Watery diarrhea is repeated (up to 15-20 times a day) defecation, which is accompanied by the release of loose loose stools. Usually the symptom is combined with other dyspeptic disorders: vomiting, cramps, abdominal pain. Diarrhea with water is most often associated with intestinal infections, but can be observed with non-infectious intestinal pathologies, enzyme deficiency. To establish the causes of diarrhea, ultrasound, x-rays, endoscopy, and laboratory tests are used. To stop diarrhea, adsorbents, enveloping and astringent preparations are used.
Causes of watery diarrhea
Water bowel movements often indicate infectious or non-infectious intestinal diseases. Sometimes pregnant women complain about the appearance of liquid unformed feces, which is caused by gestational changes in the digestive and endocrine systems. In children, watery stools can be a sign of a toxic form of dyspepsia or the initial stage of colitis. Diarrhea with water with dyspeptic disorders, weakness, hemorrhages is characteristic of alimentary-toxic aleukia. Profuse diarrhea occurs in 90% of patients with toxic shock.
Bacterial infections
The ingestion of pathogenic intestinal microflora, as a rule, is accompanied by secretory type watery diarrhea. Bacteria are able to secrete a specific enterotoxin that affects the epithelial cells of the mucosa and causes the accumulation of adenylate cyclase and cAMP in them. This contributes to an increased release of ions into the intestinal lumen with subsequent entry into the intestine along the concentration gradient of a large amount of liquid. The condition is exacerbated by concomitant inflammatory lesions of the gastrointestinal tract. The following intestinal infections lead to diarrhea with water:
- cholera . This infectious disease manifests as diarrhea, which quickly loses its fecal character and odor, becoming watery. A few hours later, repeated vomiting joins, which aggravates the condition, provoking severe dehydration. A distinctive feature is the complete absence of abdominal pain or moderate discomfort, detected in no more than 30% of patients.
- Escherichiosis . Watery diarrhea often develops when infected with enterotoxigenic strains of the microbe, when the disease proceeds as a mild variant of cholera. In young children, waterborne diarrhea is usually caused by enteropathogenic strains. Diarrhea is combined with vomiting, pain in the epigastrium, along the intestines. An increase in body temperature to subfebrile numbers is possible. General condition of patients of moderate severity.
- Salmonellosis . Dyspeptic disorders are the main manifestations of the gastrointestinal form of infection. The first symptoms of salmonellosis are general intoxication and headache, after a few hours there are severe cramping pains in the intestines, profuse bowel movements, first with the release of unformed feces, and then water with food particles, mucus. A greenish frothy stool ("swamp mud") is characteristic.
- Botulism . With the gastroenterological variant of the infection, dyspeptic symptoms come to the fore: watery diarrhea, repeated vomiting, spastic abdominal pain. Patients complain of dry mouth, sensation of a lump in the throat. Botulism is characterized by eye manifestations: double vision, flickering of "flies" before the eyes, blurred vision. In severe cases, paresis, paralysis of mimic muscles with asymmetry of the face are observed.
- Campylobacteriosis . The disease begins acutely with a rise in temperature to 38 ° C or more, pain in the muscles and joints. Multiple diarrhea immediately joins with the release of liquid, fetid feces, in which streaks of mucus and blood are detected. Patients often complain of abdominal cramps, while nausea and vomiting occur in only a quarter of patients with campylobacteriosis.
Viral infections
Dyspeptic disorders, in particular watery diarrhea, are considered the main manifestations of most viral intestinal lesions. Viruses, when they enter the gastrointestinal tract, multiply inside the epithelial cells, causing their death and desquamation from the surface of the mucosa, which leads to impaired parietal digestion, diarrhea. Pathogens also slow down the processes of reabsorption of water from the intestinal lumen, which causes profuse diarrhea. The most common viral diseases that occur with intestinal damage:
- Rotavirus gastroenteritis . Watery stools are the main manifestation of rotavirus infection. With a mild variant, the frequency of defecation is up to 1 time per day, the stools are fecal in nature, in severe cases, the leading one is profuse diarrhea with the discharge of a cloudy, fetid, yellow-green liquid. Diarrhea is combined with cramping pains in the umbilical region, subfebrile fever.
