Everyone Healthy Library
Diarrhoea
Condition / disease reference page from the Everyone Healthy database.
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Connected health information
Explore this condition in a clear order
Condition overview
Attributes
Commonalityis common
Linked signs and symptoms
14Each sign/symptom opens its own page and links back to related conditions.
- Anaemia (Anemia)
- Diarrhoea (Diarrhea)
- Fever (Raised Body Temperature)
- Flatulence (Farting)
- Mouth Ulcer
- Nausea
- Pain Abdominal
- Recent Travel History
- Steatorrhea (pale, foul-smelling and oily stools)
- Stools: Increased Frequency
- Stools: Increased Volume
- Stools: Increased Water Volume
- Vomiting
- Weight Loss (Body Mass Index Decreased)
Linked drugs / medications
4Medication information is educational only. A doctor or pharmacist should advise whether any medicine is appropriate.
Treatments, therapies and supportive options
32Grouped by treatment type. These are educational database links, not personal treatment recommendations. Evidence labels are shown only where stored in the EH database.
Medical therapy
1Lifestyle changes
1Alternative and complementary therapies
15- Black Cohosh Plant (Actaea racemosa)No Recommendation(Moderate Evidence)
- BRAT Diet (Bananas, Rice, Applesauce, Toast)
- Bromelain (Sulphydryl Proteolytic Enzyme, Ananas Comusus)No Recommendation(Low Evidence)
- Comfrey (Blackwort, Symphytum Officinale)Strongly Against(Low Evidence)
- Goldenseal (Hydrastis Canadensis)Weakly in Favour(Low Evidence)
- Gotu Kola (Centella Asiatica, Hydrocotyle Asiatica)No Recommendation(Low Evidence)
- Green TeaWeakly in Favour(Low Evidence)
- Indian Snakeroot (Rauvolfia, Rawolfia Serpentina)No Recommendation(Very Low Evidence)
- KampoNo Recommendation(Very Low Evidence)
- Mugwort (Artemisa Vulgaris)No Recommendation(Very Low Evidence)
- Peppermint OilNo Recommendation(Very Low Evidence)
- PsylliumStrongly in Favour(High Evidence)
- Red Pepper (Capsaicin)No Recommendation(Very Low Evidence)
- Therapeutic Touch
- Thuja (Eastern White Cedar, Thuja Occidentalis)No Recommendation(Very Low Evidence)
Alternative medicine
10- Goldenseal (Hydrastis Canadensis)Weakly Against(Low Evidence)
- Gotu Kola (Centella Asiatica, Hydrocotyle Asiatica)No Recommendation(Low Evidence)
- Green TeaWeakly in Favour(Low Evidence)
- Indian Snakeroot (Rauvolfia, Rawolfia Serpentina)No Recommendation(Very Low Evidence)
- KampoNo Recommendation(Very Low Evidence)
- Mugwort (Artemisa Vulgaris)No Recommendation(Very Low Evidence)
- Peppermint OilNo Recommendation(Very Low Evidence)
- Psyllium (Isphagula, Plantago Psyllium)Strongly in Favour(High Evidence)
- Red Pepper (Capsaicin)No Recommendation(Very Low Evidence)
- Thuja (Eastern White Cedar, Thuja Occidentalis)No Recommendation(Very Low Evidence)
Alternative therapies
1Vitamins and minerals
1Vitamins
1Linked diagnostic tests and investigations
24These are pulled from both EH diagnostic-test link tables, including the older large test-link table.
