Treatment

Therapy is guided by clinical features of dehydration and hypovolemia and laboratory findings in dehydration and hypovolemia.

• Mild to moderate dehydration: Start oral rehydration therapy, e.g., use oral rehydration solution. [20]

• Severe cases

  • Start IV fluid resuscitation (e.g., with normal saline) and monitor hemodynamic parameters.

  • Consider hospitalization.

Acute diarrhea is usually a self-limited viral infection and management primarily supportive.

Early rehydration is especially important in children

• Bismuth subsalicylate

• Loperamide [24][26][27]

  • Opioid receptor agonist that increases intestinal transit time

  • Best initial treatment for chemotherapy-induced diarrhea

  • Cautions

    • Should not be used for > 48 hours without reevaluation of the patient

    • Should be avoided if the patient is febrile or has bloody stools (dysenteric diarrhea)

Loperamide should be avoided in patients with suspected invasive diarrhea with inflammatory features, as it reduces intestinal motility, which consequently increases the risk of bacterial colonization and invasion.

• Fecal incontinence

  • Involuntary release of stool, usually without a sensation of urgency

  • May indicate abnormal neuromuscular function or anorectal structure

  • Diagnosis is made based on history and a digital rectal examination.

• Impaction with fecal overflow (paradoxical diarrhea)

  • Rectal distention relaxes the internal anal sphincter, allowing leakage of stool.

  • Diagnosis is made based on a digital rectal examination.

• Pseudodiarrhea

  • Frequent passage of small amounts of stool

  • Usually accompanied by fecal urgency or the feeling of incomplete emptying of the rectum

  • Often accompanies IBS and proctitis