- norovirus infection . Norovirus is characterized by simultaneous damage to the respiratory and digestive systems. The disease begins with a sore throat, nasal congestion, then dyspepsia joins - watery stools, vomiting, abdominal pain. Multiple defecation with the release of a large volume of fluid becomes a prerequisite for severe dehydration, which is manifested by dry skin, mucous membranes, a decrease in blood pressure, and oliguria.
- Hong Kong flu . With this type of influenza infection, gastrointestinal symptoms are combined with signs of damage to the respiratory system, general intoxication of the body. Along with headache, high fever, repeated diarrhea with water, moderate pain in the abdomen, nausea, and lack of appetite are noted. Respiratory manifestations (dry cough, sore throat, nasal congestion) occur on the 2nd-3rd day of illness.
- Marburg hemorrhagic fever. The disease manifests acutely with the appearance of headache, myalgia, conjunctivitis, erosions on the oral mucosa. Dyspeptic disorders in the form of watery diarrhea, vomiting, severe pain in the abdominal cavity develop on the 3rd-4th day of hemorrhagic fever. Pathognomonic signs are maculopapular rash, uterine, nasal and gastrointestinal bleeding that appear on days 5-6 of illness.
- HIV infection . AIDS is characterized by abundant watery stools without pathological inclusions, due to digestive disorders and the addition of a secondary infection against the background of severe immunodeficiency. In addition to loose stools, other nonspecific symptoms are determined - prolonged subfebrile fever, increased sweating at night. Most patients lose more than 10% of body weight.
Protozoal and helminthic invasions
Helminths and protozoa have a direct pathogenic effect on the enterocytes of the mucous membrane, causing severe disorders in the digestion and absorption of food components. Severe malabsorption syndrome, combined with increased secretion of water and electrolytes into the intestinal cavity, provokes profuse diarrhea. With insufficient replenishment of fluid losses, a dehydration syndrome of varying severity develops. Watery diarrhea is noted with such invasions as:
- Cryptosporidiosis . The protozoa parasitize in the lumen of the small intestine, potentiating malabsorption and inhibition of the activity of digestive enzymes, resulting in a watery stool with a fetid odor. Diarrhea is accompanied by severe abdominal cramps, nausea, and vomiting. The disease often affects people with immunodeficiencies. In such cases, there is a long course (up to 4 months) with severe dehydration.
- Strongyloidiasis . Intestinal manifestations are noted in the second phase of the disease, 2-3 weeks after the onset of the first symptoms - urticaria, rashes and arthralgia. The development of diarrhea is associated with an inflammatory lesion of the small intestine mucosa, the formation of hemorrhages, erosions. In addition to diarrhea, pain in the epigastric region, nausea, and vomiting are typical. Sometimes there is yellowness of the skin, pain in the right hypochondrium.
noncommunicable bowel disease
Watery diarrhea often complicates the course of organic diseases of the digestive tract, especially in the initial stages. The increase in the volume of feces is due to both violations of the processes of parietal and abdominal digestion, and the impact of various inflammatory mediators. Diarrhea is associated with disorders of intestinal motility of the hyperkinetic or hypokinetic type. With a change in the frequency and consistency of the stool, the following non-infectious pathologies of the gastrointestinal tract occur:
- Enteritis . Watery diarrhea is a symptom of non-infectious inflammation of the small intestine, which is allergic, drug-induced, or autoimmune in nature. The appearance of liquid, fetid feces is mainly caused by malabsorption and maldigestion syndromes. The chair is observed up to 10-15 times during the day, accompanied by flatulence, rumbling in the abdomen, decreased appetite, nausea, significant weight loss.
- Enteropathy . Chronic watery diarrhea is manifested in non-inflammatory intestinal pathologies. A change in the consistency of stool masses can be caused by both fermentopathy and a violation of the motility of the gastrointestinal tract (for example, a hypomotor variant of diabetic enteropathy). The pain syndrome is weakly expressed, digestive disorders that contribute to weight loss and protein-energy malnutrition predominate.
