Secretory diarrhea symptoms. Chronic diarrhea: treatment, symptoms, causes, signs

The frequency of stool depends on many factors, a change in the standard amount can be caused by various diseases and ailments in the body. One of the causes of frequent stools is secretory diarrhea. Why does it occur and how to deal with it?

Symptoms of secretory diarrhea

Secretory diarrhea is accompanied by the following symptoms:

• Diarrhea with a frequency of up to 15-20 times a day;
• Stool watery, practically odorless;
• Green shade of feces;
• Defecation contains leftover food, undigested food;
• Spasms during bowel movements, but sometimes pain is absent.

Causes

Secretory diarrhea occurs as a result of an imbalance, namely, an increase in the secretory function of epithelial cells of mucous tissues.

According to the nature of its occurrence, it is of two types:

• non-infectious;
• Infectious.

non-infectious

The main causes of non-infectious type of secretory diarrhea include the following factors:

1. Taking strong laxatives.
2. Intoxication with arsenic salts, fungi, toxins.
3. Hormone-producing tumors that disrupt the balance of secretion.
4. Pancreatic cholera (VIPoma), which stimulates the growth and development of malignant tumors of the pancreas, intestinal mucosa. This causes high hypochlorhydria, which inhibits the secretion of hydrochloric acid in the digestive tract.
5. Gastirinoma or Zollinger-Ellison syndrome is a tumor consisting of cells that stimulate the development of gastritis. In this case, the level of salt secretion in the intestinal lumen increases.
6. Carcinoid syndrome affecting the intestinal organs and bronchi. The main symptom of the disease is an excessive increase in bradykinin and serotonin.
7. Thyroid carcinoma of the modular type stimulates an imbalance in the secretion of salts and water by enterocides.
8. Hereditary chloride diarrhea caused by gene mutation.
9. Hereditary diarrhea with a high level of sodium secretion, which is caused by a mutation in the gene responsible for the formation of the brush border of enterocytes. Often this condition occurs in women during multiple pregnancies.

infectious

A disease such as cholera is the most common cause of infectious secretory diarrhea.

In this case, the volume of feces during defecation increases to 10 liters per day, due to which a water-electrolyte-acid imbalance occurs.

Possible Complications

A large volume of bowel movements with secretory diarrhea, without qualified treatment, will lead to serious consequences:

• severe dehydration;
• Violation of homeostatic mechanisms;
• Dysfunction of electrolyte metabolism;
• hypokalemia;
• Hyponatremia;
• Acidosis.

In order to prevent a threat to health, it is necessary to take immediate treatment, after examination and consultation with a doctor.

Treatment of secretory diarrhea

Secretory diarrhea is the most important symptom of pathogenic and etiological disorders, which require timely treatment.

Elimination of symptoms

In addition to the main treatment, it is necessary to take medications that relieve adverse, painful symptoms:

1. "Smecta" is a natural drug that has an adsorbing effect, envelops the inflamed intestinal mucosa. A course of treatment is prescribed in the form of 1 sachet three times a day, take the solution 20 minutes before meals.
2. The drug "Neointestopan" allows you to adsorb and eliminate pathogenic pathogens, toxins from the intestinal cavity, and also improves absorption. For effective treatment, 4 tablets are prescribed for adults and 2 tablets for children every 4 hours. Treatment is allowed to be carried out no more than 2 days.
3. In addition, in the treatment of secretory diarrhea, increased drinking is necessary to restore the water-salt balance (Regidron).

Fight against pathogenic bacteria

When infectious secretory diarrhea occurs, treatment will be based on antibacterial drugs that will help in restoring the eubiosis of the intestinal cavity and secretion:

• "Nitrosoklin" (quinolines);
• "Cifran", "Tavrid" (fluoroquinols);
• "Ftalazol", "Biseptol" (sulfonamides);
• "Furazolin", "Furadonin" (nitrofurans).

Medicines that do not have a harmful effect on the intestinal microflora are highly effective:

This diet with secretory diarrhea allows you to enhance the motor-evacuation function of the intestine.

Restoration of microflora

To restore the intestinal microflora after diarrhea and taking medications, the preparation "Hilak-forte" containing lactic acid, fatty acids, amino acids, lactose is effectively used. Treatment allows you to restore the biologically normal intestinal microflora and prevent the growth of pathogenic bacteria. Assign a course of treatment for 3-4 weeks, 50-60 drops three times a day.

Secretory diarrhea is an unpleasant painful disease, but with qualified, timely treatment, favorable results can be achieved.

Diarrhea (diarrhea) is a clinical syndrome of various etiology and pathogenesis, characterized by frequent bowel movements with the release of watery or mushy stools. Acute and chronic diarrhea is common, but accurate statistics are not available, as many patients do not see a doctor because of false shame or embarrassment, especially for short episodes of diarrhea.

Brief information about the activity of the intestine
After food processing by gastric juice, food chyme is evacuated into the duodenum and, constantly mixing, moves through the small intestine at a speed that provides sufficient exposure of nutrients for cavitary and parietal (membrane) digestion and absorption. These processes are regulated by the autonomic nervous system with the participation of the peptidergic nervous system and intestinal hormonal peptides. The innervation of the smooth muscle elements of the small intestine is carried out by the ganglia of the intramural nervous system, and the external efferent innervation is provided by the parasympathetic and sympathetic fibers of the ANS.

Normal intestinal motility is the result of a balance between adrenergic and cholinergic influences. The peptidergic (neuropeptide) nervous system, being part of the autonomic nervous system, is not included in either its sympathetic or parasympathetic divisions. Localized mainly in the intermuscular nerve plexus of the duodenum, it mainly has an inhibitory effect on intestinal motility and secretion, being a link between the nervous and intestinal hormonal systems. The afferent fibers of the vagus nerve go to the nucleus in the medulla oblongata, and the efferent fibers come from the dorsal nucleus of the vagus. Both nuclei interact both with each other and with the smooth muscle elements of the small intestine. The intestinal hormonal system is represented by various types of endocrine cells that produce peptides in response to food and other stimuli that have a strictly specific effect on target organs.

The role of neurotransmitters is performed by bombesin and enkephalin. The main factor regulating the release of certain intestinal hormones is the composition of food chyme, as well as the speed of its movement through the small intestine. In the interdigestive period, hungry periodic motor activity of the intestine is observed, with which the secretory activity of the digestive glands (stomach, pancreas - liver) correlates. This is the so-called frontal activity, or migrating myoelectric complex. After a meal, the activity of the migrating myoelectric complex ceases and the concentration of intestinal hormones increases.

The small intestine is equipped with 3 types of receptors:
1) for intestinal hormones;
2) for local biologically active substances;
3) for neurotransmitters.

When interacting with receptors, the “AC-cAMP” system, calcium ions and / or “sodium pump (pump)” are activated. In addition, there are presynaptic receptors for prostaglandins, substance "P", as well as M1 and M3 muscarinic receptors and other agonists and antagonists.

The apical membrane of enterocytes with its glycocalyx and the enzyme systems of the small intestine perform a barrier function, preventing the penetration of macromolecules with antigenic properties and toxicity into the internal environment of the body.

The immune system of the small intestine is represented by Peyer's patches that produce secretory immunoglobulin A (sIgA) and IgE, which form an additional protective layer. The duodenum is the central link in the regulation of the secretory and motor functions of the entire gastrointestinal tract, where the contents of the stomach, pancreatic secretion, bile and the secretion of the Brunner glands enter.

