Watery diarrhea is repeated (up to 15-20 times a day) defecation, which is accompanied by the release of unformed liquid stool. 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. Ultrasound, radiography, endoscopy, laboratory tests are used to determine the causes of diarrhea. To stop diarrhea, adsorbents, enveloping and astringent drugs are used.
Causes of watery diarrhea
Defecation with water often indicates infectious or non-infectious intestinal diseases. Sometimes pregnant women complain about the appearance of liquid unformed feces, which is caused by gestational changes on the part of 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 aleikia. Profuse diarrhea occurs in 90% of patients with toxic shock.
Ingestion of pathogenic intestinal microflora, as a rule, is accompanied by watery diarrhea of the secretory type. Bacteria are able to secrete a specific enterotoxin that affects the epithelial cells of the mucosa and causes the accumulation of adenylate cyclase, cAMP in them. This contributes to an increased release of ions into the intestinal lumen, followed by the entry of a large amount of liquid into the intestines along the concentration gradient. The condition is aggravated by concomitant inflammatory lesions of the gastrointestinal tract. The following intestinal infections lead to diarrhea with water:
- Cholera. This infectious disease manifests itself with diarrhea, which quickly loses its fecal character and odor, becoming watery. After a few hours, 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 develops more often when infected with enterotoxigenic strains of the microbe, when the disease proceeds according to the type of a mild variant of cholera. In young children, diarrhea with water is usually caused by enteropathogenic strains. Diarrhea is combined with vomiting, pain in the epigastrium, along the course of the intestine. It is possible to increase body temperature to subfebrile figures. The 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, copious bowel movements, first with the release of unformed feces, and then water with food particles, mucus. A greenish foamy stool (“swamp mud”) is characteristic.
- Botulism. In the gastroenterological variant of infection, dyspeptic symptoms come to the fore: watery diarrhea, repeated vomiting, spastic abdominal pain. Patients complain of dry mouth, feeling of a lump in the throat. Botulism is characterized by ocular manifestations: double vision, flashing of “flies” in front of the eyes, blurred vision. In severe cases, paresis, paralysis of facial muscles with facial asymmetry are observed.
- Campylobacteriosis. The disease begins acutely with a rise in temperature to 38 ° C or more, pain in muscles, 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 only in a quarter of patients with campylobacteriosis.
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 epithelial cells, causing their death and peeling from the surface of the mucosa, which leads to a violation of parietal digestion, diarrhea. Pathogens also slow down the processes of reverse absorption 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 10 times a day, bowel movements are fecal in nature, with a severe course, profuse diarrhea with the discharge of a cloudy, fetid yellow-green liquid is the leading one. 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 bowel movements, vomiting, abdominal pain. Repeated defecation with the release of a large volume of fluid becomes a prerequisite for severe dehydration, which is manifested by dry skin, mucous membranes, decreased blood pressure, oliguria.
- Hong Kong flu. With this type of influenza infection, symptoms from the gastrointestinal tract are combined with signs of damage to the respiratory system, general intoxication of the body. Along with headache, high fever, there is repeated diarrhea with water, moderate abdominal pain, nausea, lack of appetite. Respiratory manifestations (dry cough, sore throat, nasal congestion) occur on the 2-3 day of the disease.
- Hemorrhagic fever Marburg. 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 abdominal pain develop on day 3-4 of hemorrhagic fever. Pathognomonic signs — maculopapular rash, uterine, nasal and gastrointestinal bleeding, appearing on 5-6 days of illness.
- HIV infection. AIDS is characterized by abundant watery stools without pathological inclusions, due to digestive disorders and the addition of 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 their body weight.
Protozoal and worm infestations
Helminths and protozoa have a direct pathogenic effect on enterocytes of the mucous membrane, causing severe disorders of digestion and absorption of food components. Pronounced malabsorption syndrome in combination with increased secretion of water and electrolytes into the intestinal cavity provokes copious diarrhea. With insufficient replenishment of fluid losses, dehydration syndrome of varying severity develops. Watery diarrhea is noted with such invasions as:
- Cryptosporidiosis. 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, vomiting. The disease more often affects people with immunodeficiency. In such cases, there is a long course (up to 4 months) with severe dehydration.
