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TYPES OF DIARRHEA AND
THEIR PHYSIOLOGICAL
CAUSES.
DIARRHEA
According to WHO, Diarrhea is defined as the passage of three or

more loose or liquid stools per day (or more frequent passage than
is normal for the individual).
Diarrhea is usually a symptom of an infection in the intestinal tract,
which can be caused by a variety of bacterial, viral and parasitic
organisms.
CLASSIFICATION
Diarrhea can be classified by several methods with duration of the

symptom being foremost.
According to WHO there are three clinical types of diarrhea:
1. Acute Watery Diarrhea - lasts several hours or days.
2. Acute Bloody Diarrhea - also lasts several hours or days.
3. Persistent/Chronic Diarrhea- lasts 14 days or longer
CLASSIFICATION
CAUSES
Infection:
Diarrhea is a symptom of infections caused by a host of bacterial, viral and parasitic
organisms,
Most of which are spread by faeces-contaminated water.
Rotavirus and Escherichia coli, are the two most common etiological agents of
moderate-to-severe diarrhea in low-income countries.
Malnutrition:
Children who die from diarrhea often suffer from underlying malnutrition, which
makes them more vulnerable to diarrhea.
Diarrhea is a leading cause of malnutrition in children under five years old.
CAUSES
Source:
Water contaminated with human faeces e.g. from sewage, septic tanks and
latrines, is of concern.
Animal faeces also contain microorganisms that can cause diarrhea.
Other Causes:
Diarrheal disease can also spread from person-to-person, aggravated by poor
personal hygiene.
Food is another major cause of diarrhea when it is prepared or stored in
unhygienic conditions.
Unsafe domestic water storage and handling is also an important risk factor.
Fish and seafood from polluted water may also contribute to Acute diarrhea.
PATHOLOGICAL DISORDERS
Approximately 10 liters of fluid can move through the small intestine in a 24-
hour period from food, fluids, and secretion of various enzymes and fluids
necessary for digestion. The small and large intestines can reabsorb that and
even more fluid when functioning normally.
This normal gut physiology relies on a functioning enteric nervous system
that coordinates the gut ion transport and motor activity.
When any of these pathways are disrupted, diarrhea can occur resulting in
secretory, osmotic, Inflammatory, disordered motility or exudative diarrhea.
Secretory
Secretory diarrhea occurs when there is an increase in the amount of fluid being
drawn into the lumen of the bowel such that the ability of the intestines to reabsorb
is overwhelmed.
E.g. the toxin excreted by the pathogen cholera causes massive secretory diarrhea by
stimulating the secretion of anions, especially chloride ions. To maintain a charge
balance in the gastrointestinal tract, sodium is carried along with water.
During the acute phase, as much as 24 liters of water can be carried within 24 hours.
In this type of diarrhea intestinal fluid secretion is isotonic with plasma even during
fasting.
It continues even when there is no oral food intake.
Osmotic
Occurs when there is a dysfunction in the ability of the intestine to reabsorb fluid as it flows through the
lumen
May be caused by incomplete breakdown or maldigestion (e.g., pancreatic disease or Coeliac disease) of
nutrients in the small intestine allowing a larger and more liquid mass to enter the colon
It can also be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the
bowels).
The causes of this of osmotic diarrhea are varied but can be broken down into decreased enzymatic
availability (lactose intolerance), a genetic abnormality that decreases or eliminates the ability of the body
to absorb certain nutrients (celiac sprue), sugars that are poorly absorbed (sorbitol, mannitol or lactose),
laxatives, magnesium- containing antacids, antibiotic administration as well as malabsorption of certain
fats.
In most of these cases, osmotic diarrhea stops when the offending agent is stopped.
Inflammatory
Occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a
decreased ability to absorb these lost fluids.
Caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases.
It can also be caused by tuberculosis, colon cancer, and enteritis.
Disordered Motility
Conditions which cause altered gastric, small intestinal, or colonic motor activity may cause diarrhea by limiting the time for the
normal digestive and absorptive processes to take place.
Patients with autonomic diabetic neuropathy or hyperthyroidism may have altered intestinal motility leading to diarrhea.
Abnormal motility also likely contributes to diarrhea in patients with the irritable bowel syndrome (IBS), (due to heightened visceral
sensation and altered intestinal motility). Typically, patients alternate from being constipated to having diarrhea.
Exudative
Exudative diarrhea occurs with the presence of blood and pus in the stool.
This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and other severe infections such as E. coli
or other forms of food poisoning.
PREVENTION
Access to safe drinking-water;

Use of improved sanitation;
Hand washing with soap;
Exclusive breastfeeding for the first six months of life;
Good personal and food hygiene;
Health education about how infections spread; and
Rotavirus vaccination.
TREATMENT
Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water,
salt and sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine
and replaces the water and electrolytes lost in the faeces.
Zinc supplements: zinc supplements reduce the duration of a diarrhea episode by 25%
and are associated with a 30% reduction in stool volume.
Rehydration: with intravenous fluids in case of severe dehydration or shock.
Nutrient-rich foods: the vicious circle of malnutrition and diarrhea can be broken by
continuing to give nutrient-rich foods including breast milk during an episode, and by
giving a nutritious diet including exclusive breastfeeding for the first six months of life
to children when they are well.

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TYPES OF DIARRHEA AND

According to WHO, Diarrhea is defined as the passage of three or

Diarrhea can be classified by several methods with duration of the

Access to safe drinking-water;

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