Diarrhea, Age 12 and Older

Topic Overview

Diarrhea occurs when there is an increase in the number of bowel movements or bowel movements are more watery and loose than normal. When the intestines push stools through the bowel before the water in the stool can be reabsorbed, diarrhea occurs. It can also occur when inflammation of the bowel lining causes excess fluid to leak into the stool. Abdominal cramps, nausea, vomiting, or a fever may occur along with the diarrhea.

Diarrhea is one of the most commonly occurring health problems affecting all ages. Most adults will have 4 episodes of diarrhea each year. Diarrhea that comes on suddenly may last up to 14 days.

Diarrhea has many causes.

• Diarrhea is often caused by stomach flu (gastroenteritis) or food poisoning. Diarrhea is your body's way of quickly clearing viruses, bacteria, or toxins from the digestive tract. Since most cases of diarrhea are viral, they will clear up in a few days with good home treatment. E. coli is a common bacteria that causes diarrhea. E. coli infection is related to improper food preparation.
• Drinking untreated water or unpasteurized dairy products can cause viral, bacterial, or parasitic infections, such as Giardia lamblia. Giardia lamblia parasite can cause diarrhea that develops 1 to 4 weeks later. These infections can also occur when you use untreated water to brush your teeth, wash your dishes or vegetables, or make ice for drinks.
• Many prescription and nonprescription medicines can cause diarrhea.
  • Antibiotics may cause mild diarrhea that usually clears up without treatment. A more serious type of diarrhea caused by the bacteria Clostridium difficile (sometimes called C-diff) may occur while taking an antibiotic or shortly after finishing the antibiotic.
  • Laxatives, such as Correctol, Dulcolax, Ex-Lax, or Feen-a-Mint, may cause diarrhea.
• Using too much of products that contain sorbitol (such as chewing gum) or fructose can cause diarrhea.
• Some people get diarrhea while traveling (traveler's diarrhea).
• For some people, emotional stress, irritable bowel syndrome, anxiety, or food digestion problems (such as lactose intolerance) cause diarrhea.
• Repeated episodes of diarrhea may be caused by inflammatory bowel disease.
• Diarrhea may also be caused by malabsorption problems and certain types of cancer.
• Diarrhea may develop after stomach, bowel, or gallbladder surgery, or after bariatric surgery for obesity.

Many times the exact cause of diarrhea is difficult to determine. Almost everyone has an occasional bout of diarrhea. Although diarrhea is annoying, most cases are not serious and will clear up with home treatment.

Review the Emergencies and Check Your Symptoms sections to determine if and when you should see your doctor.

Emergencies

• Signs of shock
• Severe dehydration

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Are your stools black or bloody? When to See a Doctor See significance of black or bloody stools if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Call 911 or other emergency services if you have blood in your stool and any signs of shock. Certain foods and medicines can change how the stool looks. Taking medicines that contain bismuth, such as Pepto-Bismol, or iron tablets can make the stool black, and eating lots of beets may turn the stool red. Some food colorings also can change the color of your stool. Eating foods that contain black or dark blue food coloring can turn your stool black. Call your health professional immediately if you answer "Yes" to the following question. Yes Have you had 1 or more normal-size to large stools that are mostly black or bloody? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had 1 or more normal-size to large stools that are partly black or bloody? Yes Have you had 1 or more small stools that are mostly black or bloody? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had streaks of blood in your stools? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have diarrhea and a fever? When to See a Doctor See significance of fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think you have a high fever but you are unable to measure your temperature? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a fever of 102 °F (39 °C) or higher? Yes Do you think that you have a moderate fever but you are unable to measure your temperature? Yes Do you have a moderate fever with signs of a serious illness? Yes Have you had a recurrent or ongoing fever without an obvious cause after traveling outside your own country in the past 6 weeks? Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had a fever of 101 °F (38 °C) or higher for longer than 24 hours? Yes Do you think that you have had a mild fever for longer than 24 hours but you have been unable to measure your temperature? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Have you had severe diarrhea? When to See a Doctor See significance of severe diarrhea if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have symptoms of moderate dehydration? Yes Have you had severe diarrhea for 24 hours or longer? Yes Do you have vomiting that makes it hard to drink enough to replace the lost fluids? Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have symptoms of mild dehydration for longer than 48 to 72 hours? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have symptoms of mild to moderate dehydration? When to See a Doctor See significance of mild to moderate dehydration if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have symptoms of moderate dehydration, and you are unable to drink enough to replace the lost fluids? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have symptoms of mild dehydration for longer than 12 hours, and you are unable to drink enough to replace the lost fluids? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Have you had mild or moderate diarrhea? When to See a Doctor See significance of mild or moderate diarrhea if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have moderate diarrhea that has not improved after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had mild diarrhea for 1 to 2 weeks? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your diarrhea may be caused by a medicine? When to See a Doctor See significance of medicines if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Did your diarrhea start after an increase in a dose of medicine or after taking a new medicine? Note: Call the doctor who prescribed the medicine to determine if you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. Call your doctor if you feel you need to continue taking the medicine. Yes Did your diarrhea start after starting treatment with an antibiotic? Yes Did your diarrhea start within 2 weeks of stopping treatment with an antibiotic? Yes Do you think your diarrhea may be caused by a medicine you take regularly, such as lithium or digoxin? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have the following symptom?

