tap water and undercooked food. ⁵

For both adults and children, the first treatment recommended during a bout of diarrhoea is oral rehydration solution (ORS). As dehydration can be very dangerous, treating or preventing dehydration is critical. ^2,6

An interesting fact is that mild or moderate dehydration can be successfully treated with oral rehydration solution in 9 out of 10 cases without requiring an intravenous drip. However, less than half of South Africans use ORS during a bout of diarrhoea ^2,3

To treat the diarrhoea itself, treatment for adults and children are different. Children should be assessed by a healthcare professional to determine the cause and prescribe the most appropriate treatment. On the other hand, adults may use antidiarrhoeal medicine, such as loperamide tablets.

Some antidiarrhoeal products are available in easy-to-use formats that make taking antidiarrhoeal medicine when you are not feeling well much easier. One of these formats is a melting tablet – a convenient dissolvable tablet. When the tablet is placed on the tongue, it melts within seconds and can easily be swallowed. In other words, no water is needed, and it is especially suitable for those with swallowing difficulties. ⁷

Loperamide targets diarrhoea in 3 ways: ^8,9

1. Firstly, it controls muscle contractions to normalise gut movement, allowing more time for water and salts to be absorbed.
2. Secondly, it changes how much water and electrolytes are secreted and absorbed in the bowel, resulting in a firmer stool passing into the rectum.
3. Thirdly, it helps prevent faecal incontinence by tightening the anal sphincter (a round muscle that closes the rectum).

Loperamide gets to work within 1 hour and has shown that it significantly reduces the number of watery stools on days 1 & 2 of use vs people that take no antidiarrhoeal medication. ^9,10,11