Diarrhea has a way of ruining your day, doesn't it? Running to the bathroom every few minutes is definitely not the way anyone wants to spend their time. Plus, it can sometimes be difficult to know exactly why you are experiencing this condition.
While an occasional bout of diarrhea can be considered completely normal and chalked up to something you ate, a change in your routine or even stress, diarrhea lasting for five days or more is most likely linked to a more serious cause, such as a viral or bacterial infection. Read on for what you need to know if you're experiencing this condition.
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What Is Diarrhea?
Although it might sound strange, David Cutler, MD, a family medicine physician at Providence Saint John's Health Center in Santa Monica, California, says it's very important to understand the definition of diarrhea.
According to Dr. Cutler, the generally accepted definition of diarrhea is stool that is so liquid that it takes the shape of the container it is in, and happens three or more times per day.
For background, all stool is liquid before it reaches the large intestine, where the job of the bowel is to absorb excess water and create formed stool. With this in mind, Dr. Cutler says, diarrhea can result when:
- too much fluid is present, so the bowel can't absorb it all
- the bowel fails to absorb the fluid
- stool passes too quickly through the colon for liquid to be absorbed
- a disease of the colon causes it to leak out more fluid than it absorbs
Factors like infection, dietary changes, medications and neuromuscular effects on the intestine all can play a part in any of the above causes.
Common Causes of Acute Diarrhea
1. Foodborne Illnesses
According to Dr. Cutler, the most common causes of diarrhea are foodborne illnesses. These illnesses alone cause an estimated 50 million cases of diarrhea in the United States every year, he notes.
Diarrhea can be caused by a virus or bacteria in food that hasn't been cooked or refrigerated properly, or from improper food handling (aka when the chef doesn't wash his or her hands or instruments effectively). Most cases of foodborne illness-related diarrhea resolve on their own, but diarrhea lasting more than five days should be treated by a doctor.
According to the Centers for Disease Control and Prevention (CDC), there are five top offenders:
- Norovirus: The norovirus is a common and very contagious virus that causes diarrhea and vomiting. It's easily spread by direct contact with an infected person or via contaminated food, such as raw fruits and vegetables or shellfish. Symptoms usually last between one to three days, but you can be contagious for up to two days after you feel better.
- Salmonella: Salmonella food poisoning most commonly results from eating contaminated raw or undercooked eggs or poultry, or drinking contaminated water, unpasteurized milk or juice. Typical symptoms include diarrhea (possibly bloody), vomiting, fever and abdominal cramps usually lasting four to seven days.
- Clostridium perfringens: According to the CDC, C. perfringens is the bacterium responsible for the majority of foodborne illnesses in the U.S. (about 1 million each year). It's found frequently in raw meat and poultry, and in precooked food that sits out for a long time, such as under a warmer. Infection leads to diarrhea without vomiting, and symptoms usually pass quickly, within a day or two. However, diarrhea can last up to two weeks in older individuals and those with weakened immune systems.
- Campylobacter: Campylobacter intestinal infections most commonly come from the same types of contaminated foods as salmonella infections. Characteristic symptoms include bloody diarrhea, abdominal pain, fever and possibly nausea and vomiting. Symptoms usually last two to 10 days.
- Staph: Staphylococcus aureus, _also known as Staph bacteria,_ is found in about 25 percent of people and doesn't always cause illnesses, but it can produce toxins that can make people sick with food poisoning. Unfortunately, although Staph is killed by cooking foods, the toxins it produces are not, so it can make people sick even if the food is prepared properly. The CDC also notes that non-cooked foods, such as sliced meats, puddings, pastries and sandwiches, are also at risk for contamination with staph toxin. Fortunately, symptoms of diarrhea with staph usually don't last longer than one day.
Parasitic infections, such as giardiasis, the most common type of parasite found in water, are less common in this country but rampant in other parts of the world. So if you've recently traveled and are experiencing diarrhea, be sure to tell your doctor in case additional testing is needed.
2. Food Intolerances or Sensitivities
One other common cause of diarrhea, especially in adults, is food intolerances or sensitivities. For example, Dr. Cutler notes that some degree of lactose intolerance is present in about 50 percent of adults worldwide. People who are lactose intolerant may experience diarrhea after eating dairy products.
Other food issues, such as a gluten intolerance, may also cause diarrhea. If you think you might have a food intolerance or sensitivity, ask your doctor about appropriate testing.
Many medications have diarrhea as a possible side effect. Common culprits include antibiotics, laxatives, magnesium-containing antacids, certain blood pressure medicines as well as the diabetes drug metformin. However, it's important that you never stop taking a medication that has been prescribed to you without consulting your doctor first.
4. Dietary Changes
Recent dietary changes can potentially cause acute diarrhea.
Artificial sweeteners, such as aspartame, commonly found in sugar-free foods and drinks, might be to blame for your diarrhea. And even your favorite cup of coffee in the morning can cause diarrhea if you're especially sensitive to caffeine, or have consumed more than your normal amount.
Read more: Ice Cream and Diarrhea
5. Digestive Disorders
Diarrhea lasting at least five days might herald a more serious digestive disorder, especially if your diarrhea continues or recurs on a regular basis. A few of the more common conditions that might be to blame include:
- Irritable bowel syndrome
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
- Celiac disease
- Pancreatic or liver disease
- Ischemic colitis (colon damage caused by reduced blood flow)
- Colon or pancreatic cancer
If you suspect that any of these conditions might be to blame, contact your doctor for an evaluation.
Read more: Spinach and Diarrhea
When to See a Doctor for Diarrhea
Dr. Cutler assures us that most cases of diarrhea will resolve on their own without treatment. But if you have diarrhea that lasts for three or more days without improvement, you should see a doctor, according to the Mayo Clinic.
You should also schedule an appointment if you have additional symptoms accompanying the diarrhea. "If there is no fever, abdominal pain, blood or pus in the stool, and good hydration is maintained, then there is no immediate concern, but a cause should be sought," adds Dr. Cutler.
Seek help sooner if you have a weakened immune system, are unable to keep down fluids for more than 12 to 24 hours or if your diarrhea is accompanied by a fever. And you should seek urgent medical care if you experience any of the following symptoms:
- Dizziness, lightheadedness or fainting
- Severe or worsening abdominal pain
- Bleeding from your rectum
- Confusion or other mental changes
- Signs of dehydration, such as decreased urine production or dark urine
- Blood or puss in the stool
- Centers for Disease Control and Prevention: "Foodborne Illnesses and Germs"
- Up to Date: "Approach to the adult with acute diarrhea in resource-rich settings"
- Mayo Clinic: "Metformin (Oral Route) Side Effects"
- International Foundation for GastroIntestinal Disorders: "Common Causes of Chronic Diarrhea"
- Mayo Clinic: "Giardia Infection (Giardiasis)
- Mayo Clinic: "Antibiotic-Associated Diarrhea"
- FDA: "High Blood Pressure-Medicine to Help You"
- International Foundation for Gastrointestinal Diseases: "Antacids"
- NHS: Symptoms of Dehydration
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.