Cavitary digestion is carried out due to the distant hydrolysis of nutrients by digestive enzymes. Some of them are fixed on dense food particles, and enzymes and substrates interact at the interface between the dense and liquid phases of food chyme, splitting it into oligo- and monomers. Membrane digestion occurs in the parietal (supra-epithelial) mucous layer. Continuously rejecting enterocytes and parietal mucus form "mucus lumps" containing intestinal enzymes and pancreatic enzymes adsorbed on the mucus, which ensure the hydrolysis of a part of food biopolymers. In the brush border, intestinal enzymes (dipeptidases, monoglyceride lipase, etc.) are fixed. During membrane hydrolysis, under the influence of intestinal enzymes built into the surface of the outer side of the brush border membrane, oligo- and dimers are hydrolyzed to monomers.

The normal microflora of the proximal small intestine is not numerous (
Schematically, one can imagine a 4-link system of the digestive-transport conveyor:
cavity hydrolysis;
parietal digestion in the mucus layer;
membrane digestion;
absorption of hydrolyzed nutrients (monomers) by endocytosis.

Carbohydrates are cleaved by pancreatic α-amylase to oligosaccharides, and their final hydrolysis (to monosaccharides) occurs near the wall with the help of intestinal enzymes (sucrose, γ-amylase, lactase, isomaltase, etc.). The resorption of monosaccharides (D-glucose) is carried out with the participation of a carrier protein. Undigested carbohydrates undergo microbial cleavage in the colon under the influence of microbial hydrolases. Proteins are hydrolyzed by proteolytic enzymes of pancreatic juice (trypsin, chymotrypsin, elastase, carboxypeptidases A and B) to oligopeptides, and their cleavage to amino acids and absorption occurs on the brush border membrane. Low molecular weight peptides penetrate the enterocyte membrane and are hydrolyzed intracellularly to amino acids. Fats are first emulsified in the lumen of the small intestine by bile acids and then hydrolyzed by pancreatic lipase. Insoluble products of lipolysis are first converted into a water-soluble form, after which they are absorbed. The free fatty acids and monoglycerides formed during the hydrolysis of fats penetrate enterocytes by active transport and, having combined with the transport protein, are transferred to the endoplasmic reticulum, where resynthesis of medium chain triglycerides occurs, which are more easily absorbed than triglycerides containing fatty acids with long chains.

Transport vesicles with the products of hydrolysis of nutrients included in them are involved in intracellular metabolism. Active transport is an energy-dependent process that occurs against electrochemical and concentration gradients and depends on the presence of sodium ions on the brush border membrane. Passive transport occurs by simple diffusion and with the help of carrier proteins.

Etiology, pathogenesis and classification
According to the etiology, several groups (categories) of diarrhea can be distinguished.
Infectious diarrhea:
- bacterial (shigella, salmonella, campylobacter, yersinia, enteropathogenic Escherichia coli, etc.);
- viral (rotaviruses, Norfolk virus, astroviruses, etc.).

Diarrhea in neoplastic processes (malignant lymphoma of the small intestine; hormonally active tumors - gastrinoma, vipoma, carcinoid syndrome, etc.).
Diarrhea in endocrine diseases (diabetes mellitus, thyrotoxicosis, etc.).
Diarrhea with intestinal enzymopathies (celiac disease, disaccharidase deficiency, etc.).
Diarrhea in inflammatory idiopathic bowel diseases (ulcerative colitis - ulcerative colitis, Crohn's disease).
Diarrhea with ischemic lesions of the intestine (ischemic enteritis and colitis).
Diarrhea with medicinal lesions of the intestine (antibiotics, cytostatics, abuse of laxatives, etc.).
Diarrhea in chronic occupational intoxication (lead, arsenic, mercury, phosphorus, cadmium, etc.).
Postoperative diarrhea (postgastrectomy, postvagotomy, postcholecystectomy), after resection of a part of the small or large intestine (short bowel syndrome), with biliary-intestinal fistulas, etc.
Diarrhea in various diseases.
functional diarrhea.
Idiopathic diarrhea is diagnosed when the cause of the diarrhea cannot be established clinically. Sometimes, with a histological study of colon biopsy specimens, a diagnosis of microscopic colitis is established - lymphocytic, collagenous, eosinophilic; primary malabsorption of bile acids in the ileum, etc. In other cases, the cause of diarrhea remains unknown.

Infectious diarrhea, in turn, is divided into:
toxinogenic;
invasive.

With toxinogenic diarrhea, the decisive role belongs to the action of bacterial toxins (Vibrio cholerae, enteropathogenic Escherichia coli, Aeromonas, etc.); with invasive diarrhea - direct damage to the intestinal mucosa by bacteria penetrating enterocytes (Shigella, Salmonella, Campylobacter, Yersinia, etc.).

According to pathogenesis, they are distinguished:
hypersecretory diarrhea;
hyperosmolar diarrhea;
hyper- and hypokinetic diarrhea;
hyperexudative diarrhea.

According to the flow conditionally distinguish:
acute diarrhea (chronic diarrhea (>3 weeks).

Hypersecretory diarrhea is its most common form, which develops during pathological processes in the small intestine in cases where the secretion of water and electrolytes prevails over their absorption. It occurs with cholera, viral lesions of the small intestine, with hormonally active tumors (gastrinoma, vipoma), excessive accumulation of free bile acids and long-chain fatty acids in the intestinal lumen, as well as with the abuse of laxatives from the group of anthraglycosides (senna, buckthorn, rhubarb preparations), taking prostaglandin preparations (misoprostol, enprostil), etc. The "AC-cAMP" system takes part in the pathogenesis of secretory diarrhea. maldigestia and malabsorption, with exocrine pancreatic insufficiency, taking osmotic laxatives (sorbitol, mannitol, lactulose, polyethylene glycol, saline laxatives).

Hyper- and hypokinetic diarrhea is most often caused by a reduction in the transit time of intestinal contents through the gastrointestinal tract or a decrease in the length of the intestine in case of short bowel syndrome (after resection of a significant part of the small or large intestine), as well as after gastrectomy, vagotomy with pyloroplasty, in the presence of inter-intestinal anastomoses in the small intestine, thyrotoxic and diabetic enteropathy, irritable bowel syndrome with diarrhea, psychogenic diarrhea ("bear's disease").

Hyperexudative diarrhea occurs in inflammatory idiopathic bowel diseases, in which a lot of mucus and blood is released into the intestinal lumen; with some bacterial intestinal infections (shigella, salmonella, campylobacter, clostridia, etc.), with intestinal tuberculosis, ischemic enteritis and colitis, colorectal cancer and malignant lymphoma of the small intestine; exudative enteropathy with the release of a significant amount of protein into the intestinal lumen, etc.

Clinical picture
In case of acute diarrhea in history, there are no indications of episodes of diarrhea in the past, and its duration does not exceed 2-3 weeks. Patients usually complain of general malaise, abdominal pain (more often with damage to the colon), anorexia, sometimes vomiting, fever. With food poisoning caused by staphylococci, vomiting predominates. When the pathogens are Shigella or Salmonella, vomiting usually does not occur. In acute infectious diarrhea associated with enteropathogenic Escherichia coli, Shigella or Campylobacter, there are frequent urge to defecate, tenesmus, unformed scanty feces with an admixture of blood and mucus. In ulcerative colitis and granulomatous colitis, mucus and blood also appear in the stools. The course of acute diarrhea can be severe due to intoxication, dehydration, attacks of abdominal pain, tenesmus. In some cases, metabolic acidosis develops, convulsive syndrome (with a deficiency of calcium, magnesium, potassium). In chronic recurrent diarrhea, in addition to rapid liquid or mushy stools, patients are concerned about: flatulence, rumbling and transfusion in the intestines, abdominal pain, mainly around the navel, sometimes with irradiation to the back. The pains are pulling, arching (distensional), sometimes spastic in nature, relieved after defecation and gas discharge. With a long progressive course of diarrheal syndrome, dehydration of the body gradually develops, body weight decreases, trophic disorders appear (dry skin, maceration, brittleness and hair loss, nail deformities), changes in the oral cavity (an increase in the size of the tongue with imprints of teeth along the edges, raspberry or " polished" tongue with papillary atrophy, glossitis, cheilitis, stomatitis, fissures and ulcerations). The clinical picture in chronic diarrhea is determined mainly by the development of maldigestion and malabsorption syndromes - malassimilation with a disorder of all types of metabolism (water-salt, protein, lipid, carbohydrate, vitamin, etc.), the appearance of steatorrhea, creatorrhea and amylorrhea.

