Diarrhoea in adults

In adults diarrhoea (with or without vomiting) is usually caused by a viral infection which may occur in epidemics. The cause may sometimes be food poisoning. Other symptoms which may occur are feverishness, muscle aches and pains, and abdominal cramps.

This is usually a self-limiting illness and the patient will normally improve in 24 to 48 hours. It is important to prevent dehydration by taking frequent drinks, but avoiding milk, tea and coffee. (Dioralyte sachets from a pharmacy provide a very effective fluid replacement). Food should be avoided for 24 hours then gradually reintroduced starting with small quantities of bread, dry toast, biscuits.

Over the next few days try to reintroduce fruit, vegetables and milk. Over the counter diarrhoea remedies e.g. Loperamide, Kaolin & Morphine, Lomotil, Imodium may be used to reduce the frequency of diarrhoea but may prolong the infection and therefore are not routinely recommended (possibly the safest and most effective is Loperamide. The dose of this is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea up to a maximum of eight capsules in 24 hours). Note: do not give anti-diarrhoea medicines to children.

You should see a doctor if:

• You have persistent vomiting and are unable to drink fluids
  
• The diarrhoea is not beginning to settle after 2 days
  
• You have severe abdominal pain
  
• There is blood mixed with the diarrhoea - do not use anti-diarrhoea medicines if you pass blood with the diarrhoea
  
• You have recently returned from travelling abroad
  
• You are a food handler e.g. cook, waitress etc. as there may be work restrictions

If you have infectious diarrhoea, the following are recommended until symptoms go:

• Regularly clean the toilets that you use. Wipe the flush handle and toilet seat with disinfectant (such as household bleach) after each time you use the toilet
  
• Wash your hands thoroughly after going to the toilet. Don't share towels and flannels
  
• Do not prepare food for others
  
• Stay off work until symptoms go. If you work with food (food handlers) or work as a health carer you should stay off work until you have had no diarrhoea or vomiting for 48 hours

Diarrhoea in children

The most important part of treatment is to give the child lots to drink.

Acute diarrhoea usually clears within a week or so (often sooner) as the immune system usually clears the infection. The following are commonly advised until symptoms ease:

• Give the child lots to drink. The aim is to avoid dehydration (low body fluid). Even if the child vomits or feels sick, you should still give frequent sips as some fluid will still be absorbed. Ideally, give water as the main drink, but also give some fruit juice as this contains some sugar. However, any drink is better than none. If the child will only drink their favourite drink then that is fine (ice lollies are a useful extra source of fluid).
• Do not give anti-diarrhoea medicines to young children. They sound attractive remedies, but are unsafe to give to children due to possible complications.
• Rehydration drinks may be advised by a doctor or nurse if they are concerned that the child is at risk of dehydration. You can give these instead of, or in addition to, normal drinks. Rehydration drinks are made from sachets which you can buy from pharmacies. You add the contents of the sachet to water. Rehydration drinks provide a perfect balance of water, salt, and sugar. They are better than just drinking water alone. The small amount of sugar and salt helps the water to be absorbed better from the gut into the body. They do not stop or reduce diarrhoea, but are the best drinks to prevent or treat dehydration. Do not use home made salt drinks as the quantity of salt has to be exact.
• The child should eat as normally as possible. Do not starve a child with diarrhoea. This used to be advised but is now known to be wrong. However, if he or she does not want to eat, then that is fine. Drinks are the most important and food can wait until their appetite returns. Offer some food every now and then. Soups and food high in carbohydrate such as bread, pasta, rice and potatoes are best to start with.
• Breast fed babies should continue to breast feed if they will take it. This is in addition to extra rehydration drinks which may be advised. Bottle fed babies should be fed with their normal full strength feeds if they will take it. Again, this is in addition to extra rehydration drinks which may be advised.
  
• Give paracetamol or ibuprofen to ease a high temperature or headache.
  

In most cases the diarrhoea settles with the above measures. However, some gut infections may not clear without other treatment. For example, some infections caused by parasites or by certain bacteria may need an antibiotic or other treatment. So, if symptoms are severe or persist, a doctor may ask for a stool sample. This is sent to the lab to look for infecting bacteria, or parasites.

You should see a doctor if your child:

• Has persistent vomiting and is unable to drink fluids
  
• The diarrhoea is not beginning to settle after 2 days
  
• Then child has severe abdominal pain
  
• There is blood mixed with the diarrhoea
  
• The child has recently returned from travelling abroad
• If any other symptoms occur that you are concerned about

If a child has infectious diarrhoea, the following are also recommended until symptoms go:

• Regularly clean the toilets they use. Also, wipe the flush handle and toilet seat with disinfectant (such as household bleach) after each time they use the toilet
  
• Make sure they wash their hands after going to the toilet. Don't share towels and flannels
  
• Do not let them help to prepare food for others
  
• They should stay off school, nursery, etc, until symptoms have gone
  

Source: Adapted with permission from a © document supplied by EMIS and PIP