In the US, people are discussing diarrhea more than usual. As of late August, more than 17,000 people across the US have had cyclosporiasis, a parasitic infection often traced to contaminated produce. But tens of millions of diarrhea cases occur in the US every year, caused by lots of other factors.
Some causes, such as cyclospora infection, benefit from antibiotic treatment. But most episodes of diarrhea go away by themselves and don’t require treatment apart from staying hydrated, says Benjamin Levy, a gastroenterologist at the University of Chicago.
Although it’s unpleasant, it’s usually manageable. Here’s how to know when to seek care, and how to take care of yourself at home.
When do I need to see a doctor?
The majority of diarrhea episodes go away by themselves after three or four days, says Levy.
However, if you have diarrhea that has lasted longer than a week or is accompanied by fever or other concerning symptoms, seek care. These include a fever of 101F or higher, blood or mucus in your stool, severe abdominal pain, vomiting for more than two to three days, or feeling like you need to poop but not actually producing anything when you go to the bathroom.
Another important symptom to watch out for is dehydration. Thirst is its most well-known sign, but a more reliable indicator is a drop-off in urine production. If you’re drinking plenty of fluids but not absorbing enough to make urine at least every six hours, that’s concerning. Symptoms can include lightheadedness, confusion and dark urine. If that’s you, see a clinician – and skip the walk-in “hydration spa” IV drips. If you’re dehydrated enough to need IV fluids, Levy says, “there may be something more serious going on”.
Some people should have a lower bar for seeking care. If you’re 65 or older, you may be less aware of thirst, so let your clinician know within a day of diarrheal symptoms. Do the same if you have kidney disease, a weakened immune system, or a recent hospitalization or course of antibiotics.
Your clinician may order testing for a range of infectious or non-infectious conditions. If you think you might be at risk for something specific, like cyclosporiasis, ask if any special testing might be helpful.
What should I eat and drink?
The priority is staying hydrated. Replace fluids and electrolytes by drinking plenty of water, tea or sports drinks early on.
If you’re starting to become dehydrated, switch to an over-the-counter oral rehydration solution such as Pedialyte. These drinks are formulated with a lower concentration of dissolved sugar and salt than regular sports drinks, which helps them be absorbed better and curb poop output more effectively.
There’s no need for a strict liquid diet or the formerly recommended Brat diet (bananas, rice, applesauce, toast). But certain foods can aggravate symptoms, says Levy. He recommends skipping fatty and spicy foods, as well as high-fiber foods like whole grains and raw fruits and vegetables. He also suggests avoiding alcohol, caffeine, and drinks that are overly sugary or that contain artificial sweeteners.
So long as you have an appetite, eat modest portions of whatever you feel like outside those categories – broth-based soups with chicken or tofu, starchy foods, and eggs are all good choices.
Diarrhea often causes temporary lactose intolerance, so Levy also recommends skipping dairy other than yogurt.
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What can I do to relieve my symptoms?
For symptom relief, most adults can safely take bismuth subsalicylate (Pepto-Bismol is a common brand) for a couple of days to reduce poop frequency and cramping. (Don’t be alarmed if your poop turns black; that’s a benign side-effect.)
Many people can also safely take a few doses of loperamide (eg Imodium), but only if they meet specific conditions: the diarrhea doesn’t contain blood, they don’t have a fever and they haven’t taken antibiotics in the past three months.
With both of these medicines, follow package directions to determine the dose, and check with your doctor before taking them if you have any medical conditions.
To reduce the risk of an irritated anus, Levy recommends slightly wetting soft toilet paper at the sink and patting, rather than rubbing, when you wipe. Avoid alcohol-based wipes, which dry out the skin and may cause more irritation. Zinc oxide, dimethicone or petroleum-based barrier ointments applied after each cleanup help protect irritated skin, and you may also get relief from a plain-water sitz bath – just sit in a few inches of warm water in the tub.
For particularly severe itching or inflammation, low-dose over-the-counter creams containing the anti-inflammatory drug hydrocortisone, the numbing agent lidocaine, or both, may help.
One thing not worth reaching for: probiotics. “Not recommended,” Levy says flatly, despite what some influencers say.
How should I protect others?
If a contagious condition is causing your diarrhea, you may be contagious for days to weeks after symptoms resolve, and it typically spreads hand-to-mouth. Wash your hands, fingernails and wrists with soap and water – especially after using the bathroom and before and after handling food. Skip preparing food for anyone else while you’re sick. And if you can, stay home from work until your symptoms resolve.