- Acid Fast Bacilli (AFB Smear or Culture)
- Anion Gap
- Blood pH Test
- Blood Urea Nitrogen Tests
- Carbon Dioxide Total Content (TCO2)
- Chloride Concentration (Blood)
- Fecal Fat Determination (Fat Absorption Test, Fecal Fat Stain)
- Heamatocrit (Hct)
- Hemoglobin (Hb) Concentration
- Lactose Tolerance Test
- Magnesium Concentration (Mg, Blood)
- Potassium Concentration (K, Blood)
- Red Blood Cell (RBC) Count
- Renin Assay
- Sodium Concentration (Na, Blood)
- Stool Electrolyte Analysis (Fecal Electrolytes)
- Stool pH Test
- Urine Chloride Concentration
- Urine Ketone Concentration
- Urine Osmolality
- Urine pH Test
- Urine Potassium (K) Concentration
- Urine Sodium Quantitative (24hr)
- Urine Specific Gravity (SG)
Biological markers/agents
27This visual map shows biological markers/agents reported as increased or decreased with this condition. These are educational relationships only; test results must be interpreted by a qualified clinician because ranges vary by lab, method, age, sex and clinical context.
Often increased
14- Anion Gap (Excluding Potassium)Reference range exampleAll: 12–20 mEq/L; All: 8–16 mEq/LLinked diagnostic testsAnion Gap
- Anion Gap (Including Potassium)Reference range exampleAll: 12–20 mEq/LLinked diagnostic testsAnion Gap
- Blood Urea NitrogenReference range exampleAdult ( > 16y): 6–18 mg/dL; Child (< 10y): 5–15 mg/dLLinked diagnostic testsBlood Urea Nitrogen Tests
- Chloride (Stools, Cl)Reference range exampleAll: 0–4 mmol/dayLinked diagnostic testsStool Electrolyte Analysis (Fecal Electrolytes)
- Fecal FatReference range exampleAll: 1,000–7,000 mg/24hrsLinked diagnostic testsFecal Fat Determination (Fat Absorption Test, Fecal Fat Stain)
- Hemoglobin (Hb)Reference range exampleFemale: 78–100 gm/dL; Male: 76–100 gm/dLLinked diagnostic testsHemoglobin (Hb) Concentration, Mean Corpuscular Hemoglobin (MCH) Weight Test
- Magnesium (Mg, Stools)Reference range exampleAll: 0–150 mmol/dayLinked diagnostic testsStool Electrolyte Analysis (Fecal Electrolytes)
- Mycobacterium Avium IntracellulareReference range exampleAll: 0–1 NegativeLinked diagnostic testsAcid Fast Bacilli (AFB Smear or Culture)
- Potassium (K, Stools)Reference range exampleAll: 0–22 mmol/dayLinked diagnostic testsStool Electrolyte Analysis (Fecal Electrolytes)
- RBC MassReference range exampleFemale: 36–48 %; Male: 42–52 %Linked diagnostic testsHeamatocrit (Hct)
- Red Blood Cells (RBC)Reference range exampleAdult ( > 16y), Female: 3.6–5 106/mm3; Adult ( > 16y), Male: 4.2–5.4 106/mm3Linked diagnostic testsRed Blood Cell (RBC) Count
- ReninReference range exampleAdult ( > 16y): 0.65–3.3 ng/mL; 16y - 18y: 0–4.4 ng/mLLinked diagnostic testsRenin Assay
- Stool pHReference range exampleNewborn (0 - 1month): 5–7.5; All: 6.5–7.5Linked diagnostic testsStool pH Test
- Urine KetoneReference range exampleAdult ( > 16y): 0–0.25 mg/dLLinked diagnostic testsUrine Ketone Concentration
Often decreased
13- Blood pHReference range exampleAll: 7.35–7.45Linked diagnostic testsBlood pH Test
- Carbon Dioxide Total Content (TCO2)Reference range exampleInfant (0 - 1y): 20–27 mEq/L; Newborn (0 - 1month): 13–21 mEq/LLinked diagnostic testsCarbon Dioxide Total Content (TCO2)
- Chloride (Blood, Cl)Reference range exampleAdult ( > 16y): 97–106 mEq/L; Birth - 2wks: 94–106 mEq/LLinked diagnostic testsChloride Concentration (Blood)
- Increase in Glucose ConcentrationReference range exampleAdult ( > 16y): 20–60 mg/dLLinked diagnostic testsLactose Tolerance Test
- Magnesium (Mg, Blood)Reference range exampleAdult ( > 16y): 1.3–2.6 mEq/L; Birth - 2wks: 1.4–2.2 mEq/LLinked diagnostic testsMagnesium Concentration (Mg, Blood)
