Explosive diarrhea refers to abruptly and frequently passing runny, watery stools. It involves both an urgent need to have a bowel movement and the inability to control the bowels. Explosive diarrhea often leads to accidents and fecal incontinence.
People with explosive diarrhea typically pass stools more than three times per day. They may need to use the bathroom frequently, sometimes as often as every 15-30 minutes. The stools are often soft or liquid and may contain mucus or blood.
Explosive diarrhea comes on quickly and may last for days or weeks if underlying conditions are not treated. It can lead to dehydration, electrolyte imbalances, and other complications if severe.
What causes explosive diarrhea?
There are several potential causes of explosive diarrhea:
- Bacterial, viral, or parasitic infections: Pathogens like norovirus, rotavirus, Salmonella, Campylobacter, C. difficile, and giardia can all lead to acute infectious diarrhea.
- Food poisoning: Consuming contaminated food or water can cause foodborne illnesses that result in explosive diarrhea.
- Medications: Antibiotics, chemotherapy drugs, antacids with magnesium, and heart medications like digoxin can sometimes cause diarrhea as a side effect.
- Chronic conditions: Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), microscopic colitis, and celiac disease can trigger bouts of explosive diarrhea when active.
- Intolerances: Lactose, fructose, and artificial sweetener intolerances can provoke diarrhea after consuming trigger foods.
- Bowel obstruction: Blockages in the intestines from tumors, impacted stool, hernias, or twists can lead to explosive diarrhea as the body tries to force out the obstruction.
- Anxiety and stress: The gut-brain connection means that anxiety, fear, and emotional stress can stimulate diarrhea in some people.
In some cases, no specific cause can be found. The explosive diarrhea is then referred to as acute idiopathic diarrhea.
Accompanying symptoms
Along with frequent, loose bowel movements, explosive diarrhea can cause:
- Abdominal cramps and pain
- Urgent need to use the bathroom
- Nausea
- Vomiting
- Bloating
- Gas
- Low-grade fever
- Chills
- Fatigue
- Dehydration
- Electrolyte abnormalities
Symptoms may come on gradually or suddenly, depending on the cause. Infections tend to cause acute onset explosive diarrhea while chronic conditions like IBD and IBS more often slowly worsen.
When to see a doctor
Make an appointment with your healthcare provider if you experience:
- Diarrhea lasting more than 3 days
- Fever over 101.5°F (38.6°C)
- Blood or pus in the stool
- Dehydration symptoms like excessive thirst, dry mouth, infrequent urination
- Persistent vomiting
- Abdominal pain that is severe or progresses
- Recent antibiotic use
- Recent travel to a developing country
- A compromised immune system
- Unexplained weight loss
Seeking prompt medical attention can help identify the cause and prevent complications. People with underlying chronic illnesses like inflammatory bowel disease or irritable bowel syndrome may be advised to call their doctor when they experience a flare-up of diarrhea.
Diagnosing explosive diarrhea
To diagnose explosive diarrhea, healthcare providers typically:
- Ask about symptoms and medical history
- Perform a physical exam
- Order laboratory tests on blood and stool samples
- May do imaging tests like X-rays or CT scans of the abdomen
- Could perform a colonoscopy to view the inside of the colon
Identifying or ruling out potential causes guides recommended treatment and management. Testing often includes:
- Complete blood count (CBC)
- Basic metabolic panel to check electrolytes
- Stool studies to identify viruses, bacteria, or parasites
- Stool culture to look for bacterial infections
- Celiac disease blood tests like tTG-IgA
- Inflammatory markers like C-reactive protein (CRP) or fecal calprotectin
For chronic diarrhea, additional testing may include:
- Breath tests for lactose or fructose intolerance
- Allergy testing for food intolerances
- Colonoscopy with biopsies
- CT or MR enterography imaging studies
- Capsule endoscopy to view the small intestine
Explosive diarrhea treatment
Treating explosive diarrhea focuses on:
- Replacing lost fluids and electrolytes
- Easing symptoms
- Addressing any underlying condition
For mild cases, the following home treatments may help:
- Drinking electrolyte beverages like sports drinks or oral rehydration salts
- Getting plenty of rest
- Eating small, bland meals like bananas, rice, applesauce, and toast
- Avoiding caffeine, alcohol, dairy, high-fiber foods
- Taking over-the-counter anti-diarrheal medications like loperamide
For moderate-severe explosive diarrhea, doctors may recommend:
- Hospitalization for IV fluid replacement if dehydrated
- Electrolyte supplementation
- Medications to slow motility like diphenoxylate/atropine or codeine
- Prescription anti-diarrheal agents
- Antibiotics for infectious causes
- Corticosteroids or immunomodulators for inflammatory conditions
- Low FODMAP diet for IBS
- Surgery to remove obstructions or impacted stool
Identifying and treating any underlying condition, like celiac disease or IBD, can help resolve chronic explosive diarrhea. Lifestyle adjustments to control trigger foods, stress, or anxious behaviors may also improve diarrhea patterns.
