Loose stools may be caused by improper diet, cold abdomen, bacterial or viral infection, enteritis, indigestion, dysbacteriosis, etc. The main symptoms are repeated loose and soft stools like mud, which disperse when exposed to water, or are accompanied by undigested food.
Epidemiology
High-risk population
No specific population
symptom
Typical manifestations
The main symptoms are unformed and loose stools, sometimes accompanied by vomiting, diarrhea, abdominal pain, alternating diarrhea and constipation, etc.
reason
Overview
There are many factors that lead to loose stools, including improper diet, cold abdomen, intestinal diseases such as enteritis, ulcerative colitis, irritable bowel syndrome, and infectious diseases such as bacterial dysentery and cholera.
Cause of symptoms
1. Improper lifestyle and diet
Improper diet, cold abdomen, cold food and cold drinks, etc. can stimulate intestinal peristalsis to accelerate, resulting in a shorter retention time of food in the intestines and causing loose stools.
2. Intestinal diseases
Diseases such as enteritis, colon cancer, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, as well as indigestion, dysbacteriosis, and colon dysfunction can all cause loose stools.
3. Infectious diseases
Bacterial and viral infections, such as bacterial dysentery, intestinal tuberculosis, cholera and other diseases, can cause patients to experience varying degrees of symptoms, manifested as loose stools, and may be accompanied by vomiting, diarrhea, abdominal pain and other symptoms.
Common diseases
Intestinal tuberculosis, cholera, acute dysentery, acute gastroenteritis, colon cancer, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, etc.
Seeking medical treatment
Emergency (120) indications
1. Severe vomiting and diarrhea may lead to dehydration, acidosis, and even shock.
2. Other life-threatening situations occur.
In the above cases, you must call the emergency number or go to the emergency room immediately.
Outpatient indications
1. A history of overeating or eating unclean, rotten or spoiled food, sudden nausea, frequent vomiting, severe abdominal pain, frequent diarrhea, loose stools, etc., are mostly acute gastroenteritis.
2. Long-term recurrent abdominal distension, indigestion, changes in bowel habits, loose stools, accompanied by anemia, low fever, fatigue, weight loss, etc., should alert you to intestinal malignant tumors.
3. Acute abdominal pain, recurrent diarrhea, and mucus, pus, and blood in stool in young and middle-aged people are often seen in dysentery.
4. Other severe, persistent or progressive symptoms and signs occur.
The above cases require prompt consultation with the gastroenterology department.
Treatment department
1. If you suspect intestinal malignancy, go to the oncology department for treatment in a timely manner.
2. If you suspect that the disease is caused by infectious factors, such as dysentery, intestinal tuberculosis, etc., you can also go to the infectious disease department for treatment.
If loose stools are accompanied by life-threatening conditions, go to the emergency department immediately for treatment. For those whose condition is stable, in addition to visiting the gastroenterology department as soon as possible, they can also go to the corresponding department depending on the accompanying symptoms.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. Do not eat raw or cold food, and clean the anus in time to keep it clean and hygienic.
3. You need to bring tissues on the day of your appointment to prevent the sudden urge to defecate.
4. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
5. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
6. Arrange for family members to accompany the patient to seek medical treatment.
7. Patients can prepare a list of questions they want to ask in advance.
What questions might a doctor ask a patient?
1. How long have you had loose stools? How many times do you have bowel movements per day on average?
2. Does your stool contain undigested food? Is it pus or blood?
3. Do you still have abdominal pain, nausea, vomiting, fever or other discomfort?
4. Were your bowel movements normal before? Were your bowel movements regular?
5. Did you eat any special food?
6. Do you have any history of illness?
7. Do you have a cold abdomen?
8. Have you tried treatment?
What questions can patients ask their doctor?
