Bowel Habits: Focusing On Diarrhea In Adults

Julita, BSN, RN

Bowel Habits

When we hear the words "bowel habits," many of us immediately think it’s none of your business!! This kind of reaction usually happens when someone is asking about your bowel habits. Let’s face it; nobody really wants to talk about their bowel habits to anyone, even to a nurse. I remember many times when patients would shy away from discussing their bowel habits during admission. No one really wants to discuss in detail something they feel is their private concern. Having a bowel movement is a private activity of daily living, so private that we do it in the washroom all alone. In the healthcare service, almost everything that we talk about can be considered a private matter. That includes patients’ bowel habits.

Discussions about bowel habits usually happen between patients and caregivers during admission to the hospital or when giving personal care to the patient. Most patients feel awkward when discussing their bowel habits with healthcare professionals. The clinical environment may not seem private enough for them to discuss freely without other patients hearing.

What is Diarrhea?

Diarrhea is also known by many terms like ‘dysentery’, ‘the trots’ and ‘the runs’. Diarrhea is when your bowels are very loose, watery and sometimes mixed with blood or smell very offensive. When someone has this type of bowel movement more than three times per day it is considered diarrhea. The consistency and frequency of the bowel movement are what classify it as diarrhea. Almost every adult has had diarrhea at some point in their life making it a very common ailment. Some symptoms are present when a person has diarrhea, but sometimes there are no other symptoms involved.

Causes of Diarrhea

In most cases, the causal factors for diarrhea are unknown, but sometimes diarrhea can be caused by the following:

Viral infections: Viruses like cytomegalovirus or norovirus can cause diarrhea in adults. Anyone who comes directly in contact with someone who is infected with norovirus can get diarrhea.
Bacterial infections: Bacteria like Salmonella, Shigella and E-Coli cause diarrhea, and these bacteria can be introduced into the body through contaminated food or water.
Side effects of medications: Antacids, antibiotics and chemotherapy drugs can cause diarrhea as one of their side effects. Bowel preparation solutions also cause temporary diarrhea during the time of cleansing your bowel for colonoscopy. People on tube feeding can have diarrhea quite often.
Fructose: This type of sugar is found in fruits, honey, fruit juices and as a sweetener in many soft drinks and people who have an intolerance to fructose may experience diarrhea each time they eat these foods.
Lactose intolerance: People who cannot digest milk or any dairy products may experience diarrhea after eating dairy foods.
Laxative abuse: People who suffer from chronic constipation usually take laxatives regularly and overuse of laxatives can result in diarrhea.
Post constipation: When you take medication to relieve constipation like fleet enemas, the end result is diarrhea as the stools get loosened by the laxative.
Diseases of the digestive system: People with Crohn's, ulcerative colitis, celiac disease usually have persistent diarrhea.
Surgery: Some people develop chronic diarrhea post abdominal surgery involving the appendix, liver, pancreas, stomach and small intestine, especially where bowel resection and anastomoses are performed.

Everyone has a part to play in preventing diarrhea by maintaining good hand washing techniques, especially:

after using protective equipment
after using the washroom
before giving medication
before preparing a meal
after touching contaminated surfaces
after touching an animal
after caring for a sick person

Using soap and water to thoroughly wash your hands is usually enough to remove any potential microorganisms.

Symptoms of Diarrhea

You may notice that the frequency of your bowels begins to increase and maybe the consistency has changed too. The color may be different from what you normally see in the toilet bowl and there may be blood in your stools. Diarrhea can occur in isolation or with a combination of symptoms like:

Abdominal pain or cramps
Nausea
Frequent vomiting
Fever of 102 degrees or greater
Bloating
Blood or mucus in stools
Urgency to open your bowels
Bowel incontinence

If your diarrhea lasts longer than 3 days and you notice any of the symptoms mentioned above do not ignore them. Diarrhea can be acute, or it can be chronic in nature.

