Diarrhea is defined as a clinical condition characterized by the passage of loose stool more than three times in a day. Explosive diarrhea or severe diarrhea is a term designated to very frequent bowel movements that is expelled in an almost violent nature. In explosive diarrhea, contraction of the bowel becomes stronger and more forceful filling the rectum with the volume it cannot contain. It is also accompanied by a large amount of gases which increases the ejection and loudness of the bowel movement. A stool is composed mainly of water (75%) and another 25% of stool composition includes undigested carbohydrates, fibers, protein, fat, mucus and intestinal secretions. While passing through the different parts of the digestive systems, fluids and electrolytes are added to the content of the stool. Normally, large intestine absorbs the excess fluid. But either due to the rush of the fluid or accumulation of more than usual fluid and electrolytes during digestion explosive diarrhea occurs. It resolves spontaneously within 2-3 days in most of the cases.
Causes of Explosive Diarrhea
Explosive diarrhea is a very common presentation in the emergency room. It can be caused by various factors such as drastic changes in dietary habits, infections, some drugs, etc. some of the causes of explosive diarrhea are given below:-
1. Intake of excessive fiber
A sudden increase in intake of dietary fiber containing food such as vegetables, fruits or bran cereal increases the amount of the indigestible fiber in the intestine. These fibers act to make the stool soft and speed the transit of the fecal material through the intestine. Vegetables, fruits, and grains also contain starch and sugars, which are poorly digested by the intestines. These starches and sugars cause the production of more gases and bloating. These can also trigger diarrhea when the gut receives a huge amount of fiber and sugar load in a short period of time.
2. Bacterial infection
Salmonella and E. Coli are common bacterial infections causing diarrhea. These bacteria transmit via Oro-fecal route by consumption of contaminated foods and drinks.
3. Viral infection
Rotavirus is the commonest virus causing diarrhea in children. People working in hospitals, nursing homes and on cruise ships are also at risk for Rotavirus diarrhea.
4. Bowel disease
– Inflammatory bowel disease(ulcerative colitis, Chron’s disease)
– Celiac disease
5. Parasitic infection
Giardia lamblia and Cryptosporidium are common parasites causing explosive diarrhea. They are found mostly in contaminated water, food, and water of recreation centers.
Diarrhea is a side effect of many drugs. Antibiotics and magnesium-containing antacids can cause diarrhea.
7. Lactose intolerance
Symptoms associated with explosive diarrhea
1. Abdominal cramps.
4. Unable to hold bowel movements.
6. Increased thirst and dry mouth.
7. In adults skin may be loose, they may present with behavioral changes, increased sleep and confusion while dehydrated.
8. In case of dehydration, children suffer from sunken eye, dry mouth, less amount of urine excreted than usual and they refuse to drink or eat. They become lethargic.
Complications of explosive diarrhea
Usually, explosive diarrhea resolves itself in a short duration of time. But it is also associated with some complications that require medical treatment. Some of the complications are:-
Diarrhea causes loss of fluids and electrolyte from the body. Loss of fluid and electrolytes result in dehydration and electrolyte imbalance. Dehydration may be mild, moderate or severe, depending upon the amount of fluid loss. We should be more concerned about dehydration in infants, old age people, and immune-compromised person.
2. Chronic diarrhea
If diarrhea continues for more than 3 days, it is called as chronic diarrhea. It should be treated as soon as possible. Several tests are required to identify the cause of the condition.
3. Haemolytic uraemic syndrome (HUS)
Haemolytic uraemic syndrome is a clinical condition characterized by progressive renal failure and is associated with microangiopathic haemolytic anaemia and thrombocytopenia. It occurs mostly in children but also occurs in adults. It may result from explosive diarrhea caused by E. Coli infection. It may cause renal failure, stroke, coma, seizure or bleeding.
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Diagnosis of explosive diarrhea can be made from the history of the patient.
However, some tests may be required to confirm the diagnosis and treat the complications. Complete blood count to determine the infection. Serum Electrolytes to know the status of the electrolytes in the body.Renal function tests are needed to know whether explosive diarrhea has caused degradation of renal function or not. Stool examination (stool R/M/E and stool culture) to see the presence of mucus, blood, pus or parasites. Other tests like colonoscopy may be needed to determine the causes of chronic explosive diarrhea.
Management of explosive diarrhea
Explosive diarrhea resolves itself within a few days without treatment. However, in some cases, you need medical attention. These causes are as follows:-
a. Diarrhea lasting for 24 hours in a child or longer than 2 days in adults.
b. If symptoms of dehydration such as dry mouth, intense thirst, reduced urine output, lethargy are present.
c. If the stool contains blood, pus or is black in color.
d. If you are suffering from high fever,
e. Severe abdominal cramps.
The mainstay of treatment of explosive diarrhea is to prevent dehydration and electrolyte imbalance. Dehydration can be prevented by replacing the fluid and electrolytes. Consumption of oral fluids such as water, juice, along with oral rehydration salt helps in preventing dehydration and electrolyte imbalance. If you are suffering from severe dehydration, treatment requires hospital admission and intravenous fluid and electrolyte administration. Bacterial infections should be treated with antibiotics. Use of anti-motility drugs such as loperamide should not be taken if you are suffering from fever or has a black or bloody stool.
Prevention of explosive diarrhea
1. Maintenance of good sanitary habits which includes washing hands with soap and water before eating, after using the toilet or changing diapers.
2. Using bottled water for drinking and brushing teeth while traveling to areas where water purity is compromised.
3. Peeling raw vegetables or fruits properly.
4. Boiling and filtering water before consumption.
5. Vaccination against cholera and Rotavirus has been effective in the prevention of explosive diarrhea.
6. Avoiding consumption of stale food.
7. Avoiding drastic changes in dietary fiber containing food consumption.