Diarrhea and Dysentery

E-GUIDER | April 14, 2017 | Children Health,Family health,Health care,Sicknesses

DIARRHEA AND DYSENTERY

   When a person has loose or watery stools, he has diarrhea. If mucus and blood can be seen in the stools, he has dysentery. 

   Diarrhea can be mild or serious. It can be acute (sudden and severe) or chronic (lasting many days). 

   Diarrhea is more common and more dangerous in young children, especially those who are poorly nourished.  

   Diarrhea has many causes. Sometimes special treatment is needed. However, most diarrhea can be treated successfully in the home, using Rehydration Drink, even if you are not sure of the exact cause or causes. If a child does not eat much, give him a little food many times a day. 


THE MAIN CAUSES OF DIARRHEA

1. Poor nutrition; this weakens the child and makes diayfrom other causes more frequent and worse. 

2. Shortage of water and unclean conditions (no latrines) spread the germs that cause diarrhea. 

3. Virus infection or ‘intestinal flu’ (diarrhea usually mild). 

4. An infection of the gut caused by bacteria, amebas, or giardia. 

5. Infections outside the gut (ear infections, tonsillitis, measles, urinary infections. 

6. Malaria (falciparum type)

7. Food poisoning (spoiled food)

8. Inability to digest milk (mainly in severely malnourished children and certain adults)

9. Difficulty babies have digesting foods that are new to them. 

10. Allergies to certain foods (seafood, crayfish, etc,); occasionally babies are allergic to cow’s milk or other milk. 

11. Side effects produced by certain medicines, such as ampicillin or tetracycline. 

12. Laxatives, purges, irritating or poisonous plants, certain poisons. 

13. Eating too much unripe fruit or heavy, greasy foods. 

14. AIDS (long-lasting diarrhea may be an early sign). 

PREVENTING DIARRHEA:

   Although diarrhea has many different causes, the most common are infection and poor nutrition. With good hygiene and good food, most diarrhea could be prevented. And if treated correctly, fewer children who get diarrhea would die. 

   Children who are poorly nourished get diarrhea and die from it far more often than those who are well nourished. Yet diarrhea itself can be part of the cause of malnutrition already exists, diarrhea rapidly makes it worse.  

   This results in a vicious circle, in which each makes the other worse. For this reason, good nutrition is important in both the prevention and treatment of diarrhea. 

   To learn about the kinds of foods that help the body resist or fight off different illnesses, including diarrhea. 

   The prevention of diarrhea depends both on good nutrition and cleanliness. These include the use of latrines, the importance of clean water, and the protection of foods from dirt and flies. 

Here are some other important suggestions for preventing diarrhea in babies;

1. Breast fees rather than bottle feed babies. Give only breat milk for the first 4 months. Breast milk helps babies resist the infections that cause diarrhea. If it is not possible to breast feed a baby, feed her with a cup and spoon. Do not use a baby bottle because it is harder to keep clean and more likely to cause an infection. 

2. When you begin to give the baby new or solid foods, start by giving her just a little, and mashing it well and mixing it with a little breast milk. The baby has to learn how to digest new foods. Do not stop giving breast milk suddenly. Start with other foods while the baby is still breast feeding. If she starts with too much new food at one time, she may get diarrhea. 

3. Keep the baby clean–and in a clean place. Try to keep her from putting dirty things in her mouth. 

4. Do not give babies unnecessary medicines. 

TREATMENT OF DIARRHEA:

  For most cases of diarrhea no medicine is needed. If the diarrhea is severe, the biggest danger is malnutrition. So the most important part of treatment has to do with giving enough liquids and enough food. 

No matter what the cause of diarrhea, always take care with the following:

1. PREVENT OR CONTROL DEHYDRATION. A person with diarrhea must drink a lot of liquids. If diarrhea is severe or there are signs of dehydration, give him Rehydration Drink. Even if he does not want to drink, gently India that he do so. Have him take several swallows every few minutes. 

2. MEET NUTRITIONAL NEEDS. A person with diarrhea needs food as soon as he will eat. This is especially important in small children or persons who are already poorly nourished. Also, when a person has diarrhea, food passes through the gut very quickly and is not all used. So give the person food many times a day–especially if he only takes a little at a time. 

  • A baby with diarrhea should go on breast feeding. 
  • An underweight child should get plenty of energy foods and some bodybuilding foods (proteins) all the time he has diarrhea–and extra when he gets well. If he stops eating because he feels too sick or is vomiting, he should eat again as soon as he can. Giving Rehydration Drink will hell the child be able to eat. Although giving food may cause more frequent stools at first, it can save his life. 
  • If a child who is underweight has diarrhea that for many days or keeps coming back, give him more food more often–at least 5 or 6 meals each day. Often no other treatment is needed. 

