Most episodes of diarrhea resolve on their own and require no treatment beyond staying hydrated, according to Benjamin Levy, a gastroenterologist at the University of Chicago. In the US, discussion of diarrhea has increased recently, particularly with the rise of cyclosporiasis, a parasitic infection often linked to contaminated produce. As of late August, more than 17,000 people across the US had been affected by cyclosporiasis, though tens of millions of diarrhea cases occur annually from various causes.
When to Seek Medical Care
Levy notes that the majority of diarrhea episodes clear up within three or four days. However, medical care is advised if diarrhea lasts longer than a week or is accompanied by concerning symptoms. These include a fever of 101°F or higher, blood or mucus in the stool, severe abdominal pain, vomiting for more than two to three days, or a feeling of needing to defecate without producing stool.
Dehydration is another critical warning sign. While thirst is well-known, a more reliable indicator is reduced urine output. If you drink plenty of fluids but do not urinate at least every six hours, that is concerning. Symptoms may include lightheadedness, confusion, and dark urine. In such cases, see a clinician rather than relying on walk-in IV drips. Levy warns, “there may be something more serious going on” if IV fluids are needed.
Certain individuals should seek care sooner. Those aged 65 or older may have a diminished sense of thirst and should contact a clinician within a day of symptom onset. The same applies to people with kidney disease, weakened immune systems, recent hospitalization, or recent antibiotic use. Clinicians may order tests for infectious or non-infectious causes, and if cyclosporiasis is suspected, special testing can be requested.
Diet and Hydration Tips
The priority is staying hydrated. Drink plenty of water, tea, or sports drinks early on to replace fluids and electrolytes. If dehydration begins, switch to an over-the-counter oral rehydration solution like Pedialyte, which has a lower concentration of sugar and salt than sports drinks, aiding absorption and reducing stool output.
No strict liquid diet or the old BRAT diet (bananas, rice, applesauce, toast) is necessary. However, Levy advises avoiding fatty and spicy foods, high-fiber foods like whole grains and raw produce, alcohol, caffeine, and overly sugary drinks or those with artificial sweeteners. If you have an appetite, eat modest portions of broth-based soups with chicken or tofu, starchy foods, and eggs. Diarrhea can cause temporary lactose intolerance, so dairy other than yogurt should be skipped.
Symptom Relief and Prevention
For symptom relief, most adults can safely take bismuth subsalicylate (e.g., Pepto-Bismol) for a couple of days to reduce stool frequency and cramping. Black stool is a benign side effect. Loperamide (e.g., Imodium) is safe for many, but only if the diarrhea is not bloody, there is no fever, and no antibiotics have been taken in the past three months. Always follow package directions and consult a doctor if you have medical conditions.
To avoid anal irritation, Levy suggests wetting soft toilet paper and patting rather than rubbing. Avoid alcohol-based wipes, which dry the skin. Barrier ointments with zinc oxide, dimethicone, or petroleum jelly can protect irritated skin, and a sitz bath with warm water may help. For severe itching or inflammation, over-the-counter creams with hydrocortisone or lidocaine may be used.
Probiotics are not recommended, says Levy. To protect others, wash hands, fingernails, and wrists with soap and water, especially after the bathroom and before handling food. Avoid preparing food for others while sick, and stay home from work until symptoms resolve.
