Diarrhoea

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Introduction

Diarrhoea

Diarrhoea is where you frequently pass watery or loose poo. Some people may also have other symptoms, depending on the cause.

It affects most people from time to time and is usually nothing to worry about. However, it can be distressing and unpleasant until it passes, which normally takes a few days to a week.

The excessive loss of water in your poo can also sometimes lead to symptoms of dehydration, which can be serious if it's not recognised and treated quickly.

This topic covers:

When to seek medical advice

Causes

Treatment

Prevention

When to seek medical advice

Contact your GP or call NHS 111 for advice if you're concerned about yourself or your child.

You should also contact your GP in the situations outlined below, as they may mean an increased risk of a more serious problem.

Read more about diagnosing the cause of diarrhoea.

Babies

You should contact your GP or health visitor urgently if your baby has had six or more episodes of diarrhoea in the past 24 hours, or if they've vomited three times or more in the past 24 hours.

You should also seek advice if your baby has any symptoms of dehydration.

Children

Contact your GP if your child has: 

  • had six or more episodes of diarrhoea in the past 24 hours
  • diarrhoea and vomiting at the same time
  • watery poo
  • blood in their poo
  • a severe or continuous stomach ache
  • symptoms of dehydration

You should also contact your GP if your child has persistent diarrhoea. Most cases will pass in five to seven days.

Adults

Contact your GP if you have diarrhoea and:

  • there's blood in your poo
  • you're vomiting persistently
  • you've lost a lot of weight
  • you've passed a large amount of very watery diarrhoea
  • it occurs at night and is disturbing your sleep
  • you've recently taken antibiotics or been treated in hospital
  • you have symptoms of dehydration
  • your poo is dark or black - this may be a sign of bleeding inside your stomach

You should also contact your GP if you have persistent diarrhoea. Most cases in adults will pass in two to four days.

Causes of diarrhoea

There are many different causes of diarrhoea, but a bowel infection (gastroenteritis) is a common cause in both adults and children.

Gastroenteritis can be caused by:

  • a virus - such as norovirus or rotavirus
  • bacteria - such as campylobacter or Escherichia coli (E. coli), which are often picked up from contaminated food 
  • a parasite - such as the parasite that causes giardiasis, which is spread in contaminated water

These infections can sometimes be caught during travel abroad, particularly to areas with poor standards of public hygiene. This is known as travellers' diarrhoea.

Diarrhoea can also be the result of:

Read more about the causes of diarrhoea.

Treating diarrhoea

Most cases of diarrhoea clear up after a few days without treatment, and you may not need to see your GP.

However, diarrhoea can lead to dehydration, so you should drink plenty of fluids until it passes.

It's very important that babies and small children don't become dehydrated. Your pharmacist may suggest you use an oral rehydration solution (ORS) if you or your child are particularly at risk of dehydration.

You should eat solid food as soon as you feel able to. If you're breastfeeding or bottle feeding your baby and they have diarrhoea, you should try to feed them as normal.

Stay at home until at least 48 hours after the last episode of diarrhoea to prevent spreading any infection to others.

Medications to reduce diarrhoea, such as loperamide, are available. However, these aren't usually necessary, and most types shouldn't be given to children.

Read more about treating diarrhoea.

Preventing diarrhoea

Diarrhoea is often caused by an infection. You can reduce your risk by making sure you maintain high standards of hygiene.

For example, you should:

  • wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing food 
  • clean the toilet, including the handle and the seat, with disinfectant after each bout of diarrhoea 
  • avoid sharing towels, flannels, cutlery or utensils with others
  • wash soiled clothing and bed linen separately from other clothes and at the highest temperature possible - for example, 60C or higher for linen - after first removing any poo into the toilet 
  • avoid returning to work or school until at least 48 hours after the last episode of diarrhoea

Read more about preventing germs spreading.

Traveller's diarrhoea

It's important to practise good food and water hygiene while travelling abroad, such as avoiding potentially unsafe tap water and undercooked food.

If you're planning a trip abroad, check health advice for the countries you'll be travelling to.

You can do this by visiting the NHS Fit for Travel and National Travel Health Network and Centre (NaTHNaC) websites.

Read more about:

Rotavirus vaccination

Rotavirus is a virus that commonly causes diarrhoea in children. A vaccine that helps protect children against rotavirus is now part of the routine childhood vaccination schedule.

This vaccine is given as a liquid that's dropped into a baby's mouth. It's given in two doses, with the first given at two months and another at three months.

Read about the rotavirus vaccine.

Causes

Causes

Diarrhoea usually occurs when fluid can't be absorbed from the contents of your bowel, or when extra fluid is secreted into your bowel, causing watery poo.