FOODS FOR A PERSON WITH DIARRHEA

When the person is vomiting or feels too sick to eat, he should drink:

Watery mush or broth of rice, maize powder, or potato

Rice water (with some mashed rice)

Chicken, meat, egg, or bean broth

Sweetened drinks

REHYDRATION DRINK 

breast milk

As soon as the person is able to eat, in addition to giving the drinks listed at the left, he should eat a balanced selection of the following foods or similar ones:

ENERGY FOODS

Ripe or cooked bananas

Crackers

Rice, oatmeal, or other well-cooked grain fresh maize (well cooked and mashed)

Potatoes

Papaya

(It helps to add a little sugar or vegetable oil to the cereal food)

BODY-BUILDING FOODS

Chicken (boiled or roasted)

Eggs (boiled)

Meat (well cooked, without much fat or grease)

Beans, lentils, or peas (well cooked and mashed) 

Fish (well cooked)

Milk (sometimes this causes problems).

DO NOT EAT OR DRINK

Fatty or greasy foods most raw fruits .

Any kind of laxative or purge.

Highly seasoned food.

Alcoholic drinks. 

DIARRHEA AND MILK

Breat milk is the best food for babies. Keep giving breast milk when the baby has diarrhea. It does not cause diarrhea and will help the baby get better quickly. 

Cow’s milk, dry skim milk, and canned milk can be good sources of protein for children who have diarrhea. However, if the child is badly malnourished, he may have trouble digesting the milk, and this may cause even more diarrhea. If this happens, try giving less milk and mixing it with other foods. But remembered: a poorly nourished child with diarrhea must have enough energy foods and protein. If less milk is given, well-cooked and mashed foods such as chicken, egg yolk, meat, fish, or beans should be added. Beans are easier to digest if their skins have been taken off and they are boiled and mashed. They should not be cooked in oil. Soymilk, made from soya beans, is a good substitute. 

   As the child gets better, he will usually be able to drink more milk without getting diarrhea. 

MEDICINES FOR DIARRHEA:

For most cases of diarrhea no medicines are needed. But in certain cases, using the right medicine can be important. However, many of the medicines commonly used for diarrhea do little or no good. Some are actually harmful:

GENERALLY IT IS BETTER NOT TO USE THE FOLLOWING MEDICINES IN THE TREATMENT OF DIARRHEA 

  • ‘Anti-diarrhea’ medicines with kaolin and pectin (such as kaipectate,) make diarrhea thicker and less frequent, but do not correct dehydration or control infection. Some anti-diarrhea medicines, like diphenoxylate (Lomotil) may even make infections last longer. 
  •   ‘Anti-diarrheal’ mixtures containing neomycin or streptomycin should not be used, as these may irritate the gut and do more harm than good. 
  • Antibiotics like ampicillin and tetracycline are useful in some cases of diarrhea. But they themselves sometimes cause diarrhea, especially in small children. If, after taking these antibiotics for more than 2 or 3 days, diarrhea gets worse rather than better, stop taking them–the antibiotics may be the cause. 
  • Chloramphenicol has certain dangers in its use and should never be used for mild diarrhea or given to babies less than 1 month old. 
  • Laxatives and purges should never be given to persons with diarrhea. They will make it worse and increase the danger of dehydration. 

SPECIAL TREATMENT IN DIFFERENT CASES OF DIARRHEA:

   While most cases of diarrhea can be treated by giving plenty of liquids and food and no medicine, sometimes special treatment is needed. 

   In considering treatment, keep in mind that some cases of diarrhea, especially in small children, are caused by infections outside the gut. Always check for infections of the ears, the throat, and the urinary system. If found, these infections should be treated. Also look for signs of measles. 

   If the child has mild diarrhea together with signs of a cold, the diarrhea is probably caused by a virus, or intestinal flu, and no special treatment is called for. Give lots of liquids. 

   In certain difficult cases of diarrhea, analysis of the stools or other tests may be needed to know how to treat it correctly. But usually you can learn enough from asking specific questions, seeing the stools, and looking for certain signs.