• Nausea and vomiting: Go to the topic Nausea and Vomiting, Age 4 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Emergencies

• Signs of shock
• Severe dehydration

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Are your stools black or bloody? When to See a Doctor See significance of black or bloody stools if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Call 911 or other emergency services if you have blood in your stool and any signs of shock. Certain foods and medicines can change how the stool looks. Taking medicines that contain bismuth, such as Pepto-Bismol, or iron tablets can make the stool black, and eating lots of beets may turn the stool red. Some food colorings also can change the color of your stool. Eating foods that contain black or dark blue food coloring can turn your stool black. Call your health professional immediately if you answer "Yes" to the following question. Yes Have you had 1 or more normal-size to large stools that are mostly black or bloody? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had 1 or more normal-size to large stools that are partly black or bloody? Yes Have you had 1 or more small stools that are mostly black or bloody? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had streaks of blood in your stools? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have diarrhea and a fever? When to See a Doctor See significance of fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think you have a high fever but you are unable to measure your temperature? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a fever of 102 °F (39 °C) or higher? Yes Do you think that you have a moderate fever but you are unable to measure your temperature? Yes Do you have a moderate fever with signs of a serious illness? Yes Have you had a recurrent or ongoing fever without an obvious cause after traveling outside your own country in the past 6 weeks? Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had a fever of 101 °F (38 °C) or higher for longer than 24 hours? Yes Do you think that you have had a mild fever for longer than 24 hours but you have been unable to measure your temperature? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Have you had severe diarrhea? When to See a Doctor See significance of severe diarrhea if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have symptoms of moderate dehydration? Yes Have you had severe diarrhea for 24 hours or longer? Yes Do you have vomiting that makes it hard to drink enough to replace the lost fluids? Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have symptoms of mild dehydration for longer than 48 to 72 hours? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have symptoms of mild to moderate dehydration? When to See a Doctor See significance of mild to moderate dehydration if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have symptoms of moderate dehydration, and you are unable to drink enough to replace the lost fluids? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have symptoms of mild dehydration for longer than 12 hours, and you are unable to drink enough to replace the lost fluids? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Have you had mild or moderate diarrhea? When to See a Doctor See significance of mild or moderate diarrhea if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have moderate diarrhea that has not improved after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had mild diarrhea for 1 to 2 weeks? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your diarrhea may be caused by a medicine? When to See a Doctor See significance of medicines if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Did your diarrhea start after an increase in a dose of medicine or after taking a new medicine? Note: Call the doctor who prescribed the medicine to determine if you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. Call your doctor if you feel you need to continue taking the medicine. Yes Did your diarrhea start after starting treatment with an antibiotic? Yes Did your diarrhea start within 2 weeks of stopping treatment with an antibiotic? Yes Do you think your diarrhea may be caused by a medicine you take regularly, such as lithium or digoxin? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have the following symptom?

• Nausea and vomiting: Go to the topic Nausea and Vomiting, Age 4 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Home treatment can help you treat your diarrhea and avoid other related problems, such as dehydration.

• Take frequent, small sips of water or a rehydration drink and small bites of salty crackers.
  • Try to increase your fluid intake to at least 1 qt (1 L) per hour for 1 to 2 hours or until diarrhea symptoms disappear.
• Begin eating mild foods the next day or sooner, depending on how you feel.
  • Avoid spicy foods, fruits, alcohol, and caffeine until 48 hours after all symptoms have disappeared.
  • Avoid chewing gum that contains sorbitol.
  • Avoid dairy products for 3 days after symptoms disappear. Milk products may be harder for your body to digest when you have diarrhea.

Nonprescription medicines for diarrhea

If you are pregnant, talk with your doctor before taking any medicines for diarrhea.

