Diarrhoea, in common with constipation, is difficult to define accurately. Because there is no such thing as a normal bowel habit what may seem to be an attack of diarrhoea to one individual may, when experienced by another, be described as a bout of constipation.
Diarrhoea is usually defined in medical textbooks as ‘frequent, loose stools’. But that three-word definition includes two subjective assessments. I think it is probably wisest to assume that any increase in the frequency of bowel movements can be described as diarrhoea. Together with that assumption wc must make another: that only attacks of’diarrhoea’ which prove inconvenient rather than simply exceptional should be treated.
The commonest two causes of diarrhoea are stress and gastrointestinal infections.
Stress, anxiety, worry, nervousness – call it what you like – is a common reason for a brief, short-lived bout of diarrhoea. Soldiers suffer before a battle, students before examinations, sportsmen before events, brides before weddings, job applicants before interviews. This type of diarrhoea isn’t usually worth treating for the very good reason that it will frequently have cleared up in a matter of hours. If it does persist for more than a few hours and it is definitely caused by stress a bottle of anti-diarrhoeal mixture is unlikely to be the best solution to the problem. Learning to relax is more likely to provide a lasting solution .
When a bout of diarrhoea is caused by an infection there are likely to be clues to the cause. If other members of the family have the same disorder then the cause is likely to be something that has been eaten. If the sufferer has just returned from a trip away from home (not necessarily abroad) then the diarrhoea may have been caused by an infection contracted as a result of lower-than-usual standards of hygiene. If the diarrhoea was preceded by vomiting then once again food poisoning is a likely explanation.
There is a third common cause of diarrhoea which is well worth mentioning. It is, I’m afraid, often a fact that doctors cause diarrhoea with the pills they prescribe for infections in other parts of the body. These pills (such as penicillin) kill off the bugs which normally live in the bowel and allow other bugs to make their presence felt. When the prescribed drug is stopped the diarrhoea will usually clear up by itself. If you are taking a prescribed drug and you suspect that it may be causing your diarrhoea don’t just stop taking it – telephone the doctor who prescribed the drug and ask for advice. It may be better for you to persevere and treat the diarrhoea as well than to abandon- your course and allow the original infection to recur. In addition to antibiotics other drugs can cause diarrhoea – antacids and health salts are common culprits.
Finally, there are three other common types of diarrhoea. Firstly, there is the partygoer who eats too much or drinks too much and whose diarrhoea is a fairly understandable consequence of this overindulgence. Secondly, there is the child who has a chest infection or an ear infection and who develops diarrhoea as a symptomatic bonus. The diarrhoea will usually disappear as the main infection clears up. And thirdly, there is the patient who regularly takes a laxative and who has persistent diarrhoea as a direct result of this bad habit. This may sound bizarre but it is by no means an infrequent occurrence.
Whatever the cause of your diarrhoea the treatment is likely to be very much the same. For twenty-four hours avoid food but remember that it is important to ensure that you do not become dehydrated. Frequent bursts of diarrhoea can result in considerable fluid losses and it is vital to make sure that the lost fluid is replaced. This may be the only action necessary. Symptomatic relief can be obtained by the use of any one of the substances recommended below.
The medicines available for the treatment of diarrhoea fall into several categories.
To begin with there are the drugs which form a bulky mass inside the bowel and help carry away irritants as they are excreted. Kaolin, aluminium hydroxide and other aluminium salts, pectin, bismuth salts, calcium carbonate and activated charcoal fall into this category.
Then there are the drugs which act on the bowel wall – slowing down the movements which result in diarrhoea. Because they act on the muscle walls these drugs may also relieve the griping pains associated with diarrhoea. Drugs in this group include the opiates, such as morphine and the anticholinergic drugs. (Before the mention of morphine conjures up visions of setting up a local drug ring I should point out there isn’t very much morphine in a bottle of anti-diarrhoeal mixture and it is mixed up with kaolin. Morphine and kaolin mixture can therefore be described as both legal and binding.)
Thirdly, there are drugs like iodochlorhydroxyquin (otherwise known as clioquinol) which are intended to help eradicate invading bacteria and thereby prevent or treat infective diarrhoea.
Some products contain a mixture of substances from each of these categories. These combination therapies are unlikely to contain enough of anything to be helpful.
Finally, remember that when you start eating again after a bout of diarrhoea it is wise to begin with foods which provide roughage – dry toast and bran may help, for example. The right food may be more helpful than any medicine.
Kaolin and morphine
Kaolin is the commonest constituent of anti-diarrhoeal mixtures. Its chemical name is aluminium silicate and its value is that when given by mouth it absorbs toxic substances from the intestinal tract, increases the bulk of the faeces and helps the body get rid of irritant substances with less discomfort and less delay than might otherwise be the case.
The best way to buy kaolin is as Kaolin Mixture BPC. About 20 ml of this should be taken four or five times a day to slow down a diar-rhoeal attack. The kaolin needs to be freshly prepared. There is also a Paediatric Kaolin Mixture BPC which is perfectly suitable for children and which should be given in 5 or 10 ml doses according to age. Children over the age of five or six can be given a half-dose of ordinary Kaolin Mixture BPC.
