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This common problem is not a topic people really want to discuss. It can be an annoyance or a serious health problem. Defining diarrhea seems to be a necessary thing at this juncture. Diarrhea means having loose stools; sometimes explosive, sometimes chunky, sometimes burning. If your illness includes fever and/or black or bloody stools, that is a definite indication to go to a doctor.

Diarrhea can be an isolated nasty evacuation. Sometimes it can be a lengthy and devastating illness. Usually it’s pretty self-limiting and will go away all by itself.

The first thing to do for your run of the mill, everyday case of diarrhea is to stop eating food. It is crucial to stay hydrated. The only way to be sure you’re getting enough fluid in is to be urinating a nice dilute urine. If your pee is concentrated, really yellow, I don’t care how much you’ve drunk, it’s not enough. In distress, our bodies can store a lot of fluid in all sorts of nooks and crannies.

Focus on drinking clear fluids; water, tea, half-strength Gatorade, (mix Gatorade with equal amounts of water), Jell-o, popsicles, and broth. Fruit juices can be used but have to be very diluted. Stick to a clear liquid diet for 24 hours just to give your gut a break. When your intestinal tract is inflamed, it can’t really digest food well, and then the undigested food causes more diarrhea. By only putting clear liquids into the system, you let the gut heal, reline itself and be ready to resume its normal function.

After 24 hours, you can start with the BRAT diet. BRAT stands for Bananas, Rice, Applesauce, (not raw apples and not apple juice), Tea and Toast. The rice can be white rice or brown. It can even be plain rice cakes. The bread can be pretty much any kind, but not croissants or Ritz crackers or other such buttery types.

You definitely want to avoid milk and dairy products and any greasy foods. These present a special challenge to the intestinal tract. Don’t add these back into your diet until things have just about completely normalized.

If you are starving hungry, that is a good sign. (Another one of my mother’s wise phrases, “If you’re hungry, that means you’re healthy.”)

After a day or so of the BRAT diet, when you feel like you want to eat more, add in easily digested foods like white meats and cooked vegetables. Raw vegetables and fruit and heavier meats should wait until your gut is fully recovered. Liberalize your diet as you feel it is reasonable to do so. At any point, you may back up to the previous level of restriction.

When dealing with diarrhea in young children, the same principles apply, but for the very young, you may have to continue the milk, despite the perpetuation of the loose stools, but if that’s the bulk of their calorie intake, you can’t really withhold it.

At any point, the appearance of fever or blood in the stool or black, tarry stool would necessitate medical evaluation. If the diarrhea won’t let up despite your giving your body a real chance at it, you may need some testing done. If you’ve recently taken antibiotics, or eaten some questionable foods, or travelled somewhere out of the country, you may need to look into testing as well.

The first tests that might be run are stool studies looking for bad bacteria or parasites. (I say “bad bacteria” because poop is at least half bacteria by weight…Shocking! Who knew?) You have to put some stool into specific collecting jars and sent to the lab. The stool must be fresh and can’t be taken out of water or mixed with urine. If you have a toilet “hat” that fits on the back half of the toilet, that makes it a bit easier. If you don’t, you have to improvise. I suggest lifting the toilet seat, slinging some plastic wrap across the back half of the toilet bowl. Put the seat down and do your business. When you’ve collected the specimen, it should go fairly directly to the lab. The results can take a few days to get back. Be patient and keep hydrating.

If the situation gets bad enough, you might have to go to the Emergency Room for hydration. You may need to see a Gastroeneterologist for a colonoscopy and possibly biopsy of the colon.




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