It is proposed to distinguish:
Primary disorders of digestion and absorption:
- disaccharidase deficiency and celiac disease (gluten enteropathy);
- congenital malabsorption of sucrose, isomaltose, glucose, galactose;
- congenital disorders of absorption of amino acids (tryptophan, methionine, cysteine);
- congenital disorders of fat absorption (abetalipoproteinemia), as well as bile acids and vitamins (B12, folic acid);
- congenital disorders of absorption of minerals (zinc, magnesium, copper) and electrolytes.

Secondary disorders of digestion and absorption: - short bowel syndrome;
- secondary variable hypogammaglobulinemia;
- acquired immunodeficiency syndrome;
- secondary endocrine enteropathy (diabetic, thyrotoxic, etc.);
- hormonally active tumors of the APUD system (gastrinoma, vipoma, carcinoid syndrome, etc.);
- intestinal amyloidosis and scleroderma;
- cystic fibrosis;
- secondary intestinal fermentopathy (decreased activity of lactase, sucrase, trehalase, cellobiase, etc.);
- others.

Over time, patients with chronic diarrhea develop polyhypovitaminosis due to impaired utilization of fat-soluble (A, K, E, D) and water-soluble vitamins (B-complex, C, PP, etc.). Clinically, hypovitaminosis is manifested by hemorrhagic syndrome (bleeding gums, skin hemorrhages with vitamin K deficiency), deterioration in visual acuity, especially at night, and hyperkeratosis (with vitamin A deficiency), skin hyperpigmentation, glossitis, burning on the tip of the tongue, osteoporosis (with vitamin A deficiency). D) etc.

Complications of chronic diarrhea are: iron deficiency and megaloblastic anemia, which develop due to impaired iron utilization and absorption of vitamins B12 and folic acid; adrenal insufficiency, occurring with arterial hypotension and skin pigmentation; hypofunction of the gonads with impotence in men and dysmenorrhea in women; pituitary dysfunction with the development of diabetes insipidus, occurring with polydipsia, polyuria and nocturia.

Some patients with chronic diarrhea develop food intolerance and secondary exudative enteropathy with the loss of a significant amount of protein through the intestines and the development of hypoproteinemia, hypoalbuminemia and dystrophic (hypoproteinemic) edema, cachexia. You should also pay attention to the mental status of patients with chronic diarrhea: often they have a feeling of anxiety, anxiety, depression. Some patients focus all their attention on disorders of the act of defecation to the detriment of other interests and responsibilities, demanding the same attention to their feelings and experiences both from the doctor (which is natural) and from others.

Diagnostics
Verification of the true causes of diarrhea is an extremely difficult and sometimes impossible task. An in-depth study of the anamnesis is required, especially with intestinal enzymopathies (celiac disease, hypolactasia, etc.), features of clinical manifestations and course, as well as complications of chronic diarrhea. The most important is the rational use of numerous laboratory and instrumental diagnostic methods, taking into account their information content and correct clinical interpretation.

It is advisable to identify some of the characteristic clinical symptoms of diarrhea of ​​various origins. So, with diarrhea caused by damage to the pancreas (chronic pyelonephritis, cancer), epigastric pain occurs with typical irradiation to the back or to the left hypochondrium (in the form of a left-sided half-belt). With gastrinoma (Zollinger-Ellison syndrome) - local ulcer-like pain in the epigastric region without irradiation; with Crohn's disease - cramping abdominal pain in the umbilical region. In ulcerative colic and pseudomembranous colitis, watery diarrhea with mucus-bloody stools is observed. Fever is characteristic of ulcerative colic, Crohn's disease, malignant lymphoma of the small intestine, Whipple's disease, and acute infectious diarrhea. With hypolactasia and celiac disease, diarrhea develops every time after taking dairy products or products and dishes made from wheat, rye, oat or barley groats (flour), respectively. "Drum" fingers are found in patients with ulcerative colic, Crohn's disease, with Whipple's disease, and hyperpigmentation of the skin - with malabsorption syndrome complicated by adrenal insufficiency (Addison's disease), with celiac disease, Whipple's disease. With intestinal carcinoid syndrome, occasionally with vipoma (Werner-Morrison disease), bouts of reddening of the face, neck, and trunk occur. Lymphadenopathy is characteristic of malignant lymphoma of the small intestine and Whipple's disease, and neuropathy can complicate the course of diabetic enteropathy, intestinal amyloidosis and Whipple's disease. Abundant watery diarrhea occurs with vipoma and carcinoid syndrome, the abuse of laxatives. With exocrine pancreatic insufficiency, which occurs with steatorrhea, creatorrhoea and amylorrhea, a characteristic pancreatic stool appears: abundant, unformed, viscous, grayish in color, shiny (“fatty”) with a fetid odor, poorly washed off with water from the toilet. Scanty muco-bloody diarrhea, but without steatorrhea, occurs when the colorectal region is affected by an inflammatory or tumor process (ulcerative colic, granulomatous colitis; dysentery, amoebiasis, cancer, etc.). Laboratory and instrumental diagnosis of diarrhea of ​​various origins

In case of malabsorption syndrome, a dynamic test is performed with D-xylose, a load of albumin-131. As you know, malabsorption syndrome occurs in many diseases, so each time it is necessary to establish a nosological diagnosis. An important diagnostic value belongs to a bacteriological study with sowing of feces on bacterial media and obtaining a culture of microorganisms. At the same time, the growth of a culture of pathogenic bacteria (Shigella, Salmonella, Yersinia, etc.) is obtained, III-IV degree of colon dysbiosis is detected with a sharp inhibition of indigenous microflora (bifido-, lactobacilli) and the dominance of opportunistic or pathogenic microorganisms (clostridia , Proteus, Klebsiella, Staphylococcus, etc.).

The main disadvantages of bacteriological examination of feces in diarrhea syndrome are:
delay in obtaining results (after 3-5 days);
bacteria not always sown from feces are the true cause of diarrheal syndrome;
not all microbes that cause diarrhea grow on bacterial media.

Clostridium difficile culture is usually isolated from feces in pseudoembramotic colitis (method sensitivity 81-100%, specificity 84-98%). In addition, bacterial culture cytotoxicity test (sensitivity 67-100%, specificity 88-96%), enzyme immunoassay (sensitivity 68-100%, specificity 75-100%) or polymer chain reaction (sensitivity 97%, specificity 100%). Recently, preference has been given to the determination not of the microorganisms themselves (Clostridium difficile), but of their toxins (A and B) using the ELISA test.

Excessive bacterial contamination of the small intestine is established by inoculation of the contents of the jejunum on bacterial media, extracted using a special small intestine probe (normal
In exocrine pancreatic insufficiency, a test was recognized that detects a deficiency in the feces of the elastase-1 enzyme (enzymatic immunoassay with monoclonal antibodies: 7 g per day when taking 70-100 g of fat in the daily diet).

