Introduction
Loose stools are rather a symptom than a disease. It can point out a number of diseases of gastrointestinal origin. In some rare conditions, it can be sign of serious underlying pathology like a carcinoma. Loose stools can happen to people of any age or gender irrespective of region or race. It can start as an acute problem or can be recurrent and chronic. In today’s world where people are having toxic diet habits, sedentary lifestyles and less idea about gut microbiota, loose stools are very common. It can happen even due to emotional stress like irritable bowel syndrome and can affect the person’s quality of life. Though it is very important to address the underlying disease, symptomatic management is very important as it can be fatal due to dehydration & electrolyte imbalance in some people.
Signs & symptoms
Frequent passage of watery/sticky/loose stools with or without blood mixed with it
Abdominal cramps
Tiredness
Giddiness
Emaciation
Anorexia,
Gas trouble or abdominal discomforts like belching
loss of appetite
Excessive thirst
Pain or itching in the anal region
Causes
- Gastroenteritis (bowel infection) due t
- Virus – like rotavirus
- Bacteria- like E.coli,
- Parasite – like many varieties’ worms
- Anxiety and other emotional distress
- Food allergy
- Food poisoning
- Appendicitis
- Side effects of some medications
- Diverticular disease
- Crohn’s disease or ulcerative colitis
- Coeliac disease
- Carcinoma of stomach, intestine and other gastrointestinal organs
Diarrhoea results from the disruption in the delicate balance between the absorptive and secretory processes within the bowel. It can be either osmotic or secretory. It is the reversal of the normal net absorptive status of water & electrolyte absorption to secretion. Such a derangement can be the result of either an osmotic force that acts in the lumen to drive water into the gut or the result of an active secretory state induced in the enterocytes. In the former case, diarrhoea is osmolar in nature, as is observed after the ingestion of nonabsorbable sugars such as lactulose or lactose in people with lactose malabsorption. Instead, in the typical active secretory state, enhanced anion secretion (mostly by the crypt cell compartment) is best exemplified by enterotoxin-induced diarrhoea.
In osmotic diarrhoea, stool output is proportional to the intake of the unabsorbable substrate and is usually not massive; diarrheal stools promptly regress with discontinuation of the offending nutrient, and the stool ion gap is high, exceeding 100 mOsm/kg.
In secretory diarrhoea, the epithelial cells’ ion transport processes are turned into a state of active secretion. The most common cause of acute-onset secretory diarrhoea is a bacterial infection of the gut. Several mechanisms may be at work. After colonization, enteric pathogens may adhere to or invade the epithelium; they may produce enterotoxins (exotoxins that elicit secretion by increasing an intracellular second messenger) or cytotoxins. They may also trigger release of cytokines attracting inflammatory cells, which, in turn, contribute to the activated secretion by inducing the release of agents such as prostaglandins or platelet-activating factor. Features of secretory diarrhoea include a high purging rate, a lack of response to fasting, and a normal stool ion gap (i.e., 100 mOsm/kg or less), indicating that nutrient absorption is intact.
Diagnosis
Complete blood tests
Faecal examination
Urine culture
Fasting tests
Hydrogen breath test
Endoscopy
Ultrasound
Colonoscopy
Sigmoidoscopy
Acute-onset diarrhoea is usually self-limited. Management is generally supportive care.
Oral Rehydration therapy (ORT)
In most cases, the best option for treatment of acute-onset diarrhoea is the early use of oral rehydration therapy (ORT).Pharmacological treatment is rarely of any use, and antidiarrheal drugs are often harmful. Vaccines (e.g., rotavirus) can help increase resistance to infection. Antimicrobial and antiparasitic agents may be used to treat diarrhoea caused by specific organisms and/or specific clinical conditions. ORT is the cornerstone of treatment, especially for small intestine infections with a large volume of watery stool output. ORT with a glucose-based oral rehydration syndrome must be viewed as the safest, most physiologic, and most effective way to provide rehydration and maintain hydration in children with acute diarrhoea worldwide so far, as recommended by the WHO. Not all commercial ORT formulas promote optimal absorption of electrolytes, water, and nutrients. The ideal solution has a low osmolarity (210-250) and a sodium content of 50-60 mmol/L. Administer maintenance fluids plus replacement of losses.
Pharmacotherapy
In terms of recommended antimicrobial treatment in the immunocompetent host, enteric bacterial and protozoan pathogens can be grouped as follows:
Agents for whom antimicrobial therapy is always indicated:
The consensus includes only V cholerae, Shigella species, and G lamblia.
