Treatment of Minor Ailments: Diarrhea

Treatment of Minor Ailments

• Focuses on diarrhea, constipation, and hemorrhoids.
• Provides learning outcomes for the conditions
• Includes a "WWHAMM" summary slide with questions to help assess patients.

Learning Outcomes (Diarrhea)

• Understand the lower GI tract ailment—diarrhea.
• Recognize symptoms, causes, and treatments.
• Identify OTC medications for treatment.
• Understand the impact on electrolyte balance and how rehydration salts correct it.

Diarrhea

• Characterized by passing watery stools more than three times a day.
• Types:
  • Acute: sudden onset, lasting up to 14 days.
  • Persistent: lasting more than 14 days.
  • Chronic: lasting more than 4 weeks.

Diarrhea Mechanisms

• Increased osmotic load in the gut lumen.
• Increased secretion.
• Inflammation of the intestinal lining.
• Increased intestinal motility.
• Often multiple mechanisms are involved.

Symptoms of Diarrhea

• Watery stools, possibly with abdominal cramps.
• Flatulence, weakness, nausea, vomiting, fever, headache, and loss of appetite.
• Fluid loss can lead to electrolyte imbalance (Na+, K+, Mg2+, Cl-).

Treatment of Diarrhea

• Drink fluids to prevent dehydration (rehydration drinks recommended).
• Eat high-carbohydrate foods as soon as possible.
• Consider anti-diarrheal medicine (e.g., loperamide).
• Use pain relievers if fever or headache is present.

Rehydration Drinks

• Replace lost electrolytes but don't treat diarrhea
• Commercial products available (e.g., Dioralyte).
• Dissolve a sachet in 200ml of fresh water and drink after each loose stool.
• Helps restore fluids and electrolytes.
• "Home-made" options are available.

WHO Recommendation (Home-Made)

• ½ teaspoon salt and 6 teaspoons sugar per 1 liter of water.
• Lightly salted rice water is another option.

Antidiarrhoeals

• Loperamide is an example of an anti-diarrheal medication.
• Adults and children over 12 years can use loperamide (2 capsules initially, followed by 1 capsule after each loose stool, maximising use to 8 doses in 24 hours).
• It slows down transit time through the GI tract which improves the absorption of water and electrolytes.

Medication-Induced Diarrhea

• Detailed medical history is crucial.
• Newer or as needed medications are more prone to causing diarrhea.
• Medications like Laxatives, Antibiotics, Metformin, NSAIDs, and PPIs are potential culprits.

Warning Symptoms (Diarrhea)

• Blood or mucus in stools (bright red is okay in small amounts).
• Signs of dehydration (lethargy, headache, dry mouth).
• Duration of diarrhea longer than 5 days.
• Frequent vomiting.
• High fever.
• Recent change in bowel habits or travel abroad (especially for those who have recently traveled outside the country).

Learning Outcomes (Constipation)

• Understand the lower GI tract ailment—constipation.
• Recognize symptoms, causes, and treatments.
• Understand how to identify appropriate OTC medications for treatment.

Constipation

• Passing hard stools less often than normal.
• Inability to empty the bowels completely.

Symptoms of Constipation

• Change in stool frequency.
• Hard, lumpy, large, or small stools.
• Stomach ache and cramps.
• Feeling bloated, nauseous, loss of appetite.
• Chronic problems like hemorrhoids and fecal impaction can arise.

Causes of Constipation

• Poor diet (lack of fiber and/or fluids).
• Lack of mobility.
• Medications.
• Opioid analgesics, antidepressants, anti-epileptics and iron supplements.
• Pregnancy.
• Medical conditions (e.g., diabetes, Parkinson's, underactive thyroid).

Treatment of Constipation

• Lifestyle changes, including increasing fiber in the diet, bulking agents, and increasing fluid intake, as well as daily exercise.
• Laxatives, including stimulant, bulk-forming, and osmotic types.

Stimulant Laxatives

• Increase intestinal motility.
• Onset of action is within 8–12 hours.
• Often taken at night.
• Side effects include abdominal cramps, excessive fluid loss, and electrolyte imbalance.
• Examples include senna and bisacodyl.

Bulk-Forming Laxatives

• Stimulates peristalsis like dietary fiber.
• Onset of action is 24–36 hours.
• Drink plenty of water to avoid impaction.
• Side effects include flatulence and abdominal bloating.
• Examples include bran and ispaghula husk.

Osmotic Laxatives

• Retain fluid in the bowel via osmosis.
• Plenty of water intake is critical.
• Onset of action up to 3 days.
• Side effects include flatulence, abdominal pain, and colic.
• Examples include lactulose and magnesium salts.

Warning Symptoms (Constipation)

• Constipation alternating with diarrhea.
• Blood or mucus in stools (bright red is okay in small amounts).
• Weight loss.
• Abuse of laxatives.
• Vomiting.
• Fever.
• Angina.

Learning Outcomes (Hemorrhoids)

• Understand the lower GI tract ailment—hemorrhoids.
• Recognize symptoms, causes, and treatments.
• Identify appropriate OTC medications for treatment

Hemorrhoids (Piles)

• Anal vascular cushions swell or enlarge.
• Often self-reported, other conditions may be confused with hemorrhoids.
• Prevalence: 13–36% of the population.

Symptoms of Hemorrhoids

• Bright red rectal bleeding, not mixed in with stool.
• Pruritus (itchiness—caused by mucus discharge and irritation).
• Soiling (uncontrolled stool discharge—caused by impaired continence or mucus discharge).
• Rectal fullness or an anal lump.
• Large prolapsed hemorrhoids can thrombose (become painful and swollen).

Causes of Hemorrhoids

• Excessive straining (chronic constipation).
• Age.
• Intra-abdominal pressure (pregnancy and chronic cough).
• Other less common causes, like pelvic/abdominal masses, family history of hemorrhoids, cardiac failure, or portal hypertension.

Treatment of Hemorrhoids

• Treat constipation first.
• Use creams, ointments, and suppositories.
• These treat symptoms, not the condition.
• Topical remedies (local anesthetic, astringent, and barrier cream).
• Short-term treatment (5–7 days).

Warning Symptoms (Hemorrhoids)

• Exclude other causes of rectal bleeding (e.g., malignancy, inflammatory bowel disease, diverticular disease).
• Other anorectal symptoms may be wrongly attributed to hemorrhoids (fissures, abscesses, or perianal fistulas).