Diarrhea causes

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Overview

Patient Information

Classification

Acute Diarrhea
Chronic diarrhea

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; M.Umer Tariq [3]

Overview

The principal cause of diarrhea stems from ingestion of unsafe drinking water (typically from admixture of raw sewage to water supplies); the occurrence is predominantly in lesser developed countries. The common causes of acute diarrhea are infection, allergy, food intolerance, foodborne illness and/or extreme excesses of vitamin C and/or magnesium and may be accompanied by abdominal pain, nausea and vomiting. Infectious diarrhea is most commonly caused by viral infections or bacterial toxins. Diarrhea can also be a principal symptom of more serious diseases, such as dysentery, Montezuma's Revenge, cholera, or botulism, and can also be indicative of a chronic syndrome such as Crohn's disease. Temporary diarrhea can also result from the ingestion of laxative medications or large quantities of certain foods like prunes with laxative properties. Though appendicitis patients do not generally have diarrhea, it is a common symptom of a ruptured appendix. It is also an effect of severe radiation sickness.

Causes

Life Threatening Causes

Common Causes

Causes According to Duration

Acute Diarrhea


Chronic Diarrhea


Causes According to Etiology

  • Bacterial infections. Several types of bacteria consumed through contaminated food or water can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli (E. coli).
  • Viral infections. Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.
  • Food intolerances. Some people are unable to digest food components such as artificial sweeteners and lactose—the sugar found in milk.
  • Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
  • Reaction to medicines. Antibiotics, blood pressure medications, cancer drugs, and antacids containing magnesium can all cause diarrhea.
  • Intestinal diseases. Inflammatory bowel disease, colitis, Crohn’s disease, and celiac disease often lead to diarrhea.
  • Functional bowel disorders. Diarrhea can be a symptom of irritable bowel syndrome.

Causes by Organ System

Cardiovascular Portal vein thrombosis, superior mesenteric artery syndrome
Chemical / poisoning

Acrodynia, acute zinc toxicity, arsenic poisoning, carbamate insecticide poisoning, carbon monoxide poisoning, chlordane toxicity, chloroform toxicity, copper toxicity, diazinon poisoning, glutaraldehyde toxicity, heavy metal poisoning, lead poisoning, mercury poisoning, metal fume fever, naphthalene poisoning, organophosphate poisoning, paraquat toxicity, selenium toxicity, thallium toxicity

Dermatologic Acrodermatitis enteropathica, necrotizing fasciitis
Drug Side Effect

