Diarrhoea

Diarrhoea is passing looser or more frequent stools than is normal for you.

It affects most people from time to time and is usually nothing to worry about. However, it can be distressing and unpleasant until it passes, which normally takes a few days to a week.

What causes diarrhoea?

There are many different causes of diarrhoea, but a bowel infection (gastroenteritis) is a common cause in both adults and children.

Gastroenteritis can be caused by:

• a virus – such as norovirus or rotavirus
• bacteria – such as campylobacter and Escherichia coli (E. coli), which are often picked up from contaminated food 
• a parasite – such as the parasite that causes giardiasis, which is spread in contaminated water

These infections can sometimes be caught during travel abroad, particularly to areas with poor standards of public hygiene. This is known as travellers' diarrhoea.

Diarrhoea can also be the result of anxiety, a food allergy, medication, or a long-term condition, such as irritable bowel syndrome (IBS).

Read more about the causes of diarrhoea.

What to do if you have diarrhoea

Most cases of diarrhoea clear up after a few days without treatment, and you may not need to see your GP.

However, diarrhoea can lead to dehydration, so you should drink plenty of fluids – small, frequent sips of water – until it passes. It's very important that babies and small children do not become dehydrated.

Your pharmacist may suggest you use an oral rehydration solution (ORS) if you or your child are particularly at risk of dehydration.

You should eat solid food as soon as you feel able to. If you're breastfeeding or bottle feeding your baby and they have diarrhoea, you should try to feed them as normal.

Stay at home until at least 48 hours after the last episode of diarrhoea to prevent spreading any infection to others.

Medications to reduce diarrhoea, such as loperamide, are available. However, these are not usually necessary, and most types should not be given to children.

Read more about treating diarrhoea.

When to see your GP

Contact your GP or call NHS 24's 111 service for advice if you're concerned about yourself or your child.

It's important to see your GP if the diarrhoea is particularly frequent or severe, or associated with other symptoms, such as:

• blood in your or your child's stool
• persistent vomiting
• a severe or continuous stomach ache
• weight loss
• signs of dehydration – including drowsiness, passing urine infrequently, and feeling lightheaded or dizzy
• your stool is dark or black – this may be a sign of bleeding inside your stomach

You should also contact your GP if your or your child's diarrhoea is particularly persistent, as this may be a sign of a more serious problem. In most cases, diarrhoea should pass within about a week.

Read more about diagnosing diarrhoea.

Preventing diarrhoea

Diarrhoea is often caused by an infection. You can reduce your risk by making sure you maintain high standards of hygiene.

For example, you should:

• wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing food
• clean the toilet, including the handle and the seat, with disinfectant after each bout of diarrhoea
• avoid sharing towels, flannels, cutlery, or utensils with other household members

It's also important to practise good food and water hygiene while travelling abroad, such as avoiding potentially unsafe tap water and undercooked food.

Read more about preventing diarrhoea.

Diarrhoea is where you frequently pass watery or loose poo. Some people may also have other symptoms, depending on the cause.

Associated symptoms can include:

• stomach cramps
• nausea and vomiting
• headache
• loss of appetite

The excessive loss of water in your poo can also sometimes lead to dehydration, which can be serious if it's not recognised and treated quickly.

Signs of dehydration

Signs of dehydration in children can include:

• irritability or drowsiness
• passing urine infrequently
• pale or mottled skin
• cold hands and feet
• they look or feel increasingly unwell

Signs of dehydration in adults can include:

• tiredness and a lack of energy
• loss of appetite
• nausea
• feeling lightheaded
• dizziness
• dry tongue
• sunken eyes
• muscle cramps
• rapid heartbeat

Read more about the symptoms of dehydration.

When to seek medical advice

Contact your GP or call NHS 24's 111 service for advice if you are concerned about yourself or your child.

You should also contact your GP in the situations outlined below, as they may mean that you or your child has, or is at risk of, a more serious problem.

Babies

You should contact your GP or health visitor urgently if your baby has had 6 or more episodes of diarrhoea in the past 24 hours, or if they have vomited 3 times or more in the past 24 hours.

You should also seek advice if your baby has any symptoms of dehydration.