Of the instrumental diagnostic methods for diseases of the colon that occur with chronic diarrhea syndrome, the most informative are: contrast irrigoscopy and especially colonoscopy with targeted biopsy. In the morphological study of biopsy specimens, direct light and (according to indications) electron microscopy are used. These methods allow diagnosing peptic ulcer and Crohn's disease of the colon, pseudomembramous colitis, Whipple's disease, tuberculous ileotiflitis, congenital and acquired anomalies, stenosis; diverticulosis and other organic pathological processes in the colon. At the same time, in functional bowel diseases, neither visually nor histologically, changes in the large intestine are detected.

In case of microscopic colitis (lymphocytic, collagenous and eosinophilic), no organic changes are visually detected during colonoscopy, and the diagnosis is established by histological examination of the biopsy material. To diagnose organic pathological processes in the small intestine, contrast fluoroscopy and radiography are used, but it is less informative than colon irrigoscopy. A targeted biopsy of the small intestine is performed through an endoscope. Whipple disease is diagnosed by histological examination of biopsy specimens of the duodenum or jejunum based on the detection of PAS-positive macrophages.

In the differential diagnosis of diarrhea caused by exocrine pancreatic insufficiency and malabsorption syndrome in the small intestine, a radionuclide test with trioleate glycerol labeled with 131I and oleic acid labeled with 131 is used. oleic acid labeled with a radionuclide, not absorbed in the small intestine. Methods have been developed for the chemical determination of microbes that cause diarrhea in feces using gas chromatography and mass spectrometry, based on the analysis of the composition of monomeric chemical components of a microbial cell and its metabolites (marker substances).

Ultrasonography and computed tomography are used to assess structural changes in the liver, gallbladder, pancreas, and kidneys as possible causes of chronic diarrhea. The causes of acute and chronic diarrhea are so numerous and varied that it is impossible to describe them in one chapter. In this regard, we will limit ourselves to brief information only about some relatively rare diseases that occur with diarrhea syndrome, with which practitioners are not familiar enough.

Treatment
Due to the variety of causes of diarrhea and the complexity of its pathogenesis, it is necessary in each case to prescribe an individualized, strictly differentiated therapy, taking into account the etiology, development mechanisms and characteristics of clinical symptoms.

Health food
A diet within treatment table No. 4 and its variants is recommended, which include slimy soups, rice dishes, dried bread, baked potatoes, crackers, etc. Aggravate diarrhea addiction to beer and coffee, salty, fatty foods, spicy spices, whole milk, coarse varieties of vegetables and fruits. Salt is limited (8-10 g per day). With celiac disease, dishes and products made from wheat, rye, barley and oat flour and cereals (gluten-free diet) are completely excluded, and with hypolactasia - dairy products.

In acute diarrhea that occurs with excruciating nausea and repeated vomiting, it is recommended to spend 1-2 hungry days. It also has a diagnostic value: in the case of malabsorption syndrome of various genesis, diarrhea stops on the background of starvation, but not in vipoma and gastrinoma. In the future, they move to the treatment table No. 4b. With mild forms of diarrhea, herbal medicine helps (anise, caraway seeds, juniper, bird cherry, blueberries, St. John's wort, oregano, wormwood, yarrow, chamomile, mint, calamus, elecampane, valerian root, marshmallow).

Pharmacotherapy
In the treatment of infectious diarrhea, it is most often necessary to prescribe antibacterial agents: intestinal antiseptics, 5-nitrofuran derivatives (furazolidone, nifuroxazide, or ersefuril, etc.), 8-hydroxyquinoline (chlorquinaldol, nitroxoline), 5-nitroimidazole (metronidazole, tinidazole, ornidazole ); non-fluorinated quinolones (negrams, nevigramon) - derivatives of nalidixic acid.

Bacteriological analysis of faeces makes it possible to establish the microbial causative agent of diarrhea not earlier than after 3 days, therefore, in the first days of the disease, empirical antimicrobial therapy is carried out with intestinal antiseptics (intetrix, enterosediv, etc.), fluoroquinolones (ciprofloxacin, etc.) or rifaximin.

In the treatment of diarrhea caused by shigella, it is preferable to prescribe ciprofloxacin (500 mg 2 times a day, 5-7 days), nifuroxazide (200 mg 4 times a day, 5-7 days) or cotrimoxazole (960 mg 2 times a day, 5 days ); with salmonella infection - chloramphenicol (2000 mg 3 times a day, 14 days), cotrimoxazole or ciprofloxacin; with campylobacter - doxycycline (100-200 mg per day, 10-14 days) or ciprofloxacin (3-5 days); with yersiniosis - tetracycline (250 mg 4 times a day, 5-7 days) or ciprofloxacin. It should be borne in mind that intestinal infection and its treatment with antibacterial agents in 100% of cases cause the development of colonic dysbiosis of varying severity and can cause antibiotic-associated diarrhea and its most severe (fulminant) form - pseudomembranous colitis, the causative agent of which is Clostridium difficile. First-line drugs are recommended vancomycin (125-250 mg 4 times a day, 7-10 days) or metronidazole (500 mg 4 times a day, 7-10 days), and bacitracin (125 thousand IU 4 times) as a reserve antibiotic. per day, 7-10 days). Prevention of recurrence of clostridial infection is achieved by taking enterol containing medicinal yeast fungi Saccharomyces boulardii: 2-4 sachets (500-1000 mg per day, 3-4 weeks).

For traveler's diarrhea, which is most often caused by enteropathogenic Escherichia coli, co-trimoxazole, ersefuril (200 mg 3 times a day, 5-7 days), tannacomp, and more recently rifaximin are prescribed. Co-trimoxazole, ciprofloxacin, doxycycline, intetrix and metronidazole are effective in Whipple's disease, which are prescribed for a long period (6-10 months) in combination with pro- and prebiotics. Some authors additionally recommend taking budesonide (capsules 3 mg 2-3 times a day, 5-7 days), nitazoxanide (500 mg 2 times a day) or a combination of paromomycin (1000 mg 2 times a day) with azithromycin (600 mg per day). days). In schistosomiasis, praziquantel (biltricid) is most active at a dose of 40-60 mg / kg of body weight per day in 2-3 doses, 10-14 days.

With candidal diarrhea, intestopan (200 mg 3 times a day) is prescribed, and with disseminated forms, amphotericin B (from the group of polyene antibiotics) intravenously, 50 thousand units in a 5% glucose solution (often gives side effects). Viral diarrhea (rotavirus, etc.) in most cases does not require medical treatment and stops on its own within 5-7 days. In order to increase the body's resistance to viral infection, some authors recommend the appointment of immunomodulating agents.

Diarrhea caused by exocrine pancreatic insufficiency is treated with microencapsulated preparations of pancreatic enzymes (creon, pancitrate, licrease, etc.). For functional diarrhea, the symptomatic antidiarrheal drug Imodium is used: 4 mg per dose, then 2 mg after each episode of diarrhea. With secondary diarrhea (diabetic, thyrotoxic, etc.), the most important condition for achieving the effect is the successful treatment of the underlying disease, complicated by diarrhea syndrome; symptomatic agents are also used.

