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I receive many letters from people who complain of having “dysentery” or “always” having “diarrhoea”, which stops them from functioning effectively in their jobs or studies. The terms diarrhoea and dysentery are freely interchanged, leading to confusion in the minds of patient and physician. Diarrhoea occurs when the consistency and frequency of the bowel movement changes. It becomes either watery or frequent (usually more than three times a day) or both. Dysentery occurs when there is blood and mucous in the stool.
Our intestines are full of good bacteria. These colonise the bowel and produce essential vitamins of the B group as well as vitamin K. They also kill disease-causing bacteria ingested with food. Antibiotics, prescribed for various infections, kill these good bacteria too. So harmful bacteria can gain a foothold, leading to diarrhoea. This accounts for the mild tummy upset that may follow a course of antibiotics.
Infective diarrhoea can be viral, bacterial or parasitic. Organisms are ingested with every meal. The acid in the stomach, the first line of defence, destroys these. Acidity in the stomach is reduced by antacids and medications such as ranitidine, omeprazole and pantaprazole. Large numbers of disease-causing bacteria in contaminated food can overwhelm even normal stomach defences. Bacterial overgrowth can also occur in food if it is left outside and reheated and used the next day. A very common form of this occurs if leftover rice is eaten the next day. Even if it is fried, the bacterial toxins withstand the heating process.
In victims of diarrhoea, rehydration is important. You can use commercial ORS (oral rehydrating solution), tender coconut water, salted lime juice, buttermilk or a watery mixture of rice and dal. Make an estimate of the amount of fluid lost and replenish it. If diarrhoea continues for more than three days, or if urine output decreases, consult a physician immediately.
Anti motility agents such as lomotil and lomofen do not cure diarrhoea. They merely reduce the movement of the intestine so that the frequency becomes less. They are contraindicated in children under the age of five. They do not work in dysentery. Viral diarrhoeas do not respond to antibiotics. They subside on their own. Bacterial and parasitic diarrhoeas can be treated with specific medications. Make sure to complete the course, otherwise the organism becomes resistant, causing diarrhoea to recur after 2-3 days.
Dysentery means that there is blood and mucous in the stool. It is usually caused by an infecting organism (such as bacteria and amoebae) invading the large intestine. There may by paroxysms of pain and fever. The full course of medication should be followed.
“Probiotic” capsules are often prescribed to restore intestinal flora to its original state. They are expensive and of dubious efficacy. A similar effect can be obtained by swallowing one tablespoonful of home-made curd early in the morning on an empty stomach. Curd is not a true probiotic but contains sufficient lactobabillus and other bacteria to repopulate the intestine. Taking zinc supplements also reduces the duration and frequency of diarrhoea.
If diarrhoea or dysentery persists for two weeks, it is classified as chronic and needs to be re-evaluated by a physician. It may be an ordinary or exotic infection that has been missed in the preliminary round of investigations. Also, not all diarrhoeas, or dysentery-like diseases, are due to infections. Mucous may appear as a part of IBS (idiopathic bowel syndrome). Blood may appear in diverticulosis of the large intestine or if there are polyps present. In children milk allergy or lactose intolerance can read as recurrent diarrhoea or dysentery. Haemorrhoids (piles) or a fissure can be the reason for blood in the stool. On very rare occasions, cancer of the large intestine can also be the reason for blood in the stool.
Cholera, typhoid (which can also cause diarrhoea) and rotavirus infections are preventable by timely immunisation. The cholera vaccine is now given by mouth in two doses and the typhoid as an injection repeated every three years. Rotavirus is likely to affect children and can be fatal. The vaccine is administered orally and is best given before the age of six months as two doses a month apart.
Diarrhoea falls just behind respiratory illness in frequency and mortality. One of the reasons is that 50 per cent of 1.2 billion Indians lack toilets and defecate in the open, perpetuating the cycle of diarrhoeal illness. Tourists and travellers to India expect and dread the onset of diarrhoea.
In the long term, improvements in sanitation, safe water supply, regulated food safety and community awareness of preventive measures will go a long way towards reducing the frequency of diarrhoeal diseases.
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
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