Irritable Bowel Syndrome

Understanding IBS with Diarrhea (IBS-D)

An Overview of Diarrhea

Diarrhea is the unpleasant experience of having loose and watery stools. In this overview, you will learn what you need to know to deal with the symptom of diarrhea, whether it has just started happening, or it's been going on for weeks and just won't seem to go away.

What Is Diarrhea?

In addition to stools being loose and watery, some definitions of diarrhea include an increase in the frequency of bowel movements to more than three times per day.

Diarrhea can be characterized as acute, which is of sudden onset and lasting less than two weeks; persistent, which lasts 14 to 28 days; or chronic, in which symptoms have been present for longer than four weeks.

Acute diarrhea is a fairly common phenomenon and may be caused by a wide variety of things, but is most often caused by some kind of infection. On average, adults typically deal with one bout of acute diarrhea per year, while young children, on average, experience two bouts of acute diarrhea per year.

Chronic diarrhea, on the other hand, can also be caused by an infection or may be a symptom stemming from some other types of illness.

Most of the time, people who experience a bout of acute diarrhea get better on their own. However, diarrhea can become a life-threatening situation for infants, older adults, and people who have a compromised immune system from an illness such as cancer or HIV.

A look at the anatomy of the digestive system.

Common Signs and Symptoms of Diarrhea

As stated above, the primary symptom of acute diarrhea is the presence of loose and watery stools. Other symptoms may include:

  • increased frequency of bowel movements
  • abdominal cramps
  • a sense of bowel urgency
  • soiling accidents

If the reason behind diarrhea is an infection, the following symptoms may also be experienced:

People who have chronic diarrhea will experience episodes of loose and watery stools. In some cases, these episodes will occur intermittently. They are also likely to experience other symptoms stemming from the underlying health problem. For example, people who have celiac disease may also experience weight loss and malnutrition. 

Dehydration Signs and Symptoms

One of the dangers associated with diarrhea is that a person can become dehydrated. Dehydration is a state in which the body is lacking adequate amounts of fluids and electrolytes. If untreated, dehydration can result in serious health problems and even death. Small infants, older adults, and people who have other, comorbid illnesses (e.g. heart disease, liver disease) are all at greater risk for experiencing the severe complications associated with dehydration.

In adults, symptoms of dehydration include:

  • dry mouth
  • thirst
  • decreased urine output
  • urine is a dark yellow or amber
  • dry skin
  • fatigue
  • dizziness or light-headedness

Dehydration in infants and small children will present itself with some or all of the following symptoms:

  • dry tongue and mouth
  • when crying, there are no or few tears
  • decreased urination - In infants, this means no wet diapers for three or more hours
  • thirstiness
  • eyes, cheeks, and soft spot in skull (in infants) are sunken
  • dry skin
  • fever
  • sleepiness or lack of energy
  • irritability
  • constipation
  • dizziness or light-headedness

Danger signs of dehydration, which require immediate medical attention, include:

  • extreme irritability, sleepiness, fussiness (babies), and/or confusion (adults)
  • mouth, skin, and mucous membranes are all quite dry
  • eyes are sunken, in infants the "soft spot" may be sunken as well
  • crying does not produce tears
  • little to no urination; what is passed is quite dark in color
  • skin doesn't rebound when folded
  • rapid breathing and heart rate
  • low blood pressure
  • fever
  • delirium or unconsciousness

Causes of Diarrhea

The symptom of diarrhea can have many causes. Diarrhea can come simply from eating too much fruit or fiber. 

Acute diarrhea is often caused by a virus, a condition known as viral gastroenteritis. Examples of viral infections include rotavirus, the most common form to affect children, and norovirus, sometimes called "cruise ship diarrhea."

Acute diarrhea can also be caused by a bacteria (bacterial gastroenteritis) or parasitic disease. Bacterial infections often come from consuming contaminated food or water, and include C. difficileE. coli, salmonella, shigella and campylobacter. Parasites can also be contracted through contaminated food and water.

Diarrhea can also be a side effect of certain types of medications, including antibiotics, antacids, chemotherapy, heart medications, antidepressants, high blood pressure medications, and diuretics.

Diarrhea may occur following bariatric surgery or gallbladder removal.

Health problems that may have chronic diarrhea as a symptom include celiac disease, the inflammatory bowel diseases of Crohn's disease and ulcerative colitis, irritable bowel syndrome (IBS), and food intolerance (such as fructose or lactose malabsorption).

Less common causes of chronic diarrhea include colon cancer, ongoing parasitic infections, and radiation therapy.