Protracted, severe forms of chronic diarrhea are complicated by dehydration, disturbances in the water-electrolyte and alkaline-acid state of the body, and endogenous intoxication. For rehydration, glucose-salt solutions of various compositions are used for oral administration: rehydron, citroglucosolan, etc. Additionally, complex carbohydrates (rice powder and other cereals), attapulgite (neointestopan) are taken orally, 4 tablets in the morning and 2 tablets after each episode of diarrhea, or tannacomp , which includes ethacridine and tannin-albuminate. In rare cases, there is a need for infusion therapy (2-3 liters per day) with the use of protein hydrolysates, amino acid mixtures, fat emulsions, glucose, electrolytes, vitamins, microelements. At the same time, it is advisable to prescribe protein anabolizers (retabolil, etc.). A few words should be said about sandostatin (octreotide), a synthetic analogue of somatostatin, which is effective in diarrhea caused by hormonally active tumors (gastrinoma, vipoma, carcinoid syndrome) occurring with resistant forms of secretory diarrhea; with short bowel syndrome, diabetic enteropathy. Octreotide inhibits the synthesis of VIP, serotonin, gastrin, inhibits intestinal motility and secretion. Dose - 100 mcg subcutaneously 3 times a day, 7-8 days. The success of the treatment of various forms of acute and chronic diarrhea depends entirely on the appointment of an individualized etiotropic and pathogenetically justified selection of drugs.

Diarrhea(diarrhea) - rapid, repeated loose stools. Diarrhea is usually accompanied by pain, rumbling in the abdomen, flatulence, tenesmus. Diarrhea is a symptom of many infectious diseases and inflammatory processes of the intestine, dysbacteriosis, and neurogenic disorders. Therefore, the diagnosis and treatment of the underlying disease plays an important role in the prevention of complications. The loss of a large amount of fluid during profuse diarrhea leads to a violation of the water-salt balance and can cause heart and kidney failure.

General information

Diarrhea is called a single or frequent bowel movement with liquid stools. Diarrhea is a symptom that signals a malabsorption of water and electrolytes in the intestine. Normally, the amount of feces excreted per day by an adult varies between 100-300 grams, depending on the characteristics of the diet (the amount of vegetable fiber consumed, poorly digestible substances, liquids). In the case of increased intestinal motility, the stool may become more frequent and thin, but its amount remains within the normal range. When the amount of fluid in the feces increases to 60-90%, then they talk about diarrhea.

There are acute diarrhea (lasting no more than 2-3 weeks) and chronic. In addition, the concept of chronic diarrhea includes a tendency to periodically plentiful stools (more than 300 grams per day). Patients suffering from malabsorption of various nutrients have a tendency to polyfaeces: the excretion of large amounts of stool containing undigested food debris.

Causes of diarrhea

With severe intoxication in the intestine, excessive secretion of water with sodium ions into its lumen occurs, which helps to thin the stool. Secretory diarrhea develops with intestinal infections (cholera, enteroviruses), taking certain medications and dietary supplements. Osmolar diarrhea occurs with malabsorption syndrome, insufficiency of sugar digestion, excessive consumption of osmotically active substances (laxative salts, sorbitol, antacids, etc.). The mechanism of development of diarrhea in such cases is associated with an increase in osmotic pressure in the intestinal lumen and diffusion of fluid along the osmotic gradient.

A significant factor contributing to the development of diarrhea is a violation of intestinal motility (hypokinetic and hyperkinetic diarrhea) and, as a result, a change in the rate of transit of intestinal contents. Strengthening of motility is facilitated by laxatives, magnesium salts. Motor function disorders (weakening and strengthening of peristalsis) occur with the development of irritable bowel syndrome. In this case, they talk about functional diarrhea.

Inflammation of the intestinal wall causes the exudation of protein, electrolytes and water into the intestinal lumen through the damaged mucosa. Exudative diarrhea accompanies enteritis, enterocolitis of various etiologies, intestinal tuberculosis, acute intestinal infections (salmonellosis, dysentery). Often with this type of diarrhea in the stool there is blood, pus.

Diarrhea can develop as a result of taking medications: laxatives, antacids containing magnesium salts, certain groups of antibiotics (ampicillin, lincomycin, cephalosporins, clindamycin), antiarrhythmic drugs (quindiline, propranol), digitalis preparations, potassium salts, artificial sugars (sorbitol, mannitol) , cholestyramine, chenodeoxycholic acid, sulfonamides, anticoagulants.

Classification

There are the following types of diarrhea: infectious (with dysentery, salmonellosis, amebiasis, food poisoning and entroviruses), alimentary (associated with disorders in the diet or an allergic reaction to food), dyspeptic (accompanies digestive disorders associated with insufficiency of the secretory functions of the digestive system: liver, pancreas, stomach; as well as with insufficient secretion of enzymes in the small intestine), toxic (with arsenic or mercury poisoning, uremia), drug (caused by drugs, drug dysbacteriosis), neurogenic (with changes in motility due to impaired nervous regulation associated with psycho-emotional experiences).

Clinical Features of Diarrhea

In clinical practice, acute and chronic diarrhea are distinguished.

Acute diarrhea

chronic diarrhea

Diarrhea that lasts more than 3 weeks is considered chronic. It can be the result of various pathologies, the identification of which is the main task for determining treatment tactics. History data, concomitant clinical symptoms and syndromes, and physical examination can provide information about the causes of chronic diarrhea.

Particular attention is paid to the nature of the stool: the frequency of defecation, daily dynamics, volume, consistency, color, the presence of impurities in the feces (blood, mucus, fat). When questioned, the presence or absence of concomitant symptoms is revealed: tenesmus (false urge to defecate), abdominal pain, flatulence, nausea, vomiting.

Pathologies of the small intestine are manifested by abundant watery or fatty stools. For diseases of the large intestine, less abundant stools are characteristic, streaks of pus or blood, mucus may be noted in the feces. Most often, diarrhea with lesions of the large intestine is accompanied by pain in the abdomen. Diseases of the rectum are manifested by frequent scanty stools as a result of increased sensitivity to stretching of the intestinal walls, tenesmus.

Diagnosis of diarrhea

Acute diarrhea, as a rule, is characterized by a very pronounced loss of fluid and electrolytes with feces. During examination and physical examination of the patient, signs of dehydration are noted: dryness and a decrease in skin turgor, increased heart rate and a decrease in blood pressure. With a pronounced calcium deficiency, the symptom of a "muscle roller" becomes positive, there may be convulsions.

With diarrhea, the patient's stool is always carefully examined, in addition, it is desirable to carry out a proctological examination. Identification of an anal fissure, fistula, paraproctitis may suggest the presence of Crohn's disease. With any diarrhea, a comprehensive study of the digestive tract is performed. Instrumental endoscopic techniques (gastroscopy, colonoscopy, irrigoscopy, sigmoidoscopy) allow you to examine the inner walls of the upper gastrointestinal tract and large intestine, detect mucosal damage, inflammation, neoplasms, bleeding ulcers, etc.

Microscopy of feces reveals a high content of leukocytes and epithelial cells in it, which indicates the presence of inflammation of the mucous membrane of the digestive tract. The detected excess of fatty acids is a consequence of malabsorption of fats. Together with the remnants of muscle fibers and a high content of starch in the stool, steatorrhea is a sign of malabsorption syndrome. Fermentation processes due to the development of dysbacteriosis contribute to a change in the normal acid-base balance in the intestine. To identify such disorders, intestinal pH is measured (normally 6.0).

Persistent diarrhea in combination with excessive gastric secretion is characterized by Zollinger-Ellison syndrome (ulcerogenic adenoma of the pancreas). In addition, prolonged secretory diarrhea may be the result of the development of hormone-producing tumors (for example, vipoma). Laboratory blood tests are aimed at identifying signs of an inflammatory process, biochemical markers of liver and pancreas dysfunction, hormonal disorders that can be causes of chronic diarrhea.

