Diarrhea

WHEN TO SEE YOUR DOCTOR

* You have diarrhea for more than one week.

* You're also losing weight.

What Your Symptom Is Telling You

Diarrhea may very well be the thunderstorm of stomach problems—a painful, sometimes embarrassing display of both sound and fury. But you have to really search to find a silver lining behind this dark digestive cloud. In fact, doctors say the best you can do is to learn how to weather the storm or avoid it altogether.

Why the weather analogy? Consider the crucial role water plays in your discomfort. Including both what you drink and the liquid contained in the food you eat, three to four gallons of fluid reach your intestines each day. If all goes well (pardon the pun), no more than eight ounces or less of fluid a day is supposed to come out when you visit the bathroom, says William B. Ruderman, M.D., chairperson of the Department of Gastroenterology at the Cleveland Clinic­Florida in Fort Lauderdale.

And when you get liquid when you were expecting solids? That's diarrhea, says Barry Jaffin, M.D., a motility disorder specialist and clinical instructor in the Department of Gastroenterology at Mount Sinai Hospital in New York City. "Whether you're talking about three times a day or five times a day—if your stool is basically watery and of increased frequency compared to the normal amount, then that's defined as diarrhea," says Dr. Jaffin.

Sorting out the causes of your distress is a little bit trickier than defining it, says Dr. Ruderman.

If your stomach lacks an enzyme needed to properly digest the sugar in milk—a condition called lactose intolerance—nonabsorbed fluid will continue to build up in your colon as long as you eat dairy products, says Dr. Jaffin.

Excess magnesium, found in most antacids, can also cause fluid in the colon, says Dr. Jaffin, as can sorbitol, an artificial sweetener found in some diet products. Many antibiotics, such as penicillin, which are prescribed for common infections, have also been known to cause diarrhea, says Dr. Jaffin.

And if you've been infected by a parasite or bacteria, the organism can actually cause your gut to secrete fluid until the bug is dead, says Dr. Jaffin. Ordinarily, none of these should cause your distress to last more than a week. But here's where diarrhea gets tricky.

Other bugs, like those caught during a trip overseas, for example, seem to hang on like a palm tree in a hurricane. The result: Some forms of diarrhea can last more than two weeks.

Other causes of chronic diarrhea include everything from a malfunctioning pancreas and bacterial overgrowth to inflammatory bowel disease and thyroid disease. "There are hundreds of different causes of diarrhea," says Dr. Ruderman. "But if you've had diarrhea for over one week, you need to see your doctor."

Symptom Relief

While doctors says it's best to try to ride out a case of diarrhea, there are a few things that may make life more pleasant. Try these.

Drink up. Even not-so-severe diarrhea can cause dehydration, which often leads to weakness and dizziness, says Dr. Jaffin. Drinking clear liquids during a particularly nasty bout helps prevent dehydration, but sports drinks like Gatorade are even better because they replace glucose and potassium—nutrients vital to good health. "A lot of people have the misconception that if they drink, they're going to cause more diarrhea, and that's just not true," says Dr. Jaffin. "You have to replace that fluid that you're losing every time you go to the bathroom or you're going to end up in the hospital."

Cut the caffeine. Because caffeine stimulates the intestine, it can worsen your diarrhea. You'll want to avoid drinks high in caffeine, such as coffee, Eliminate your trouble. You may be able to dump noninfectious diarrhea by eliminating the foods that could be causing the problem, says Dr. Jaffin. If you're suffering from lactose intolerance, for example, removing milk products from your diet may end the problem. Also, try eliminating sorbitol and see if that helps.

Ease back into eating. Instead of trying to make up for lost meals, ease back into eating after your symptoms begin to subside by sticking with bland fare, says Dr. Ruderman. Among the best: bananas, broth or soup, toast, juices and Jell-O, he says. When you can tolerate this lighter fare, try more solid bland food, like chicken or baked fish.

Say yes to yogurt. To have any effect at all on noninfectious diarrhea, you need yogurt that still contains lactobacilli. These are active yogurt cultures that may balance out bacteria in your colon and may help in reducing lactose intolerance, says Peter Holt, M.D., chief of the Division of Gastroenterology at St. Luke's­Roosevelt Hospital Center and professor of medicine Columbia University College of Physicians and Surgeons in New York City. "Although there's not a lot of scientific data to back this up, people over the years have reported good results," he says. You may have to do a little label reading, but you should be able to find yogurt with live cultures. If you can't find it in the supermarket, try the local health food store.

Try Pepto-Bismol. Some doctors recommend Pepto-Bismol for travelers' diarrhea, says Nicholas J. Talley, M.D., associate professor of medicine at the Mayo Clinic Medical School in Rochester, Minnesota.

See your doctor. If you suspect you've been infected during your travels, ask your doctor about several prescription antibiotics that are extremely effective, says Dr. Talley. Among them are Cipro and Bactrim.

Review your medications. List all the medications you are currently taking—prescription and over-the-counter drugs—and ask your doctor whether any of them could be contributing to the problem. Your doctor may be able to make helpful substitutions.