You get a bout of diarrhea that just won't seem to let up, accompanied by stomach cramping and bloating, maybe nausea and vomiting. What should you do? After respiratory infections, acute episodes of diarrhea are the most common illness in the United States—so don't panic, say experts at the American College of Gastroenterology. The average adult endures acute episodes of diarrhea about four times annually, and children will experience seven to 15 bouts by age 5, according to the National Digestive Diseases Information Clearinghouse.
Still, it's hard to tell on your own what is causing your diarrhea and stomach pain. Among the many causes of diarrhea are inflammatory bowel disease, also known as IBD, irritable bowel syndrome, or IBS, and viral or bacterial infections. A bad reaction to a medication can cause diarrhea, too. You should be evaluated by a doctor for any case that lasts longer than a few days or if you see blood in your stool. Other reasons to see a doctor quickly: severe pain in your stomach or rectum or a fever 102 degrees or higher. (The American Academy of Family Physicians offers a flowchart to help evaluate your symptoms.) "People are often delayed in their diagnosis" of serious stomach problems because they ignore or self-treat their symptoms for too long, says Karen Kroeker, gastroenterology resident at the University of Alberta in Canada, who presented research this week at the Digestive Disease Week conference, a meeting sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association Institute, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.
Most cases of diarrhea do resolve themselves on their own. Meantime, it's important to avoid becoming dehydrated by drinking plenty of fluids. If you nevertheless develop signs of dehydration, seek medical attention. In honor of Digestive Disease Week, we take a look at several diarrhea causes—and explore what you can do about them.
* Inflammatory Bowel Disease, which includes Crohn's disease and ulcerative colitis, can lead to inflammation or swelling that results in the colon emptying too often. Right now, people with Crohn's usually first get treated with medications to help decrease inflammation, including sulfasalazine (Azulfidine), mesalamine (Asacol or Pentasa), and olsalazine (Dipentum). Steroids, sometimes in combination with immunosuppressive medications, are often used to treat Crohn's disease. A medication called infliximab (Remicade) is typically recommended for moderate-to-severe Crohn's that fails to respond to other types of therapy. Ulcerative colitis is treated similarly with olsalazine, mesalamine, or balsalazide (Colazal). Corticosteroids and immunosuppressive medications also are used to treat this condition. Some people will eventually need surgery for IBD.
Research is looking into whether a stronger approach early on might work better to treat IBD. Some early data suggest that giving patients infliximab (Remicade) and an immunosuppressant called azathioprine (Azasan) early in the course of illness can help keep Crohn's disease in remission.
* Irritable bowel syndrome is sometimes confused with IBD, but the conditions are different. IBD "really is an inflammation of the bowel, as opposed to IBS, where there is no inflammation," says Geoffrey Nguyen, an assistant professor of medicine at the University of Toronto and adjunct assistant professor of medicine at the Johns Hopkins University School of Medicine who is presenting IBD data this week at the Digestive Disease Week conference. Symptoms range from stomach pain and bloating to constipation and diarrhea.
Properly treating IBS requires recognizing the factors that trigger its symptoms, says Aaron Tokayer, associate professor of medicine in the division of gastroenterology at Montefiore Medical Center in New York. Greasy, fatty, or fried foods may bring on diarrhea in people with IBS, as can psychological stress; triggers can be different from person to person. In December, the American College of Gastroenterology published an updated set of guidelines for how to manage and treat IBS.
Reader Comments Read all comments (6)