|Beijing Scene, Volume 5, Issue 7, April 30 - May 6|
What You Can Do About Diarrhea
Let me warn you. This is not the article to read
while you are eating breakfast. For this week the topic is diarrhea,
the runs, the trots, turista, Montezumaís revenge. Hardly the subject
of polite conversation, but letís face it, it happens all the time in
Imagine for a moment a bucket containing everything
that you ate and drank yesterday. You will realize that our diet is
a very liquid one. All this material goes in at the top end, the stomach
and intestines process all this stuff, take out the nutrients, absorb
90 percent of the water and put out a solid product at the other end.
Normally this process is slow, giving the gut plenty of time to deal
with all the water that has to be absorbed.
It is difficult to think of diarrhea in a positive
way but it is in fact one of the bodyís protective mechanisms. If we
consume anything that feels dangerous to our bodies, the digestive tract
takes action to remove it from the body as soon as possible. The gut
shifts into overdrive and all the contents are rushed through as quickly
as possible which does not give the colon, the last part of the digestive
system, time to absorb the fluids and out it comes in a liquid state.
Because it is all coming through very quickly, the colon demands to
be emptied frequently and the result is frequent visits to the toilet.
The gut works hard to move things through as quickly as possible and
this sometimes causes stomach cramps, accompanied by quite a symphony
of gurgling sounds.
In most cases the digestive tract goes back to its
normal state fairly quickly, but one complicating factor is that diarrhea
is often accompanied by vomiting. What a trap! Diarrhea medications
taken by mouth are vomited out as fast as they are swallowed. Rectal
suppositories for the treatment of vomiting are not going to be very
effective and putting them in the rectum is rather like trying to run
up the down escalator. Both of these conditions cause a terrific loss
of fluid and this can lead to dehydration. This is a particular worry
in children whose reserves of water are much smaller than adultsí.
Most attacks of diarrhea are not too worrying and
resolve quickly. The minor attacks that last for one or two days need
simple treatment and are a nuisance rather than a serious medical condition.
These are often called "Stomach Flu," a totally inaccurate name as it
has nothing at all to do with the influenza virus, although it is similar
in that it is a disease that lasts a short time that doctors canít do
much to cure.
Prevention is obviously a priority. Drinking untreated
tap water is risky and I recommend you stick to bottled water. Check
the seal to make sure it is intact: there is a lively trade in filling
empty bottles with tap water. All vegetables and fruit should be meticulously
washed, as feces is the most commonly-used fertilizer. Microwave cooking
is remarkably good at killing bacteria. It is a good idea to at least
flash vegetables through before or after washing them. Meat that is
going to be barbecued should always be microwaved before being put on
the grill. It would be nice if you could identify the risk of eating
at local restaurants by their appearance, but this does not seem to
work. I have had no problems after eating at rather suspect-looking
local restaurants and have been violently ill after eating at one of
the finest hotels in the city.
There is a very good argument that you should not
treat diarrhea too vigorously for the first few hours, as the body needs
to rid itself of whatever is bothering it. Fluid replacement however
should start immediately. Special Oral Rehydration Salts (ORS) are widely
available. I would advise you to keep some at home at all times. Gatorade
is a good alternative for a short time but has too much sugar for long-term
use. If you need some fluid in the middle of the night you can make
your own. Take a liter or quart of water and add half a teaspoonful
of baking soda, half a teaspoonful of salt (Lite Salt is even better)
and three tablespoons of sugar. Shake it all up and start sipping on
it immediately. You can tell if you are well-hydrated by observing your
urine. There should be plenty of it and it should be the color of a
fine white wine.
Three medications, all of which are available without
prescription may be helpful:
Kaopectate is not really a drug as it is not absorbed into the system. It acts by absorbing the toxins in the gut and helping to solidify things. It looks like cement, tastes like cement and sets like cement. I have not been able to see this in any local drug stores and would advise you to put it on your shopping list when you take a trip home. The dose is 15 to 30 mls every four hours, but personally I just drink it out of the bottle every time I pass the bathroom. Stop taking it as soon as things start to improve as you may progress to constipation. Pepto Bismol is a similar product. I donít think it is quite as effective and turns things a strange color, but it is widely available in Beijing.
Dr. Moreton is an Obstetrician and Gynecologist
at Beijing United Family Hospital. Got a medical question? Email it
in to firstname.lastname@example.org