General treatment of acute diarrhoea includes rest, encouragement of fluid intake, and taking of oral opiate-containing agents.
Intravenous fluid and electrolyte replacement may be necessary in infants and elderly people. Oral sugar-electrolyte solutions may be prescribed in certain cases of diarrhoea.
The following methods may help reduce symptoms of mild diarrhoea:
• Avoid solid food for a few hours until you feel better.
• Ask your doctor to prescribe some zinc as this shortens the duration and reoccurrence of diarrhoeal disease. Children weighing less than 10kg should take 10mg zinc daily for ten days, while those weighing more than 10kg should take 20mg zinc daily for ten days.
• Avoid dehydration. Take frequent, small sips of water or a rehydration drink. Adults should drink about two cups of water an hour unless they are vomiting. Children older than two years can drink up to about 2.25 litres a day. Ask your doctor what to give a child under two years.
Apart from water, you may choose liquids such as clear broth, caffeine-free soft drinks, weak tea with sugar, sports drinks, iced lollies, fruit juices (except prune juice), jelly, or a mixture of four teaspoons of sugar and one teaspoon of salt with four cups of boiled water.
• Avoid very hot or cold liquids.
• Avoid milk and all dairy products as these can worsen diarrhoea.
• Avoid alcohol.
• Most mild cases of diarrhoea don't require antibiotics or over-the-counter anti-diarrhoea products, such as Imodium. These may slow the elimination of the infectious agent, so avoid these products at least for the first six hours. Use them only if there are no other signs of illness, such as fever, and if discomfort continues.
• If the diarrhoea was caused by an infection:
• Wash your hands after using the toilet, and before handling food.
• Dry your hands with paper towels and discard these.
In young children, oral rehydration solutions (ORSs) can be used to correct dehydration. ORSs contain the right balance of minerals and sugar to help replace body fluids. The amount of ORS taken depends on dehydration severity.
For babies to one-year olds:
• Don't wait until signs of dehydration develop to replace lost fluids.
• Increase frequency of feedings. Give ORS between feedings if signs of dehydration develop. If the baby is vomiting, your doctor may suggest that you stop milk feeding and only give clear fluids.
• The amount of ORS needed depends on the baby's weight and the degree of dehydration. Continue giving ORS until the baby's stools return to normal.
• If you are bottle-feeding give a lactose-free formula
• If your baby has started eating, you may replace lost fluids with foods such as cereal or mashed bananas after each diarrhoea stool.
• Nappy rash is common after diarrhoea. Protect the nappy area with zinc oxide or any other suitable cream.
For one to three-year olds:
• ORS, half-strength juice, or water (if the child is eating food) may be used to replace lost fluids. Offer the child half to one cup of fluid after each loose stool. The child should drink as much fluid as he or she wants. If diarrhoea persists or the child is dehydrated, use ORS as the main replacement fluid. Give ORS until stools return to normal. Other drinks do not contain the right mixture of minerals and sugar to replace lost fluids and may worsen the diarrhoea.
• Do not withhold food. Give the child at least six small meals daily of easily digestible foods such as, cooked beans or carrots, mashed bananas. Give biscuits that are free of milk (e.g. Baumanns cream crackers, water biscuits or Vitola digestive).
• Avoid foods and drinks high in sugar, such as juice, soft drinks and sweets.
• If the child drinks cow's milk, change to a lactose-free formula or soya formula.
• Do not give the child prescription or non-prescription medicine to stop diarrhoea, unless so instructed by a doctor.
When the diarrhoea starts to improve:
• Begin eating bland, mild foods such as rice, dry toast or banana.
• Avoid other fruits, spicy and fatty foods, alcohol and coffee until 48 hours after symptoms disappear, and dairy products for three days after symptoms disappear.
• Eat small amounts of soft foods like cooked potatoes.
• Avoid meat, nuts and beans. Avoid foods that are hard to digest, such as raw fruits and vegetables, fried foods and sweets, whole-grain bread or bran cereal.
• As symptoms improve, start to eat low-fibre foods, such as soda crackers, toast, eggs, rice, or chicken and other tender cuts of meat.
• Even if you feel ravenous, try not to overeat. Eat small meals at regular intervals.
• Don't exercise strenuously until you are free of symptoms.
When to see the doctor
The Cape Metro Diarrhoea Team provides the following guidelines on danger signs that indicate you need to take your child to a doctor or clinic if you notice any of the following:
• Child is unable to drink or breastfeed
• Child vomits everything that he/she drinks and eats
• Child is having fits/convulsions
• Child is weak or lethargic
• Child has difficulty breathing
• There is blood in the child’s stools
• Child passes less or no urine (indicated by a dry nappy)
Risk factors of diarrhoea
Symptoms of diarrhoea
Causes of diarrhoea
Revised and reviewed by Dr Saville Furman, MBChB MFGP (SA). Family Physician, Part time lecturer in family medicine and primary care at UCT, Red Cross Children’s Hospital and Groote Schuur hospital, Cape Town. February 2015.
Previously reviewed by Dr Naayil Rajabally MBBCh (Wits), FCP (SA), Cert Gastroenterology (Phys) Division of Gastroenterology, Department of Medicine, Groote Schuur Hospital. Updated, October 2011