- Potassium (K, Blood)AbbreviationKReference range exampleInfant (0 - 1y): 4.1–5.3 mEq/L; Child (0 - 16y): 3.4–4.7 mEq/LLinked diagnostic testsPotassium Concentration (K, Blood)
- Sodium (Na, Blood)Reference range exampleInfant (0 - 1y): 134–150 mEq/L; Child (0 - 16y): 136–145 mEq/LLinked diagnostic testsSodium Concentration (Na, Blood)
- Stool MucusLinked diagnostic testsStool Mucus Test
- Urine ChlorideReference range exampleInfant (0 - 1y): 2–10 mmol/day; Child (0 - 16y): 15–14 mmol/dayLinked diagnostic testsUrine Chloride Concentration
- Urine OsmolalityReference range exampleAdult ( > 16y): 250–950 mOsm/kgLinked diagnostic testsUrine Osmolality
- Urine Potassium (K)Reference range exampleAdult ( > 16y): 25–100 mmol/dayLinked diagnostic testsUrine Potassium (K) Concentration
- Urine SodiumReference range exampleChild (0 - 16y): 41–115 mmol/day; Adult ( > 16y): 40–220 mmol/dayLinked diagnostic testsUrine Sodium Quantitative (24hr)
- Urine Specific Gravity (SG)Reference range exampleAdult ( > 16y): 1.005–1.03Linked diagnostic testsUrine Specific Gravity (SG)
Introduction / full article
Diarrhoea
Diarrhea
Diarrhea is a relatively common condition that involves frequent passing of loose or watery stools. It may be mild and go away in a couple of days, or it may be persistent and suggest an underlying medical illness.
Types
The condition can be classified as either acute or chronic. In the acute type, symptoms appear rapidly and usually last about five to ten days. This is frequently seen in developing countries and is a major cause of mortality in pediatric patients.
Chronic diarrhea, as the name implies, is diarrhea that takes place over a longer period, such as in inflammatory bowel syndrome (IBS) and Crohn's disease.
Causes
Most commonly, diarrhea is viral and usually resolves spontaneously after a few days. Bacteria are the etiologic organisms in many cases of food poisoning, particularly E. coli. Parasites such as Giardia lamblia may also cause the condition. Travel to endemic areas is a risk factor.
Some people may develop diarrhea due to intolerance to lactose, a type of sugar found in milk and dairy products. Some individuals may also have trouble digesting fructose, another form of sugar found in fruits and certain beverages.
Diarrhea can be present in some patients who have undergone surgical procedures, such as gallbladder removal.
Chronic diarrhea can be seen in various diseases such as Crohn's disease, ulcerative colitis, and celiac disease.
Other less frequent causes include radiation therapy and nerve disorders.
Signs and Symptoms
Patients may have abdominal cramps, stomach pain, vomiting, appetite loss, fatigue, bloating, nausea, and loose watery stools. Some may have blood in the stool, fever, and headache.
Diagnosis
After obtaining the patient's medical history, the physician performs a physical examination. When needed, the patient's stool is examined. Depending on the case, certain procedures may be performed, such as sigmoidoscopy.
Treatment
In the majority of cases, diarrhea resolves on its own without the need for medical intervention. Dehydration should be watched for. The affected person should drink plenty of fluids and avoid medications that are not prescribed. Specific drugs may be given depending on stool test results. Diet and lifestyle changes may help in chronic cases.
References
Efficacy of Alternative and Other Treatments According to GRADE Ranking
Vitamin A [1, 45, 46, 47, 48, 49, 50, 51]
Please note, this management does not treat the condition itself. It may mildly help in preventing some symptoms, and even then has insufficient evidence to back up this claim at present. This acts as a preventative treatment, not necessarily symptomatic relief.
