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    On the Run: Managing Diarrhea

    Jacklyn Oakley, MD Deaconess Family Medicine Residency 09/06/2016

    Few things can make a person as miserable as a case of diarrhea (also known as “the runs, “the trots” and other charming euphemisms).  No one wants to talk about it, but I’m going to because I want to help you know how to treat diarrhea well at home-- both to ease the misery as quickly as possible, and to possibly prevent an unnecessary doctor’s visit.
    Acute (temporary) illness with diarrhea is a common problem that I and fellow physicians encounter in office visits.  Diarrhea is defined as an increase in frequency, water-content, and/or volume of bowel movements.  The most common cause of acute diarrhea is viral gastroenteritis, which is a contagious infection.  Along with the diarrhea, many people will experience abdominal cramping, nausea, and vomiting.
    Diarrhea can also be caused by medications (antibiotics are frequent culprits, as they can disturb the balance of both good and bad bacteria in the gut), bacterial infections such as food poisoning, and inflammatory bowel disease.  Diarrhea is considered chronic if symptoms last longer than 30 days.
    The good news is that most cases of diarrhea do not require any bloodwork or stool samples, and most cases can be treated at home.
    At-Home Treatment Options
    Re-hydrating is a very important part of treatment, but be sure to avoid sugary drinks (especially juice), as these can make diarrhea worse.  Follow a bland diet, avoiding dairy products and high-fat foods.  Yogurt is the dairy exception, as the healthy bacteria cultures in yogurt can help.
    Probiotics will help reduce the length of time of having diarrhea by about one day. Culturelle, Florastor and Align are great examples of over the counter probiotics.  Other over the counter products such as Imodium/similar medications (Loperamide/Simethicone) may be used to treat non-bloody diarrhea for school-aged children and above.
    Appropriate hand-washing can prevent viral gastroenteritis.  When washing your hands be sure to:

    • Rinse both of your hands with clean, running water and apply soap.
    • Lather your hands with the soap. Be sure to lather between your fingers, the backs of your hands, and under your nails which are frequently forgotten.
    • Scrub your hands for at least 20 seconds. Humming the "Happy Birthday" song two times is about 20 seconds long if you don’t have any way to track the time.
    • Rinse your hands under the running water.
    • Dry your hands using a clean towel or automatic hand dryer.

    Vaccinations are another prevention method.  Infants routinely get the rotavirus vaccination series.  If you plan to travel, contact your Board of Health as vaccinations are available for certain travel-related causes of diarrhea.
    Preparing food correctly and storing at appropriate temperatures can also prevent diarrhea.  Be careful about “cross contamination” of foods, and avoid eating raw or undercooked beef, pork, poultry, seafood or unpasteurized milk. Also, if you’re a hiker/camper, don’t drink water from streams.
    When to call your doctor’s office or schedule an appointment
    If you experience any of the following, call your doctor’s office.

    • Bloody stool
    • Persistent fevers (temperature >100.4F)
    • Severe dehydration signs/symptoms:◦A child is severely dehydrated if he/she does not have any tears with crying
      • If you press on your skin, let go, and the color does not come back to normal in 2 seconds, you likely are dehydrated.
      • Low urine output
    • Persistent diarrhea (lasting longer than 3-7 days)
    • If you are immunosuppressed, such as due to medications, chemotherapy, or chronic illness.
    • Recent travel to foreign country (traveler’s diarrhea)
    • Recent hospitalization, which increases the risk of acquiring Clostridium difficile, which needs to be treated.
    • Severe abdominal pain

    I hope this has been helpful, and that you don’t need to use this advice often!

    Learn more about the author

    Jacklyn Oakley, MD
    Specialty: Bariatrics
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