Explosive diarrhoea

Are you suffering from irrepressible diarrheal discharges throughout the day, which give you no respite and cause you inability to work, exhaustion, and sometimes abdominal pain?

Acute diarrhea is an extremely common condition that is not a pathology per se, but is an extreme defense of our intestines to a disturbing element that is attacking it.

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Read this page to find out what diarrhea can be caused by and what can be done to counteract it.

What is meant by diarrhea?

In Medicine, diarrhea, also called dysentery, is a classic stool dysfunction, involving the emission of unformed stools in a liquid or semi-liquid state.

On a very general level, on average, a healthy adult male emits about 150g of solid, cylindrical, well-formed, soft stool, with a not particularly nauseating odor and the right color (neither too light nor too dark).

In the case of diarrhea, these conditions are lacking: the feces emitted are liquid or semi-liquid, are extremely abundant in quantity (over 200g), have a generally pungent and unpleasant odor, and have the characteristic of being particularly too yellow or too dark.

This is an abnormal condition due to a violent defense reaction of the colon, which attempts to quickly expel something it perceives as toxic or dangerous.

Are there different types of diarrhea?

Yes, two specific types of diarrhea are identified at the clinical level: acute and chronic diarrhea.

The acute form of diarrhea, called explosive or severe diarrhea, which consists of the emission of liquid stools for a period of less than two weeks, beyond which it more properly begins to enter the chronic form.

According to World Health Organization, the majority of diarrhea cases worldwide at any given time can be attributed to acute diarrhea, the result of food poisoning due to poor hygienic and sanitary conditions of water supply sources.

What are the causes of diarrhea?

Diarrhea, as mentioned just above, is an extreme response of our body, particularly our intestines, which reacts violently to an attack that it judges to be irritating-infectious.

In fact, most cases of acute diarrhea are attributable to bacterial, parasitic or viral infections, which attack the mucosa of the intestine and thus cause inflammation and a disruption of normal peristalsis.

These infections are also capable of altering the normal and natural bacterial flora that is regularly present in our intestines (and that aids our digestion), impairing it and thus causing unbalanced situations, which aggravate the symptoms of dysentery.

There is an almost endless list of all the microorganisms that can cause diarrhea, but the main ones are Staphylococcus aureus, Escherichia coli, Salmonella enterica, and Vibrio cholerae (the infectious agent of cholera).

These bacteria alone make up most of the intestinal infections that then originate in dysentery situations.

Diarrhea, however, can also be caused by chemical, not microbial, irritation.

For example, there are cases of diarrhea due to the prolonged use of antibiotics (which also kill the bacteria in the intestinal flora with which we live in symbiosis), or the administration of chemotherapy or radiation therapy (actinic diarrhea).

Although in smaller statistical amounts, episodes of dysentery caused by heavy metal intoxication, or other non-bacterial chemical toxins, are also not to be forgotten.

Some cases of diarrhea, on the other hand, are related to congenital disorders, such as celiac disease, which causes a constant, nonreducible intolerance to gluten.

Chronic diarrhea, on the other hand, is dependent on triggering conditions that cause, in the long run, constant intestinal irritation.

This is mainly related to congenital diseases such as Crohn's disease, ulcerative rectocolitis, or otherwise pathological conditions such as irritable bowel syndrome.

These diseases have the characteristic of making the sufferer experience periods of acute recrudescence, alternating with periods of remission of symptoms.

What is the symptomatology of diarrhea?

Diarrhea is an extreme response of our colon, the symptoms and intensity of which vary greatly from subject to subject, also depending on the underlying trigger.

That being said, it is still possible to divide diarrhea into four main categories, depending on the symptomatology:

Secretory diarrhea

It usually occurs after the attack of bacterial infectious agents, such as Vibrio cholerae or Campulobacter.

It forces the intestines to a high secretion of salts (one above all, sodium chloride), which by chemical attraction draws in large amounts of water and potassium, thus making the stool almost totally liquid and extremely foul-smelling;

Osmotic diarrhea

It occurs when the colon fails adequately to absorb water from the chyle (the food now deprived of nourishment), thus failing in its main function.

Osmotic diarrhea is not necessarily caused by a bacterial or viral attack, but it can be caused by excessive stress, food intolerances (such as lactose), a significant reduction in the friendly bacterial flora that populates the intestines and is essential to ensure good function.

