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Diarrhoea

Diarrhoea is the passing of watery stools more than three times a day. It is often a symptom of an infection or long-term condition.
Brought to you by NHS Choices

Overview

Introduction

Diarrhoea can either be:

  • acute - diarrhoea that comes on suddenly, but only lasts for five to 10 days, or
  • chronic - diarrhoea that lasts for more than two weeks.


What causes diarrhoea?

Acute diarrhoea is usually caused by a viral or bacterial infection and affects almost everyone from time to time.

Chronic diarrhoea may be a sign of a more serious condition and should always be investigated by your doctor.

Go to the ‘causes’ page for more information.

How common is it?

Diarrhoea and vomiting is very common, especially in children. A baby or toddler will probably have diarrhoea and vomiting two or three times a year.

How serious is it?

Diarrhoea usually clears up in a couple of days and is not serious. However, it can be serious in babies and the elderly because of the risk of dehydration.

If diarrhoea is persistent or associated with symptoms such as blood, you should see your GP (see ‘diagnosis’ page).

If your child is between three months and one year old, diarrhoea should last no longer than 48 hours. If it is any longer, contact your GP.

Symptoms

Symptoms of diarrhoea

Symptoms can range from slightly watery stools and a brief upset stomach, to longer-term extremely watery stools and cramp.

Common symptoms associated with diarrhoea are:

  • cramping stomach pains,
  • an urgency to go to the toilet,
  • nausea or vomiting,
  • fever,
  • headache, and
  • loss of appetite.


If your diarrhoea lasts for more than two weeks, it is considered chronic and you should see your GP. Advice for children is:

  • If your child is between three months and one year old and has had diarrhoea for more than 48 hours, contact your GP.
  • If your child is older than one and has had diarrhoea for more than five days, you should take them to see your GP.

Causes

Causes of diarrhoea

Diarrhoea usually occurs when fluid cannot be absorbed from your bowel contents, or when extra fluid is secreted into the bowel, causing watery stools (see box, right).

Acute diarrhoea

Short-term diarrhoea is usually a symptom of gastroenteritis, which is an infection of the bowel. Gastroenteritis may be caused by:

  • a virus, such as norovirus or rotavirus,
  • food poisoning - usually caused by salmonella, campylobacter or staphylococci bacteria,
  • an Escherichia coli bacterial infection, which causes secretory diarrhoea (see box, right),
  • antibiotics, or
  • contaminated food or waterfrom a foreign country, causing ‘traveller’s diarrhoea’ (see ‘useful links’).

For more information on gastroenteritis, go to ‘useful links’.

Other, short-term causes of diarrhoea include:

  • emotional upset or anxiety,
  • drinking too much alcohol,
  • drinking too much much coffee, or
  • the side effect from some medicines.


Chronic diarrhoea

Chronic (persistent) diarrhoea can be caused by:

  • a bacterial or viral infection,
  • laxatives,
  • poor diet (too much coffee, alcohol or sweets), and
  • a long-term condition (see below).

Long-term conditions that cause diarrhoea include:

  • ulcerative colitis,
  • Crohn’s disease,
  • irritable bowel syndrome (IBS),
  • lactose intolerance,
  • coeliac disease,
  • diabetes, and
  • pancreatitis.

These conditions should be investigated by your doctor. For more information on any of these conditions, go to the individual topics in the NHS Choices A-Z index.

Diagnosis

Diagnosing diarrhoea

If you have acute (short-term) diarrhoea, the symptoms are very likely to settle down within a week and tests are usually unnecessary.

However, if your diarrhoea becomes more persistent or if you have other symptoms (such as blood in your stools, or dehydration) your GP may ask for a stool sample to investigate for bacteria or parasites.

Other tests for chronic diarrhoea may include blood tests or a sigmoidoscopy (a procedure that involves passing a thin fibre-optic tube, attached to a viewing lens, through the rectum to view the intestine).

When to see your doctor

Seek medical advice if you or your child has:

  • persistent diarrhoea - lasting for more than 14 days in adults, five days in children or 48 hours in babies younger than one,
  • diarrhoea associated with blood or fever, or
  • diarrhoea associated with severe or constant stomach cramps.

Treatment

Treating diarrhoea

Diarrhoea often goes away without treatment after a few days, as your immune system fights off the infection.

In the meantime, you can ease your symptoms by following the steps below.

