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Hysteroscopy: When is it Necessary?

Posted Aug 24 2008 1:49pm
DAVID MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. Today we're discussing diarrhea. It's usually not serious and goes away on its own, but there are a number of conditions that can cause diarrhea.

Joining us today to talk about the topic are two experts. First is Dr. Lucy Harris. She's a gastroenterologist at Cornell Medical Center. Welcome.


DAVID MARKS, MD: Along with her, also from Cornell Medical Center, is another gastroenterologist, Dr. Mark Pochapin. Thanks for being here. Lucy, what is diarrhea?

LUCINDA HARRIS, MS, MD: I think you have to think of diarrhea in two ways. One is the frequency of bowel movements. I think that bowel movements greater than three times a day are generally what we as physicians consider to be diarrhea. Also, watery stools are also considered, the consistency, in other words, are also a component of what we consider diarrhea.

DAVID MARKS, MD: What about a change in a person's pattern of bowel movements?

MARK POCHAPIN, MD: That's very important, because some people who don't go very frequently as their baseline may actually have looser bowel movements or more frequent bowel movements. In addition to that, you may notice a change in the size or the shape of the bowel movement, and that might trigger a new problem that needs to be evaluated medically.

DAVID MARKS, MD: For example, if someone's normal cycle is, they go once every three days, and then they start going every day, is that considered diarrhea?

LUCINDA HARRIS, MS, MD: I wouldn't consider that strictly diarrhea. I'd consider it a change in bowel habit, for which consulting a physician might be an important thing to do.

DAVID MARKS, MD: What are some of the causes of diarrhea?

LUCINDA HARRIS, MS, MD: Some of the causes of diarrhea can be dietary. Certain people have food intolerances, either to lactose, which is a milk sugar. And we all lose the ability to digest that milk sugar as we grow up, to some extent, some people more than others. There can be other causes, such as sorbitol, which is found in chewing gums and artificially sweetened candies. Also, some people are not aware that high fructose corn syrup, which is in some of the juice-like beverages or fruit punches, can also be a cause of diarrhea.

In addition, there can be endocrinologic conditions like thyroid disease or diabetes that can cause diarrhea. Medications can be another cause.

DAVID MARKS, MD: I notice you didn't mention infections.

LUCINDA HARRIS, MS, MD: Infections, that is a very cause.

DAVID MARKS, MD: Could be the most common cause.

LUCINDA HARRIS, MS, MD: That's true.

MARK POCHAPIN, MD: The other thing, in addition to infections, are inflammatory conditions, where you have inflammation within the intestine itself. Now, an infection can cause an inflammatory condition, but sometimes it occurs on its own.

DAVID MARKS, MD: Now, there's a difference between small bowel conditions and large bowel conditions that can cause diarrhea. Should a person even worry about that, number one? And, number two, how can they tell if the problem's in the small bowel or the large bowel?

MARK POCHAPIN, MD: The problem is, the terminology is so poor. The small intestine is actually the thinner caliber intestine. It's actually longer, the longest component, and does most of the absorption. So if you have a problem with the small intestine, in fact, a lot of fluid gets malabsorbed, which means that it stays within the intestine, and travels down and basically overwhelms the intestine. So a lot of fluid comes out. But it doesn't occur so frequently. So a person might go to the bathroom, have a lot of fluid come out, and then not go again for another few hours.

When the large intestine's involved, the large intestine primarily takes in the fluid and tries to make the stool more solid. When you have that problem there, you go very frequently, because you're not able to reabsorb that fluid. But the amount that you go is not as much as when it involves the small intestine. From a person's perspective, a patient's perspective, it doesn't matter. That's more a diagnostic tool. But the etiology and the causes and the treatments are very different between the two.

DAVID MARKS, MD: How long is a normal, let's say an infectious course of diarrhea? What period of time should a person actually say: Okay, this is nothing, and beyond that, a patient start worrying?

LUCINDA HARRIS, MS, MD: It can vary with the cause of the diarrhea. Viruses oftentimes cause short courses of diarrhea, somewhere in the neighborhood of 24-72 hours. Occasionally it can be longer. Bacterial diarrheas can last a little bit longer on occasion. But generally, infectious diarrheas usually don't last longer than two weeks all told. Maybe the exception to that is if they have a parasitic diarrhea that's not been treated, it can last a little bit longer.

MARK POCHAPIN, MD: There are some infections that actually occur after antibiotics, which can last for a very long time. The actual organism is clostridium difficile, but it's out there, and patients who develop diarrhea and it doesn't go away, should really seek attention, and not just say "Oh, my infection hasn't gone."

DAVID MARKS, MD: What period of time should a person give themselves to get better, after which they call their doctor or they start to be concerned?