1. Why do I have loose stools?
2. Will I develop more severe symptoms?
3. What tests do I need to do?
4. Is my condition serious? Do I need to be hospitalized?
5. What treatment do I need? Is it curable?
6. Are there risks associated with these treatments?
7. What are the next steps in my diagnosis and treatment?
8. What issues do I need to pay attention to in daily life?
9. If taking medication, what are the usage, dosage and precautions?
10. Do I need follow-up examinations? How often?
examine
Scheduled inspection
Doctors will generally first conduct a physical examination to gain a preliminary understanding of the patient’s condition, and then selectively have the patient undergo routine blood tests, fecal occult blood tests, pathogen tests, X-rays, and CT scans, etc., and may perform histopathological examinations if necessary.
Physical examination
The skin and mucous membranes can be checked for abnormalities and to determine whether there are any symptoms such as anemia and dehydration.
Laboratory tests
1. Routine blood test
If the white blood cell count is elevated and neutrophilia is present, gastrointestinal inflammatory disease may be considered.
2. Fecal occult blood test
Positive results can be seen in gastrointestinal ulcerative lesions, colon polyps or malignant tumors, perianal lesions, etc.
3. Tuberculin test
It helps in the diagnosis and differentiation of diseases such as intestinal tuberculosis.
4. Pathogen and immunological examination
Pathogens can be identified and classified, which helps in the diagnosis and differentiation of infectious diseases.
Imaging examinations
1. If a niche shadow is found during X-ray barium meal examination, ulcerative lesions may be considered.
2. CT and magnetic resonance imaging can determine the location of the tumor, its relationship with adjacent structures, and the presence of metastasis.
Pathological examination
If cancer is present, the nature of the tumor or other lesions can be determined.
Other tests
Colonoscopy can directly detect intestinal ulcers, bleeding, polyps and other lesions.
diagnosis
Diagnostic principles
The diagnosis can be made based on the patient’s clinical presentation, medical history, and relevant auxiliary examinations. During the diagnosis process, the doctor will need to check for conditions such as acute dysentery, acute gastroenteritis, colon cancer, and irritable bowel syndrome. They will also need to check for loose stools caused by poor dietary habits.
Differential diagnosis
1. Acute gastroenteritis
A history of overeating or consuming unclean, spoiled food leads to an acute onset of symptoms, with frequent nausea and vomiting, severe abdominal pain, and frequent diarrhea, often watery and containing undigested food, small amounts of mucus, and even blood. Fever, headache, general malaise, and varying degrees of poisoning are common. Severe vomiting and diarrhea can lead to dehydration, acidosis, and even shock. Physical signs are subtle, with tenderness in the epigastrium and around the umbilicus, without muscle tension or rebound tenderness, and often with hyperactive bowel sounds.
2. Dysentery
Clinical manifestations include fever, abdominal pain, diarrhea, tenesmus, and bloody, mucus-purulent stools, accompanied by systemic toxemia. Severe cases can lead to septic shock and/or toxic encephalopathy. Bacillary dysentery occurs sporadically year-round, most commonly in summer and autumn, and is a common and frequently occurring disease in my country. Children and young adults are particularly susceptible. Stool routine examination and bacterial culture can aid in diagnosis.
3. Colon cancer
Symptoms may be absent in the early stages, but in the middle and late stages, symptoms may include abdominal distension and indigestion, followed by changes in bowel habits, abdominal pain, and mucus or blood in the stool. As the tumor ulcerates, blood is lost, and toxins are absorbed, symptoms such as anemia, low-grade fever, fatigue, weight loss, and lower limb edema often develop. Sigmoidoscopy and fibercolonoscopy can aid in diagnosis.