2C-B, 5-HT3 antagonist, 5-methoxy-diisopropyl tryptamine, abacavir, acamprosate, acarbose, acebutolol, acyclovir, acitretin, aconitine, adefovir, alatrofloxacin, albendazole, aldesleukin, alendronate, aliskiren, allopurinol, alosetron, alpha-amanitin, alpha-glucosidase inhibitor, alprazolam, altretamine, ambenonium chloride, amifostine, amiloride, aminocaproic acid, aminophylline, amlexanox, amlodipine, ammonium lauryl sulfate, amoxicillin, amphetamine, amphotericin B, amprenavir, amitriptyline, anadenanthera peregrina, anagrelide, anakinra, anastrozole, anisindione, aprepitant, atazanavir, atenolol, atorvastatin, atovaquone, auranofin, azithromycin, aztreonam, bacitracin, baclofen, barium nitrate, barium sulfate, benazepril, bentiromide, bepridil, betaxolol, bethanechol, bevacizumab, bezafibrate, bicalutamide, biguanide, bisacodyl, bisoprolol, bortezomib, brompheniramine, bumetanide, buspirone, busulfan, candesartan, capecitabine, carbamazepine, carbidopa, carboplatin, carvedilol, cefaclor, cefadroxil, cefamandole nafate, cefazolin, cefazolin, cefdinir, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, cefpodoxime, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, cephalexin, cephradine, cerivastatin, cetuximab, cevimeline, chloral hydrate, chlorambucil, chlordiazepoxide, chlorodyne, chlorothiazide, chlorpheniramine, chlorthalidone, cholestyramine, ciclosporin, cidofovir, cilostazol, cimetidine, cinacalcet, cisapride, citalopram, cladribine, clamoxyquine, clarithromycin, clavulanic acid, clindamycin, clofarabine, clofibrate, clomipramine, clonazepam, clopidogrel, clorazepate, colchicine, colistimethate, cyclophosphamide, cyproheptadine, cytarabine, dactinomycin, dalfopristin, dantrolene, daptomycin, darbepoetin alfa, darifenacin, darunavir, dasatinib, daunorubicin, deferasirox, delavirdine, demeclocycline, deracoxib, desoxyn, dextroamphetamine, dextromethorphan, diacerein, diazepam, diclofenac, dicloxacillin, didanosine, diflunisal, digitoxin, digoxin, diltiazem, dipyridamole, dirithromycin, disopyramide, docetaxel, dofetilide, dolasetron, donepezil, doripenem, doxorubicin, doxycycline, DTPA, duloxetine, efavirenz, emtricitabine, enalapril, endosulfan, enoxacin, entacapone, epirubicin, eplerenone, epoetin alfa, ergotamine, erlotinib, erythromycin, esomeprazole, estazolam, estradiol, ethacrynic acid, ethosuximide, etidronate, etodolac, etoposide, exemestane, exenatide, ezetimibe, famciclovir, famotidine, felbamate, fexofenadine, floxuridine, fluconazole, flucytosine, fludarabine, fluoride, fluorouracil, fluoxetine, flurazepam, flutamide, fluticasone, fluvastatin, fluvoxamine, fosamprenavir, foscarnet, fosinopril, frovatriptan, fulvestrant, gabapentin, galantamine, ganciclovir, gatifloxacin, gefitinib, gemcitabine, gemeprost, gemfibrozil, glatiramer, glycopyrrolate, granisetron, griseofulvin, guanethidine, guanfacine, hydralazine, hydrochlorothiazide, hydroxychloroquine, hydroxyurea, hyoscyamine, ibandronate, ibuprofen, idarubicin, imatinib, infliximab, interferon alfacon-1 , interferon beta-1b, irinotecan, iron supplements, isocarboxazid, isradipine, itraconazole, ketoconazole, lamivudine, lamotrigine, lanreotide, lansoprazole, lanthanum, leflunomide, letrozole, leuprolide, levalbuterol, levetiracetam, levocarnitine, levodopa, levofloxacin, linezolid, liothyronine sodium, lisinopril, lithium, lomefloxacin, lopinavir, loracarbef, loratadine, lorazepam, loxapine, magnesium hydroxide, mebendazole, mechlorethamine, meclofenamate, mefenamic acid, mefloquine, megesterol, meprobamate, mercaptopurine, meropenem, mesalazine, mesna, mesoridazine, metformin, methamphetamine, methenamine, methotrexate, methoxychlor, methsuximide, methyclothiazide, methylergonovine, methyprylon, metoclopramide, metolachlor, metolazone, metoprolol, metronidazole, miconazole, mifepristone, miglitol, minocycline, misoprostol, mitotane, moclobemide, modafinil, moexipril, moricizine, moxifloxacin, mycophenolate, nabumetone, nafcillin, naltrexone, naphthalene, natalizumab, natamycin, nateglinide, nelfinavir, nevirapine, niclosamide, nizatidine, norfloxacin, nystatin, ofloxacin, omalizumab, omeprazole, ondansetron, oseltamivir, oxaliplatin, oxazepam, oxcarbazepine, oxtriphylline, oxybutynin, palivizumab, pancrelipase, pantoprazole, pegaspargase, peginterferon alfa-2a, peginterferon alfa-2b, pemetrexed, pemoline, penbutolol, penicillin, pentamidine, pentostatin, pergolide, perindopril, perphenazine, phenazopyridine, phentermine, pilocarpine, pimecrolimus, pimozide, piroxicam, plicamycin, polythiazide, posaconazole, pramipexole, pramlintide, prazepam, praziquantel, prazosin, procainamide, procarbazine, promethazine, propafenone, propranolol, protriptyline, pseudoephedrine, pyridostigmine, quinapril, quinidine, quinupristin, rabeprazole, ramipril, ranitidine, rasagiline, repaglinide, reserpine, retapamulin, ribavirin, rifampin, rilmenidine, riluzole, risedronate, risperidone, ritonavir, rituximab, rivastigmine, rizatriptan, salsalate, saquinavir, sargramostim, selegiline, sevelamer, sildenafil, simethicone, simvastatin, sirolimus, sitagliptin, sodium oxybate, sodium picosulfate, sodium polystyrene sulfonate, solanine, solifenacin, sorafenib, sotalol, sparfloxacin, spironolactone, stavudine, streptozocin, sulfadiazine, sulfasalazine, sulfisoxazole, sulfisoxazole, sulindac, sumatriptan, sunitinib, tacrine, tamsulosin, tegaserod, telbivudine, telithromycin, telmisartan, temozolomide, teniposide, tenofovir, terbinafine, teriparatide, theophylline, thiabendazole, thioguanine, thioridazine, thiothixene, thyroxine, ticlopidine, tiludronate, tipranavir, tocopherol, tolcapone, topiramate, topotecan, trandolapril, tranylcypromine, trastuzumab, trazodone, treprostinil, triamterene, triazolam, trifluoperazine, trihexyphenidyl, trimeprazine, trimethadione, trimethobenzamide, trimetrexate glucuronate, trimipramine, triprolidine, trovafloxacin, valacyclovir, valganciclovir, valproic acid, valsartan, verapamil, vinblastine, voriconazole, vorinostat, zanamivir, zidovudine, ziprasidone, zoledronic acid, zolmitriptan