Short-term diarrhoea

Diarrhoea is usually a symptom of a bowel infection (gastroenteritis), which can be caused by:

Other possible causes of short-term diarrhoea include:

Medicines

Diarrhoea can also sometimes be a side effect of a medication, including:

The patient information leaflet that comes with your medicine should state whether diarrhoea is a possible side effect.

Long-term diarrhoea 

Conditions that can cause persistent diarrhoea include:

Persistent diarrhoea can also sometimes occur after surgery on the stomach, such as a gastrectomy.

Diagnosis

Diagnosis

Most cases of diarrhoea get better within a week, and you may not need to visit your GP.

The information below explains what will happen if you need to see your GP.

Read about when to visit your GP if you have diarrhoea.

Identifying the cause

To identify what's causing your diarrhoea, your GP may ask you questions about:

  • what your stools are like - for example, if they're very watery or contain blood
  • how often you need to go to the toilet
  • whether you have other symptoms, such as a high temperature (fever) 
  • whether you've been in contact with anyone else who has diarrhoea, or have recently travelled abroad - this may mean you have picked up an infection
  • whether you have recently eaten out anywhere - this may mean you have food poisoning
  • whether you're taking medication and if it's recently changed 
  • whether you've been stressed or anxious recently

Stool sample

Your GP may ask you for a stool sample so it can be analysed for signs of an infection if you have:

  • persistent diarrhoea that's lasted more than two weeks
  • blood or pus in your stools 
  • symptoms that affect your whole body, such as a fever or dehydration
  • a weakened immune system - for example, because you have HIV 
  • recently travelled abroad
  • recently been in hospital or been taking antibiotics

Find out how to collect and store a stool sample.

Blood tests

Your GP may suggest you have some blood tests if they suspect your diarrhoea is being caused by an underlying health condition.

For example, your blood can be tested for signs of inflammation, which may suggest inflammatory bowel disease.

Read more about the possible causes of diarrhoea.

Rectal examination

Your GP may recommend a digital rectal examination (DRE) if you have unexplained persistent diarrhoea, particularly if you're over 50.

During a DRE, your GP will insert a gloved finger into your bottom to feel for any abnormalities. It can be useful for diagnosing conditions that affect your rectum and bowel.

Further investigations

If you have persistent diarrhoea and your GP is unable to find the cause, they may refer you to your local hospital for further investigation.

You may have:

  • a sigmoidoscopy - a thin, flexible tube with a small camera and light on one (a sigmoidoscope) is inserted into your bottom and up into your bowel
  • colonoscopy - a similar procedure that uses a larger tube called a colonoscope to examine your entire bowel

Treatment

Treatment

Diarrhoea usually clears up without treatment after a few days, particularly if it's caused by an infection.

In children, diarrhoea usually passes within five to seven days and rarely lasts longer than two weeks.

In adults, diarrhoea usually improves within two to four days, although some infections can last a week or more.

While waiting for your diarrhoea to pass, you can ease your symptoms by following the advice outlined below.

Drink fluids

It's important to drink plenty of fluids to avoid dehydration, particularly if you're also vomiting. Take frequent small sips of water.

Ideally, adults should drink a lot of liquids that contain water, salt and sugar. Examples are soup broth or water mixed with juice.

If you're drinking enough fluid, your urine will be light yellow or almost clear.

It's also very important for babies and small children not to become dehydrated. Give your child frequent sips of water, even if they're vomiting. A small amount is better than none.

Fruit juice or fizzy drinks should be avoided as they can make diarrhoea worse in children.

If you're breastfeeding or bottle feeding your baby and they have diarrhoea, you should continue to feed them as normal.

Contact your GP immediately if you or your child develop any symptoms of dehydration.

Oral rehydration solutions

Your GP or pharmacist may suggest using an oral rehydration solution (ORS) to prevent dehydration if you're at risk - for example, if you're frail or elderly. ORS can also be used to treat dehydration that has already occurred.

Rehydration solutions usually come in sachets available from your local pharmacist without a prescription. They are dissolved in water, and replace salt, glucose and other important minerals that are lost if you're dehydrated.

Children

Your GP or pharmacist may recommend giving your child an ORS if they're dehydrated or at risk of becoming dehydrated.

The usual recommendation is for your child to drink an ORS each time they have an episode of diarrhoea. The amount they should drink will depend on their size and weight.

Your pharmacist can advise you about this. The manufacturer's instructions should also give information about the recommended dose.

You may be able to give your baby an ORS if they become dehydrated, but check with your GP, pharmacist or health visitor first.

Eating

Opinion is divided over when and what you should eat if you have diarrhoea. However, most experts agree you should eat solid food as soon as you feel able to. Eat small, light meals and avoid fatty or spicy foods. 

