Seasonal Diarrhoea
Introduction
Diarrhoea is usually an acute disease associated with passage of frequent liquid stools or having more stools per day than is normal for that person. When diarrhoea persists for more than 14 days, then it is known as chronic diarrhea.
There are distinct seasonal patterns of occurrence of diarrhoea in many geographical areas. Usually towards the end of summer and early rainy season, seasonal diarrhea is common. In temperate climate, bacterial diarrhoea occurs more frequently during the warm season, whereas viral diarrhoea, particularly diarrhoea caused by rotavirus reaches its peak during the drier, cool months.
Diarrhoeal disease form major public health problem in children under 5 years of age, especially in developing countries. In India, presently the diarrhoeal morbidity stands at 1.07 million cases and mortality stands at 2040 in these children.
References
Annual Report to the People on Health, Govt of India , Ministry of Health and Family Welfare, December 2011
Annual Report to the People on Health, Govt of India , Ministry of Health and Family Welfare, December 2011
Causes
Unhygienic living conditions, non-potable drinking water, poor nutrition, overfeeding, infections and ingestion of non-absorbable substance are the important causative factors for diarrhoeal disease. Other issues responsible for the diseases are:
1. Route of spread: The infectious agents that cause diarrhoea are usually spread by the faecal-oral route, which includes the ingestion of faecal contaminated water or food, and direct contact with infected faeces.
2. Behavior patterns /habits that increase the risk to diarrhoea
i. Failure to breast-feed exclusively for the first 4-6 months of life lowers immunity and increases risk of developing severe diarrhoea . Risk of diarrhea is many times greater in infants who are not breast-fed than in those who are exclusively breast-fed; the risk of death from diarrhoea is also substantially greater.
ii. Using infant feeding bottles. These easily become contaminated with faecal bacteria and are difficult to clean. This increases risk of contamination
iii.Storing cooked food at room temperature. When food is cooked and then saved to be used later, it may easily be contaminated, for example, by contact with contaminated surfaces or containers
iv. Using drinking-water contaminated with faecal bacteria. Water may be contaminated at its source or during storage in the home. Contamination in the home may occur when the storage container is not covered, or when a contaminated hand comes into contact with the water while collecting it from the container.
v. Failure to wash hands properly after defecation, after disposing of faeces or before handling food.
3. Host Factors:
Many host factors are associated with increased incidence, severity, or duration of diarrhoea.
i. Failure to breast-feed until at least 2 years of age. Breast milk contains antibodies that protect against certain types of diarrhoeal disease, such as shigellosis and cholera.
ii. Malnutrition. The severity, duration, and risk of death from diarrhoea are increased in malnourished children, especially those with severe malnutrition. .
iii. Measles. Diarrhoea and dysentery are more frequent or severe in children with measles or who have had measles in the previous 4 weeks. This presumably results from immunological impairment caused by measles.
iv. lmmunodeficiency or immunosuppression. This may be temporary, e.g. after certain viral infections (e.g. measles), or it may be prolonged, as in people with acquired immunodeficiency syndrome (AIDS). When immunosuppression is severe, diarrhoea can be caused by unusual pathogens and may also be prolonged.
v. Immunity of a person: people will lower immunity catch the infections more easily than people with good immunity
vi. Susceptibility: According to homeopathy concept, every person has a susceptibity to certain diseases. People with more susceptibity to gastric infections are more likely to get diarrhea when exposed to pathogens that cause diarrhoea. With rightly given homeopathic medicines immunity is increased and susceptibilities to diseases which a person is prone is decreased and hence patients tendency to catch those infections is also reduced.
Reference
Blackwood A, The food Tract: and its ailments and disease of peritoneum. RADAR Homeopathic Software
Symptoms
Frequent watery stool, urgency and incontinence, lower abdominal pain or cramping, loss of appetite, weight loss and dryness of mouth are the common symptom associated with diarrhoea.
Watery stools happen due to toxin secretion by some bacteria. Enterotoxigenic E. coli, V: cholera and some other bacteria produce toxins that alter epithelial cell function. These toxins reduce the absorption of sodium by the villi and may increase the secretion of chloride in the crypts, causing secretion of water and electrolytes. Recovery occurs when the affected cells are replaced by healthy ones after 2-4 days.
