Diarrhea And Dysentery-Causes,Prevention,Treatment.
Diarrhea is when a person has loose or watery stools. But if mucus and blood can be seen in the stools, he or she has dysentery. Diarrhea can be mild or serious. It can be acute (sudden and severe) or chronic (lasting many days).
Diarrhea is more common and more dangerous in young children especially those who are poorly nourished.
A child that is well nourished is less likely to get diarrhea. If he gets it, he or she will usually get well again quickly. But a that is poorly nourished is more likely to get diarrhea and there is a much greater chance that he or she will die from it.
Diarrhea has many causes. Sometimes special treatment is needed. However, most diarrhea can be treated successfully in the home using Rehydration Drink, even if you are not sure of the exact cause or causes. If a child does not eat much, give the child a little food many times a day.
THE MAIN CAUSES OF DIARRHEA
- Poor nutrition; this weakens the child and makes diarrhea from other causes more frequent and worse.
- Shortage of water and unclean conditions (no latrines) spread the germs that causes diarrhea.
- Virus infection or intestinal flu (this diarrhea is usually mild).
- An infection of the gut caused by bacteria (ameba, giardia).
- Infections outside the gut (ear infections, tonsillitis, measles, urinary infections)
- Malaria (falciparum type).
- Food poisoning (spoiled food).
- Inability to digest milk (mainly in severely malnourished children and certain adults).
- Difficulty babies have digesting foods that are new to them.
- Allergies to certain foods (seafood like crayfish, prawn etc) occasionally babies are allergic to cow’s milk or other milk.
- Side effects produced by certain medicines such as ampicillin or tetracycline.
- Laxatives, purges, irritating or poisonous plants.
- Eating too much unripe fruits or heavy, greasy foods.
- AIDS (long-lasting diarrhea may be an early sign)
Although diarrhea has many different causes, the most common are infection and poor nutrition. With good hygiene and good food, most diarrhea could be prevented. And if treated correctly, fewer children who get diarrhea would die.
Children who are poorly nourished get diarrhea and die from it far more often than those who are well nourished. Yet diarrhea itself can be part of the cause of malnutriton. And if malnutrition already exists, diarrhea rapidly makes it worse.
Malnutrition causes diarrhea. Diarrhea causes malnutrition.
This results in a vicious circle in which each makes the other worse. For this reason, good nutrition is important in both the prevention and treatment of diarrhea.
Prevent diarrhea by preventing malnutrition. Prevent malnutrition by preventing diarrhea.
The prevention of diarrhea depends both on good nutrition and cleanliness. Many suggestions for personal and public cleanliness which include the use of latrines, the importance of clean water and the protection of foods from dirt and flies are very essential to prevent diarrhea.
IMPORTANT SUGGESTIONS TO PREVENT DIARRHEA IN BABIES.
- Breast feed rather than bottle feed babies. Give only breast milk for the first 4 months. Breast milk helps babies resist the infections that cause diarrhea. If it is not possible to breast feed a baby, feed him or her with a cup and spoon. Do not use a baby bottle because it is harder to keep clean and more likely to cause an infection.
- When you begin to give the baby new or solid foods, start by giving her just a little and mashing it well and also mixing it with a little breast milk. The baby has to learn how to digest new foods. Do not stop giving breast milk suddenly. Start with other foods while the baby is still breast feeding. If he or she starts with too much new food at one time, she may get diarrhea.
- Keep the baby clean and in a clean place. Try to keep the baby from putting dirty things in his or her mouth.
- Do not give babies unnecessary medicines.
For most cases of diarrhea, no medicine is needed. If the diarrhea is severe, the biggest danger is dehydration. If the diarrhea lasts a long time, the biggest danger is malnutrition. So the most important part of treatment has to do with giving enough liquids and enough food.
No matter what the cause of diarrhea, always take care with the following :
- PREVENT OR CONTROL DEHYDRATION. A person with diarrhea must drink a lot of liquids. If diarrhea is severe or there are signs of dehydration, give the person Rehydration Drink. Even if the person does not want to drink, gently insist that the person do so. Have him or her several swallows every few minutes.
- MEET NUTRITIONAL NEEDS. A person with diarrhea needs food as soon as he or she will eat. This is especially important in small children or persons who are already poorly nourished. Also, when a person has diarrhea, food passes through the gut very quickly. So give the person food many times a day especially if he or she only takes a little at a time.
- A baby with diarrhea should go on breast feeding.