Self-Care of Acute Diarrhea

Most of the time, acute diarrhea will clear up on its own. However, there are things that you can do to help your child or your body to heal:

The most important thing to do is to make sure that the person who has diarrhea is adequately hydrated. This means that they are taking in more fluids than normal. These fluids can include:

  • clear soups and broths
  • clear juices
  • an electrolyte drink such as Pedialyte or sports drinks

There are foods and drinks that you will want to avoid for a few days following the onset of your diarrhea as they can make your symptoms worse. These include:

  • milk and other dairy products
  • heavy, fatty, greasy foods
  • drinks containing caffeine, such as coffee, tea, and colas

You will want to eat foods that are soft and bland until your symptoms improve. Good food choices are bananas, cooked carrots, potatoes, toast, rice, and plain chicken.

Be sure to get plenty of rest to help your body to fight off the underlying infection.

Over-the-counter medications, like Imodium, Pepto-Bismol, and Kaopectate, should only be used by adults who have no signs of fever or bloody diarrhea. Such medications are generally not recommended for children and thus should only be used under direction by a doctor.

When to See Your Doctor

Although most cases of diarrhea resolve themselves, there are other times when medical attention is an absolute necessity in order to prevent serious illness or even death. If you see signs of diarrhea in a newborn or infant, call your doctor right away. You should also call your doctor if you or your child have any of the following symptoms:

  • diarrhea that lasts longer than 24 hours in a child or 48 hours for an adult
  • any of the above signs of dehydration
  • stools that are bloody, pus-covered, black, or tarry

The following symptoms require immediate medical attention:

  • any of the danger signs related to dehydration listed above
  • severe abdominal or rectal pain
  • fever of 102 degrees or above
  • signs of severe weakness or confusion

Tests to Expect

Your doctor may not run any tests until your diarrhea has been present for longer than 48 hours, although this might not be the case depending on your medical history and other circumstances, such as recent travel.

If your doctor thinks that it is indicated, they may run stool tests for bacteria or parasites, particularly if you have traveled recently and/or you are experiencing fever and/or bloody diarrhea. They may also choose to run blood tests to rule out other diseases.

If you are experiencing chronic diarrhea, your doctor may do more in-depth testing to try to figure out what may be underlying your symptoms. This testing may include an upper endoscopy, sigmoidoscopy, and/or colonoscopy.

Medical Treatment of Diarrhea

If a person is showing signs of severe dehydration, hospitalization will be indicated. At the hospital, an IV will be started in order to replace lost fluids and electrolytes.

For some types of bacterial infections, an antibiotic may be prescribed.

Treatment of chronic diarrhea will be primarily aimed at treating the underlying condition. The use of an over-the-counter medication like Imodium might be recommended to directly address the symptom of diarrhea.

Prevention of Diarrhea

Of course, the best way to deal with diarrhea is to not get it in the first place! Thorough hand-washing with soap and water can be very effective for preventing infection. This is especially crucial when cooking, after using the toilet, or when out in public.

People who are at higher risk for getting seriously sick if exposed to a disease-causing organism need to be extra vigilant to avoid getting sick. As stated above, this includes infants, older adults, and people who have compromised immune systems. Pregnant women should also take extra precautions. Foods for anyone in these groups to avoid include:

  • under-cooked meats and unheated deli meats
  • raw (unpasteurized) dairy products, as well as soft cheeses
  • raw shellfish

Everyone should maintain safe food and drink practices when traveling out of their home country so as to prevent travelers' diarrhea. This means to avoid any use of, or drinking of, tap water and avoiding all raw meats, fish, fruits, vegetables, and dairy products. Cooked foods should only be eaten if they are served hot. You can eat raw fruit only if it has a peel that you have removed yourself. You can drink bottled water, hot drinks, and soft drinks. Before traveling, you may want to talk to your doctor about any possible need to take antibiotics before you leave or to have them on hand in case you do get sick.


DiarrheaNational Institute of Diabetes & Digestive & Kidney Diseases website. Accessed July 5, 2016.

Diarrheal Diseases – Acute and ChronicAmerican College of Gastroenterology website. Accessed July 5, 2016. 

Guerrant RL, Van Gilder T, Steiner TS, et al. Practice Guidelines for the Management of Infectious DiarrheaClinical Infectious Diseases 2001;32(3):331-351.

Minocha A. & Adamec C. The Encyclopedia of the Digestive System and Digestive Disorders (2nd Ed.) New York:Facts on File. 2011.

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