- Acute colitis . For colitis, spasms in the left iliac region, painful urge to defecate, the presence of pathological impurities of mucus, blood in the feces are typical. The stool at first has a fecal character, a fetid odor, as the disease progresses it becomes watery. The frequency of bowel movements reaches 25 times a day. Similar changes are noted in pseudomembranous colitis with exudative enteropathy.
enzyme deficiency
In the absence of enzymes in the initial sections of the small intestine, the appearance of profuse diarrhea with water is associated with an osmotic mechanism. The presence of a large number of undigested large molecules, especially disaccharides and peptones, is a prerequisite for an increase in pressure in the intestinal lumen, the release of fluid and sodium ions. Diarrhea occurs with fibrosis of the pancreas and a decrease in its exocrine function by 80-90%, as a result of which the digestion of all types of food is disturbed. The condition is aggravated by the addition of a secretory mechanism of diarrhea associated with cAMP activation.
Watery stools are possible with gastrinoma, Zollinger-Ellison syndrome. Increased secretion of gastrin and hydrochloric acid leads to the destruction of digestive enzymes, an increase in the osmolarity of the chyme. Diarrhea is combined with intense pain in the epigastrium, sour belching. In children, defecation with water becomes a consequence of galactosemia - intolerance to milk due to a congenital lack of an enzyme. The symptom appears immediately after the start of breastfeeding, accompanied by malnutrition, jaundice, inhibition of reflexes.
Survey
Watery diarrhea always indicates a problem with the digestive system. Examination of patients with complaints of watery diarrhea is carried out by a gastroenterologist or infectious disease specialist. To verify the clinical diagnosis, a comprehensive examination of the gastrointestinal tract using laboratory and instrumental methods is necessary to detect morphological changes and determine the cause of diarrhea. The most valuable in terms of diagnostics are:
- Radiography . With the help of a survey radiography of the abdominal cavity, the condition of the gastrointestinal tract of the patient is quickly assessed. For a detailed study of the internal surface of the digestive tract, oral contrasting with barium sulfate is used. The method is quite informative in detecting non-infectious processes that cause watery stools.
- Ultrasonic research . A non-invasive examination method is used as a screening diagnosis to exclude severe organic diseases of the digestive system, neoplasms. Ultrasound of the abdominal cavity allows you to identify signs of the inflammatory process. Sonography is also performed to assess the condition of the pancreas.
- Fecal analysis . To study the processes of digestion, absorption of food, a microscopic examination of feces with pH measurement is carried out. Watery diarrhea is often caused by infectious processes, so all patients undergo bacteriological culture of feces, analysis for helminth eggs. To exclude ulcerative-destructive processes, the Gregersen reaction is shown.
- Serological reactions . The search for antimicrobial antibodies or specific antigens in the blood is the most accurate way to identify various infectious diseases, especially those of a viral nature. The study is not sufficiently informative in the first few days from the onset of the disease, when the concentration of antibodies in the blood has not yet increased.
As an additional general clinical method, a biochemical blood test is used to help determine the degree of malabsorption and protein deficiency. If specific lesions of the gastrointestinal wall are suspected, endoscopic examination with biopsy is recommended. To assess the exocrine function of the pancreas, a blood test for amylase, lipase is sometimes prescribed.
Adsorbents are used to reduce the incidence of watery diarrhea
Symptomatic therapy
Requires dietary adjustments. With an acute disorder, a starvation diet is indicated with the gradual introduction of rice dishes, products containing pectins, salted soups, broths, dietary protein foods (veal, turkey, chicken, hard-boiled eggs). With watery diarrhea, a significant amount of fluid is lost, therefore, when the patient is in a satisfactory condition, it is important to provide plenty of fluids to prevent severe dehydration.
Adsorbents, astringents, and coating agents are used to reduce the frequency of watery diarrhea until the exact cause of stool disorders is established. In no case should you take medications that inhibit intestinal motility, as this can increase intoxication and lead to a deterioration in the patient's condition. Antibacterial agents and antidiarrheal drugs are selected only by a doctor, taking into account the results of the examination, the sensitivity of pathogenic microorganisms.