Agents for whom antimicrobial therapy is indicated only in selected circumstances, include the following:
- Infections by enteropathogenic E coli, when running a prolonged course
- Entero-invasive E coli, based on the serologic, genetic, and pathogenic similarities with Shigella
- Yersinia infections in subjects with sickle cell disease
- Salmonella infections in very young infants, if febrile or with positive blood culture findings
Such medications include the following:
- Cefixime
- Ceftriaxone
- Cefotaxime
- Erythromycin
- Furazolidone
- Iodoquinol
- Metronidazole
- Paromomycin
- Quinacrine
- Sulfamethoxazole and trimethoprim
- Vancomycin
- Tetracycline
- Nitazoxanide
Probiotics
Recently, some strains of probiotics (defined as live microorganisms that when ingested in adequate doses, provide a benefit to the host) have been found to be effective as an adjunct when treating children with acute diarrhoea. They consistently show a statistically significant benefit and moderate clinical benefit of a few, now well-identified probiotic strains (mostly Lactobacillus GG and Saccharomyces boulardii but also Lactobacillus reuteri) in the treatment of acute watery diarrhoea (primarily rotaviral) in infants and young children in developed countries. Probiotics can also reduce the risk of spreading rotavirus infection by shortening diarrhoea duration and volume of watery stool output and by reducing the faecal shedding of rotavirus.
Prognosis
The prognosis of diarrhoea is generally good. The discomforts will be subsided within days.
Complications
Dehydration
Electrolyte imbalance
Kidney failure
Organ damage
Malabsorption
Disease & Ayurveda
Atisaara
Nidana
Excess water intake
Intake of dry meat & meat of emaciated animal
Food which is not habitual or suitable to body
Sesame (dry, grinded and oil removed)
Sprouts
Alcohol
Dry food intake
Excess food intake
Haemorrhoids
Faulty routine during ghee intake (as a treatment)
Intestinal parasites
Suppression of natural urges
Purvaaroopa
Pricking pain in chest, rectum and abdomen
Weakness of body
Constipation
Distended abdomen
Indigestion
Samprapti
Due to the causative factors, Vaata dosha vitiates and brings the water content in the body into the koshtha and expels through anus. With this excess water in koshtha, reduces the Agni (digestive fire), damages the gastrointestinal tract along with faecal matter and causes loose stools. It makes the stool watery and the disease diarrhoea gets manifested especially in people who eat unwholesome diet.
Lakshana
Vaathika
Watery, more frequent stools with obstruction
Defaecation with pain & abnormal sounds
Dry, frothy/clear or hardened stools
Resembles over-cooked jaggery
Sticky stools passed with severe tearing pain
Dryness of mouth
Rectal prolapse
Horripilation
Groaning
Paittika
Yellow, black, green like grass,
With blood
Foul smelling,
Excess thirst
Fainting/giddiness
Excess sweating
Burning sensation
Abdominal pain
Heat and inflammation of rectum & anus
Kaphaja
Heavy, sticky, with thread-like structures, white in colour, oily & sticky, faeces with particles of undigested food
Irregular & interrupted flow containing only a little faecal matter in one vega with mucous &foul smell,
With flatulence
Pain
Excess sleep
Lazy
Aversion to food
Horripilation
Feeling that not completely voided faeces after defaecation
Sannipatajam
All three doshalakshanas are present
Bhayajam and Shokajam
(Resembles Vaata-Pitta akshanas)
Very hot and liquified stools
Very light & floating
Divisions
6 types
- Vaatika
- Paittika
- Kaphaja
- Thridoshaja or sannipaatika
- Bhayajam (due to fear/anxiety)
- Sokajam (due to grief)
2 types
Saamam – with indigestion
Niraamam – without indigestion
2 types
Saraktam – with bleeding
Araktam – without bleeding
Prognosis
Kricchrasadhya in healthy individuals without any complications & dhatudushti.
Asaadhya in children, old persons and with complications.
Chikithsa
Ayurveda treatment for atisaara includes fasting as an important method.
Samana
Langhana – fasting
Upekshaa – Leaving the body to expel out the excess doshas by atisaara
Aamapachana
Agnideepana
Sodhana
Vamana – In atisaara with severe abdominal pain & distension
Snehavasti
Kashayavasti-Picchavasti
Commonly used medicines
Kutajarishtam
Pippallyasavam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Home remedies
Taking Oral Rehydration Therapy: Mix one glass of boiled water with one teaspoon of sugar & one pinch of salt. Take it sip by sip for 3-4 hours. This is the simplest method of rehydration which can be done at home.
Moderate fasting on solid foods till feeling better & hungry.
Fenugreek seeds boiled in water for drinking
Carminatives like cumin seeds help correct the indigestion
Buttermilk boiled with turmeric, curry leaves, ginger, etc.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
carbonated drinks – makes the stomach more acidic and disturbed digestion
refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
curd – causes vidaaha and thereby many other diseases
- To be added
Drink only boiled water
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves
freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid sitting continuously for a long time and avoid squatting.
Yoga
Complete bedrest is advised for a patient with loose stools But after regaining normal health, following a daily exercise routine will help the person to improve digestion & health.
Stretching exercises and specific yoga asanas like pavanamuktasana, vajrasana, bhujangasana etc are recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within and with surroundings.
Pavanamuktasana
Vajrasana
Bhujangasana
Exercises for Low backache
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
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