Caregiver Guide: Diarrhea

Understanding the Problem

Diarrhea is the passing of three or more loose or watery stools per day, or a definite decrease in consistency and increase in frequency of bowel movements based upon what is usual for the individual. (Simply put, diarrhea is when a person goes to the bathroom more often than usual for that person and the stool is not as firm as usual.) It is a common problem that usually lasts a day or two and goes away on its own without any special treatment. Diarrhea that lasts more than three weeks can be a sign of a serious problem, or may be due to a less serious condition such as irritable bowel syndrome.

Diarrhea can cause dehydration, which means the body doesn’t have enough fluid to function properly. Dehydration is particularly dangerous in older people, and it must be treated promptly to avoid serious health problems.
 
People of all ages can get diarrhea. The average adult has an episode of diarrhea about four times a year.

Symptoms of diarrhea

Diarrhea may be accompanied by cramping abdominal pain, bloating, nausea, and an urgent need to use the bathroom. Depending on the cause of the diarrhea, a person might have a fever or bloody stools.

Diarrhea can be either acute or chronic. The acute form, which lasts less than three weeks, is usually related to a bacterial, viral, or parasitic infection.

Chronic diarrhea lasts more than three weeks and is usually related to other problems like irritable bowel syndrome (characterized by recurring abdominal pain associated with a change in consistency and frequency of stools) or diseases like celiac disease (characterized by malabsorption and intolerance to gluten, the protein in wheat) or inflammatory bowel disease (characterized by bloody diarrhea and abdominal pain).

Causes of diarrhea

A few of the more common causes of diarrhea include the following:

Bacterial and viral infections

Certain types of infections can impact our gut, causing us to pass watery stool.

Food intolerance

Some people are unable to digest a component of food, such as lactose (the sugar found in milk) or gluten (the protein found in wheat), which results in celiac disease. In addition, the artificial sweeteners sorbitol and mannitol found in chewing gum and other sugar-free products can cause diarrhea.

Medicine

Diarrhea can be a side effect of many medicines, particularly antibiotics. Antibiotics can disturb the natural balance of bacteria in the intestines.

Other causes

  • Intestinal diseases such as inflammatory bowel disease or celiac disease.
  • Functional and other bowel disorders such as irritable bowel syndrome, or the result of stomach surgery, or removal of the gallbladder.
  • People who visit foreign countries are at risk for traveler's diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites.
  • In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.

Your goals are to:

  • Call for professional help when needed
  • Replace lost fluids and nutrients
  • Consider diarrhea medicines
  • Avoid offering certain foods while there is diarrhea
  • Do what you can to increase the older person’s comfort

Click on each of the topics below to read more.

When to Get Professional Help

Call the healthcare provider immediately or go to the emergency room if any of the following symptoms occur

Severe diarrhea

Severe diarrhea means that a lot of fluid is being lost. With severe diarrhea, stools are very runny, frequent (as often as hourly), and often accompanied by stomach cramps. Dehydration can occur with prolonged diarrhea. It is important to replace fluid loss to prevent dehydration. Anti-diarrhea medicines can be useful, but should be used with caution or after discussion with the healthcare provider.

Diarrhea along with fever above 101.4 F (38.5 C)

A high fever is generally a sign of serious infection somewhere in the body.

Signs and symptoms of dehydration caused by diarrhea

  • Strong thirst can be one of the signs and symptoms of dehydration. (This symptom may not be noticed by the person you are caring for, because the sensation of thirst is decreased in some older people.)
  • Less frequent urination
  • Dark colored urine
  • Fatigue
  • Light-headedness
  • Confusion

If you suspect that the person you are caring for is dehydrated, call the doctor immediately. Severe dehydration may require hospitalization.

Call the healthcare provider during office hours to discuss the following problems

Diarrhea for more than one day

Continuing diarrhea could mean a more serious medical condition such as an infection, reaction to a drug, or intestinal problems. Serious health problems can result if a person is dehydrated for a long period of time.

Blood in the diarrhea stool

This could be caused by irritation of the skin around the rectum or by hemorrhoids. Blood in the stool could also be an indication of colon cancer, severe constipation, infection, or other serious intestinal or medical disorders.

Diarrhea during or following a course of antibiotics

Antibiotics themselves can cause diarrhea. In more rare cases, a bacterium called Clostridium difficile can infect the stool following antibiotics and will require treatment with additional different antibiotics.

Know the answers to the following questions before calling the doctor

  • How many bowel movements does the older person usually have each day?
  • How many bowel movements have there been in the last 24 hours?
  • What was the consistency of the stool?
  • What was the color of the stool?
  • Are there any other symptoms with the diarrhea? Such as:
    • stomach pain
    • stomach cramps
    • bloating? (feeling very full in the stomach or abdomen)
    • nausea
    • vomiting
    • fever
    • blood in the diarrhea
    • confusion
  • How much liquid and food have been consumed in the past two days?
  • What medicines were taken in the last 2 to 3 days? Any laxatives or antidiarrheal medicines like LomotilTM, Pepto-BismolTM, or ImodiumTM)
  • Has weight been lost? How much?
  • Is there any history of other bowel problems such as colitis, diverticulitis, or irritable bowel syndrome?
  • Are there signs of dehydration?