Blood in stools is due to mocusal invasion. E. coli and Salmonella can cause bloody diarrhoea by invading and destroying mucosal epithelial cells.
Reference
Blackwood A, The food Tract: and its ailments and disease of peritoneum.
RADAR Homeopathic Software.
Diagnosis
The clinical assessment consists of taking a brief history and examining the patient to detect dehydration, determine its degree of severity, to diagnose dysentery, if present; to evaluate feeding practices in children and determine the child's nutritional status, especially to detect severe malnutrition and to determine the cause or any concurrent illness.
Stool test can be done to evaluate the causative organism if diarrhoea doesn’t settle in 2-3 days. Stool for microscopy & culture and occult blood test are also carried out where ever required.
Complications
Diarrhoea causes de-hydration because the body loses water and salts. Infants, young children, and older adults are at risk of developing severe dehydration as a result of diarrhoea. Symptoms of dehydration include dry skin, thirst, less frequent urination, light-headedness, and dark-coloured urine.
Patients with severe diarrhoea may not be able to hold or control the passage of stool. This condition is called faecal incontinence.
Reference
www.sharecare.com/health/diarrhea/what-complications-diarrhea
http://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gi-disorders/diarrhea
Treatment and Management
General management is to keep the body hydrated. Oral Rehydration Therapy is advised to maintain water and electrolyte balance. The treatment of patients with diarrhoea must be based on the major features of the disease and an understanding of the underlying pathogenetic mechanisms.
If there is frequent diarrhea, it is advised to consult a doctor if you've also got:
The main principles of treatment are as follows:
1. Watery diarrhoea requires replacement of fluids and electrolytes- irrespective of its cause. ORS and Electrolytes should be given to patients and in case of unavailability, a solution of water with salt and sugar can also be given.
2. Feeding should be continued during all types of diarrhoea to the greatest extent possible, and should be increased during convalescence so as to avoid any adverse effect on nutritional status.
Diarrhoeal diseases can be treated effectively by homeopathic remedies. The treatment can be based on symptoms and presentation of case. Few recommendations are given below with symptoms, however its best to take in consultation with your homeopathic practitioner.
Most people who have a digestive distress after overindulgence or over eating shall feel better after a little rest, controlled diet or a fasting
Commonly used Homeopathic remedies are their indications are as under:
Aloes Socotrina: Diarrhoea is always associated with flatulence, and the patients have incontinence of the bowel when passing flatus or passing urine. Diarrhoea with pain and soreness, burning in the rectum; stools copious and watery, with much flatus; great exhaustion and faintness after stool are main indications.
Arsenic album: It is indicated in acute gastritis when there are pains, thirst, restlessness, and diarrhoea. Very offensive, with persistent coldness; dysenteric; white, involuntary; burning; chronic, watery and painful. Mostly indicated after eating spoiled food.
Nux Vomica: The diarrhoea consists of frequent small stools, with ineffectual urge for stools. Persistent nausea and vomiting. Diarrhoea due to indigestion, over eating and partying.
Colocynth: Colitis accompanied by severe colic and diarrhoea. Difficulty of retaining the stool Cutting colic with great urging.
Veratrum album: Nausea, with violent and profuse vomiting, usually associated with diarrhoea. Vomiting of food, of green mucus, with cold sweat.
Some other remedies used in diarrhoea are Bryonia, Carbo veg, Chamomilla, Croton tiglium, Ipecacuana, Podophyllum, Pulsatilla, Podophyllum and Sulphur.
References:
1. Blackwood A, The food Tract: and its ailments and disease of peritoneum. RADAR Homeopathic Software
2. Borland D, Homeopathy in Practice, RADAR Homeopathic Software
3. Bell James, Homeopathic Therapeutics of Diarrhoea Boericke W, Boericke O. E. New Manual of Homoeopathic MateriaMedica& Repertory [with relationship of remedies]. B. Jain Publishers (P) Ltd, New Delhi –110055.
4. WHO Readings on diarrhoea, student Manual1992
