Diarrhea: understanding, preventing and treating it

Definition of diarrheal diseases

Diarrhea is characterized by three main elements:

• Stools that are usually liquid
• A larger than normal volume (more than 300g/day)
• A frequency higher than normal (more than 3 times a day)

It can be acute or chronic.

• Acute diarrhea usually occurs over a short period of time and is often a symptom of a virus, parasite or bacterial infection.
• Chronic diarrhea, on the other hand, is more persistent and has been going on for more than 4 weeks. It can be a sign of a more serious disease and it is important to consult your doctor if you have any doubt. [0]

Focus on diarrhea in children

Diarrhea is a real danger for children, especially the youngest.
Indeed, every year, 1.7 billion cases of childhood diarrhea are recorded in the world and this disease can be fatal for them since 525,000 children under five years of age die every year. Diarrheal diseases are the second most common cause of death in children [1].

Moreover, the majority of children affected by this disease live in low-income countries, particularly in sub-Saharan Africa and South Asia for 80% of them [2]. Children under 3 years of age suffer from an average of 3 diarrheal episodes per year [1].

Today, diarrhea kills more people than AIDS, malaria and measles combined. [2]

Causes and symptoms of diarrhea

Diarrhea is usually a symptom of an intestinal infection that can be caused by a variety of microorganisms, bacteria, viruses or parasites. The infection is transmitted through contaminated water or food, or from person to person in cases of poor hygiene [1].

According to UNICEF, 88% of diarrhea deaths worldwide are due to unsafe water, poor hygiene or inadequate sanitation [3].

Consumption of outdated or poorly preserved food is also a major issue. Indeed, diarrheal diseases are the most common illnesses resulting from the consumption of contaminated food: 550 million people become ill each year, including 220 million children under the age of 5. [4]
Food prepared and stored under unsanitary conditions causes more than 200 diseases, ranging from diarrhea to cancer [5].

Thus, it is important to ensure that the food you eat is of good quality and safe to eat. Food traceability is also very important, as even fish and shellfish caught in polluted waters can cause diarrheal diseases [1].

In addition, it is possible to contract acute diarrhea from direct contact with the virus or bacteria.  For example, by touching objects that have been handled by an infected person (utensils, handles, toys…) or surfaces contaminated by stool or vomit (bathroom…). Direct contact with the infected person is also a risk. One can be contaminated simply by shaking hands with an infected person, if their hands have not been washed or disinfected beforehand [6].

It should be noted that other factors such as food intolerance, stress or nervousness can also cause acute diarrhea.

When to visit the physician? [7]

In the following cases, it is recommended that you consult your doctor who will be able to guide you towards the most appropriate treatment for your situation:

• If you show signs of dehydration (dry mouth, small amount of urine, fatigue), confusion or drowsiness
• If you refuse to drink or drink very little
• If you are at risk: under 5 years old, over 75 years old, chronically ill or immunosuppressed
• If, in addition to diarrhea, you have the following symptoms: fever, vomiting, weight loss, stomach or headache, blood and/or mucus in the stool
• If the diarrhea lasts more than 2 days
• If you are on a new treatment

What to do to prevent and treat diarrhea?

Follow strict hygiene rules

It is important to pay close attention to your hygiene to protect yourself and others from diarrhea.

• Start by washing your hands with soap and water regularly after going to the bathroom, before eating, before cooking or after taking transportation.
• Dry your hands with a clean towel if possible.
• Wash dishes regularly and change hand towels.
• Reinforce the cleaning of surfaces that you touch often (handles, doors, sinks) and disinfect toilets daily.
• Clean children’s play areas, as well as toys that children usually put in their mouths.
• Store your food properly and disinfect your refrigerator regularly. Don’t eat expired food, avoid refreezing defrosted food and keep fresh food in the refrigerator [8].

Take care of your diet

Specific dietary rules in addition to possible medication help acute diarrhea to disappear spontaneously [9].

Foods to favor:

• Cooked vegetables with soft fibers such as carrots
• Lean meats such as poultry (cooked)
• Fish (cooked)
• Hard cheeses (Gruyère, Emmental, etc.) and plain yogurt
• Starchy foods such as rice, pasta, semolina or potatoes
• Vegetable oils (olive, sunflower, rapeseed, etc.)

Foods to avoid:

• Vegetables that have not been mentioned above
• Fruits
• Mutton, lamb, fried, breaded or sauced meat and fish, cold cuts
• Milk, Greek yogurt and cheeses containing cream
• Legumes (lentils, kidney/white beans, chickpeas), wholemeal bread, French fries, pastries
• Animal fats (butter, cream, mayonnaise)

Drink plenty of water

Diarrhea causes significant water loss, so you must be careful not to become dehydrated. You should drink 2 liters of water per day, preferably mineral water. If you do not have access to mineral water, you can boil tap water for at least 1 minute or use an appropriate water filter. Alcoholic and iced beverages, coffee, cold fruit juices and spices should also be avoided, as they are all irritating to the intestinal mucosa [9].

[0] Chronic / acute diarrhea – SNFGE – Available on : https://www.snfge.org/content/diarrhee-chronique et https://www.snfge.org/content/diarrhee-aigue
[1] Diarrheal diseases – WHO – Available on : https://www.who.int/fr/news-room/fact-sheets/detail/diarrhoeal-disease
[2] Diarrheal diseases: thousands of children die every day – MSF – Available on : https://www.msf.ch/nos-actions/maladies/maladies-diarrheiques
[3] Diarrhea keeps killing – UNICEF – Available on : https://www.unicef.fr/article/la-diarrhee-tue-encore
[4] Salmonella – WHO – Available on : https://www.who.int/fr/news-room/fact-sheets/detail/salmonella-(non-typhoidal)
[5] Establishment of an international food safety day: the progress made – United Nations – Available on : https://www.un.org/fr/observances/food-safety-day/background
[6] Gastroenteritis – Quebec – Available on : https://www.quebec.ca/sante/problemes-de-sante/grippe-rhume-et-gastro/gastro-enterite#:~:text=Transmission,apr%C3%A8s%20la%20disparition%20des%20sympt%C3%B4mes.
[7] What to do if you have diarrhea – VIDAL – Available on: https://www.vidal.fr/maladies/estomac-intestins/diarrhee-adulte/que-faire.html
[8] How to prevent diarrhea – VIDAL – Available on: https://www.vidal.fr/maladies/estomac-intestins/diarrhee-adulte/prevention.html
[9] – Food recommendation sheet – CREGG – 2010 – Available on: https://www.cregg.org/wordpress/wp-content/uploads/2012/06/documents-tinymce-00004-fiche-diarrhe.pdf

POI 0711-09/22