What You Can Do to Help

Replace lost fluids and nutrients

Offer clear liquids

Chicken broth, tea, ginger ale, Popsicles, apple, cranberry, or grape juice, all provide liquid as well as important food and nutrients. It is best to not use milk at this time.

Serve fluids between meals

Drinking liquids between meals is less likely to cause cramps in the stomach or intestines than drinking large amounts of liquid at mealtimes.

Serve low-fiber foods such as bananas, rice, applesauce, mashed potatoes, dry toast, crackers, eggs, fish, poultry, cottage cheese, and yogurt

These foods are easier to digest than high-fiber vegetables and grains.

Serve several small meals instead of three large meals

Smaller meals are easier to digest. Also, more liquid and food are taken in with many smaller meals than with three larger meals.

Serve foods high in potassium

Apricot or peach nectar, bananas, and mashed or baked potatoes are all high in potassium. With diarrhea, potassium is lost and it is important to replace it. Discuss this first with the healthcare provider if the older adult has kidney problems or is taking medicines that can already increase potassium levels (certain blood pressure medicines or some diuretics).

Give medicines for diarrhea

Anti-diarrhea medicine is a fast way to stop the problem

Follow the instructions on the bottle. Too much can cause stomach cramps, constipation, or sleepiness. These medicines should not be used on a daily basis without discussing with the healthcare provider. If the older person has just completed a course of antibiotics, do not use anti-diarrhea medicines without consulting the healthcare provider.

Avoid certain foods

Avoid foods that produce gas

These include foods such as beans, raw vegetables, raw fruits, broccoli, corn, cabbage, cauliflower, carbonated drinks, and chewing gum. These foods cause a feeling of fullness and produce gas, which adds to discomfort.

Avoid foods that contain acids

These include foods such as spicy foods or citrus juices. These foods and drinks make the intestines churn and cause more discomfort and diarrhea.

Avoid fatty foods such as fatty meats and greasy fried foods

Fats are difficult to digest. If a person has diarrhea, fats are pushed through the intestines without being digested.

Cool down hot foods and drinks

Hot foods and liquids make the bowels move. Avoid these until the diarrhea has stopped.

Limit caffeine

Coffee, strong teas, sodas, and chocolate all contain caffeine. Caffeine makes the bowels work faster. With diarrhea, the bowels are already overactive.

Avoid milk and milk products

Milk may make diarrhea worse and can cause cramps. Yogurt is good, however, because it has bacteria in it which make the milk easier to digest and can help treat diarrhea from antibiotics.

Wash your hands often

Encourage frequent, careful hand washing to help prevent the spread of any potentially infectious diarrhea

Increase comfort

Clean the rectal area

Stools that are runny can burn the skin. It is very important to clean the rectal area after each episode of diarrhea. Have the older person use diaper wipes, a soft washcloth, or warm water to gently clean the area. Allow the skin to air dry to reduce redness and prevent skin infection.

Put a warm water bottle wrapped in a towel on the stomach

Warmth can relieve pain and discomfort caused by stomach tightness or cramps.

Apply soothing creams, ointments, or astringent pads such as TucksTM to the rectal area

Creams prevent skin from chapping. Astringent pads help to dry the area and soothe irritated skin. Protect the rectal skin with an ointment such as VaselineTM, BalmexTM, A&DTM, DesitinTM, or AnusolTM. If diarrhea continues and the rectal area becomes very sore and red, apply a low dose steroid ointment such as Hydrocortisone 1.0% and then apply BalmexTM, A&DTM or DesitinTM.

Carrying Out Your Plan

Problems you might have carrying out your plan

You may have some beliefs about the older person’s condition that might get in the way of carrying out your plan. Here is an example and a possible response.

"He's had nothing to eat or drink for days, so this diarrhea can't last much longer."

The body can lose fluid for much longer than you think. Fluid is taken from body tissues, and diarrhea can continue even if the person stops eating or drinking for days. Persistent diarrhea should be reported to the healthcare provider.

Think of other problems you might have carrying out your plan

What other problems could get in the way of doing the things suggested in this presentation? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?

You need to make plans for solving these problems.

Checking on Progress

Keep track of the frequency and severity of diarrhea. Are you able to stop the diarrhea when it happens? If not, get professional help. Is the rectal skin cleansed and protected to keep it free from damage? Are other precautions with liquids and diet being followed to prevent diarrhea?

If the problems with diarrhea are getting worse or the person is becoming weak, review the section on “When to Get Professional Help.” 

If diarrhea is not severe but continues for several days, contact the healthcare provider for help. Tell what you have done and what the results have been.