Treatment of diarrhea

Diarrhea is a symptom of many diseases, therefore, in the choice of medical tactics, the main role is played by the identification and treatment of the underlying pathology. Depending on the type of diarrhea, the patient is referred for treatment to a gastroenterologist, an infectious disease specialist, or a proctologist. It is imperative to seek medical attention if you have diarrhea that lasts more than 4 days, or if you notice streaks of blood or mucus in the stool. In addition, symptoms that should not be ignored are: tarry stools, abdominal pain, fever. If there are signs of diarrhea and there is a possibility of food poisoning, it is also necessary to consult a doctor as soon as possible.

Treatment for diarrhea depends on the type of diarrhea. And it includes the following components: dietary nutrition, antibacterial therapy, pathogenetic treatment (correction of malabsorption in case of enzyme deficiencies, reduction of gastric secretion, drugs that normalize intestinal motility, etc.), treatment of the consequences of prolonged diarrhea (rehydration, restoration of electrolyte balance).

With diarrhea, foods are introduced into the diet that help reduce peristalsis, reduce the secretion of water into the intestinal lumen. In addition, the underlying pathology that caused diarrhea is taken into account. Diet components should correspond to the functional state of digestion. Products that promote the secretion of hydrochloric acid and increase the rate of evacuation of food from the intestines are excluded from the diet for the duration of acute diarrhea.

Antibiotic therapy for diarrhea is prescribed to suppress the pathological flora and restore normal eubiosis in the intestine. With infectious diarrhea, broad-spectrum antibiotics, quinolones, sulfonamides, nitrofurans are prescribed. The drugs of choice for intestinal infections are drugs that do not adversely affect the intestinal microbiocenosis (combined drugs, nifuroxazide). Sometimes, with diarrhea of ​​various origins, eubiotics may be prescribed. However, more often such treatment is prescribed after the signs of diarrhea subside to normalize the intestinal flora (eliminate dysbacteriosis).

As symptomatic agents, adsorbents are used, enveloping and astringent agents that neutralize organic acids. To regulate intestinal motility, loperamide is used, in addition, acting directly on the opiate receptors of the small intestine, reducing the secretory function of enterocytes and improving absorption. A pronounced antidiarrheal effect is exerted by somatostatin, which affects the secretory function.

In infectious diarrhea, drugs that reduce intestinal motility are not used. Loss of fluid and electrolytes with prolonged and profuse diarrhea requires rehydration measures. Most patients are prescribed oral rehydration, but in 5-15% of cases there is a need for intravenous administration of electrolyte solutions.

Prevention of diarrhea

Diarrhea prevention includes body hygiene and nutrition. Washing hands before eating, thoroughly washing raw vegetables and fruits, and properly cooking foods help avoid food poisoning and intestinal infections. In addition, it is worth remembering the need to avoid drinking raw water, unfamiliar and suspicious food, food products that can cause an allergic reaction.

Diarrhea (diarrhea ) is a condition in which there is a fairly frequent or single emptying of the intestines of a person, during which the feces of a liquid consistency are released. In an adult healthy person, from 100 to 300 g of fecal mass is excreted per day. Its amount varies depending on the amount of fiber in the food and the amount of undigested substances and water remaining. If the duration of the disease remains within two to three weeks, then in this case there is acute diarrhea . If a person has loose stools for more than three weeks, diarrhea becomes chronic. At chronic diarrhea the patient also has systematically abundant stools. In this situation, the mass of feces will exceed 300 g per day. Diarrhea occurs when the water content in a person's stool increases dramatically - from 60 to 90%. With impaired absorption of nutrients from food, patients are diagnosed with polyfecal matter : an unusually large amount of stool is released, which consists of food debris that has remained undigested. In case of impaired intestinal motility, the stool will be very liquid and frequent, but in general its mass will not exceed 300 g per day. That is, even in the case of an initial analysis of the features of the course of diarrhea, you can find out what is the cause of such a pathology and, therefore, facilitate the process of establishing a diagnosis and selecting subsequent therapy.

Diarrhea of ​​any kind is a pathological process in which there is a violation of absorption in the intestine of water and electrolytes. In view of this, with diarrhea of ​​any kind, approximately the same picture is observed. Both the large and small intestines have a very high water absorption capacity. So, every day a person consumes about two liters of liquid. In general, about seven liters of water enter the intestines, taking into account saliva , , intestinal And , . At the same time, only 2% of the total volume of liquid is excreted with feces, while the rest is absorbed directly in the intestine. If the amount of fluid in the stool changes even very slightly, then the stool becomes too hard. If there is too much fluid in the large intestine, then the person develops diarrhea. This disease manifests itself due to a disorder in the process of digestion, problems with absorption, secretion and intestinal motility. In the case of diarrhea, the small and large intestines are perceived as a single physiological unit.

Types of diarrhea

At secretory diarrhea there is an increased secretion of electrolytes and water into the intestinal lumen. In more rare cases, the cause of this type of diarrhea is a decrease in the absorption functions of the intestine. So, secretory diarrhea manifests itself with cholera , escherichiosis , salmonellosis . But sometimes a similar condition occurs in patients with some non-infectious pathologies. If a patient has this type of diarrhea, the osmotic pressure of the blood plasma is higher than the osmotic pressure of the stool. The patient has watery and rather abundant stools, their color is green. The causes of secretory diarrhea are the active process of secretion of sodium and water in the intestine. The occurrence of this process is provoked by bacterial toxins, enteropathogenic viruses, a number of drugs and other biologically active substances. So, provoke the occurrence of secretory diarrhea can long chain fatty acids And bile free acids , laxatives , which contain antraglycosides , Castor oil .

At hyperexudative diarrhea sweating occurs plasma , slime , blood into the intestinal lumen. This condition is typical for patients suffering from infectious and inflammatory bowel diseases ( shigellosis , salmonellosis , campylobacteriosis , clostridium ). Also, this type of diarrhea is characteristically manifested in non-communicable diseases, such as nonspecific ulcerative colitis , . the osmotic pressure of blood plasma is higher than the osmotic pressure of feces.

The osmotic pressure of fecal matter is lower than the osmotic pressure of blood plasma. Feces are liquid, there is an admixture of pus, blood, mucus.

At hyperosmolar diarrhea the patient has a disorder of absorption in the small intestine of certain nutrients. Metabolic processes are noticeably disturbed in the body. This type of diarrhea manifests itself with excessive use of laxatives of the salt type. The osmotic pressure of fecal matter is higher than the osmotic pressure of blood plasma. This condition is characterized by loose and copious stools, in which particles of undigested food are found.

At hyper- And hypokinetic diarrhea the patient has violations of the transit of intestinal contents. The cause of this condition is low or high intestinal motility . Very often, this condition is typical for people suffering from irritable bowel syndrome, as well as for those who use too many laxatives and antacids. The osmotic pressure of fecal matter in this condition is the same as the osmotic pressure of blood plasma. The stool is not particularly plentiful, liquid or mushy consistency. The last two types of diarrhea occur only in patients with non-communicable diseases.

Causes of diarrhea

The occurrence of diarrhea is affected by the following phenomena: intestinal secretion , too much high pressure V intestinal cavity , intestinal exudation , violations in progress transportation intestinal contents . All these mechanisms have a certain connection, however, for a certain type of disease, the predominance of the corresponding type of disorder is characteristic.

diarrhea symptoms

Acute diarrhea is manifested by various infections, inflammation in the intestines and due to exposure to certain drugs. As a rule, diarrhea appears in combination with a number of other manifestations: it can be , swelling , stomach ache , weakness , feeling chilly , increase in body temperature .

Symptoms of the infectious type of the disease are the general malaise , manifestations , bad , vomit . Very often, the causes of diarrhea are poor-quality food, as well as travel (the so-called tourist diarrhea appears). The appearance of loose stools with blood elements indicates the presence of damage in the intestinal mucosa. Their occurrence is provoked by some pathogenic microbes or with enteropathogenic properties. The patient's condition with this form of the disease is severe due to septic symptoms and the presence of pain in the abdomen.