Excessive antibiotic treatments, for example, tend to damage the friendly bacteria that live in our colon and with which we live in symbiosis, thus causing osmotic diarrhea.

Osmotic diarrhea has the characteristic of being particularly acidic with a very pungent odor that is immediately recognizable;

Inflammatory diarrhea

It occurs when the intestinal mucosa is irritated by a chronic, inflammatory disease, such as Crohn's disease, ulcerative rectocolitis, celiac disease, or diverticulitis.

The mucosa, which becomes inflamed, turns red and, in some cases, even bleeding, secreteing a large amount of mucus and fluid, which go to feed the diarrheal fecal mass.

It usually generates great abdominal pain and spasms, and is also often associated with severe inflammation of the rectum and anus, which worsen the symptoms and also cause symptoms similar to those of tenesmus;

Malabsorption diarrhea

It occurs concurrently with irritable bowel syndrome, which actually turns out to be its true etiological origin.

It is a type of diarrhea associated with severe abdominal cramping and meteorism, compounded by failure to absorb bile salts.

This malabsorption causes increased secretion of water and electrolytes, thus generating diarrhea.

Also present in the diarrheal discharges, reported as extremely exhausting by patients, are large amounts of undigested fatty substances (steatorrhea), which make the stools particularly oily.

How is diarrhea diagnosed?

Diarrhea is easy for a Physician to diagnose: just be aware of the discharges reported by the patient.

The diagnosis of the original cause of diarrhea, on the other hand, is enormously more complex, and requires a rigorous and careful history, followed by the investigation aimed at identifying the origin of the inflammation: bacterial, viral, chemical, etc.

This can be complicated, and the Physician may therefore have specific examinations.

What is the right treatment for diarrhea?

As well understood so far, diarrhea is a symptom and a natural defense of the body, which tries to get rid of something that is harmful.

The right therapy must therefore aim to discover the source of that something, getting to the root of the problem: that is what needs to be treated, to solve the dysentery.

Most acute diarrheas caused by food poisoning or bacterial infections heal spontaneously within a few days.

In that case, supportive care is best, avoiding the greatest danger during dysentery, which is dehydration.

The use of antibiotics should be avoided, at least for non-pathological, non-immunocompromised, healthy individuals: the risk is to worsen the symptoms, as antibiotic treatment would necessarily go on to kill even the friendly bacteria that live in symbiosis with our colon.

The use of antidiarrheals should also be avoided, or at least severely limited: in the case of diarrhea due to intoxication, it is good for the body to expel as many toxins as possible, and this is done precisely by discharges.

In the case of chronic and autoimmune diseases, it is necessary to provide, where possible, for the restoration of a balanced situation, including administering the appropriate immunosuppressive therapy.

In the case of Crohn's disease or diverticulitis, surgical intervention is sometimes necessary, to remove the now irreversibly inflamed sector of the intestine, and where drugs no longer have therapeutic room.

In the case of cealic patients, violent diarrheal attacks are given solely by the ingestion of gluten-contaminated food (it only takes insignificant amounts to trigger a violent gut response).

This usually happens accidentally, almost always when the patient frequents restaurants or places of possible contamination, or otherwise eats unsafe prepared foods.

In that case, it is necessary to wait until the body has expelled all the contaminated food, and the situation returns to normal.

In any case of constipation, restoring the body's hydro-electrolyte balance is imperative, and should always be combined with the administration of probiotics that can restore, as best as possible, the natural intestinal bacterial flora.

Which Physician to contact in case of acute diarrhea?

Severe diarrhea of bacterial origin can be safely diagnosed and treated by any Physician, even the general practitioner.

These are situations in which the Clinician has no particular power to act, but is limited to ensuring proper hydration for the patient and, at most, prescribing palliative therapy.

Therefore, there is no need for specialized knowledge to treat it.

Cases of chronic diarrhea, either with unclear origins or pertaining to major colon-proctological situations, should be treated by a Medical Specialist: a Colon-Proctologist or a Gastroenterologist.

Both professionals are specialized in intestinal issues, and can intervene by any means to get to the root of chronic diarrhea, and thus provide the right treatment.