Diarrhea may be non-specific as is caused by fear, anxiety or apprehension, and indigestion. People on the move are often afflicted with traveller's diarrhoea due to the change in environment. Specific diarrhea is caused by infection in the intestines, a systemic disease, or by drugs. Three mechanisms operate in causing diarrhea: 1) Increased formation of fluid; 2) Increased activity of gut (bowels) and 3) Bacterial overgrowth.



What is to be Done for Diarrhea? The first step is to discover the cause of diarrhea. If it is due to fear, anxiety or apprehension, it lasts for a short period only. Rest, reassurance, and if necessary, use of anti-anxiety drugs, will usually cure it. In India, diarrhea is a common complaint during the wedding season when one feast follows another. In such cases, diarrhoea comes under control by itself, as the increased activity of the intestines is followed by a phase of slow activity, and usually, no drug is necessary. Certain food like ice-creams, cheese, chocolates (all have lactose, sugar) and soft drinks (fructose sugar) can cause diarrhoea. This type of diarrhoea occurs in those who have lactose intolerance.

Infection in the intestines may be caused by contaminated food or water, viruses (in children), bacterial toxins or bacterial infection. In these cases treatment with anti-bacterial drugs is necessary. Diarrhea may be secondary to some diseases like cholera, typhoid, allergic disorders, or a complication of diabetes. It can be controlled by treating the underlying disease. Chronic (longer lasting) diarrhoea is due to malabsorption syndrome, wheat allergy or tuberculosis.

Some drugs like broad-spectrum antibiotics, digitalis, cholchicine and purgative may cause diarrhea. In these cases reduction of doses or withdrawal of the drug is suggested. A potentially serious condition is pseudomembranous enterocolitis which occurs on use of powerful antibiotics.

Treatment and Drugs

In most cases diarrhoea is due to a short lasting disturbance but is associated with loss of fluids and salts. This dehydration (excessive loss of fluids and salts like sodium, potassium, calcium, and magnesium) accounts for more than two-third of the deaths due to diarrhoea. To replace these fluids and salts, a rehydration powder WHO-ORS formula dissolved in water, should be given at frequent intervals.

Dehydration can be prevented by ensuring that the fluid lost in diarrhoea is replaced by increasing the intake of fluids available at home and an oral rehydration solution. Home­available fluids (HAF) include chhach, lassi, neembu pani, light tea, daal ka pani, chawal ka maand, and salt-sugar solution. Preparing a rehydration solution at home is simple. In the case of a child, more of these home-available fluids should be given as the requirement is higher.

Besides oral rehydration salts (ORS) which contain a mixture of sodium chloride, sodium bicarbonate or citrate, potassium chloride and glucose can be given for greater efficacy. In children ORS has been able to reduce number of deaths due to diarrhoea by 90%. ORS recommended by the UNICEF/WHO is available at all chemists' shops under different trade names. It is available at government hospitals and dispensaries free of cost. Similar preparations with different composition are also available, but it is advisable to insist on WHO formula when buying ORS.