 Here are some guidelines for treatment accounts to signs:

1. Sudden, mild diarrhea. No fever. (Upset stomach? ‘Intestinal flu’?)

  • Drink lots of liquids. Usually no special treatment is needed. For a ‘plug’ a mixture of kaolin and penctin, such as Kaopectate, can be used, but it is never necessary and does not help either to correct dehydration or get rid of infection–so why waste money buying it? It should not be given to persons who are very I’ll, or to small children. 
  • If severe colic (painful cramps) is a problem, an antispasmodic like belladonna may help. 

2. Diarrhea with vomiting. (Many causes)

  • If a person with diarrhea is also vomiting, the danger or dehydration increases, especially in small children. It is very important to give the Rehydration Drink tea, or whatever liquids he will take. Keep on giving it even if there is vomiting. Some will stay inside. Give sips every 5 to 10 minutes. If vomiting does not STOL soon, you can use medicines like promethazine or phenobarbital. 
  • If you can control the vomiting or if dehydration gets worse, seek medical help fast. 

3. Diarrhea with mucus and specks of blood. Often chronic. No fever. Usually no dehydration. There may be diarrhea some days and constipation others days. (Possibly amebic dysentery).

  • Use metronidazole or diloxanide furoate. Take the medicine according to the recommended dose. If the diarrhea continues after treatment, seek medical advice. 

4. Acute diarrhea with fever, with or without blood. (Bacteria dysentery? Typhoid? Malaria?)

  • If the  person with diarrhea has a fever lasting more than 6 hours after beginning treatment for dehydration, and seems very ill, give ampicillin possible. If not, give tetracycline. 
  • If the person’s condition is very poor or he is not improving with ampicillin or tetracycline, seek medical help. If there are signs of typhoid fever, give chloramphenical in the recommended dose. 
  • In areas where the falciparum type of malaria is common, it is a good idea that persons with diarrhea and fever also be treated with an anti-malaria drug, especially if they have a large spleen. 

5. Persistent bad-smelling diarrhea, sometimes yellow and frothy, without blood or mucus. (Giardia?)

  • This may be caused by microscopic parasites called giardia or perhaps by malnutrition. In either case, plenty of liquid, nutritious food, and rest are often the only treatment needed. Severe giardia infections can be treated with metronidazole. 

6. Chronic diarrhea (diarrhea that lasts a long time or keeps coming back). 

  • This is most commonly due to malnutrition, less commonly to a chronic infection such as that caused by amebas. See that the child eats more nutritious food, especially foods rich in proteins. If the diarrhea still continues, seek medical help. Adults may be suffering from AIDS. 

7. Diarrhea like rice water. (Cholera?)

  • Rice water’ stools are a sign of cholera. In countries where this dangerous disease occurs, cholera often comes in epidemics (striking many people at once) and is usually worse in older children and adults. Dehydration is extreme, especially if there is vomiting also. Treat the dehydration continuously and give tetracycline, co-trimoxazole or chloramphenicol. Cholera should be reported to the health authorities. Seek medical help. 

CARE OF BABIES WITH DIARRHEA

   Diarrhea is especially dangerous in babies and small children. Often no medicine is needed, but special care must be taken because a baby can die very quickly of dehydration. 

  • Continue breast feeding and also give sips of Rehydration Drink made with water, sugar and salt only. 
  • If vomiting is a problem, give breast milk often, but only a little at a time. Also give Rehydration Drink in small sips every 5 to 10 minutes. 
  • If there is no breast milk, try giving frequent small feedings of some other milk or milk substitute (like mill made from soybeans,) mixed to half normal strength with boiled water. If milk seems to make the diarrhea worse, give some other protein (mashed chicken, eggs, lean meat, or skinned mashed beans, mixed with honey, sugar, or well-cooked rice or another carbohydrate and boiled water). 
  • If the child is younger than 1 month, try to find a health worker before giving any medicine. If there is no health worker and the child is very sick, give him an ‘infant syrup’ that contains ampicillin: half a teaspoon 4 times daily. It is better not to use other antibiotics. 

WHEN TO SEEK MEDICAL HELP IN CASES OF DIARRHEA

     Diarrhea and dysentery can be very dangerous_especially in small children. In the following situations you should get medical help:

  • If diarrhea lasts more than 4 days and is not getting better__or more than 1 day in small child with severe diarrhea. 
  • If the person is dehydrated and getting worse. 
  •  If the child vomits everything he drinks, or drinks nothing, or if frequent vomiting continues for more than 3 hours after beginning Rehydration Drink. 
  •  If the child begins to have fits, or if the feet and face swell. 
  •  If the person was very sick, weak, or malnourished before the diarrhea began (especially a little child or a very old person).  
  • If there is much blood in the stools, this can be dangerous even if there is little diarrhea. 

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