- An underweight child should get plenty of energy foods and some body-building foods (proteins) all the time the child has diarrhea; and extra when the child gets well. If the child stops eating because he or she feels so sick or is vomiting, the child should eat again as soon as he or she can. Giving Rehydration Drink will help the child be able to eat. Although giving food may cause more frequent stools at first, it can save the child’s life.
- If a child who is underweight has diarrhea that lasts for many days or keeps coming back, give him or her more food often; at least 5 or 6 meals each day. Often no other treatment is needed.
FOODS FOR A PERSON WITH DIARRHEA
When the person is vomiting or feels too sick to eat, he or she should drink :
- Watery mush or broth of rice, maize powder or potato.
- Rice water with some mashed rice.
- Chicken, meat, egg or bean broth.
- Sweetened drinks.
- Breast milk
As soon as the person is able to eat, in addition to giving the drinks listed, he or she should eat a balanced selection of the following foods or similar ones :
- Energy foods : Ripe or cooked bananas crackers, rice, oatmeal or other well-cooked grain fresh maize (well cooked and mashed), potatoes, papaya (it helps to add a little sugar or vegetable oil to the cereal food).
- Body-building foods : Chicken (boiled or roasted), eggs (boiled), meat (well cooked, without much fat or grease), beans, lentils, peas (well cooked and mashed), fish (well cooked), milk (sometimes this causes problems).
FOODS PERSON WITH DIARRHEA SHOULD AVOID
- Fatty or greasy foods
- Most raw fruits.
- Any kind of laxative or purge.
- Highly seasoned food
- Alcoholic drinks
DIARRHEA AND MILK
Breast milk is the best food for babies. Keep giving breast milk when the baby has diarrhea. It does not cause diarrhea and will help the baby get better quickly.
Cow’s milk, dry skin milk and canned milk can be good source of protein for children who have diarrhea. However, if the child is badly malnourished, he or she may have trouble digesting the milk and this may cause even more diarrhea.
If this happens, try giving less milk and mixing it with other foods. But remember that a poorly nourished child with diarrhea must have enough energy foods and protein. If less milk is given, well cooked and mashed foods such as chicken, egg yolk, meat, fish or beans should be added.
Beans are easier to digest if their skins have been taken off and they are boiled and mashed. They should not be cooked in oil.
Soymilk made from soya beans is a good substitute. As a child gets better, he or she will usually be able able to drink more milk without getting diarrhea.
MEDICINE FOR DIARRHEA
For most cases of diarrhea, no medicines are needed. But in certain cases, using the right medicine can be important. However, many of the medicines commonly used for diarrhea do little or no good. Some are actually harmful.
Generally it is better not to use the following medicines in the treatment of diarrhea.
- Anti-diarrhea medicines with kaolin and pectin (such as kaopectate) make diarrhea thicker and less frequent, but they do not correct dehydration or control infections. Some anti-diarrhea medicines like diphenoxylate (lomotil) may even make infections last longer.
ANTI-DIARRHEA MEDICINES ACT LIKE PLUGS. THEY KEEP IN THE INFECTED MATERIAL THAT NEEDS TO COME OUT.
- Anti-diarrhea mixtures containing neomycin or streptomycin should not be used, as these may irritate the gut and do more harm than good.
- Antibiotics like ampicillin and tetracycline are useful in some cases of diarrhea. But they themselves sometimes cause diarrhea especially in small children. If after taken these antibiotics for more than 2 or 3 days, diarrhea gets worse rather than better, stop taking them; the antibiotics may be the cause.
- Chloramphenicol has certain dangers in its use and should never be used for mild diarrhea or given to babies less than 1 month old.
- Laxatives and purges should never be given to persons with diarrhea. They will make it worse and increase the danger of dehydration.
SPECIAL TREATMENT IN DIFFERENT CASES OF DIARRHEA
While most cases of diarrhea can be treated by giving plenty of liquids and food and no medicine, sometimes special treatment is needed.
In considering treatment, keep in mind that some cases of diarrhea especially in small children are caused by infections outside the gut. Always check for infections of the ears, the throat and the urinary system. If found, these infections should be treated. Also look for signs of measles.
If the child has mild diarrhea together with signs of a cold, the diarrhea is probably caused by a virus or intestinal flu and no special treatment is called for. Give lots of liquids.
In certain difficult cases of diarrhea, analysis of the stools or other tests may be needed to know how to treat it correctly. But usually, you can learn enough from asking specific questions, seeing the stools and looking for some certain signs.