Also, the manifestations of diarrhea can provoke some medications. Level the body can be assessed already with the help of examinations of the patient. If there is a significant loss of electrolytes and water in the body, then dry skin is observed, a decrease in its turgor, and hypotension . Due to calcium losses felt by the body, there may be a tendency to convulsions .

In chronic diarrhea, that is, a disease that lasts more than three weeks, the examination should first of all be directed to find out the causes of its occurrence. The specialist studies the data of the anamnesis, conducts all relevant studies of feces. It is important in the diagnostic process to establish the duration of diarrhea, to determine what is the volume of stool per day, the frequency and severity of intestinal motility, weight fluctuations. If there is disease of the small intestine, the stool will be bulky, watery, or greasy. Diseases of the colon are accompanied by frequent stools, but it will be less plentiful, containing pus, blood, mucus. In the pathology of the colon, diarrhea, as a rule, will be accompanied by pain in the abdomen.

Diagnosis of diarrhea

Diagnosis includes a routine physical examination. At the same time, the specialist carefully examines the condition of the patient's feces and conducts a proctological examination. If the patient's stool contains blood , There is , or , then we can assume that the patient has Crohn's disease . In the process of microscopic examination of feces, it is important to determine in it inflammatory cells, fat, the presence of eggs and protozoa.

Using the method of sigmoidoscopy, it is possible to diagnose, pseudomembranous colitis . To establish the diagnosis of "acute diarrhea", the doctor is guided primarily by the patient's complaints, anamnesis, proctological examination, and physical examination. The laboratory conducts macro- and microscopic examination of stool samples.

If during the diagnosis process it turns out that there is no inflammation in the intestines, then, most likely, diarrhea in this case will be associated with malabsorption. In some cases, the occurrence of acute diarrhea is provoked by enteroviruses. If a viral enteritis is suspected, the doctor should make sure that the symptoms and manifestations of this condition coincide. So, with viral enteritis, there are no blood and inflammatory cells in the feces, antibiotic therapy is ineffective in the treatment process, the patient can recover spontaneously. The specialist necessarily notes all the described features in the differential diagnosis of various kinds of intestinal diseases.

In the process of diagnosing chronic diarrhea, first of all, they find out if there is a connection in the occurrence of diarrhea with infections or inflammations. To do this, conduct a study of feces - microscopic , bacteriological , sigmoidoscopy . Also, to exclude inflammation, the pathogenetic mechanism of diarrhea should be determined. Often, a certain period of staying on a certain diet for diarrhea helps to establish the correct diagnosis.

Treatment of diarrhea

Some approaches to the treatment of diarrhea are common to all four types of the disease. So, symptomatic drugs and drugs with antibacterial action are equally effective. First of all, changes in eating style are practiced. So, a diet for diarrhea involves the use of foods that contribute to the inhibition of peristalsis, reduce the secretion of water and electrolytes. At the same time, it is important to exclude those products whose properties suggest an increase in the motor-evacuation and secretory functions of the intestine.

Treatment for diarrhea includes antibacterial drugs , which are designed to restore intestinal eubiosis. Patients with acute diarrhea should take antibiotics , antimicrobial And sulfanilamide drugs , antiseptics . The most preferred remedy for diarrhea is one that does not disturb the balance of the intestinal microflora.

Alternative medicine for diarrhea are considered bacterial drugs , the course of treatment which lasts up to two months. Used as a symptomatic adsorbents , which neutralize organic acids, and also prescribe binders And enveloping facilities.

Also, diarrhea is treated with the help of drugs that regulate motility and reduce intestinal tone. And to eliminate the state of dehydration of the body is used rehydration . If the patient is diagnosed with an acute condition, then rehydration is carried out by the oral route, in rare cases, crystalloid polyionic solutions are infused intravenously for rehydration.

The doctors

Medications

Intestinal suffering is usually represented by two opposite types - diarrhea And . Moreover, the first delivers a lot of trouble, because of which it is impossible even to leave the house. Usually, (the official name for diarrhea) is a malaise that is expressed by frequent and very liquid, watery stools. She is, of course, unpleasant. But most importantly, it can be an indicator of a fairly serious illness caused by intestinal infections or food poisoning.

The main danger - as its consequence - dehydration which may even cause the patient to die. Of course, at the first signs of diarrhea, it is necessary to consult a doctor and correctly diagnose. The specialist will prescribe treatment in accordance with the characteristics of your body, but, perhaps, the main thing for all patients remains severe.

Both with the treatment prescribed by the doctor, and at the first signs of diarrhea, even before going to the hospital, you should drink as much mineral water without gas, fruit juice, any juice and other liquids as possible. The exception will be dairy products and coffee.

How to get rid of diarrhea?

Along with drug treatment (if the infectious nature of the disease or food poisoning is revealed), it is not only possible, but also necessary to resort to folk remedies. For example, for more than a hundred years they have been getting rid of diarrhea as follows: chicken stomach cut off the yellow shell, rinse it well and dry, then crush with a wooden pusher or rolling pin to a powder state. Take this powder for 1 tbsp. spoon - adults, and 1/2 tbsp. spoon - children. Drink plenty of water. Apply once a day.

Even easier to use potato starch : 1 tbsp. dilute a spoon in a glass of cooled boiled water and drink. Adults can resort to another fairly simple recipe: dilute 1 teaspoon of salt in less than half a glass of vodka and consume immediately.

At home, it is quite simple to prepare another version of the drug: cut the raw onion crosswise (not at the root) and put it in a glass of hot tea (not strong, without sugar). insist this way onion 10 minutes, then drink.

A solution prepared from two components also helps well - cinnamon and red pod pepper . With excellent astringent property, such decoction also helps to remove from the body gases.

Decoctions from the walls, infused in alcohol for 2-3 days, and from the peel are very common among the people. grenade, brewed with boiling water. Berries mixed with honey can also help - viburnum, cranberry marsh. And of course, rice or, more precisely, decoction of rice (1:7 - the ratio of cereals and cold water, boil until half-baked). Just use uncrushed rice.

diarrhea during pregnancy

Diarrhea is quite common with . There are a number of reasons for the occurrence of this condition in pregnant women. So, sometimes diarrhea occurs due to diseases of the intestines or the gastrointestinal tract as a whole. In some cases, the cause of diarrhea in pregnant women is general ailments. However, during pregnancy, a woman's body becomes particularly susceptible to a variety of infections, so infectious diseases and local poisoning can provoke diarrhea. So, pregnant women are highly sensitive to toxins. However, diarrhea can also be caused by disturbances in the functioning of the nervous system, the presence of worms, and insufficient production of enzymes in the body. Pregnancy is often the cause of diarrhea.

In some cases, diarrhea may not pose a danger to a woman, performing the function of a kind of cleansing of the body before the upcoming childbirth . However, the causes of diarrhea should be closely monitored. After all, if this condition arose due to food or other poisoning, then it is very dangerous for both the unborn child and the woman.

During pregnancy, the treatment of diarrhea should be carried out only under the close supervision of a doctor, who will certainly take into account all individual points. In parallel, the specialist adjusts the patient's nutrition by prescribing a special diet for her. For a future mother, it is very important to constantly observe the drinking regimen, using a sufficient amount of fluid, because dehydration is an undesirable condition for the fetus and mother.