Good examples are potatoes, rice, bananas, soup and boiled vegetables. Salty foods help the most.

You don't need to eat if you've lost your appetite, but you should continue to drink fluids and eat as soon as you feel able to.

Children

If your child is dehydrated, don't give them any solid food until they have drunk enough fluids. Once they stop showing signs of dehydration, they can start eating their normal diet.

If your child isn't dehydrated, offer them their normal diet. If they refuse to eat, continue to give them fluids and wait until their appetite returns.

Medication 

Antidiarrhoeal medicines

Antidiarrhoeal medicines may help reduce your diarrhoea and slightly shorten how long it lasts. However, they're not usually necessary. 

Loperamide is the main antidiarrhoeal medicine used, as it has been shown to be effective and causes few side effects.

Loperamide slows down the muscle movements in your gut so more water is absorbed from your stools. This makes your stools firmer and they're passed less frequently.

An alternative to loperamide is a different type of antidiarrhoeal medicine called racecadotril, which works by reducing the amount of water produced by the small intestine.

Evidence suggests this medication may be as effective as loperamide for treating diarrhoea.

Some antidiarrhoeal medicines can be bought from a pharmacy without a prescription.

Check the patient information leaflet that comes with the medicine to find out whether it's suitable for you and what dose you should take. Ask your pharmacist for advice if you're unsure.

Don't take antidiarrhoeal medicines if there's blood or mucus in your stools or you have a high temperature (fever). Instead, you should contact your GP for advice.

Most antidiarrhoeal medicines shouldn't be given to children. Racecadotril can be used in children over three months old if it's combined with oral rehydration and the other measures mentioned above, although not all doctors recommend it.

Painkillers

Painkillers won't treat diarrhoea, but paracetamol or ibuprofen can help relieve a fever and a headache. If necessary, you can give your child liquid paracetamol or ibuprofen.

Always read the patient information leaflet that comes with the medication to check if it's suitable and find out the correct dose. Children under 16 years of age shouldn't be given aspirin.

Antibiotics

Treatment with antibiotics isn't recommended for diarrhoea if the cause is unknown. This is because antibiotics:

  • won't work if the diarrhoea is caused by a virus 
  • can cause unpleasant side effects 
  • can become less effective at treating more serious conditions if they're repeatedly used to treat mild conditions

Antibiotics may be recommended if you have severe diarrhoea and a specific type of bacteria has been identified as the cause.

They may also be used if you have an underlying health problem, such as a weakened immune system.

Hospital treatment 

Occasionally, hospital treatment may be needed to treat serious dehydration. Treatment involves administering fluids and nutrients directly into a vein (intravenously).

Treating the underlying cause

If you've been diagnosed with a specific condition that's causing your diarrhoea, treating this may help improve your symptoms.

For example:

Read more about common causes of diarrhoea.

Probiotics

Probiotics are live bacteria and yeasts found in some yoghurts and food supplements.

There's some evidence that certain probiotics can slightly shorten a period of diarrhoea, although the evidence isn't yet strong enough to recommend taking them.

There's also evidence to suggest some probiotics may reduce your chances of developing diarrhoea after taking antibiotics.

'Hygiene wasn't always at the forefront of my mind'

'Hygiene wasn't always at the forefront of my mind'

TV producer Clare Gilbert arrived in Mumbai for a two-week backpacking trip and promptly came down with a nasty bout of diarrhoea.

"I travelled with a girlfriend. We'd both been busy working right up to the day of departure, and I'd just had my wisdom teeth out. Apart from buying a guide book, we hadn't done much preparation.

"It was the first time I'd been to India and I suppose hygiene wasn't always at the forefront of my mind. I don't know where I caught the infection, but some time on the first day I picked up a most unpleasant bug.

"The first night, I was going to the toilet every 20 or 30 minutes. My stomach hurt badly and I felt terrible. It was just as bad for my friend because she didn't get any sleep either. 

"I tried eating some papaya, which the hotel manager recommended, but it didn't help. Nor did Imodium. I couldn't eat for two or three days, but I drank bottled water as often as I could.

"I gradually got better and we managed to continue our trip, even though I never felt completely well."

When she got back home to Devon, Clare continued to feel unwell for several weeks. A friend suggested Clare may have developed long-term symptoms, and she took a nutritional supplement that claims to rebalance the "good" and "bad" bacteria.  

"I've been back to India since then and was absolutely fine. I started to take a probiotic supplement before I left, and was careful with what I ate and what I ate it off.

"I've learnt that, if you're careful, you can avoid diarrhoea. And it's certainly worth making the effort to take precautions."