Avoid dehydration

You can avoid becoming dehydrated by drinking lots of fluids. You are more likely to be dehydrated if you are also vomiting.

Try to take small, frequent sips of water or diluted fruit juice. It is especially important that babies and small children do not become dehydrated. Even if your child vomits, you should still give them frequent sips of water. A small amount of fluid is better than none.

If your child shows signs of dehydration (drowsiness, passing little urine, few or no wet nappies, a dry mouth and tongue, unresponsiveness or glazed eyes) you should contact your GP immediately.

Rehydration drinks

If you are worried that you are becoming dehydrated, your doctor or pharmacist may advise rehydration drinks. You can buy these sachets from your pharmacy and add them to water. They provide the correct balance of water, salt, and sugar.

Rehydration drinks do not help to cure diarrhoea, but are ideal to prevent or treat dehydration.

Your doctor or pharmacist may also recommend rehydration drinks for your child, if you are worried they may become dehydrated. Do not use homemade salt or sugar drinks - always consult your pharmacist.

Eat as soon as you can

The old advice was to not eat anything for a day or two, but now it is recommended that you eat foods high in carbohydrates (bread, pasta, rice or potatoes) and other foods as soon as you feel like it. Salty foods such as soup can help replace salt lost from your system.

If you feel you cannot eat, it will do you no harm, but make sure you continue drinking fluids and eat as soon as you are able.

If your child wants to eat, offer soups and foods high in carbohydrates at first. Your child can eat normally as soon as possible. If your child refuses to eat, continue to offer drinks and wait until their appetite returns.

Anti-diarrhoea medicines

Anti-diarrhoea drugs such as loperamide can relieve symptoms by slowing down the movement of bowel contents, and sometimes by increasing water absorption from the gut.

Loperamide can be taken once or twice a day, over a long period.

However:

  • do not take anti-diarrhoea drugs if there is blood in your stools or if you have a high temperature (check with your pharmacist), and
  • do not give anti-diarrhoea drugs to your child.


Continue breastfeeding or bottle-feeding

If you are breastfeeding or bottle-feeding your child and they have diarrhoea, continue if they will still feed (use their normal-strength feed if they are bottle-fed). Rehydration drinks should also be given if necessary.

Painkillers

You can take recommended doses of paracetamol or ibuprofen if you have a fever or headache. You should not take ibuprofen if you are asthmatic, or if you have stomach, liver or kidney problems.

Liquid paracetamol or ibuprofen can also be given to your child if necessary. Children aged under 16 should not take aspirin.

Treating sore skin around the anus

  • Wipe with moist toilet paper or damp cotton wool. Avoid baby wipes, which tend to contain alcohol.
  • Try to wash the anus after a bowel movement. Use a bidet, a shower attachment or a soft, disposable cloth.
  • Use non-scented soap and pat the area dry.
  • Try applying a little witch hazel with wet cotton wool.
  • Apply a thin layer of barrier cream or ointment to the anal area.
  • Wear cotton underwear and avoid tight-fitting clothes.

Source: NACC

Complications

Complications of diarrhoea

Complications are uncommon, but see your GP if you or your child has the following symptoms:

  • dehydration (signs in children include passing little urine, a dry mouth and tongue, unresponsiveness, glazed eyes, drowsiness and confusion),
  • blood in your stools,
  • vomiting that continues for more than a day,
  • diarrhoea that does not clear upafter five days, or
  • an infection that was caught while travellingabroad.


You or your child may be admitted to hospital if symptoms are severe, or if complications develop. Sometimes an intravenous fluid drip might be needed if dehydration occurs.

Prevention

Preventing diarrhoea

Washing hands regularly will help to prevent you and your family from catching infectious diarrhoea. You should always wash your hands:

  • after using the toilet or potty,
  • after playing with pets,
  • after gardening, and
  • before touching food.

Your child should be taught to wash their hands regularly, as soon as they are old enough to understand.

You can also prevent germs from spreading by:

  • cleaning the toilet with disinfectant after using it, and
  • not sharing towels.

How long should I stay at home?

  • If your child has infectious diarrhoea, keep them at home until they are free of diarrhoea for 48 hours.
  • If you have infectious diarrhoea and your job involves preparing food, do not work until 48 hours after your symptoms clear up.

Useful links

NHS Choices links

External links

This article was originally published by NHS Choices

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