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Watery Diarrhea

What is Watery Diarrhea?

Everyone experiences diarrhea at some point in their lives. The intensity of diarrhea depends on the underlying problem that has caused such changes in the intestinal transit. Watery diarrhea is suggestive of a more serious imbalance of the microbiome but it can also be caused by an infection. The treatment for watery diarrhea includes is both symptomatic and addressed to the underlying condition. There are also certain measures that you yourself can take, in order to improve the symptoms.


A healthy stool is firm and has a characteristic elongated shape. In the situation of watery diarrhea, the stool is liquid. Doctors speak about watery diarrhea, in the situation that liquids account for more than 70% of the stool weight. It is very important not to mistake watery diarrhea for cholera, a serious infectious condition with a high risk for death.

Symptoms of Watery Diarrhea

These are the most common symptoms associated with the appearance of watery diarrhea:

  • Nausea and vomiting
  • Abdominal cramps
  • Fever (from moderate to high-running)
  • Changed color of the stool (mustard yellow, tan)
  • Blood in the stool (suggestive of infection with campylobacter)
  • Dehydration
  • Flatulence
  • Greasy stool
  • Foul-smelling stool
  • Bloating
  • Malabsorption
  • Weight loss (consequence of dehydration)
  • Loss of appetite
  • Fatigue
  • State of general weakness.

Watery Diarrhea Causes

These are the most common causes that can lead to the appearance of watery diarrhea:

  • Infection (gastroenteritis)
    • Higher risk – HIV patients (weakened immune system)
    • Common infection – Clostridium difficile
  • Malabsorption syndrome
    • Common cause of watery diarrhea
    • The small intestine cannot absorb the nutrients in a healthy manner
    • The large intestine does not absorb water adequately
    • Another characteristic – fatty and floating stool
  • Chronic intestinal disorders
    • Common – Crohn’s disease, inflammatory bowel disease
    • Frequent watery stools
  • Food intolerance/allergy
    • Symptoms resemble the ones of the malabsorption syndrome
    • Common – lactose intolerance, gluten intolerance (celiac disease), fructose intolerance (fructose malabsorption), glucose malabsorption, galactose malabsorption
  • Diet
    • Unhealthy eating choices – foods that have been extensively processed, caffeine-based drinks, alcohol, fast food, junk food, spicy foods, foods that are rich in saturated fats
    • Not eating moderately can also trigger watery diarrhea (overeating/abstinence from food – fasting)
  • Medication/supplements
    • Watery diarrhea appears as a side-effect of various medication
    • Antacid medication or laxatives that contain magnesium
  • Accidental ingestion of a poisonous substance
    • The watery diarrhea appears as the body tries to eliminates the poison in a faster manner
  • Psychological problems
    • Common – stress, anxiety or depression
    • Can have a negative effect on the bowel movements
  • Other conditions
    • Pancreatitis (inflammation of the pancreas)
    • Gallstones
    • Liver disease
    • Hyperthyroidism
    • High sugar juice intake (apple or pear juice)
    • Excessive consumption of chewing gum (active substance ingested – sorbitol)
    • Excessive usage of laxatives.

Diagnosis

These are the most common methods used for the diagnosis of watery diarrhea:

  • pH analysis of the stool
    • Under 5.5 → carbohydrate intolerance → viral illness (transient)
  • Examination of exudate located in the stool
    • Identification of leukocytes → colitis → infection, allergy or inflammatory bowel disease
  • Culture medium
    • Isolation of bacteria responsible for the watery diarrhea
  • Examination of stool
    • Identification of parasites → infectious condition
  • Other tests
    • Stool anion gap
    • Intestinal biopsy.

The differential diagnosis can be made with the following conditions: inflammation of the appendix (appendicitis), neoplasm (carcinoid tumor), intestinal enterokinase deficiency, protozoal disease, intussusception, Meckel diverticulum, microvillus inclusion disease, cystic fibrosis (sinonasal manifestation) etc.

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How to Treat Watery Diarrhea?

These are the most common treatment measures recommended for watery diarrhea:

  • Rehydration
    • Purpose – maintain fluid and electrolyte normal status
    • Administration of oral rehydration solution (replacement of fluids and electrolytes lost through the watery stools)
    • Intravenous rehydration – recommended in more severe cases (commonly administered – Ringer’s solution – high concentration of electrolytes)
  • Antimicrobial treatment
    • Recommended in case of enteric infection (campylobacter, E.coli and Shigella)
    • Not recommended for viral gastroenteritis (does not respond to the treatment)
    • For parasitic enteric infections – cyclosporiasis, isosporiasis, metronidazole
  • Anti-diarrheic medication
    • Regulates the functioning of the digestive system
    • Reduces the number of stools
    • Recommended choices – bismuth subsalicylate and loperamide
  • Probiotic supplements
    • Restore the healthy bacteria at the level of the gastrointestinal tract
    • Recommended choice – lactobacillus
    • Available as powder or as capsules.

Self-care measures

The first and most important thing that you have to do is increase your fluid intake, as this will prevent the dehydration of the body. You should drink water, fruit juice or soup, avoiding caffeine-based drinks, alcohol or sugary drinks, as the latter can accentuate the dehydration. Keep in mind that it is necessary to increase your fluid intake, because the watery diarrhea leads to the loss of both water and electrolytes. Young children are especially at risk for such problems, so be sure to administer fluids to them, in adequate quantities.

When you suffer from watery diarrhea, the last thing on your mind is food. However, you have to try and eat something, so as to help the body recover from the health problem. During the recovery period, it is recommended that you eat foods that are low in fiber. The higher your fiber intake, the more accelerated your intestinal transit is going to become. Try to choose foods that are either rich in proteins or carbs, as these will help you get your GI tract on the right track.

Prognosis

If there are no associated complications and the necessary hydration measures are taken, the patient will return to full health in a couple of days. It is important to drink plenty of fluids and maintain a healthy diet, so as to avoid the return of the watery stools. Special care should always be paid to children, as they can dehydrate quickly and enter into vascular shock. In case there is a suspicion of food intolerance or allergy, a specialist should be visited, in order to establish a new diet. If the same diet is maintained, the watery diarrhea is going to become a common occurrence. The specialist can recommend the foods that should be included in the diet and the ones that should definitely be avoided.

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