Complications
Potential complications of explosive diarrhea include:
- Dehydration: Frequent watery stools can lead to dehydration, especially in infants, young children, and older adults. Dehydration requires urgent fluid and electrolyte replacement.
- Electrolyte problems: Losing fluids through diarrhea can deplete essential electrolytes like sodium, potassium, and chloride. Imbalances can disrupt heart rhythms and neurological function.
- Malnutrition: Poor absorption of nutrients from frequent diarrhea stools can lead to vitamin, mineral, and protein deficiencies.
- Rectal prolapse: Repeated straining to pass stool can sometimes cause the rectal lining to telescope outward through the anus, requiring surgical repair.
- Hemorrhoids: Increased pressure in the lower rectum from frequent stools and wiping can trigger painful hemorrhoids.
- Skin breakdown: Liquid stools can lead to redness, irritation, and painful skin lesions around the anus.
- Medication interactions: Explosive diarrhea depletes your body of water. This can raise the levels of certain medications in your blood to toxic levels.
Can explosive diarrhea be prevented?
Some tips for preventing explosive diarrhea include:
- Practicing good hygiene like handwashing and food handling
- Drinking purified or bottled water when traveling
- Getting recommended vaccines for travel destinations
- Avoiding possible food intolerances and allergens
- Managing chronic health conditions, like IBD and IBS
- Learning to reduce stress through relaxation techniques
- Taking probiotics to support gut health
Promptly treating acute infections with antibiotics can also prevent short-term diarrhea from becoming a prolonged problem. For people prone to chronic explosive diarrhea, medications taken at the first signs of a flare may help reduce severity.
Risk factors
Factors that increase explosive diarrhea risks include:
- Age: Children and older adults are more susceptible to dehydration and complications from frequent diarrhea.
- Weakened immune system: People with HIV/AIDS, cancer patients on chemotherapy, transplant recipients on immunosuppressants, and those taking oral steroids have higher risks from infectious causes.
- Intestinal disorders: Pre-existing conditions like IBS, IBD, celiac disease, and microscopic colitis predispose to episodes of explosive diarrhea during flare-ups.
- Gastric surgery: Procedures like gastrectomy and gastric bypass increase likelihood of nutrient malabsorption and explosive diarrhea from rapid food transit.
- Nervous system disorders: Conditions like multiple sclerosis, Parkinson’s, strokes, and spinal cord injuries can impair normal GI functioning and continence.
- Medications: Many prescription drugs like antibiotics, antacids, statins, NSAIDs, and immunosuppressants can cause diarrhea as a side effect.
- Travel: Risks are higher when visiting developing countries with lower hygiene standards and exposure to new pathogens.
Paying attention to risk factors allows people to take preventive steps to reduce likelihood of problematic diarrhea episodes.
When to seek emergency care
Call 911 or go to the emergency room if explosive diarrhea is accompanied by:
- Blood loss significant enough to cause dizziness, lightheadedness, rapid heart rate, confusion
- Fever over 102°F (38.9°C)
- Difficulty breathing
- Confusion or inability to arouse
- Chest or abdominal pain
- Persistent vomiting
- Bloody or black stools
- No urine output for 8 hours
Infants with explosive diarrhea who become lethargic, excessively drowsy, or have sunken eyes or fontanels require emergency assessment to check hydration. Prompt IV rehydration can prevent life-threatening dehydration and shock.
Coping with explosive diarrhea
Having explosive diarrhea can significantly affect quality of life. Strategies for coping include:
- Planning activities around bathroom availability
- Carrying extra underwear and toiletries when out
- Discussing limitations with employers
- Identifying trigger foods
- Joining a support group
- Trying mental health counseling
- Practicing stress management techniques
- Communicating needs clearly with friends and family
- Working with doctors to find effective treatments
Seeking understanding from loved ones and asking for accommodations at school or work can ease social anxiety around explosive diarrhea episodes occurring publicly. Therapy also helps some people overcome depression or embarrassment related to bowel incontinence.
Outlook
The prognosis for explosive diarrhea depends on the underlying cause. Acute infections typically resolve within days to weeks with appropriate treatment. Chronic conditions like IBD may follow a relapsing-remitting pattern. Lifestyle adjustments to control triggers along with medical treatment can often significantly improve diarrhea and quality of life.
Seeking prompt medical attention when explosive diarrhea persists or causes dehydration can help prevent short-term bouts from becoming ongoing problems. People with recurring issues should work closely with their healthcare provider to identify underlying causes and develop an effective long-term management plan.
Conclusion
Explosive diarrhea involves abruptly passing loose, watery stools multiple times per day. It can lead to fecal incontinence and dehydration if severe. Potential causes include infections, chronic illnesses like IBD, food intolerances, bowel obstructions, and anxiety. Treatment focuses on fluid replacement, symptom relief, and addressing underlying conditions if present. Seeking prompt medical attention for significant diarrhea helps prevent complications and identify correctable causes. People prone to recurring explosive diarrhea episodes can work with their healthcare provider to develop preventive and coping strategies to improve quality of life.