Diarrhoea: diagnosis

If you suffer with diarrhoea, it is important to find the underlying cause of the problem. Accurate identification of the cause is the first step towards finding a proper treatment pathway.

If the diarrhoea is particularly intense or prolonged, it is essential to consult your GP. During the examination the clinician can make a diagnosis or look at further tests to find a cause.

The initial phase of the diagnostic process is a review of the clinical history. The doctor will collect information on the frequency of the evacuations, the stool consistency and volume, how long the problem has been going on and any related symptoms.

The specialist may then carry out an anoscopy and a rectal examination and may palpate the abdomen to check for abnormal masses.

The doctor may also prescribe laboratory tests, such as:

• a faecal occult blood test
• specific blood tests
• a stool test

If there are chronic symptoms or a family history of this, further tests may be required such as a colonoscopy or radiological examinations.

Diarrhoea: nutrition and prevention

If there are no specific diseases found then the episodes of diarrhoea can be prevented by following certain precautions and good eating habits.

Your doctor will advise on the best diet to follow and the correct hygiene/behavioural habits to be adopted.

If the diarrhoea is caused by specific intestinal diseases (e.g. Crohn's disease, ulcerative colitis), the doctor will provide information on the specific diet to follow or make a referral to a specialist nutrionist.

If the diarrhoea is of infectious origin, it is important to follow the hygiene rules for food safety and only ingest foods and beverages where the origin is certain and controlled, particularly in exotic countries.

In the presence of diarrhoea caused by medicines, foods or beverages which are not well tolerated, removing these products from your diet will be sufficient and your doctor will advise on any medicines needed.

Diarrhoea: what to eat

Some of the foods and beverages which can contribute to the cause of diarrhoea most often are:

• coffee
• alcohol, in particular beer
• cold or iced drinks
• fruit juices and very sweet drinks
• milk and dairy products (e.g. mozzarella, ricotta)
• foods which naturally possess laxative properties (e.g. kiwis, legumes, whole grains, plums, dried fruit, beer, oilseeds, liquorice, figs)
• food that is very fatty and difficult to digest (e.g. sausages and cold cuts, fat cheeses, creamy desserts etc.)
• diet foods and beverages with artificial sweeteners (e.g. aspartame)
• excessive seasonings
• fried or stewed foods

Other products which may help to contain the symptoms associated with diarrhoea, are:

• astringent foods and beverages (e.g. lemon, bananas, boiled potatoes, boiled rice, apples)
• lean meats (e.g. chicken, turkey, rabbit)
• lean fish (e.g. sea bream, sea bass, cod)
• low-fat and aged cheeses (e.g. parmesan cheese)

Lifestyle

Some environmental and lifestyle situations which can cause the onset of sporadic or chronic diarrhoea, are:

• emotional tension and stress.
• poor hygiene in storing, handling and preparing foods and drinks.
• chills and sudden temperature changes.
• meals which are too abundant and eaten quickly.

Therefore, in order to reduce the risk of diarrhoea, it is advisable to follow a balanced lifestyle, paying attention to the diet, food preservation and preparation.

Complications of diarrhoea

It is important not to ignore or neglect the disorder, especially if it persists. Diarrhoea may in fact hide more serious problems.

Furthermore, even when diarrhoea is not associated with more serious illnesses, it can still pose risks to our health, particularly if it is present over an extended period of time.

Dehydration and loss of mineral salts

The greatest risk associated with diarrhoea is probably dehydration: in a short time, the body loses a high volume of fluids and mineral salts which are vital for its proper functioning. Dehydration is particularly dangerous for the elderly and for children.

Reduced absorption of food and nutrients

Frequent discharges of diarrhoea result in a reduced absorption of nutrients from the foods we eat. In more serious cases this can lead to malnutrition due to malabsorption.

Infections of the perianal area

It is essential to practice good hygiene in the perianal area with specific products. Proper hygiene helps prevent the onset of local infections and inflammations.

Psychological problems and limitation of social activities

Diarrhoea can create psychological problems for sufferers, limiting daily activities and social life.

Diarrhoea: medicines

The use of medicines or supplements to treat diarrhoea depends on the features of the disease. Often, the types of diarrhoea which require pharmacological treatment are those associated with a bowel infection caused by bacteria or parasites.

In these cases, there are several medicines and supplements which are useful to counteract the problem:

• specific antibiotics to fight bacterial infection
• activated charcoal to promote the absorption of excess liquids
• antiprotozoal agents to counteract protozoan infections
• lactic ferments and probiotics to restore intestinal bacterial flora
• antispasmodics to reduce spasms

It is important that the intake of medicines and supplements should always be evaluated in advance by your GP.

Diarrhoea: remedies and medical therapies

Remedies and medical therapies for the treatment of diarrhoea normally aim to treat the underlying disease and are therefore very different from each other.

Chronic diarrhoea can also be caused by inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, tumours, diverticulitis, irritable bowel syndrome or other diseases requiring specific care. It is therefore necessary to listen to the doctor’s opinion before starting any therapy.