LUCINDA HARRIS, MS, MD: I think that there are also a constellation of symptoms. I think if the diarrhea has gone on for greater than two weeks, then definitely they should also call. But if their diarrhea in the initial stages is accompanied by high fever, blood in the stool or severe abdominal pain, they may need to call earlier, within the first couple of days.

MARK POCHAPIN, MD: The other thing I would add to that is, we talked about small and large bowel diarrhea. People die from diarrhea. In fact, diarrhea is still one of the most common leading causes of death in Third World countries for children, because they get so dehydrated. And adults die from diarrhea, too. So if they're having a lot of volume, if a lot of fluid is coming out, they shouldn't even wait a day. They might need to be treated with intravenous fluid, or at least a certain oral solution, something they drink, to help keep themselves hydrated, because patients die from dehydration.

LUCINDA HARRIS, MS, MD: Right. If they can't keep down enough fluids and they're feeling dizzy, then those are warning symptoms that they should also keep in mind.

MARK POCHAPIN, MD: By the way, just on the topic, the most important thing to do is not drink just plain water, but to drink something that has some sugar and salt in it. Some of the commercial things. Pedialyte is the best, but it doesn't taste that great for adults. But something like Gatorade or some of these sports drinks are actually good rehydration solutions when patients have diarrhea.

DAVID MARKS, MD: What about laxative abuse? Is that a problem that you see with diarrhea?

LUCINDA HARRIS, MS, MD: I think that's more a select population of patients that actually have severe diarrhea from that alone.

DAVID MARKS, MD: Can you get a rebound from that?

MARK POCHAPIN, MD: Oh, yeah. I think what ends up happening is, the laxative abuse patient has more of a psychological problem. But some patients start abusing laxatives without knowing that they're doing it. They start taking some, and then they need more. And ultimately they're taking so much to go, and what ends up happening is the intestine itself gets damaged from all that heavy laxative use.

DAVID MARKS, MD: You mentioned some of the warning signs earlier. Go over the warning signs that a person should look for that should send them to the doctor.

LUCINDA HARRIS, MS, MD: I think the warning signs are, if the diarrhea's accompanied by chronic fever, if there's blood in the stool, if they have severe abdominal pain.

MARK POCHAPIN, MD: And abdominal bloating. If they feel like they have a lot of nausea or vomiting associated with that. If they feel weak or dizzy, they can't seem to get out of bed for more than a day.

LUCINDA HARRIS, MS, MD: Maybe also weight loss as well, or inability to keep foods down or severe loss of appetite.

DAVID MARKS, MD: There are also a couple of chronic conditions, Crohn's disease being one of them, that can cause diarrhea, too.

MARK POCHAPIN, MD: Actually, when you look at problems related to diarrhea, you sort of break them up into things that happen acutely that have not been there before, and things that have been there for a long time, chronically. The chronic illnesses, these inflammatory bowel conditions such as Crohn's disease or ulcerative colitis, usually have some symptoms or signs prior to a patient realizing that they have some diarrhea. They've known about it for a while, and now it's getting worse.

It can just occur suddenly, but that's less likely. But there are other chronic conditions, other things that cause diarrhea. For example, irritable bowel. Lucy's done a lot of work with irritable bowel. Some patients always have diarrhea. It's just part of their makeup, their irritable bowel makeup, and Lucy might want to mention that. LUCINDA HARRIS, MS, MD: There are patients that have diarrhea predominant irritable bowel syndrome. They're approximately a third of the patients that present with this syndrome. Some people have alternating constipation and diarrhea that have that syndrome.

Usually it's something that presents in the teen years or young adulthood, and is chronic in nature. There's also a subset of patients that have either pain/bloat predominant irritable bowel syndrome or constipation predominant irritable bowel syndrome.

DAVID MARKS, MD: What's the final nugget that people should know about diarrhea? Are there final words of wisdom about the topic?

MARK POCHAPIN, MD: I think if I had to give final words of wisdom: It's common, and that they should not drink water. They should drink something that has sugar and salt in it, and stay away especially from lactose and foods that you wouldn't give to a baby with diarrhea, because a lot of times people with diarrhea eat the wrong foods and make the diarrhea worse. Milk's one of them.

LUCINDA HARRIS, MS, MD: Remember the BRAT diet: bananas, rice, apples, apple juice, tea and toast, especially for acute diarrhea. Staying away from milk and milk products, particularly with a viral diarrhea, and fatty foods, is extremely important.

DAVID MARKS, MD: Okay, great. And if you have any of those warning signs, call your doctor. Thank you both for being here. Thank you for joining our webcast. I'm Dr. David Marks. Goodbye.

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