delhi belly

Delhi belly

Your Health
DR GITA MATHAI

Keep diarrhoea away
• Always wash hands with soap or a hand sanitizer before eating
• Drink water that has been boiled for 5 minutes, purified through a machine or bought as “mineral water” from a reputed company
• If that is not available, add a drop of tincture iodine or a pinch or turmeric to the water
The monsoons may bring a good harvest but the stagnant rainwater, overflowing drains and flooded roads also play havoc with our health. Flooding leads to back flow in sewage drains and drinking water can become contaminated. This results in outbreaks of diarrhoea, dysentery and, occasionally, cholera epidemics.

Diarrhoea is defined as stools that are more frequent, bulkier or more watery than usual. It occurs either because a damaged intestine does not absorb fluid from the food or secretes excess fluid. If blood and mucous is present in the stool as well, then it is called dysentery. Other incidental symptoms are fever, vomiting or stomach pain.

Viruses, bacteria and parasites damage the lining of the intestines. There is “intestinal hurry” as food is rushed through it before the liquid portion can be fully absorbed.

In weddings and other functions, diarrhoea can affect a number of people, and is referred to as food poisoning. This is caused by heat stable intestine damaging toxins released by the bacteria which initially contaminated the food. Subsequent cooking destroys the bacteria, but not the toxin.

Usually diarrhoea (even infective ones) subsides on its own, without specific treatment, in 3 to 7 days. If it lasts two weeks or longer, it needs to be investigated. The diagnosis requires a detailed history, stool and blood tests and sometimes endoscopy studies.

Common causes for such diarrhoea are alcohol, coffee, tea and allergy to food, particularly the oil used, or the preservatives or colouring added. Some people are intolerant to milk and if “a little extra” is consumed, it results in diarrhoea. Even if you did not have milk intolerance in childhood, it can occur later in life. Also, the blood supply to the intestines may be inefficient because of a hernia, prior surgery, radiation treatment, diabetes or an abnormal lipid profile and this can lead to diarrhoea.

Antibiotics can also kill the friendly bacteria in the gut that help in digestion and absorption. This results in antibiotic diarrhoea. Antacids containing magnesium, painkillers and cholesterol-lowering statin group of drugs are other offenders. Sometimes people take laxatives (allopathy or homeopathy) and this can also result in chronic diarrhoea.

Painful but non-infectious diarrhoea may occur as a result of a poorly understood condition called the irritable bowel syndrome. Coeliac disease (where the person is intolerant to wheat and wheat products) responds only to a strict diet. Cancer of the intestine can result in constipation alternating with diarrhoea.

Acute diarrhoea can result in dehydration as fluids are lost from the body faster than they are replaced. It makes the person drowsy, irritable, lethargic and giddy with cold and clammy hands and feet and sunken eyes. Urine may not be passed for 6-8 hours. Dehydration is dangerous. If it is not corrected, it can lead to kidney failure and even death.

Dehydration can be prevented by taking small frequent sips of water alternating with rice gruel, watery khichdi (combination of equal quantities of rice and dal) and banana. This replaces the electrolytes lost. Commercially available ORS (oral rehydration solution) sachets can also be reconstituted and used. Tea, coffee, fruit juices and fizzy drinks are best avoided.

Loperamide and Lomotil can be used to reduce intestinal motility and stop the diarrhoea. They do not treat the disease, only its symptoms. They can cause intestinal bloating and should not be used in children or in older patients.

Antibiotics do not work in viral diarrhoea or in food poisoning. They should not be used unless there is an identified bacteria causing the diarrhoea. Single doses should not be purchased from medical shops without a prescription and taken indiscriminately, as it results in the development of resistant bacteria.

Immunisation is available to prevent diarrhoea due to the rotavirus (for children), cholera, seasonal flu and typhoid.

A doctor should be consulted if there is dehydration, the diarrhoea has persisted for more than three days, there is fever, blood and mucous in the stool, or if it follows treatment with antibiotics.

Probiotics sold as sachets and tablets have gained popularity. They are advertised widely and are reputed to check antibiotic induced and other diarrhoeas. They are “good bacteria” which normally populate the intestine and prevent overgrowth of disease producing bacteria. Potent probiotics are found in freshly prepared home-made curd. A spoon of curd every morning can prevent overgrowth of diarrhoea producing organisms.

Breast-fed babies are less likely to develop diarrhoea. This is because human milk contains white blood cells that kill germs. It also contains immunoglobulin (IgA) which gives the baby’s intestines a protective coating and prevents infections and allergies.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in