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Diarrhoea may be described as an increase in the frequency of defecation, accompanied by abnormally soft and watery faeces. Dehydration is a big risk in the elderly and the very young. Diarrhoea is generally rapid in onset with associated abdominal cramps, flatulence and weakness. Family members may similarly be suffering at the same time, as acute diarrhoea is often due to a mild viral/bacterial (e.g. Salmonella) infection. It may sometimes be due to irritable bowel syndrome (IBS), or even a tumour or ulcerative colitis. You should inform the pharmacist if you are suffering from diarrhoea continuously.

The basis of treatment of acute diarrhoea is electrolyte and fluid replacement; in addition anti-diarrhoeals are useful in adults and older children.

Infections causing diarrhoea are either viral or bacterial.

Viruses are often responsible for gastro-enteritis. In infancy the virus is often one that enters through the respiratory tract - symptoms may often include a cough or a cold.

Sometimes diarrhoea often returns when milk feeds are re-introduced, this is because one of the enzymes needed for the digestion of milk is temporarily inactivated. Milk therefore passes through the bowel undigested causing diarrhoea.

Bacterial infections are the cause of food poisoning that typically occurs when poultry is under cooked or contaminated food is reheated insufficiently. Symptoms may arise within 6-72 hours after ingestion of contaminated food.

The main treatment is rehydration and the infection is usually self-limiting and eliminated quickly from the bowel.

Great care has to be taken with the old and the very young to protect them against dehydration. Due to the dangers of dehydration it would be wise to bring infants suffering from diarrhoea for longer than one day to your GP.

You may treat diarrhoea that has been present for up to three days: if it has been longer than three days go to your GP. Most cases of diarrhoea will be acute and self-limiting. If you are suffering from other symptoms especially if there is vomiting or fever, or if you have recently been travelling abroad you should call into your local pharmacist or GP.

Many prescriptions or OTC medications may cause diarrhoea, so these should be mentioned to the pharmacy sales assistants. If you have any bowel problems make sure to mention these also.

All those with diarrhoea, but especially the elderly and very young should be given replacement fluids to guard against dehydration. The rehydration sachets we recommend can be given together with anti-diarrhoeals and are very safe to use, except in diabetics and those on a restricted sodium diet. The sachets should be made up with freshly boiled and cooled water, and the solution can be kept for 24 hours if it is stored in the fridge.

Fizzy, sugary drinks often make the problem worse, and standards like REHIDRAT/ DIORALYTE are much safer. There are preparations available to adults to STOP the diarrhoea. Anti-diarrhoea medication is suitable only from the age of 12 years and is not recommended in the elderly unless the GP advises otherwise.

Practical Points:
- Patients with diarrhoea should be advised to drink plenty of clear, non-milky fluids such as water and diluted orange. Patients with diarrhoea should avoid milk as there can be a temporary intolerance to lactose, (a sugar present in milk), which makes diarrhoea worse.
- No solid food is advised for 24 hours, and bottle fed infants should not be given any milk for 24 hours, and should be re-introduced to it gradually. Breast-feeding, however can continue.

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