Recommendation: Strong. Vitamin A may help to prevent diarrhea due to its role in the body's immune function.
Grade of Evidence: High quality of evidence.
Thuja (Eastern White Cedar, Thuja occidentalis) [1, 42, 43, 44]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.
Recommendation: No recommendation. There is insufficient evidence to support claims that Thuja helps to treat diarrhea.
Grade of Evidence: Very low quality of evidence.
Psyllium (Ispaghula, Plantago psyllium) [1, 36, 37, 38, 39, 40, 41]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Strongly in favor. Clinical trials have shown that psyllium is effective in treating side effects of cancer therapy such as diarrhea.
Grade of Evidence: High quality of evidence.
Peppermint Oil [1, 30, 31, 32, 33, 34, 35]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. There is insufficient evidence to support claims that peppermint helps to treat diarrhea.
Grade of Evidence: Very low quality of evidence.
Mugwort (Artemisia vulgaris) [1, 27, 28, 29]
Please note, this management does not treat the condition itself. It has been proposed only as weak supportive symptomatic support, and even then has been discounted due to potentially life-threatening side effects.
Recommendation: No recommendation. There is insufficient evidence to support claims that mugwort helps to treat diarrhea. More research is needed.
Grade of Evidence: Very low quality of evidence.
Kampo [1, 25, 26]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. Initial studies indicate a possible reduction of diarrhea severity when using Kampo. However, more studies are needed, and the side effects of the treatment are relatively unknown.
Grade of Evidence: Very low quality of evidence.
Indian Snakeroot (Rauvolfia, Rauvolfia serpentina) [1, 23, 24]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. There is insufficient evidence to support claims that Indian Snakeroot helps to treat diarrhea in any way.
Grade of Evidence: Very low quality of evidence.
Green Tea [1, 18, 19, 20, 21, 22]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Weakly in favor. There is insufficient evidence to support claims that green tea helps to treat diarrhea in any way. Although reports are positive, more studies are needed.
Grade of Evidence: Low quality of evidence.
Gotu Kola (Centella asiatica, Hydrocotyle asiatica) [1, 12, 13, 14, 15, 16, 17]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. There is insufficient evidence to support claims that Gotu Kola helps in the treatment of diarrhea in any way. More research is needed.
Grade of Evidence: Low quality of evidence.
Goldenseal (Hydrastis canadensis) [1, 5, 6, 7, 8, 9, 10, 11]
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Weakly against. Animal studies show that Goldenseal may help reduce certain types of diarrhea. However, more studies on humans are needed. Goldenseal may produce toxic effects, including depression, constipation, rapid heartbeat, stomach pain, mouth ulcers, and vomiting.
Grade of Evidence: Low quality of evidence.
Comfrey (Blackwort, Symphytum officinale) [1, 2, 3, 4]
Please note, this herb is toxic if taken orally or if applied to an open wound. It can cause severe liver or kidney damage and lead to death. It may only be used as a cream over intact skin, and does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Strongly against. If taken orally to treat diarrhea, Comfrey can lead to severe liver and kidney damage, and can even lead to death.
Grade of Evidence: Low quality of evidence.
Red Pepper (Capsaicin)
Please note, this management does not treat the condition itself. It is proposed only as weak supportive symptomatic support, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. There is insufficient evidence to support claims that red peppers help to treat or prevent diarrhea.
Grade of Evidence: Very low quality of evidence.
Bromelain (Sulphydryl Proteolytic Enzyme, Ananas comosus)
Please note, this management does not treat the condition itself. It is proposed only as weak supportive symptomatic support, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. Available evidence does not support claims that bromelain helps to treat diarrhea.
Grade of Evidence: Low quality of evidence.
Black Cohosh (Cimicifuga racemosa)
Please note, this management does not treat the condition itself. It is proposed only as weak supportive symptomatic support, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. Available evidence does not support claims that Black Cohosh helps to treat symptoms of diarrhea in any way. Studies have yielded mixed results.