Children

Contact your GP if your child has: 

• had 6 or more episodes of diarrhoea in the past 24 hours
• diarrhoea and vomiting at the same time
• watery poo
• blood in their poo
• a severe or continuous stomach ache
• symptoms of dehydration

You should also contact your GP if your child has persistent diarrhoea. Most cases will pass in 5 to 7 days.

Adults

Contact your GP if you have diarrhoea and: 

• there is blood in your poo
• you are vomiting persistently
• you've lost a lot of weight
• you have passed a large amount of very watery diarrhoea
• it occurs at night and is disturbing your sleep
• you have recently taken antibiotics or been treated in hospital
• you have symptoms of dehydration
• your poo is dark or black – this may be a sign of bleeding inside your stomach

You should also contact your GP if you have persistent diarrhoea. Most cases in adults will pass in 2 to 4 days.

Diarrhoea usually occurs when fluid cannot be absorbed from the contents of your bowel, or when extra fluid is secreted into your bowel, causing watery poo.

Short-term diarrhoea

Diarrhoea is usually a symptom of a bowel infection (gastroenteritis), which can be caused by:

• a virus – such as norovirus or rotavirus
• bacteria – such as campylobacter, Clostridium difficile (C. difficile), Escherichia coli (E. coli), salmonella or shigella; these can all cause food poisoning
• parasites – such as the Giardia intestinalis parasite that causes giardiasis

Other possible causes of short-term diarrhoea include:

• feelings of anxiety
• drinking too much alcohol
• a food allergy
• appendicitis
• damage to the lining of the intestines as a result of radiotherapy 

Medicines

Diarrhoea can also sometimes be a side effect of a medication, including:

• antibiotics 
• antacid medicines that contain magnesium 
• some chemotherapy medicines
• non-steroidal anti-inflammatory drugs (NSAIDs) 
• selective serotonin reuptake inhibitors (SSRIs) 
• statins – cholesterol-lowering medicines
• laxatives – medicine used to help empty your bowels

The patient information leaflet that comes with your medicine should state whether diarrhoea is a possible side effect.

Long-term diarrhoea 

Conditions that can cause persistent diarrhoea include:

• irritable bowel syndrome (IBS) – a poorly understood condition that affects the normal functions of the bowel
• inflammatory bowel disease – conditions that cause the gut to become inflamed, such as Crohn's disease and ulcerative colitis
• coeliac disease – a digestive condition where you have an adverse reaction to gluten
• bile acid malabsorption – where bile produced by the liver builds up in the digestive system
• chronic pancreatitis – inflammation of the pancreas
• diverticular disease – where small bulges or pockets develop in the lining of the intestine
• bowel cancer – this can cause diarrhoea and blood in your stools

Persistent diarrhoea can also sometimes occur after surgery on the stomach, such as a gastrectomy. This is an operation to remove part of the stomach – for example, as a treatment for stomach cancer.

Most cases of diarrhoea get better within a week and you may not need to visit your GP.

Read more about when to visit your GP if you have diarrhoea.

The information below explains what will happen if you need to see your GP.

Identifying the cause

To identify what is causing your diarrhoea, your GP may ask you questions, such as:

• what your stools are like – for example, if they are very watery or contain blood
• how often you need to go to the toilet
• whether you have other symptoms, such as a high temperature (fever) 
• whether you have been in contact with anyone else who has diarrhoea, or recently travelled abroad – this may mean you have picked up an infection
• whether you have recently eaten out anywhere – this may mean you have food poisoning
• whether you're taking medication and if it has recently changed 
• whether you have been stressed or anxious recently

Stool sample

Your GP may ask you for a stool sample so it can be analysed for signs of an infection if you have:

• persistent diarrhoea that has lasted more than two weeks
• blood or pus in your stools 
• symptoms that affect your whole body, such as a fever or dehydration
• a weakened immune system – for example, because you have HIV 
• recently travelled abroad
• recently been in hospital or been taking antibiotics

Blood tests

Your GP may suggest you have some blood tests if they suspect your diarrhoea is being caused by an underlying health condition.

For example, your blood can be tested for signs of inflammation, which may suggest inflammatory bowel disease.

