Dr. D. Datta, Ex Emergency Medical Officer.
Read Time: 5 minutes.
Diarrhoea is a major health problem in developing countries including India causing heavy burden on health services. Diarrhoea is prevalent in countries with poor socioeconomic status such as countries of Asia and sub-Saharan Africa.
In 2021 approximately 9 percent of all deaths worldwide among children under 5 years of age was due to Diarrhoea.
Each year 444,000 children die worldwide due to diarrhoea. Globally diarrhoea is the 9th leading cause of death in all age groups and 5th leading cause of death under 5 yrs of age in 2016.
Diarrhoea can be prevented by better hygiene, sanitation and use of safe drinking water. Malnourished childrens are easily infected with Diarrhoea due to their low immunity.
Types of diarrhoea
1. Acute diarrhoea–
Acute diarrhoea is defined as loose, watery or liquid stools more than three times per day. There are recent changes in consistency & character of stool. There is an uncontrollable urge for passing stool. If diarrhoeal stool is kept in a container it takes the shape of the container.
But frequent passage of formed stool is not diarrhoea.
Pasty stool passed by breast fed baby is not diarrhoea though it may be more than three times.
2. Persistent diarrhoea–
Most acute diarrhoea usually resolves within 2 weeks. If it persists more than 2 weeks it is called persistent diarrhoea. Persistent diarrhoea lasts more than 2 weeks but less than 4 weeks.
3. Chronic diarrhoea–
Diarrhoea that persists more than 4 weeks is called chronic diarrhoea. Symptoms of chronic diarrhoea may be constant or they may come and go.
Chronic diarrhoea may be an indication of a more serious underlying health problem. Therefore chronic diarrhoea should not be neglected, evaluation of chronic diarrhoea is necessary.
4. Pseudo diarrhoea–
Rectal urgency due to proctitis ( inflammation of rectum ) may cause frequent passage of small volume stools. It is called pseudo diarrhoea.
5. Overflow diarrhoea–
In a bedridden patient due to constipation and fecal impaction the number of stools may increase. In this case a per-rectal examination by a doctor will show rectum full of stool. It is called overflow diarrhoea.
6. Fecal incontinence–
Structural anorectal problem or neuromuscular disorder may increase the number of stools more than three times due to involuntary discharge of rectal contents. It is fecal incontinence. So these things to be kept in mind before making a diagnosis of diarrhoea.
Another situation faced at the emergency department of hospitals is organophosphorus (one type of insecticide) poisoning. Patients may present with acute diarrhoea and sometimes history of poisoning may not be obtained from the patient or patient party. Here the smell of organophosphorus and other signs of organophosphorus poisoning readily differentiate it from acute diarrhoea.
These symptoms are-
D=diarrhoea,
U=urination,
M=miosis (excessive constriction of pupils),
B=bradycardia (slowing of heart rate as evidenced by pulse rate less than 60 per minute.)
B=bronchorrhea (production of excessive amounts of watery sputum),
E=emesis (vomiting),
L=lacrimation,
S=salivation.
On examination of the chest with a stethoscope there are bilateral crepts.
Acute gastroenteritis (AGE)–
Also known as infectious diarrhoea or stomach flu is sudden inflammation of stomach and small intestine due to an infective agent commonly virus , however bacteria, parasites, fungus can cause gastroenteritis.
Symptoms of Acute gastroenteritis are diarrhoea, vomiting, abdominal pain, fever, and other symptoms due to dehydration. One of the major symptoms of Acute gastroenteritis is Diarrhoea.
On the other hand diarrhoea may be due to Acute gastroenteritis or due to some other cause.
Food poisoning–
Is an acute gastrointestinal disorder caused by ingestion of food or drink contaminated by bacteria and/or their toxin or by ingestion of animal or plant that is inherently unsuitable for human consumption and contains a variety of toxins.
In most cases of food poisoning there is a history of taking a particular food.
Usually many people are affected at the same time by taking that particular food, and the majority of persons who are affected, suffer from similar signs and symptoms.
Dysentery–
Is inflammation of intestines especially colon resulting in severe diarrhoea with presence of blood and mucus in stool. Symptoms of dysentery may include fever, feeling of Incomplete evacuation, abdominal pain.
CAUSES OF DIARRHOEA –
There are several causes of acute diarrhoea-
1) Viral- Rotavirus (common in Babies.), Norovirus (common in adults )
2) Bacterial- Shigella, Salmonella, E. Coli, Campylobacter, Vibrio cholerae.
3) Parasite- Cryptosporidium, Giardia Spp., Entamoeba histolytica.
4) Disturbance of gut flora by antibiotics- Antibiotic associated diarrhoea (AHA) (Clostridium difficile, Clostridium perfringens, Staph.aureus, Klebsiella oxytoca).
5) Diarrhoea may be caused by diseases of other organs also – ENT infection, Respiratory tract infection, Urinary tract infection, Bacterial meningitis or simple teething.
(Among all age groups cause of death in diarrhoea in 2016, Rotaviral-199000, Shigella- 164000, Salmonella- 90300) .
Mode of transmission Of Diarrhoea-
Most pathogens are transmitted primarily or exclusively by feco oral route ( feco oral route is described as a particular route of transmission of a disease where pathogens in fecal particles pass from one person to the mouth of another person ).
Main causes of Feco oral disease transmission is lack of adequate sanitation ( leading to open defecation ) & poor hygiene.
If soil or water bodies are polluted with fecal material, humans can be infected by waterborne diseases or soil transmitted diseases.
Taking fecal contaminated foods and drinks can cause Feco oral transmission.
5 Fs (i.e. fingers, flies, fields, fluid & food) are responsible for faeco-oral transmission.Â
Situations where Feco-oral transmission may occur–
i) By shaking one’s hand that has been contaminated with stool.
ii) Changing a child’s diaper.
iii) Working in the garden
iv) Dealing with livestock or housepet.
v) Open defecation.
vi) Poor or absent handwashing after using the toilet or handling feces ( eg changing diaper.)
vii) Poor or absent cleaning of anything that has been in contact with feces.
viii) Sexual practices that may involve oral contact with feces such as anilingus, coprophilia, or ass to mouth.
ix) Eating feces in children or in a mental disorder- Coprophagia.
x) Eating soil – Geophagia.                                                                                                                                                                                                                                                                                                                              Diarrhoea: Symptoms, Prevention and Treatment- Read more                                                                                                                                                                                                                                                                                                                                                                    Â