Types of Diarrhea

Acute diarrhea

lasts less than 3 days and shorter than 2wks at the most
has a sudden onset
can result in severe abdominal cramps
viruses like norovirus in adults and coronavirus Covid-19 can cause acute diarrhea
Salmonella bacteria can cause acute traveler’s diarrhea typically seen among tourists in developing countries

Chronic diarrhea

means that it lasts longer than 4 wks
it keeps recurring more frequently
can be found in people who have gastrointestinal disorders like, irritable bowel syndrome, celiac disease, small intestinal bacterial overgrowth (SIBO), Crohn's and ulcerative colitis
can result in weight loss, malnutrition, dehydration, reduced sleep and lack of appetite

Many people with chronic diarrhea also have other underlying issues like bowel cancer, bowel obstruction, radiation to the abdomen and HIV which may contribute to the cause of diarrhea.

Why do you have diarrhea?

First of all, you need to be familiar with your own bowel habits. What is normal for one person, may not be normal for someone else. Our bowels are not like one size fits all. Some people have frequent bowel movements several times every day. Other people’s bowel movements are so infrequent, taking 2 or 3 days without opening their bowels. There are no specific criteria for normal bowels because everyone’s normal is different. Therefore, when things deviate from your normal pattern then you know something needs to be addressed.

Sometimes causes of diarrhea are unclear, and it may resolve without intervention but sometimes having diarrhea might mean that:

your intestines are not absorbing nutrients well
something is changing in your bowels
you might be getting severe side effects from medications
you may be having an allergic reaction to certain foods

Most caregivers want to know about patient’s bowel habits because they want to offer help. Always consult with your doctor or specialist and report any changes related to your bowel habits. Your doctor will need to thoroughly investigate the cause of your diarrhea if symptoms worsen.

Treatment for Diarrhea

The hospital’s infection control policy must be implemented in a timely manner to curb the spread of infection. If the diarrhea is caused by infectious microorganisms, healthcare staff may need to isolate the patient who is having diarrhea from other patients into a private room. Where such private rooms are not available the patient may have to be moved to another facility within the hospital where precaution measures can be adequately implemented. It’s very important to wear protective equipment like gowns, gloves and masks where necessary when dealing with a patient with diarrhea. Protective equipment should be removed before leaving the patient’s room to avoid cross infection.

It is crucial to identify the causes of diarrhea in order to treat it effectively. If the diarrhea symptoms are mild, then you may not need to take any medications for it. Diarrhea that is caused by certain foods like prunes or papaya may resolve on its own once you stop eating those foods. Whether you are at home or in hospital, symptom control is paramount in dealing with diarrhea. Diarrhea can be treated with anti-diarrheal drugs like:

Loperamide which can be taken as liquid or tablets
Octreotide can be given to patients whose diarrhea is caused by certain tumors

Caution is given to patients with diarrhea not to take medications without professional advice.

Certain foods can also help alleviate the symptoms of diarrhea like a ginger drink for stomach pain
Ensure that you replace any lost fluids by drinking plenty of fluids if there is no nausea associated with your diarrhea
Most healthcare professionals recommend drinking at least up to 8 ounces of fluid per day to avoid dehydration
A salt and sugar solution is preferable because it helps the intestines to absorb the fluids

It may be necessary to limit the movement of people in and out of the patient’s room until the diarrhea is effectively controlled. Good hand washing techniques must be practiced by all healthcare workers and visitors who come in contact with the patient with diarrhea.

Conclusion

All healthcare professionals play an important role in caring for a patient with diarrhea. Diarrhea is a common ailment that requires timely intervention. A good knowledge of how to treat a patient with diarrhea is life-changing. Managing diarrhea can be achieved by implementing simple changes in the patient’s diet. As healthcare providers, we should apply effective solutions to solve the patient’s problems and encourage patients to communicate their bowel habits openly.

References

CDC: Norovirus

Diarrheal Diseases: Acute and Chronic: American College of Gastroenterology

Diarrhea. Canadian Cancer Society. Last reviewed April 2021.

Diarrhea as a symptom of the Coronavirus (Covid-19) Canadian Digestive Health Foundation. Updated Dec 2021.

Diarrhea: Mayo Clinic

Diarrhea: Medline Plus

Guide To Infection Control In The Hospital. International Society for Infectious Diseases.

Symptoms and Causes of Diarrhea: NIH - National Institute of Diabetes and Digestive and Kidney Diseases

Diarrhea: WebMD