Diet, food for diarrhea

List of sources

• Ivashkin V.T., Sheptulin A.A., Sklyanskaya O.A. Diarrhea syndrome - M.: GEOTAR-MED, 2002.
• Guide to gastroenterology: in three volumes / Ed. F.I. Komarova and A.L. Grebnev. T.Z.-M.: Medicine.-1996.
• Belousova E.A., Zlatkina A.R. Diarrhea syndrome in the practice of a gastroenterologist: pathophysiology and a differentiated approach to treatment. - 2008.
• Diarrhea treatment. - Training manual for doctors and other categories of senior health workers. - WHO, 2006.

Chronic diarrhea is a pathological process that is a sign of serious diseases of the digestive system.

Intestinal upset can last for several weeks, accompanied by flatulence, abdominal pain, cramps.

In chronic diarrhea, treatment should be aimed not only at reducing its manifestations, but also at the underlying disease. In addition to drug therapy, patients are prescribed a special diet.

Etiology of chronic diarrhea

Chronic diarrhea can last for more than a month. If the causes of diarrhea are not found out in time, then serious complications will develop that will lead to disruption of the work of all body systems.

Persistent diarrhea causes dehydration, loss of nutrients and essential electrolytes.

The causes of chronic diarrhea are diverse and are divided into two large groups: infectious and non-infectious. In some cases, the cause of the disease may remain unknown.

The most common nature of the disease is infectious. There are lesions of the gastrointestinal tract caused by intestinal stick, salmonella and other pathogenic microbes and helminths. In addition, diarrhea in adults and children can develop after exposure to viruses.

Infectious causes of chronic diarrhea:

• infection with protozoa and fungi - cryptosporidium, dysenteric amoeba, cyclospores, microsporidia, giardia;
• bacterial infections - aeromonas, E. coli, salmonella, campylobacter;
• viral infection - rotavirus (stomach flu).

Chronic diarrhea of ​​a non-infectious form occurs as a result of poisoning with chemicals (alcohol, drugs, poisons), pathologies of the digestive system and prolonged stress.

The main causes of non-infectious diarrhea are:

• acute and chronic pancreatitis;
• cystic fibrosis of the pancreas;
• colitis;
• proctitis;
• uncontrolled intake of antibacterial drugs;
• pathology of the thyroid gland;
• excessive consumption of sweeteners;
• benign and malignant tumors;
• insufficient absorption of bile acids;
• violation of the blood supply to the intestines;
• diverticulitis;
• Crohn's disease.

In addition to these reasons, chronic diarrhea can develop in people suffering from intolerance to gluten, a protein found in cereals.

In order for the function of the intestine to be restored, in this situation it is enough to exclude bakery products made from wheat and oat flour from the diet.

Symptoms of pathology

The main symptom of chronic diarrhea is frequent loose bowel movements. During the day, the patient can visit the toilet more than 5 times.

Intestinal upset is often accompanied by pain, cramping, increased gas production, and mucus in the stool.

If diarrhea is caused by the pathology of the small intestine, then defecation will occur with fatty, liquid feces.

With a disease of the large intestine, the volume of bowel movements will decrease, but the urge to go to the toilet will occur more often. The feces may contain impurities of pus, blood and mucous secretions.

Unlike diarrhea due to diseases of the small intestine, colonic upset is accompanied by pain.

In inflammatory processes in the lower intestines (proctitis, colitis), patients experience frequent false urge to empty.

Other observed signs are determined by the underlying disease that caused the onset of chronic diarrhea. Patients with colorectal cancer experience weakness, fatigue, and gradually lose weight.

Chronic diarrhea can be replaced by intestinal obstruction, in severe cases, a rupture of the intestinal wall develops.

In the later stages of the development of cancer pathology, the patient is subjected to severe intoxication, he has cachexia and hyperthermia.

For inflammation occurring in the gastrointestinal tract and causing chronic diarrhea, hyperthermia of varying severity and other extraintestinal symptoms are characteristic: stomatitis, arthralgia, and so on.

With neuroendocrine and endocrine pathologies of the intestine in sick people, hormonal disorders can be noticed.

With prolonged diarrhea, you should consult a doctor, especially if the pathology is accompanied by severe pain and blood in the stool.

If treatment is not started on time, the patient will develop dehydration, nausea, vomiting, fever, and muscle cramps.

Due to nutritional deficiencies, the patient will become underweight. The exact cause of the disease that caused chronic diarrhea can only be established by a doctor based on the results of the examination.

Diagnosis of chronic bowel disorder

The doctor makes a diagnosis based on a conversation with the patient, in which he finds out the manifestations of the disease - how long the diarrhea lasts, whether there is pain and cramps, bloating and asymmetry of the abdomen, and so on.

Then laboratory tests are prescribed, the results of which can determine how to treat diarrhea.

In chronic diarrhea, the most important are the following indicators of the body:

• complete blood count;
• serum calcium concentration;
• concentration of B vitamins;
• the amount of iron;
• determination of the functioning of the thyroid gland and liver;
• screening for celiac disease.

Depending on the underlying cause that caused chronic diarrhea, additional examinations are prescribed for patients to confirm or clarify the diagnosis and prescribe the correct treatment regimen.

The doctor may prescribe:

• ultrasound examination of the abdominal organs;
• x-ray examination of the abdominal cavity;
• colonoscopy with taking intestinal tissue for biopsy.

Since chronic diarrhea is not an independent disease, but a symptom of the pathology of internal organs, the main goal of diagnosis is to identify the main cause of diarrhea.

Based on the results of the examination, the gastroenterologist will determine what diseases affect the small or large intestine.

Microbiological analysis of feces helps to determine the presence of an inflammatory process in the intestine and the type of pathogenic organisms.

Coprological examination of patients with chronic diarrhea reveals amylorrhea, steatorrhea, and creatorrhoea.

During irrigoscopy with cancerous tumors and polyps, all kinds of filling defects are found.

With the help of sigmoidoscopy and colonoscopy, it is possible to examine the intestinal wall, the presence and appearance of ulcers, polyps and other neoplasms.

If there is a special need, then during the examination, the specialist collects tissue samples for biopsy.

If you suspect a violation of the hormonal background and pathology of the thyroid gland, you need to consult an endocrinologist, with uremia - a urologist.

The scheme of treatment of pathology

To cure chronic diarrhea or reduce its manifestations, you need to undergo all the necessary examinations and find out the cause of the unpleasant symptom.

The therapeutic regimen includes antibacterial drugs, probiotics and adsorbents. During treatment, patients must follow a special diet.

Antibacterial drugs are prescribed to destroy the microorganisms that caused chronic diarrhea. During treatment, patients are prescribed antimicrobial and antiseptic agents.

The drug contains dodecyl sulfate and tiliquinol. The course of taking Entoban lasts 6-10 days, 4-6 capsules per day.

The next remedy Mexaform contains kaolin, streptomycin, sodium citrate and pectin. The drug is prescribed 1 tablet three times a day for a week.

Suspension Depental-M, which includes metronidazole and furazolidone, also has bactericidal properties. Take it 1 scoop after each meal for 5 days.

Intestinal disorders of various nature can be effectively corrected with the help of probiotics.

The drug Bactisubtil contains cultures of beneficial microbes needed by the intestines, and calcium carbonate. The remedy should be taken within 10 days twice in 1 capsule.

After a course of antibiotics, patients are prescribed Enterol, Linex and Bificol to restore the natural ratio of microorganisms in the intestine.

These medications should be taken for at least one month. Drops of Hilak-Forte, which contain waste products of lactobacilli, can reduce the reproduction of pathogenic bacteria.

Smecta is used as an enveloping absorbent for the treatment of chronic diarrhea.

Kaopectate solution has similar properties. The drug binds and removes toxic substances and harmful microbes from the intestines.

For treatment to be successful, patients must follow a diet. Proper nutrition will make up for the lack of nutrients in the body and help normalize the natural intestinal motility.