- Strongyloidosis. Intestinal manifestations are noted in the second phase of the disease, 2-3 weeks after the appearance of the first symptoms — urticaria, rashes and arthralgia. The development of diarrhea is associated with an inflammatory lesion of the small intestinal mucosa, the formation of hemorrhages, erosions. In addition to diarrhea, the appearance of pain in the epigastric region, nausea, vomiting is typical. Sometimes there is jaundice of the skin, pain in the right hypochondrium.
Non-communicable intestinal diseases
Watery diarrhea often complicates the course of organic diseases of the digestive tract, especially in the initial stages. The increase in the volume of fecal masses is due to both violations of the processes of parietal and abdominal digestion, and the influence of various inflammatory mediators. Diarrhea can be associated with intestinal motility disorders of the hyperkinetic or hypokinetic type. With a change in the frequency and consistency of 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 has an allergic, medicinal or autoimmune nature. The appearance of liquid fetid feces is mainly caused by malabsorption and maldigestion syndromes. Stool is observed up to 10-15 times during the day, accompanied by flatulence, rumbling in the stomach, decreased appetite, nausea, significant loss of body weight.
- Enteropathy. Chronic watery diarrhea is manifested in non-inflammatory intestinal pathologies. The change in the consistency of fecal masses can be caused by both fermentopathies and violation of gastrointestinal peristalsis (for example, hypomotor variant of diabetic enteropathy). Pain syndrome is poorly expressed, digestive disorders that contribute to weight loss, protein and energy deficiency prevail.
- 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 smell, as the disease progresses, it becomes watery. The frequency of bowel movements reaches 25 times a day. Similar changes are observed in the pseudomembranous variant of colitis with exudative enteropathy.
In the absence of enzymes in the initial parts of the small intestine, the appearance of copious diarrhea with water is associated with an osmotic mechanism. The presence of a large number of undigested large molecules, especially disaccharides and peptones, serves as a prerequisite for an increase in pressure in the intestinal lumen, the release of fluid and sodium ions. Diarrhea occurs with pancreatic fibrosis and a decrease in its exocrine function by 80-90%, as a result of which the digestion of all types of food is disrupted. The condition is aggravated by the addition of a secretory mechanism of diarrhea associated with the activation of cAMP.
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, acid belching. In children, defecation with water becomes a consequence of galactosemia – milk intolerance due to the congenital absence of an enzyme. The symptom appears immediately after the start of breastfeeding, accompanied by hypotrophy, jaundice, inhibition of reflexes.
Watery diarrhea always indicates the presence of problems with the digestive system. The examination of patients with complaints of watery diarrhea is carried out by a gastroenterologist or an 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 diagnostic terms are:
- Radiography. With the help of an overview radiography of the abdominal cavity, the condition of the patient’s gastrointestinal tract is quickly assessed. For a detailed study of the inner surface of the digestive tract, oral contrast with barium sulfate is used. The method is quite informative when detecting non-infectious processes that cause watery stools.
- Ultrasound examination. The noninvasive 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 an inflammatory process. Sonography is also performed to assess the condition of the pancreas.
- Analysis of feces. 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 fecal culture, 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 determine various infectious diseases, especially of a viral nature. The study is not informative enough 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, an endoscopic examination with a biopsy is recommended. To assess the external secretory function of the pancreas, a blood test for amylase, lipase is sometimes prescribed.
Correction of the diet is required. 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 diarrhea, a significant amount of fluid is lost with water, therefore, with a satisfactory condition of the patient, it is important to provide abundant drinking to prevent severe dehydration.
Until the exact cause of stool disorders is established, adsorbents, astringents and enveloping agents are used to reduce the frequency of watery diarrhea. In no case should you take medications that inhibit intestinal peristalsis, as this can increase intoxication and lead to a deterioration of 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.