All humans, from those at the beginning of life to those at the end it, have “diarrhoea” at some time. However, since bowel habits are idiosyncratic and one size does not fit all, careful introspection and evaluation need to be exercised before actually labelling motion frequency as diarrhoea.

Babies can pass anything between 1-2 and 5-10 motions a day, or one every two or three days, and still be normal. Breast milk gets almost completely absorbed in the intestine, leaving minimal residue to form a motion. As long as the motion is golden yellow, do not worry. You need to visit the physician if the motion is green, watery, forceful, contains blood and the baby pulls its legs up to the stomach (this is a sign of pain).

Normal bowel habits in adults also vary. Diarrhoea is defined as an increase in frequency (more than three times a day) and change in consistency (watery) of motion.

Most diarrhoeas subside on their own within two or three days. It is most often due to food poisoning. The food may have been left outside, and bacteria may have grown. Reheating the food kills the live bacteria. Any toxins (poisons) released by the bacteria, however, are not destroyed by heat, so they can cause diarrhoea.

Often, diarrhoea is due to a viral infection. Then antibiotics (which act against disease-causing bacteria) will not help. Our intestines are full of good bacteria, which maintain equilibrium so that we do not get indigestion, bloating or diarrhoea. Antibiotics given for some infection in the body, or self-administered for diarrhoea, may kill the good bacteria in the gut and cause an overgrowth of diarrhoea-producing bacteria.

Artificial sweeteners like sorbitol or fructose remain in the intestine and are not absorbed. They pull fluid from the body into the intestine and cause diarrhoea. These may be found in syrups, “sugar-free” snacks or beverages, so labels need to be carefully read.

About 60 per cent of Indians are lactose intolerant. They either completely lack the enzyme lactase required to digest milk, or they are deficient in it. As a result, they can only tolerate small quantities of milk, curd and other partially digested milk. If they drink milk for “calcium” or because it is “nutritious”, they may develop diarrhoea after a few days.

Diarrhoea can initially be tackled at home. Cook equal quantities of parboiled rice and moong dal with a little salt in a pressure cooker, mash it well, add water and boil again so that it is the consistency of dosai or pancake batter. Eat a tablespoon of this every half an hour. Alternate with sips of water. Eat small quantities of bananas. Watch out for dehydration. If you are dehydrated, consult a physician. If the diarrhoea does not subside within three days, see a doctor.

It is called persistent diarrhoea if it lasts for more than two weeks. It may be due to an infection, but it can be due to systemic diseases.

Diarrhoea and dysentery are not terms to be interchanged. In dysentery, bowel movements are frequent with blood and mucous. It can last for days without treatment. It may be accompanied by abdominal pain and fever. It can be due to bacteria like shigella or a parasite like amoeba, but it can also be due to non-infective causes. It has to be evaluated.

Anti-motility agents like loperamide (Imodium) and diphenoxylate with atropine (Lomotil) are extensively self-administered for diarrhoea. They can cause dangerous side-effects in children and should not be used in those under 12 years. In adults, too, they should be used with caution and not randomly swallowed two at a time to stop diarrhoea quickly.

Signs of dehydration

• Infrequent urination (less than once in 6-8 hours), passing small quantities of high-coloured urine
• Loss of skin turgor
• Sunken eyes
• Fatigue

The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in