Grade of Evidence: Moderate quality of evidence.
Therapeutic Touch
Please note, this management does not treat the condition itself. It may mildly help with some symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation. There is insufficient evidence to support claims that Therapeutic Touch can help to treat diarrhea in any way.
Grade of Evidence: Very low quality of evidence.
GRADE reference: www.gradeworkinggroup.org
Summary References
Treatments
- Ades T, Alteri R, Gansler T, Yeargin P. Complete Guide to Complementary & Alternative Cancer Therapies. American Cancer Society; 2009.
- PubMed PMID: 19460762
- American Cancer Society: Comfrey
- PubMed PMID: 2103401
- NCCAM: Goldenseal
- Tierra M. The Way of Herbs. New York: Pocket Books; 1998.
- Grieve M. A Modern Herbal. New York: Dover Publications; 1971.
- Mills S, Bone K. Principles and Practice of Phytotherapy. Philadelphia: Churchill Livingstone; 2000.
- Tice R. Goldenseal and Two of its Constituent Alkaloids: Berberine and Hydrastine. National Institute of Environmental Health Sciences; 1997.
- Henriette's Herbal: Hydrastis
- American Cancer Society: Goldenseal
- Winston D, Maimes S. Adaptogens: Herbs for Strength, Stamina, and Stress Relief. 2007; pp. 226-227.
- Bradwejn J, Zhou Y, Koszycki D, Shlik J. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. Journal of Clinical Psychopharmacology. 2000;20(6):680-684.
- Hausen BM. Centella asiatica (Indian pennywort), an effective therapeutic but a weak sensitizer. Contact Dermatitis. 1993;29(4):175-179.
- Cataldo A, Gasbarro V, et al. Effectiveness of the combination of alpha tocopherol, rutin, melilotus, and Centella asiatica in the treatment of patients with chronic venous insufficiency. Minerva Cardioangiology. 2001;49(2):159-163.
- Wikipedia: Gotu Kola medicinal effects
- American Cancer Society: Gotu Kola
- American Cancer Society: Green Tea
- PubMed PMID: 16968850
- Denver Post article
- MedlinePlus Natural Medicines: Green Tea
- NCCAM: Green Tea
- American Cancer Society: Indian Snakeroot
- Merck/Dorland's reference
- Shibata Y, Wu J. Kampo Treatment for Climacteric Disorders: A Handbook for Practitioners. Paradigm Publications; 1997.
- American Cancer Society: Kampo
- Anliker MD, Borelli S, Wüthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis. 2002;46:72-74.
- American Cancer Society: Mugwort
- Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia: Lippincott Williams & Wilkins; 2004.
- American Cancer Society: Peppermint
- PubMed PMID: 17420159
- PubMed PMID: 19507027
- Oxford Bandolier: Peppermint
- MedlinePlus Natural Medicines: Peppermint
- NCCAM: Peppermint Oil
- MedlinePlus Natural Medicines: Psyllium
- MedlinePlus Drug Information: Psyllium
- NCBI Bookshelf: Psyllium
- American Cancer Society: Psyllium
- Mayo Clinic: Cholesterol-lowering supplements
- Ageless: Psyllium
- MedlinePlus: Thuja poisoning
- USDA Plant Guide: Thuja occidentalis
- MedlinePlus search: Thuja
- MedlinePlus Natural Medicines: Vitamin A
- MedlinePlus: Vitamin A
- NIH ODS: Vitamin A
- WHO: Vitamin A deficiency
- Latham ME. Human Nutrition in the Developing World. FAO Food and Nutrition Paper; 1997. ISBN: 92-5-103818-X.
- Sommer A. Vitamin A Deficiency and Its Consequences: A Field Guide to Detection and Control. Geneva: World Health Organization; 1995. ISBN: 92-4-154478-3.
- UNICEF: A World Fit for Children