GUIDELINES FOR TREATMENT ACCORDING TO SIGNS
- Sudden, mild diarrhea. No fever (Upset stomach? intestinal flu) : Drink lots of liquids. Usually no special treatment is needed. For a ‘plug’, a mixture of kaolin and pectin such as kaopectate can be used, but it is never necessary and does not help either to correct dehydration or get rid of infection. So it should be given to persons who are very ill or to small children.
If severe colic (painful cramps) is a problem, an antispasmodic like belladonna may help.
- Diarrhea with mucus and specks of blood. Often chronic. No fever. Usually no dehydration. There may be diarrhea some days and constipation other days.(possibly amebic dysentery). Use metronidazole or diloxanide furoate. Take the medicine according to the recommended dose. If the diarrhea continues after treatment, seek medical advice.
- Acute diarrhea with fever, with or without blood. (bacterial dysentery? Typhoid? Malaria?). If the person with diarrhea has fever lasting more than 6 hours after beginning treatment for dehydration, and seems very ill, give ampicillin if possible. If not, give tetracycline.
If the person’s condition is very poor or the person is not improving with ampicillin or tetracycline, seek medical help. If there are signs of typhoid fever, give chloramphenicol in the recommended dose.
In areas where the falciparum type of malaria is common, it is a good idea that persons with diarrhea and fever also be treated with an anti-malaria drug; especially if they have a large spleen.
- Diarrhea with vimiting (many causes). If a person with diarrhea is also vomiting, the danger of dehydration increases, especially in small children. It is very important to give the Rehydration Drink tea or whatever liquids he or she will take. Keep on giving it even if there is vomiting.
Some will stay inside. Give sips every 5 to 10 minutes. If vomiting does not stop soon, you can use medicines like promethazine or phenobarbital.
If you cannot control the vomiting or if the dehydration gets worse, seek medical help.
- Persistent bad-smelling diarrhea, sometimes yellow and frothy, without blood or mucus (Giardia?). This may be caused by microscopic parasites called giardia or perhaps by malnutrition. In either case, plenty of liquid, nutritious food and rest are often the only treatment needed. Severe giardia infections can be treated with metronidazole.
- Chronic diarrhea (diarrhea that lasts a long time or keeps coming back). This is most common due to malnutrition, less commonly to a chronic infection like the ones caused by ameba. See that the child eats more nutritious food, especially foods rich in proteins. If the diarrhea still continues, seek medical help. Adults may be suffering from AIDS.
- Diarrhea like rice water (cholera?). Rice water stools are a sign of cholera. In countries where this dangerous disease occurs, cholera often comes in epidemics (striking many people at once) and is usually worse in older children and adults. Dehydration is extreme, especially if there is vomiting also. Treat the dehydration continuously and give tetracycline, co-trimoxazole or chloramphenicol. Cholera should be reported to the health authorities. Seek medical help.
CARE OF BABIES WITH DIARRHEA
Diarrhea is especially dangerous in babies and small children. Often, no medicine is needed but special care must be taken because a baby can die very quickly of dehydration.
- Continue breast feeding and also give sips of Rehydration Drink made with water, sugar and salt only.
- If vomiting is a problem, give breast milk often but only a little at a time. Also give Rehydration Drink in small sips every 5 to 10 minutes.
- If there is no breast milk, try giving frequent small feedings of some other milk or milk substitute (like milk made from soyabeans) mixed to half normal strength with boiled water. If milk seems to make the diarrhea worse, give some other protein (mashed chicken, eggs, lean meat or skinned mashed beans, mixed with honey, sugar or well-cooked rice or another carbohydrate and boiled water).
- If the child is younger than 1 month, try to find a health worker before giving any medicine. If there is no health worker and the child is very sick, give him or her an ‘infant syrup’ that contains ampicillin : half a teaspoon 4 times daily. It is better not to use other antibiotics.
WHEN TO SEEK MEDICAL HELP IN CASES OF DIARRHEA
Diarrhea and dysentery can be very dangerous especially in small children. In the following situations you should get medical help :
- If diarrhea lasts more than 4 days and is not getting better; or more than 1 day in small a child with severe diarrhea.
- If the person is dehydrated and getting worse.
- If the child vomits everything he or she drinks, or drinks nothing, or if frequent vomiting continues for more than 3 hours after beginning Rehydration Drink.
- If the child begins to have convulsion (fits) or if the feet and face swell.
- If the person was very sick, weak or malnourished before the diarrhea began (especially a little child or a very old person).
- If there is much blood in the stools, this can be dangerous even if there is little diarrhea.