Nonprescription medicines may be helpful in treating your diarrhea. Follow these tips when taking a nonprescription medicine for diarrhea:

• Use nonprescription antidiarrheal medicine if you have diarrhea for longer than 6 hours. Do not use nonprescription antidiarrheal medicines if you have bloody diarrhea, a high fever, or other signs of serious illness.
• Read and follow all label directions on the nonprescription medicine bottle or box. Be sure to take the recommended dose.
• Long-term use of nonprescription antidiarrheal medicine is not recommended. To avoid constipation, stop taking antidiarrheal medicines as soon as stools thicken.
• If your child or teen gets chickenpox or flu, do not treat the symptoms with over-the-counter medicines that contain bismuth subsalicylate (such as Pepto-Bismol and Kaopectate). Subsalicylate has been linked to Reye's syndrome, a rare but serious illness. If your child has taken this kind of medicine and he or she has changes in behavior with nausea and vomiting, call your doctor. These symptoms could be an early sign of Reye's syndrome.

There are several types of antidiarrheal medicines: those that absorb water and thicken the stool, and those that slow intestinal spasms.

• Thickening mixtures, such as psyllium, contain clay or fruit pectin which break down in the intestine and become food for the bacteria and toxins in the intestine. This gives the stool more bulk.
• Antispasmodic antidiarrheals, such as Imodium A-D and Pepto Diarrhea Control, slow intestinal spasms. Some products contain both thickening and antispasmodic ingredients.
• Probiotics, such as Lactobacillus, are available in either pills or powder. This bacteria occurs naturally in the intestine and may help with digestion. When diarrhea is present, the number of these bacteria is reduced.

General tips

To clean up diarrhea from hard surfaces, such as a toilet seat or bathroom floor, you can use diluted chlorine bleach. To do this, mix 5 tablespoons of 6% household bleach in 1 gallon of water. The solution needs to stay on the surface area for 10 minutes to be effective. Let the surface air dry if possible. Protect your hands with gloves while using the bleach solution. Wash your hands after you are done cleaning up. Soiled linens and clothing should be handled as little as possible and washed separately in a hot water cycle.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following develop during home treatment:

• Signs of dehydration develop.
• Severe diarrhea (large, loose bowel movements every 1 to 2 hours) develops.
• Diarrhea is present for longer than 1 to 2 weeks.
• Black or bloody stools develop.
• A fever develops.
• Other symptoms develop.
• Your symptoms become more severe or more frequent.

Prevention

Food poisoning is a common cause of diarrhea in children and adults. Most cases of food poisoning may be prevented by taking a few precautions when preparing and storing food at home. Perishable foods, such as eggs, meats, poultry, fish, shellfish, milk, and milk products, should be treated with extra care. Also, precautions should be taken if you are pregnant, have an impaired immune system or a chronic illness, or you are preparing foods for other high-risk groups, such as young children or older adults. For more information, see the topic Food Poisoning and Safe Food Handling.

The U.S. Department of Agriculture (USDA) recommends the following steps to prevent food poisoning:

• Prepare foods safely.
• Shop safely.
• Cook foods to a safe temperature.
• Store foods safely.
• Follow labels on food packaging.
• Serve foods safely.
• When in doubt, throw it out.

Many counties in the United States have extension services listed in the phone book. These services can answer your question about safe home canning and food preparation.

For information on how to prevent traveler's diarrhea, see traveler's diarrhea.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• How long have you had diarrhea?
• How many times per day are you having diarrhea?
• What does your diarrhea look like? Describe the color, consistency (watery, mushy), and other characteristics (contains blood or mucus).
• When was your last episode of diarrhea?
• Have you recently increased the amount of fiber in your diet (more fresh fruit, vegetables, or other high-fiber foods)?
• What prescription and nonprescription medicines do you take?
  • Are you taking any new medicines?
  • Did you recently increase the dose of a medicine?
  • Have you taken any antibiotics recently?
  • Did you recently receive an antibiotic while in the hospital?
• Do you routinely use laxatives or stool softeners?
• Have you been under an unusual amount of stress at home, work, or both?
• Does anyone you live with or work with have diarrhea?
• Did your diarrhea start after eating at a restaurant? Has anyone who ate there with you become ill?
• Did you drink lake or stream water or untreated well water?
• Have you recently visited a foreign country or taken a ship cruise?
• Do you have any risk factors that make you more susceptible to diarrhea, such as irritable bowel syndrome?
• What home treatment measures have you tried? Be sure to include any nonprescription medicines you have taken.
• Do you have other symptoms, such as vomiting, fever, or dehydration?
• Do you have any health risks?

Related Information

• Abdominal Pain, Age 12 and Older
• Dehydration
• Diarrhea, Age 11 and Younger
• Food Poisoning and Safe Food Handling
• Giardiasis
• Irritable Bowel Syndrome (IBS)
• Nausea and Vomiting, Age 4 and Older
• Rectal Problems

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