Severe Diarrhea: Causes, Symptoms, and Management Tips

Since yesterday, the diarrhea has been getting progressively worse?

Hello, doctor.
Recently, I visited a physician due to a feeling of urgency and heaviness in my lower abdomen, which I believe was caused by hemorrhoids.
The doctor diagnosed me with irritable bowel syndrome (IBS) and an exacerbation of hemorrhoids.
Noticing my anxiety, the doctor scheduled a colonoscopy, which I thought was a good idea at my age, especially since I have been experiencing ongoing gastrointestinal issues.
The procedure took place at the end of September this year.
After the colonoscopy, the doctor did not require a follow-up appointment, stating that everything was fine, with no polyps or malignancies found in my intestines.
He advised me to take good care of my health and mentioned that IBS is a functional issue, and very few people require surgery for it.
I thought that since I had just undergone the procedure, it was unlikely to be another condition.
Recently, my bowel movements have been normal, but the frequency has increased.
I am unsure if this is due to the colonoscopy or something else.
After a bowel movement, I often feel the urge to go again within an hour, sometimes having multiple bowel movements in a short time.
However, a couple of days ago, I accidentally stayed up late for work and couldn't sleep.
I decided to hold off until the evening to restore my routine.
I usually take probiotics, but after staying up late, I developed diarrhea (this happens whenever I stay up late).
The symptoms worsened yesterday; while showering, I accidentally exerted myself and felt a sharp pain in my abdomen, which subsided after resting for 2-3 minutes.
I initially thought it was just gas, but as the evening progressed, I experienced typical diarrhea, having about two episodes within 30 minutes after a meal.
I was then awakened by abdominal pain in the middle of the night, experiencing four bowel movements within an hour.
The stools were soft, floating initially and then sinking, resembling mud, and mostly dark brown in color.
Although the abdominal pain lessened after bowel movements, I still felt a lingering discomfort, especially when lying flat compared to sitting or reclining.
I am wondering if this could be acute gastroenteritis due to my sudden change in routine, leading to a gastrointestinal infection.
Currently, I am only experiencing severe diarrhea and abdominal discomfort, with no signs of dehydration or fever.
I have had acute gastroenteritis before, but it resolved quickly.
Back then, my routine was more regular, and I wasn't eating much.
Now, I am considering whether to monitor my condition and maintain a bland diet.
Should I also pause my probiotic intake? From my understanding, probiotics are bacteria, and given my current inflammatory state in the intestines, they might be attacked by immune cells, potentially worsening the inflammation.
I am concerned that my previous quick recovery from acute gastroenteritis was due to not eating, and now that I am eating, it may have worsened.
Many doctors have told me that probiotics are merely supportive supplements, but I worry about my sensitive constitution.
In this inflammatory state, my body might treat them as harmful agents.
Additionally, I have a history of allergic reactions to antibiotics, having developed a rash after taking them along with painkillers.
An endocrinologist suggested that I could be allergic to either of those medications, but I suspect antibiotics are the more likely culprit.
I later received corticosteroids and IV treatment to manage the rash.
Therefore, I am currently unable to determine whether to use antibiotics.
Most doctors have advised me to investigate whether my allergy is indeed related to antibiotics.
In the past, I managed less severe cases of acute gastroenteritis through self-healing.
However, this time it has become more severe, possibly due to changes in my bowel habits after the colonoscopy.
Previously, I had less frequent bowel movements, typically every 2-3 days, but after adjusting to a regular routine, I now go at least 4-6 times a day (with 2 of those occurring within an hour in the morning, afternoon, and evening).
In the past, even with acute gastroenteritis, I would only have 2-3 bowel movements with smaller volumes, unlike now, where the volume is significantly greater.
My previous poor dietary habits, often eating only one meal a day, contributed to the lower volume, but now I ensure I eat lunch and dinner.

Mr. Chen, 30~39 year old female. Ask Date: 2022/10/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please cooperate with a gastroenterologist to adjust your schedule and take your medication.

Reply Date: 2022/10/26

More Info

Severe diarrhea can be a distressing condition, often accompanied by abdominal pain and discomfort. Understanding the potential causes, symptoms, and management strategies is crucial for addressing this issue effectively.

Causes of Severe Diarrhea
1. Infections: One of the most common causes of acute diarrhea is infections, which can be viral (like norovirus or rotavirus), bacterial (such as E. coli, Salmonella, or Campylobacter), or parasitic (like Giardia). These infections can result from contaminated food or water, or close contact with infected individuals.

2. Food Intolerances and Allergies: Certain food intolerances, such as lactose intolerance or gluten sensitivity, can lead to gastrointestinal distress, including diarrhea. Allergies to specific foods can also trigger similar symptoms.

3. Irritable Bowel Syndrome (IBS): As you mentioned, IBS is a functional gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, and changes in bowel habits, including diarrhea. Stress and dietary changes can exacerbate these symptoms.

4. Medications: Certain medications, particularly antibiotics, can disrupt the natural balance of gut bacteria, leading to diarrhea. This is often referred to as antibiotic-associated diarrhea.

5. Stress and Lifestyle Factors: Stressful situations, such as work-related pressures or changes in routine (like sleep deprivation), can significantly impact gut health. The gut-brain connection means that psychological stress can manifest as physical symptoms, including diarrhea.

Symptoms to Monitor
In addition to diarrhea, you may experience:
- Abdominal cramps or pain
- Bloating and gas
- Urgency to have a bowel movement
- Nausea or vomiting
- Fever (in some cases)
It’s important to monitor for signs of dehydration, which can occur with severe diarrhea. Symptoms of dehydration include:
- Increased thirst
- Dry mouth and skin
- Dizziness or lightheadedness
- Reduced urine output

Management Strategies
1. Hydration: The most critical aspect of managing diarrhea is maintaining hydration. Drink plenty of fluids, such as water, clear broths, or oral rehydration solutions that contain electrolytes.

2. Dietary Adjustments: Initially, it may be beneficial to follow a bland diet. The BRAT diet (bananas, rice, applesauce, toast) is often recommended for easing gastrointestinal distress. Avoid dairy, fatty foods, and high-fiber foods until symptoms improve.

3. Probiotics: While you expressed concern about the use of probiotics during an active inflammatory state, they can be beneficial in restoring gut flora after an episode of diarrhea. However, if you feel that they exacerbate your symptoms, it may be wise to pause their use until your condition stabilizes.

4. Avoiding Triggers: Identify and avoid foods or beverages that may trigger your symptoms. Caffeine, alcohol, and spicy foods can irritate the gastrointestinal tract.

5. Rest: Ensure you get adequate rest, as fatigue can worsen gastrointestinal symptoms. Try to maintain a regular sleep schedule to support your overall health.

6. Medical Consultation: If diarrhea persists for more than a couple of days, or if you experience severe symptoms such as high fever, blood in your stool, or signs of dehydration, it is crucial to seek medical attention. A healthcare provider may recommend tests to identify the underlying cause and determine appropriate treatment, which may include medications.

Conclusion
In summary, severe diarrhea can stem from various causes, including infections, food intolerances, and stress. Monitoring your symptoms and maintaining hydration are essential steps in managing this condition. If symptoms persist or worsen, consulting a healthcare professional is vital for proper diagnosis and treatment. Remember, your health is paramount, and addressing these symptoms early can prevent complications.

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