4. Rectal cancer
Most patients may experience changes in bowel habits and blood in the stool in the early stages, diarrhea, tenesmus, a feeling of incomplete defecation, discomfort during defecation, and a prolapsed anus. In the late stages, there may be lower abdominal pain. The stool may be bloody, and in severe cases, blood and pus may form in the stool. The frequency of bowel movements may also increase. Symptoms of intestinal stenosis include initially deformed and narrowed stools. After the cancer partially obstructs the intestinal lumen, there may be abdominal distension, paroxysmal abdominal pain, hyperactive bowel sounds, and difficulty defecating. In the late stages, rectal cancer that invades the prostate may cause frequent and painful urination. Invasion of the presacral nerves may cause severe, persistent pain. Liver metastases may present with cachexia, including hepatomegaly, ascites, jaundice, anemia, weight loss, and edema.
5. Rectal ulcer
Onset is often slow, with a history of chronic constipation or straining during bowel movements. The main clinical manifestations include abdominal pain, constipation, diarrhea, bloody stools, and thin stools. The pain is often dull and located in the lower abdomen and perineum, sacrum, and coccyx. It worsens with defecation and improves afterward. Defecation is difficult, with tenesmus and heaviness. Stools may contain blood, mucus, or bloody stools. A few may experience alternating diarrhea and constipation. Rectal prolapse is often present. A few cases present with an acute onset, often related to stress, with severe abdominal pain, bloody stools, and even life-threatening acute bleeding, intestinal perforation, or intestinal necrosis.
6. Irritable bowel syndrome
The main clinical symptoms are abdominal pain, which is relieved after defecation; abdominal distension, vomiting, and significant weight loss; changes in bowel habits, diarrhea and/or constipation; except for mild abdominal tenderness, there are usually no other abnormal findings.
treat
Expected treatment
Ulcerative colitis and irritable bowel syndrome are common causes of loose stools. Doctors will prescribe targeted treatments based on a clear diagnosis. At the same time, you should avoid eating raw, cold, or irritating foods and maintain a regular lifestyle.
Treatment
1. Ulcerative colitis
The goal is to induce and maintain symptom relief and mucosal healing, prevent and treat complications, and improve the patient’s quality of life. Appropriate medications are selected based on the severity of the disease and the location of the lesion.
(1) Control inflammatory response
① Aminosalicylic acid preparations: including 5-aminosalicylic acid (5-ASA) preparations and sulfasalazine (SASP).
② Glucocorticoids: The first choice treatment for moderate and severe patients who are ineffective with 5-ASA.
③Immunosuppressants: used for maintenance treatment of patients with poor response to 5-ASA maintenance therapy, recurrent symptoms and hormone dependence.
(2) Symptomatic treatment
Correct fluid and electrolyte imbalances promptly; patients with severe anemia may receive blood transfusions, and those with hypoproteinemia should receive albumin supplements. In severe cases, patients should fast and receive total parenteral nutrition. For symptomatic treatment of abdominal pain and diarrhea, anticholinergics or antidiarrheal drugs such as diphenoxylate (phenoxylate) should be used with caution but should be avoided in critically ill patients due to the risk of toxic megacolon. For severe cases with secondary infection, aggressive antimicrobial therapy should be administered intravenously with broad-spectrum antibiotics.
(3) Patient education
During the active phase, patients should get adequate rest, regulate their mood, and avoid excessive psychological stress. During the acute active phase, a liquid or semi-liquid diet can be administered. Once the condition improves, switch to a nutritious, easily digestible, low-residue diet that is not too spicy. Maintain a healthy diet and avoid intestinal infections. Take medications as directed and visit your doctor regularly for follow-up. Do not stop medication without authorization. Patients with recurrent active symptoms should be prepared for long-term medication.
(4) Surgical treatment
Patients with massive bleeding, intestinal perforation, or toxic megacolon who have not responded to active medical treatment should undergo emergency surgery. Elective surgery may be performed based on the patient’s condition for patients with colon cancer, unsatisfactory medical treatment responses, intolerable drug side effects, or severe impact on their quality of life.
2. Irritable bowel syndrome
Aims to improve patients’ symptoms, enhance their quality of life and eliminate their worries.
