The Lowdown on Diarrhea: When is It Time to See a Doctor?

by Nidhi Malhotra, MD, Gastroenterologist
December 11, 2018

Diarrhea is a menace in the form of hard-to-control bowel movements and loose, watery stools three or more times per day—quite the hassle when you’re at work, traveling, or doing everyday activities. Other unpleasant diarrhea symptoms include:

  • An urgent need to use the bathroom
  • Inability to control bowel movements
  • Nausea
  • Stomach pain

But along with being annoying, severe diarrhea can dehydrate the body, leading to further health complications, such as low blood pressure or fainting.

Diarrhea comes in two forms: acute and chronic. The conditions have similar symptoms, but much different implications for patients. Acute diarrhea lasts for less than two weeks and gets better on its own. It’s usually a sign of an infection, food poisoning, lactose intolerance, or gastroenteritis. Chronic diarrhea can last much longer and can be a symptom of a more serious condition, such as ulcerative colitis, Crohn’s disease, celiac disease, or C. difficile infection.

Most acute cases can be managed at home, but severe diarrhea warrants a visit with the doctor. Let’s discuss how to manage diarrhea and the tell-tale signs of when to go see your doctor.

LISTEN: Dr. Malhotra discusses diarrhea symptoms and management in the Medical Intel podcast.

5 ways to overcome diarrhea

1. Stay hydrated

There are over-the-counter oral rehydration solutions sold in pharmacies, but I always suggest to patients an easy way to make it at home. Mix six teaspoons of sugar, one-half teaspoon of salt, and a half-gallon of water in a container and drink it throughout the day. The sugar and salt help your body absorb water better, which keeps you better hydrated.

2. Consider taking zinc supplements

Zinc been shown to reduce the severity and duration of diarrhea, especially in children. This is used more commonly in developing countries, but something to keep in mind if you’re having ongoing acute diarrhea.

3. Eat a healthy diet

I advise my patients to eat a healthy, nutritious diet full of plant-based protein, increased yogurt intake, and additional prebiotic foods. These nutrients can restore the beneficial bacteria that diarrhea causes your body to flush out.

4. Avoid antibiotics

Antibiotics could be used to treat diarrhea, but most times they can do more harm than good. Antibiotics can disrupt the microbiome, or the trillions of bacteria, viruses, and fungi found primarily in a person’s gut, and can cause more long-term symptoms. Plus, they can cause antibiotic-associated diarrhea from irritation or changes to the colon bacteria and even cause an infection with C. difficile. I reserve antibiotic treatment for those patients for whom it’s the only feasible treatment, such as for a proven, serious infection.

5. Consider taking probiotics

If I do prescribe an antibiotic, I typically recommend eating yogurt, which includes Lactobacillus, a natural probiotic that reduces the severity and duration of antibiotic-associated diarrhea. Keep in mind, most probiotic supplements are not FDA regulated, so buying a probiotic and expecting big results could be a shot in the dark. Fermented foods are an excellent source of prebiotics as well and a great addition to your daily food intake. Examples of such foods are sauerkraut, kombucha tea, tempeh (made from fermented soy beans), and miso (a Japanese seasoning made from soybeans fermented with koji, which is a natural fungus.

Prebiotics are foods that feed the good bacteria in our gut. You can find prebiotics in plant-based foods such as dandelion greens, onion, garlic, leeks, and common foods like asparagus, green unripe bananas, oats, and barley.

When to seek treatment

Even when taking preventative measures, there are times, what I call “red flag symptoms,” when a person should visit their doctor, such as when there are:

  • Nocturnal stools or waking up in the middle of the night to have a bowel movement
  • Signs of blood in the stool
  • Symptoms of weight loss, fevers, or night sweats
  • Times when diarrhea occurs even without eating, or on an empty stomach

I remember treating a young woman who had been on antibiotics many times for sinusitis and urinary tract infections, and she was suffering with chronic diarrhea. After tests from her primary care provider showed no obvious conditions, we gave her a breath test and discovered she was suffering from small bowel bacterial overgrowth. After initially treating her with a non-absorbable antibiotic (we had to in order to get rid the overgrowth), we helped the patient improve her diet with more plant-based foods, adding prebiotic foods, and probiotics. Her condition vastly improved in the following months.

For most patients, the first step in diagnosing the cause of chronic diarrhea is a stool study to uncover undiagnosed infections or diseases. The doctor also might conduct lab work to identify any conditions, such as anemia or abnormal liver numbers.

If your doctor identifies any underlying conditions, you might need further testing. For example, an endoscopy may be necessary so we can take biopsies of the small bowel. Sometimes, a colonoscopy may be necessary if there’s blood in the stool or ongoing nocturnal stools, as it could show inflammatory bowel disease or microscopic colitis.

Diarrhea can make everyday activities a hassle, but it also can signify a more serious condition. If you’re suffering from severe or chronic diarrhea, see your doctor for help right away.

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Category: Healthy Living, Medical Intel     Tags: diarrheaprebioticsprobioticsstomach problems