Read more about the possible causes of diarrhoea.

Rectal examination

Your GP may recommend a digital rectal examination (DRE) if you have unexplained persistent diarrhoea, particularly if you're over 50.

During a DRE, your GP will insert a gloved finger into your bottom to feel for any abnormalities. It can be useful for diagnosing conditions that affect your rectum and bowel.

Further investigations

If you have persistent diarrhoea and your GP is unable to find the cause, they may refer you to your local hospital for further investigation.

You may have:

• a sigmoidoscopy – an instrument called a sigmoidoscope (a thin, flexible tube with a small camera and light on one end) is inserted into your bottom and up into your bowel
• a colonoscopy – a similar procedure that uses a larger tube called a colonoscope to examine your entire bowel

Diarrhoea will usually clear up without treatment after a few days, particularly if it's caused by an infection.

In children, diarrhoea will usually pass within 5 to 7 days and will rarely last longer than 2 weeks.

In adults, diarrhoea usually improves within 2 to 4 days, although some infections can last a week or more.

While waiting for your diarrhoea to pass, you can ease your symptoms by following the advice outlined below.

Drink fluids

It's important to drink plenty of fluids to avoid dehydration, particularly if you're also vomiting. Take small, frequent sips of water.

Ideally, adults should drink a lot of liquids that contain water, salt, and sugar. Examples are water mixed with juice and soup broth. If you're drinking enough fluid, your urine will be light yellow or almost clear.

It's also very important for babies and small children not to become dehydrated. Give your child frequent sips of water, even if they are vomiting. A small amount is better than none. 

Fruit juice or fizzy drinks should be avoided as they can make diarrhoea worse in children.

If you're breastfeeding or bottle feeding your baby and they have diarrhoea, you should continue to feed them as normal.

Contact your GP immediately if you or your child develop any symptoms of dehydration.

Oral rehydration solutions

Your GP or pharmacist may suggest using an oral rehydration solution (ORS) to prevent dehydration if you're at risk – for example, if you're frail or elderly. ORS can also be used to treat dehydration that has already occurred.

Rehydration solutions usually come in sachets available from your local pharmacist without a prescription. They are dissolved in water and replace salt, glucose, and other important minerals that are lost if you are dehydrated.

Children

Your GP or pharmacist may recommend giving your child an ORS if they are dehydrated or at risk of becoming dehydrated.

The usual recommendation is for your child to drink an ORS each time they have an episode of diarrhoea. The amount they should drink will depend on their size and weight.

Your pharmacist can advise you about this. The manufacturer's instructions should also give information about the recommended dose.

You may be able to give your baby an ORS if they become dehydrated, but check with your GP, pharmacist, or health visitor first.

Eating

Opinion is divided over when and what you should eat if you have diarrhoea. However, most experts agree you should eat solid food as soon as you feel able to. Eat small, light meals and avoid fatty or spicy foods.

Good examples are potatoes, rice, bananas, soup, and boiled vegetables. Salty foods help the most.

You don't need to eat if you've lost your appetite, but you should continue to drink fluids and eat as soon as you feel able to.

Children

If your child is dehydrated, do not give them any solid food until they have drunk enough fluids. Once they have stopped showing signs of dehydration, they can start eating their normal diet.

If your child is not dehydrated, offer them their normal diet. If they refuse to eat, continue to give them fluids and wait until their appetite returns.

Medication

Antidiarrhoeal medicines

Antidiarrhoeal medicines may help reduce your diarrhoea and slightly shorten how long it lasts. However, they're not usually necessary.

Loperamide is the main antidiarrhoeal medicine used, as it has been shown to be effective and causes few side effects.

Loperamide slows down the muscle movements in your gut so more water is absorbed from your stools. This makes your stools firmer and they're passed less frequently.

An alternative to loperamide is a different type of antidiarrhoeal medicine called racecadotril, which works by reducing the amount of water produced by the small intestine. Evidence suggests this medication may be as effective as loperamide for treating diarrhoea.

Some antidiarrhoeal medicines can be bought from a pharmacy without a prescription. Check the patient information leaflet that comes with the medicine to find out whether it's suitable for you and what dose you should take. Ask your pharmacist for advice if you're unsure.