(1) General treatment
Identify triggering factors and try to eliminate them; guide patients to develop healthy living habits and dietary structure, avoiding foods that trigger symptoms. Sedatives may be given appropriately for those with insomnia and anxiety.
(2) Symptomatic treatment
① Abdominal pain: antispasmodics such as pinaverium bromide, atropine, etc., and drugs that regulate visceral sensation such as 5-HT3 selective antagonists alosetron and ramosetron, etc.
Diarrhea: Patients with diarrhea can choose appropriate antidiarrheal medications based on their condition. Loperamide or diphenoxylate are effective and suitable for those with severe diarrhea, but long-term use is not recommended. Mild cases should be treated with absorbent antidiarrheal medications, such as montmorillonite powder or medicinal charcoal.
③ Constipation: Laxatives such as polyethylene glycol, lactulose or sorbitol, methylcellulose, etc. Prokinetic drugs such as mosapride, itopride, etc.
④Intestinal microecological preparations: such as Bifidobacterium, Lactobacillus, Butyric acid bacteria and other preparations.
(3) Psychological and behavioral therapy
If the symptoms are severe and persistent and general treatment and drug therapy are ineffective, psychological and behavioral treatment should be considered, including psychotherapy, cognitive therapy, hypnosis therapy and biofeedback therapy.
Related drugs
5-aminosalicylic acid preparations, sulfasalazine, phenoxylate, pinaverium bromide, atropine, bifidobacteria, lactobacilli, butyric acid bacteria, polyethylene glycol, lactulose or sorbitol, methylcellulose, mosapride, itopride, montmorillonite powder, medicinal charcoal, etc.
daily
Nursing principles
If the stool is not formed and the patient has diarrhea, the nursing points are as follows:
1. General care
Patients with acute onset and significant systemic symptoms should rest in bed, exercise moderately, and avoid dizziness and falls. Keep the abdomen warm. Hot compresses can be used to reduce bowel movements, decrease bowel movements, and help alleviate symptoms such as abdominal pain. Patients with mild, chronic symptoms can exercise moderately. If diarrhea occurs, contaminated clothing and bedding should be changed promptly, and windows should be opened for ventilation to remove odors.
2. Psychological care
Patients and their families should maintain a good attitude, treat the disease correctly, and avoid emotional stress.
3. Dietary care
Eat low-residue, easily digestible foods and avoid raw, cold, high-fiber, and strongly flavored foods. For acute diarrhea, fasting, liquid, semi-liquid, or soft food should be administered according to the patient’s condition and doctor’s advice.
4. Medication care
When using antidiarrheal drugs, pay attention to the patient’s bowel movements and stop taking the drug promptly when diarrhea is under control; pay attention to the side effects of antispasmodics and analgesics, such as atropine.
5. Skin care
Frequent bowel movements can cause irritation from stool, leading to damage to the perianal skin, erosion, and infection. After bowel movements, wash the perianal area with warm water, keeping it clean and dry. Apply sterile petroleum jelly or antibiotic ointment to protect the perianal skin or promote healing.
6. Disease monitoring
Dynamically observe the patient’s fluid balance and monitor changes in vital signs, consciousness, and urine volume; check for signs of dehydration such as thirst, dry lips, decreased skin elasticity, decreased urine volume, and apathy; and check for signs of hypokalemia such as muscle weakness and arrhythmia. If any abnormalities are found, seek medical attention promptly.
prevention
Preventive measures
1. Strengthen physical exercise, engage in appropriate outdoor activities, and enhance the body’s immunity.
2. Pay attention to climate changes and prevent overcooling or overheating, especially infants and young children should avoid getting their abdomens cold.
3. Infants and young children should be fed appropriately, with breastfeeding encouraged. Summer weaning and supplementary feeding should be avoided, as should any illness. Adults should avoid overeating, consuming leftovers, and consuming large amounts of spicy and irritating foods.