Ear Nose Throat Otitis media in children
Endocrine

Addison's disease, carcinoid syndrome, diabetes insipidus, diabetic neuropathy, glucagonoma, Graves disease, hyperthyroidism, hypoaldosteronism, neuroendocrine tumors, somatostatinoma, subacute thyroiditis

Environmental Abrus precatorious, azalea poisoning, bee stings, datura stramonium poisoning, endosulfan toxication, food poisoning, herbal extract overdose, honey intoxication, insect bite allergy, isomalt toxicity, marine toxins, mushroom poisoning, narcissus pseudonarcissus, oleander poisoning, phytohaemagglutinin poisoning, pesticide poisoning, phytolacca americana toxicity, ricinus communis poisoning, snakebites, solanine poisoning
Gastroenterologic

Abdominal abscess, abdominal cancer, achlorhydria, acute appendicitis, acute gastritis, bile acid sequestrant, biliary atresia, biliary tract cancer, blind loop syndrome, caecitis, carcinoid syndrome, celiac disease, cholestatic jaundice, colitis, colonic inertia, colonic malakoplakia, colonic villous adenomata, colorectal cancer, colorectal polyps, Crohn's disease, diverticulitis, enteritis, enterocele, enterocolitis, food poisoning, fructose malabsorption, gastric dumping syndrome, gastrinoma, gastritis, gastro-enteropancreatic neuroendocrine tumor, gastroenteritis, gastrointestinal amyloidosis, glucose-galactose malabsorption, gluten sensitivity, ileitis, inflammatory bowel disease, intestinal lymphangiectasis, intestinal pseudoobstruction, intususception, irritable bowel syndrome, ischemic colitis, lactose intolerance, listeriosis, malabsorption syndrome, malassimilation, Meckel diverticulitis, polyposis, proctitis, protein losing enteropathy, tropical sprue, ulcerative colitis, Whipple's disease, Zollinger-Ellison syndrome

Genetic

Abetalipoproteinaemia, Arakawa's syndrome II, aromatic amino acid decarboxylase deficiency, aromatic amino acid decarboxylase deficiency, aspartylglycosaminuria, congenital adrenal hyperplasia, congenital disorder of glycosylation type 1B, congenital intrinsic factor deficiency, congenital short bowel syndrome, congenital toxoplasmosis, Cornelia de Lange syndrome 2, Fabry's disease, familial amyloid polyneuropathy, galactosemia, Gardner's syndrome, Gilbert's syndrome, Hartnup disease, hereditary angioedema, HNPCC, hyper IgM syndrome, hyperlipoproteinemia type I, inborn amino acid metabolism disorder, juvenile polyposis syndrome, lipoid congenital adrenal hyperplasia, long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency, malonic aciduria, malonyl-CoA decarboxylase deficiency, mucopolysaccharidosis, neuroblastoma, neurofibromatosis, Sanfilippo syndrome, Slone's disease, sphingolipidosis, sucrase-isomaltase deficiency, Turcot syndrome, very long-chain acyl-coenzyme A dehydrogenase deficiency, Von Gierke disease, Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia

Hematologic

Amyloidosis, C1 esterase inhibitor, chronic myeloproliferative disorders, hyper IgM syndrome, megaloblastic anemia, neutropenia, porphyria Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia

Iatrogenic

Colonoscopy, dumping syndrome, graft versus host disease, percutaneous endoscopic gastrostomy, postileal resection, postvagotomy, radiation proctitis, rectal surgery, radiation sickness, short bowel syndrome

Infectious Disease

Adenophorea, adenoviridae, adenovirus, AIDS, amebiasis, ancylostoma duodenale, anguillulosis, anthrax, ascariasis, astrovirus, bacillary dysentery, bacillus cereus, bacterial toxin, balantidiasis, beef tapeworm, blastocystis hominis, borrelia anserina, botulism, campylobacter jejuni, candida, capillaria, cestoda, ciguatera poisoning, clostridium difficile, clostridium perfringens, clostridium sordellii, clostridium welchii, coccidia, cryptosporidiosis, cyclosporiasis, cysticercosis, cytomegalovirus, dientamoeba fragilis, diphyllobothrium infection, dipylidium caninum infection, Ebola, echinococcosis, ehrlichiosis, entamoeba histolytica, escherichia coli, fasciolopsiasis, filariasis, flavivirus, fusarium venenatum, giardia lamblia, hantavirus pulmonary syndrome, helminthiasis, hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, hepatitis X, hookworm infection, isosporiasis, katayama fever, lassa fever, legionella pneumophila, legionnaires' disease, leptospirosis, lymphogranuloma venereum, malaria, marburg virus, measles, metagonimiasis, mycobacterium avium complex, norwalk gastroenteritis, opisthorchis infection, paragonimus infection, pelvic abscess, pseudomembranous colitis, psittacosis, Q fever, rhabditida, rotavirus, roundworm, salmonellosis, sarcocystis, schistosomiasis, secernentea, shigellosis, small bowel bacterial overgrowth syndrome, staphylococcal food poisoning, staphylococcal toxic shock syndrome, streptobacillus, streptococcal infections, strongyloides, tapeworms, trematoda, trichinella spiralis, trichinosis, trichuriasis, tularemia, typhoid fever, vibrio cholerae, vibrio mimicus, vibrio parahemolyticus, vibrio vulnificus, visceral leishmaniasis, Whipple disease, whipworm infection, yersinia enterocolitica

