Diarrhea is a condition characterized by loose and watery stools, typically more than three bowel movements per day, associated with gassiness, bloating, and abdominal pain. In the Philippines, it is the 3rd leading cause of child illness and the 4th leading cause of death among children under five years. It is transmitted through ingestion of contaminated food and drinking water.
Signs and symptoms
According to the Department of Health (DOH), signs and symptoms of diarrhea include:
- Movement of watery stools at least three times a day
- Abdominal pain
- Excessive thirstiness
- Sunken eyeballs and fontanel
Causes and risk factors
Diarrhea may be caused by an infection due to the following micro-organisms:
- Viruses – Rotavirus and Hepatitis B virus
- Bacteria – Cholera and Shigella
- Intestinal parasites - E. Histolytica and pinworm
These [[Micro-organism|micro-organisms] are usually transmitted by contaminated hands or through food and water.
Diarrhea can also be due to sensitivity to some food such as dairy products and spices. Medications such as laxatives, antacids, and antibiotics may also cause loose bowel movements. It can also be caused by inflammatory bowel disease (ulcerative colitis), emotional stress, or colon cancer.
Diagnosis and tests
Getting a stool sample from the patient intended for lab examination (for certain bacteria or parasites) is not usually necessary unless there is presence of high fever, blood in the stool, recent travel, or prolonged disease.
Blood tests may be needed if the patient has other medical problems or severe disease. In some cases, a patient undergoes colonoscopy, a procedure that uses an endoscope intended to view the entire colon to evaluate for infections or structural abnormalities that could lead to diarrhea. If the patient experiences prominent pain, imaging tests such as X-rays or CT scans are performed in order to rule out structural abnormalities as the cause of diarrhea.
Immediate treatment of diarrhea involves giving the patient am (rice soup) or undergoing oral rehydration therapy to replace the body fluid lost by the body. Continued feeding is advised. If diarrhea does not stop, the patient should consult a doctor or nearest barangay health center.
A physician should be consulted in the following cases:
- Patient is less than 3 years old; pregnant woman
- Diarrhea is accompanied by fever and dehydration
- Diarrhea persists for more than 3 days
- Diarrhea comes with with bloody mucoid stools which is one of the symptoms of dysentery
- Diarrhea is associated with abdominal tenderness and cramping
Patients with severe diarrhea and dehydration may require hospitalization. Intravenous therapy (IV) is often administered to dehydrated patients who have difficulty eating or drinking to replace lost fluids and salts in the body.
Dehydration happens when there is too much loss of electrolytes from the body. Patients with mild dehydration may feel thirsty and have dry mouths. Dehydration is common among infants and young children who experience viral gastroenteritis or bacterial infection. Adult patients become dehydrated from acute diarrhea with large amounts of stool along with little fluid intake, nausea, and vomiting.
Patients with moderate to severe dehydration may experience fainting upon standing up because of the lowered volume of blood causing blood pressure to drop. There is also a decreased output of urine, severe weakness, shock, kidney failure, confusion, acidosis (excessive acid in the blood), and even coma.
Electrolytes or minerals such as sodium and potassium also are lost with water when diarrhea is prolonged or becomes severe. Abnormalities in chloride and bicarbonate levels may also develop.
Finally, there irritation of the anus may be experienced due to the frequent passage of watery stools containing irritating substances.
Prevention and control
According to the Department of Health, diarrhea can be avoided by drinking water from safe sources. To ensure safety, water can be sterilized by boiling for three minutes or doing chlorination. Food should always be properly prepared and cooked well. Fruits and vegetables should be washed in clean water before eating or cooking. Always cover food to keep it away from insects and rats. Moreover, the public is discouraged from eating street food. Proper hygiene, such as washing the hands before eating and after using the toilet, should be practiced.
Cases in the Philippines
The Department of Health often goes on alert for possible diarrhea outbreaks during the wet season. According to DOH 7 Director Susanna Madarieta, diarrhea is among the top three leading causes of death (the other two being pneumonia and respiratory diseases) in Central Visayas.
In July 2010, 55 people in Barangay Calmante in Tudela, Cebu City fell ill of diarrhea in just one week. The reported diarrhea outbreak was due to water contamination. Department of Health Environmental Health Program coordinator Evangeline Canoneo urged the locals to boil the water for 3 to -5 minutes and store the water in clean containers before drinking. Environment sanitation and cleanliness were also stressed.
Cebu City Health Department recorded 1,443 diarrhea cases, with four deaths from January to August 2010. Most of the patients affected by diarrhea were children between six months to 15 years old.
- Diarrhea among top causes of absence in school (Acessed 15 October 2010.)
- Department of Health – Health Advisories: Diarrhea (Accessed 14 October 2010.)
- Department of Health – Common Illnesses: Diarrhea (Accessed 14 October 2010.)
- eMedicine Health – Diarrhea (Accessed 14 October 2010.)
- MedicineNet.com – Diarrhea (Accessed 14 October 2010.)
- Inquirer Global Nation - DOH official warns public of diarrhea. (Accessed 14 October 2010.)
- PhilStar.com - DOH warns of diarrhea this rainy season. (Accessed 14 October 2010.)