Most of the anti-diarrhoeal mixtures available which contain kaolin also contain other substances. Boots Diarrhoea Mixture contains kaolin and aluminium hydroxide gel. Woodward’s Diarrhoea Mixture contains kaolin and apple pectin. Sterling Health Anti-Diarrhoeal Mixture contains just ordinary kaolin.
Adults Diarrhoea Mixture contains an impressive-sounding mixture of kaolin, calcium carbonate, clioquinol, cinnamon oil, nutmeg oil, clove oil and cardamom oil. Car/nil contains pectin, kaolin, morphine hydrochloride and atropine methonitrate. Enterosan Tablets contain camomile, kaolin, morphine hydrochloride, sorbitol, belladonna tincture and peppermint oil. Savory and Moore Sickness and Diarrhoea Mixture contains kaolin, pectin, peppermint oil, chloroform and belladonna. I do not recommend any of these products because I see no advantage in using multiple mixtures.
Diatabs and Diocalm Tablets both contain morphine hydrochloride and a kaolin-like substance. Since they are available in a more convenient form they are obviously of use to travellers who might find carrying a bottle of kaolin or kaolin and morphine inconvenient.
J. Collis Browne’s mixture
This product has been on sale for over a century and is advertised for use by people with coughs as well as those with diarrhoea. The reason for this ‘double value’ is simple – the compound contains morphine which has an effect on both symptoms. In addition to morphine the constituents are chloroform, spirit, capsicum extract, peppermint oil and glycerol.
This mixture has been diluted in recent years and its present morphine content is so low that anyone hoping to satisfy a craving for morphine would need to buy and drink several bottles a day.
As an anti-diarrhoeal medicine I cannot see any particular reason to recommend this mixture.
A few years ago just about everyone going abroad used to carry a box of magic anti-diarrhoeal tablets. And, of course, anyone taking these tablets who didn’t get diarrhoea would swear by the effectiveness of the product.
The usual basic constituent of those tablets (the most widely known of which was probably Entero- Viofomi) was clioquinol. The disease with which clioquinol has been associated, Asian subacute myelo-optic neuropathy, was first recognized in the late 1950s and since then over 10,000 people have been diagnosed as having it in Japan alone. It is perhaps enough to say that the Committee on Safety of Medicines has recently advised that this product should be available only on prescription, and in my experience it is not often prescribed.
Clioquinol is still available in some home medicines. Before buying any brand name anti-diarrhoeal read the label carefully. Don’t buy anything which contains this substance.
Every year thousands of holidaymakers have their expensive days in the sun ruined by what they may later wryly refer to as ‘Spanish tummy’. Most of these physically wearing and socially disastrous incidents could have been avoided not by consuming large quantities of protective medicines (which do not help and may be dangerous) but by following some simple basic rules while abroad.
The first mistake which many people make is to leap off the aeroplane and immediately start downing vast quantities of local food and washing it down with litres of rough, local wine. After such outrageous insults diarrhoea is not only inevitable, it is also deserved. It may be the only way that the human body can hope to cope with what may be an unprecedented problem. If you’re going abroad, or even travelling in your own country, then eat and drink in moderation for the first two or three days to give your body a chance to adapt.
If you are staying in an area renowned for stomach upsets and you suspect that the drinking water is not thoroughly purified, then drink only bottled water. Having decided to do that remember to clean your teeth with bottled water, to throw ice cubes out of drinks, to avoid freshly washed salads and fruit that you cannot peel yourself and to avoid ice-creams that are not packed in individual wrappers bearing the name of a reputable manufacturer.
Should these precautions prove unsuccessful and you do develop diarrhoea starve for twenty-four hours and drink plenty of bottled fluids. See the list on p193 for details of medicines to take with you when travelling abroad.
Do drink plenty of fluids if you get diarrhoea – fruit squash is fine and has the advantage that you can add a pinch of salt without making yourself sick. This helps because salt depletion following diarrhoea can result in faintness. Other useful replacement fluids include Bovril, Marmite and Oxo, all of which contain essential sodium. There is even good sense in drinking a cup of clear chicken broth – an old family remedy.
Do not eat until the diarrhoea has begun to settle. Then start off by eating bland foods which give plenty of bulk. If you eat very hot, spicy food while you’re recovering you must expect the diarrhoea to return.
If the diarrhoea is particularly unpleasant or troublesome and you want to get out and about a little while you’re suffering and recovering try Kaolin Mixture BPC or Kaolin and Morphine Mixture BPC. Don’t expect to feel fit and lively for a day or two even if the diarrhoea has slowed down.
See a doctor if the diarrhoea continues for more than five days, if it’s accompanied by severe abdominal pain, is accompanied by bleeding or keeps on recurring. Diarrhoea can be a symptom of a threatening disease. And any potentially dangerous disease is easier to deal with when diagnosed early.
Note If you regularly take a prescribed medicine and you have an attack of diarrhoea the pills you’re taking may not have a chance to be properly absorbed. Ask your doctor if you’re worried. A woman taking the contraceptive pill should consider herself unprotected for the rest of her cycle if she has diarrhoea after or while taking her pill.