Musculoskeletal / Ortho

Myleofibrosis

Neurologic Common migraine, neuroblastoma, Waterhouse-Friederichsen syndrome
Nutritional / Metabolic

Folate deficiency, food allergies, food intolerances, iron supplements, kwashiorkor, lactose intolerance, milk allergy, pellagra, pernicious anemia, protein losing enteropathy, sucrose intolerance, vitamin C toxicity, zinc deficiency

Obstetric/Gynecologic Childbirth, endometriosis, neonatal sepsis, ovarian cancer, ovarian hyperstimulation syndrome
Oncologic

Carcinoid syndrome, colorectal cancer, Ewing's sarcoma, Gardner's syndrome, gastric cancer, HNPCC, juvenile polyposis syndrome, Kaposi's sarcoma, multiple endocrine neoplasia type 1, neuroendocrine tumors, pancreatic adenoma, peritoneal mesothelioma, neuroendocrine tumors, ovarian cancer, small bowel lymphoma, somatostatinoma, thymus cancer, Vipoma,

Opthalmologic No underlying causes
Overdose / Toxicity

Boron overuse, Carbon monoxide toxicity, Carnitine overuse, Colchicine toxicity, Digoxin, Ergotism, Heavy metal ingestion, Lycorine, Mazindol, Tetrodotoxin

Psychiatric Anxiety-tension syndrome, panic attack
Pulmonary Cystic fibrosis, legionellosis
Renal / Electrolyte Acute kidney failure, hyperchloremia
Rheum / Immune / Allergy

Angioedema, Amyloidosis, Anaphylaxis, Athabaskan severe combined immunodeficiency, Autoimmune adrenalitis, Autoimmune enteropathy, Autoimmune polyendocrine syndrome, Autonomic neuropathy, Chronic granulomatous disease, Complement 5 deficiency, Kawasaki disease, Omenn syndrome, Satoyoshi syndrome, Reiter’s syndrome

Trauma No underlying causes
Urologic Proctitis, Reiter’s syndrome
Miscellaneous

Alcohol intoxication, Alcohol withdrawal, Anopsology, Capsaicin, Chronic fatigue syndrome, Idiopathic hypereosinophilic syndrome, Idiopathic intestinal pseudoobstruction, Idiopathic sclerosing mesenteritis, POEMS syndrome, Smoking stools syndrome, Waldmann disease, Water hemlock (Cicuta sp.), Waterhouse-Friederichsen syndrome, Water-skier colon, Weil's syndrome

Causes in Alphabetical Order


Other Important Causes

  • Ischemic bowel disease. This usually affects older people and can be due to blocked arteries.
  • Bowel cancer: some (but not all) bowel cancers may have associated diarrhea. Cancer of the large intestine is most common.
  • Hormone-secreting tumors: some hormones (e.g. serotonin) can cause diarrhea if excreted in excess (usually from a tumor).
  • Bile salt diarrhea: excess bile salt entering the colon rather than being absorbed at the end of the small intestine can cause diarrhea, typically shortly after eating. Bile salt diarrhea is a possible side-effect of gallbladder removal. It is usually treated with cholestyramine, a bile acid sequestrant.
  • Alcohol: Chronic diarrhea can be caused by chronic ethanol ingestion.[1] Consumption of alcohol affects the body's capability to absorb water - this is often a symptom that accompanies a hangover after a heavy drinking session. The alcohol itself is absorbed in the intestines and as the intestinal cells absorb it, the toxicity causes these cells to lose their ability to absorb water. This leads to an outpouring of fluid from the intestinal lining, which is in turn poorly absorbed. The diarrhea usually lasts for several hours until the alcohol is detoxified and removed from the digestive system. Symptoms range from person to person and are influenced by both the amount consumed as well as physiological differences. Alcohol-induced diarrhea is often accompanied by "the follow through" where a feeling that the patient is going to break wind (flatulence) instead becomes an uncontrolled episode of diarrhea.

References

  1. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.

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