Do not take antidiarrhoeal medicines if there is blood or mucus in your stools or you have a high temperature (fever). Instead, you should contact your GP for advice.

Most antidiarrhoeal medicines should not be given to children. Racecadotril can be used in children over 3 months old if it's combined with oral rehydration and the other measures mentioned above, although not all doctors recommend it.

Painkillers

Painkillers will not treat diarrhoea, but paracetamol or ibuprofen can help relieve a fever and a headache. If necessary, you can give your child liquid paracetamol or ibuprofen.

Always read the patient information leaflet that comes with the medication to check if it's suitable for you or your child and find out the correct dose. Children under 16 years of age should not be given aspirin.

Antibiotics

Treatment with antibiotics is not recommended for diarrhoea if the cause is unknown. This is because antibiotics:

• will not work if the diarrhoea is caused by a virus 
• can cause unpleasant side effects 
• can become less effective at treating more serious conditions if they're repeatedly used to treat mild conditions

Antibiotics may be recommended if you have severe diarrhoea and a specific type of bacteria has been identified as the cause.

They may also be used if you have an underlying health problem, such as a weakened immune system.

Hospital treatment 

Occasionally, hospital treatment may be needed if you or your child are seriously dehydrated. Treatment will involve administering fluids and nutrients directly into a vein (intravenously).

Treating the underlying cause

If you've been diagnosed with a specific condition that's causing your diarrhoea, treating this may help improve your symptoms.

For example:

• irritable bowel syndrome (IBS) can be treated with changes to your diet and medications – read more about managing IBS
• inflammatory bowel disease can be treated with medications that help reduce inflammation in the bowel
• coeliac disease can be treated by excluding foods containing gluten from your diet – read more about treating coeliac disease
• bile acid malabsorption can be treated with medication that helps stop bile building up in the digestive system

Read more about common causes of diarrhoea.

To prevent the spread of infections that cause diarrhoea, you should always maintain high standards of hygiene.

You should:

• wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing food 
• clean the toilet, including the handle and the seat, with disinfectant after each bout of diarrhoea
• avoid sharing towels, flannels, cutlery or utensils with others
• wash soiled clothing and bed linen separately from other clothes and at the highest temperature possible – for example, 60C or higher for linen – after first removing any poo into the toilet 
• avoid returning to work or school until at least 48 hours after the last episode of diarrhoea

You or your child should also avoid swimming pools for 2 weeks after the last episode of diarrhoea.

Food hygiene

Practising good food hygiene will help avoid getting diarrhoea as a result of food poisoning. You can do this by:

• regularly washing your hands, surfaces and utensils with hot, soapy water 
• never storing raw and cooked foods together 
• making sure food is kept properly refrigerated 
• always cooking your food thoroughly 
• never eating food past its use-by date

Read more about preventing food poisoning.

Rotavirus vaccination

Rotavirus is a virus that commonly causes diarrhoea in children. A vaccine that helps protect children against rotavirus is now part of the routine childhood vaccination schedule.

This vaccine is given as a liquid that's dropped into a baby's mouth. It's given in 2 doses, with the first given at 2 months and another at 3 months.

Travellers' diarrhoea

There is no vaccination that can protect you from all possible causes of travellers' diarrhoea. The best way to avoid it is to practise good food and water hygiene while abroad. 

If you're travelling in a country where standards of public hygiene are low, you should avoid:

• tap water – water should be boiled for at least one minute if you're not sure whether it's safe to drink
• ice cubes and ice cream
• raw or undercooked seafood, meat, and chicken
• foods that might contain uncooked eggs, such as mayonnaise
• unpasteurised milk and dairy products, such as cheese
• fruit and vegetables with damaged skins
• salads

It's generally safe to eat or drink:

• food that has been thoroughly cooked and is served piping hot
• sealed bottles or cans of water, fizzy drinks, and alcohol
• fruit and vegetables you peel yourself
• tea or coffee

If you're planning a trip abroad, check health advice for the countries you will be travelling to. You can do this by visiting NHS Fit for Travel and National Travel Health Network and Centre (NaTHNaC) websites.