Loose Motion (Diarrhea)

Diarrhoea may be associated with some or all of the following symptoms:

• Watery or semi-formed stools with or without

• Abdominal cramps/stomach ache

• Frequent urge to excrete stools

• Rumbling in the tummy

• Nausea and vomiting

• Headache

• Fever

• Muscle aches

• Blood in stools - indicative of damage to the intestinal wall.

• Mucus in stools

• Bloating

The following are some of the significant reasons for loose motion.

• Infection- Bacteria, viruses and parasites can cause diarrhoea or loose motions.

• Viral infections- Viral gastroenteritis is one of the most common causes of diarrhoea. Viruses such as norovirus and rotavirus can cause diarrhoea. Diarrhoea may also occur along with COVID-19.

• Bacterial infections- Common bacteria that cause diarrhoea or loose motion are Escherichia coli, Shigella, Campylobacter, and Salmonella. An important cause of chronic diarrhoea, especially among Indians, is tuberculosis of the intestines.

• Parasitic Infections- Entamoeba Histolytica, Cryptosporidium and Giardia Lamblia are common parasites that can cause diarrhoea.

• Side effects of medications- Certain medications can cause diarrhoea as a side effect, such as:

  • Antibiotics

  • Antacids that contain Magnesium

  • Medicines for treating Cancer

  • Medications such as mycophenolate that suppress the immune system

  • Medications used to treat diabetes, such as Metformin.

  • Ibuprofen and naproxen - Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Food allergies- Some people are allergic to cow’s milk, spices, cereal grains, eggs, soy and seafood; thus, it is yet another reason for loose motion.

• Gluten sensitivity or wheat allergy- Celiac disease may be an important cause of long-term diarrhoea and malabsorption.

• Lactose intolerance- As the name suggests, it is intolerance to consuming food or drinks that contain milk or milk products.

• Fructose intolerance- It is intolerance to food and drinks containing fructose, a type of sugar which is found in fruits, honey and fruit juices.

• Sugar alcohol- Sugar-free candies and gums contain sugar alcohol such as sorbitol, xylitol and mannitol.

• Digestive tract diseases- The following inflammatory diseases of the intestine cause chronic diarrhoea with or without blood-mixed stools:

  • Crohn’s disease

  • Ulcerative colitis

  • Small intestinal bacterial overgrowth

• Overuse of antibiotics- Using antibiotics such as Macrolides, Cephalosporins, Fluoroquinolones and Penicillins for a prolonged period can lead to a change in natural gut flora and an increase in diarrhoea-causing bacteria.

• Complete Blood Count (CBC)- To check for infections and anaemia.

• Kidney Function test and Electrolyte levels- To check for abnormalities in electrolyte levels.

• Tests for wheat allergy

• Tests for vitamin deficiencies

• Stool tests- The stool test may help determine the bacteria, parasite or virus responsible for causing diarrhoea. The stool test may also help in identifying rare causes of diarrhoea.

• Hydrogen breath test- This test is used to diagnose lactose intolerance and small intestinal bacterial overgrowth (SIBO). Generally, the hydrogen level in your breath is less, but in the case of lactose intolerance, there is a high amount of hydrogen in your breath due to undigested milk and milk products.

• Flexible sigmoidoscopy or colonoscopy- Colonoscopy is done with a thin, flexible tube with a camera chip at its tip to check the entire large intestine from inside, whereas sigmoidoscopy is used to check only a small part of the colon.

• Upper endoscopy- It is done using a similar flexible tube to examine the upper gastrointestinal tract from the inside.

Treatment to replace fluids: As mentioned earlier, dehydration is the most important concern in diarrhoeal illnesses. Oral Rehydration Solution (ORS) is given frequently to prevent dehydration. Other drinks, such as coconut water, lime water, etc can also be used.

Drinks with high sugar content, such as soft drinks and juices, must be avoided as they can deteriorate the condition.

• Anti diarrhoeals: Medicines which reduce the fluid content of the stools or reduce the movement of the intestines are frequently used to control simple diarrhoea.

• Antibiotics or anti-parasitics: Medications such as Fluoroquinolones, Rifaximin, metronidazole, and ornidazole are prescribed to treat acute diarrhoea depending on the severity and type of microorganism.

• Lifestyle and home remedies: You should avoid food items such as fried and greasy items, dairy products, stale food, caffeine, and food items with high fibre content. Increase the intake of water to prevent dehydration, and take probiotics (yoghurt), bananas, apple cider vinegar, ginger, and chamomile tea.

• Probiotics: Probiotics or good bacteria are sometimes used as an adjunct to other treatments in order to restore the balance between good and bad bacteria.

• Hospitalisation: Patients who get severely dehydrated or experience repeated vomiting and, therefore, the inability to consume anything orally should be admitted for rapid IV fluid replacement. If delayed, such patients may develop kidney failure, loss of consciousness and a drop in blood pressure.

• Poor hygiene

• Poor availability of clean water and food

• Poor nutrition

• Weak immune system

• Contact with patients suffering from GI infection.

• Poor sanitisation

• Overuse of antibiotics without medical prescription

Acute diarrhoea can cause dehydration, and chronic diarrhoea may, in addition, cause malabsorption of nutrients and anaemia. Consult your doctor immediately if you have the following symptoms of dehydration because it can prove to be a life-threatening condition if not taken care of. Symptoms of dehydration include:

• Feeling dizzy or lightheaded

• Feeling thirsty

• Dry mouth, lips and eyes

• Falling urine output

• Feeling tired

• Dark yellow urine with a strong smell

• Dry skin

• Rapid breathing or heartbeat

• Confusion and lack of energy

• Wash your hands with soap and water, especially before handling food and drinks

• Improve sanitisation

• Maintain good personal hygiene

• Drink clean/filtered water or boiled water

• Rotavirus vaccination

• Awareness and health education

• Eat only thoroughly cooked food items

• Avoid raw food and meat

• Disinfect the kitchen area

Acute diarrhoea lasts several hours to days, but chronic diarrhoea is a condition in which loose stools last for at least 3-4 weeks. Acute diarrhoea usually presents suddenly and may lead to the rapid development of dehydration due to the loss of significant fluid and electrolytes in stools.

On the other hand, patients with chronic diarrhoea keep losing fluids and nutrients over many weeks and months, leading to nutritional deficiency in addition to dehydration. Acute diarrhoea is usually caused by acute viral, bacterial or parasitic infections.

Chronic diarrhoea may be infectious in origin (e.g. tuberculosis of the intestines) or may be caused by wheat allergy or intestinal inflammatory conditions such as Crohn’s disease. Acute diarrhoea may be self-limiting and only require anti-diarrhoeal and ORS, whereas chronic diarrhoeas usually require specific treatment of the underlying cause.

Chronic loose stools are caused due to-

• Irritable bowel syndrome

• Infections eg Tuberculosis

• Endocrine disorders

• Inflammatory bowel disease

• Medications, food supplements and herbs

• Food allergies

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Reviewed by Dr. Kaushal Madan, Principal Director & Head - Clinical Hepatology, Gastroenterology, Hepatology & Endoscopy, Liver Transplant and Biliary Sciences on 19-Jan-2023.