What is the best treatment for diarrhea?

The most common medicines used to treat diarrhea are loperamide (Imodium), atropine/diphenoxylate (Lomotil) and bismuth subsalicylate (Pepto-Bismol). These have the potential to stop diarrhea; however, they do not treat the underlying cause, and as soon as the effects of the medicine wear off, your diarrhea will return.

Diarrhea is a way for our body to purge itself of infection or to deal with a disruption in our stomach or bowel. Sometimes it is better to let your body get rid of the toxins; however, there are always circumstances when it is just not practical or possible to constantly be within a short distance of a toilet. Anti-diarrhea medicines may be used occasionally to provide symptom relief from acute diarrhea.

People who experience chronic or long-term diarrhea should only use these medications under a doctor's supervision. Anti-diarrhea medicines may also help with symptoms such as abdominal cramps.

How do anti-diarrhea medicines work and how fast do they work?

Loperamide works on receptors inside the bowel to help slow down peristalsis (this is when the muscles of the bowel wall contract - contraction is increased during diarrhea). This allows more water to be absorbed back into the body, making the stool less watery and decreasing the number of bowel movements. Loperamide may take anywhere between 2.5 and 5 hours to have an effect, although some effects are seen within 20 minutes.

Atropine/diphenoxylate (only available on prescription) acts directly on the smooth muscle inside the bowel wall to prolong the transit time of bowel contents. It is not an innocuous drug and may not be suitable for everybody, especially seniors. It should not be used in children aged less than two and recommended dosages should be followed strictly. Time to onset of effect varies, but some anecdotal reports indicate some people experience excessive slowing of the bowel for several days after just a few tablets.

Bismuth subsalicylate may be used to treat indigestion, nausea, and diarrhea. The way bismuth subsalicylate works to stop diarrhea is not completely understood; however, it is thought to reduce secretions in the digestive tract, reduce inflammation and, inhibit the growth of bacteria and viruses. It generally has a weak effect on reducing diarrhea and it may take several hours and multiple doses before an effect is seen. Because it contains salicylate, it should not be used by people with bleeding problems, those already taking salicylates such as aspirin) or with allergies to salicylates or NSAIDs. It may cause temporary and harmless darkening of the tongue and stool, and should only be taken as directed on the label.

Saccharomyces boulardii lyo (Florastor) is a yeast with probiotic effects; it works by preventing the growth of harmful bacteria in the stomach and intestines and may be more effective when used to treat diarrhea associated with antibiotic or feeding-tube use. It may take hours to days to have an effect.

Are there any home remedies that stop diarrhea?

Several foods found around the home may help reduce some symptoms of diarrhea, although most likely only have a weak effect. Yogurt that contains live bacterial cultures such as lactobacillus acidophilus or bifidobacterium can help restore levels of good bacteria in the bowel and may help with antibiotic-induced diarrhea. Dried goldenseal has an antibacterial effect and may help with E.coli-induced diarrhea. Black tea and other tannin-rich foods such as blackberries can help reduce bowel inflammation. Foods such as carrots and bananas, as well as being bland, contain high amounts of pectin, a soluble fiber that can soak up extra fluid in the intestine. Ground psyllium seeds can also help bulk up the stool and slow its transit.

What foods should I eat or avoid?

Keeping hydrated is the most important thing you can do when you have diarrhea. This does not mean drinking copious amounts of water - although water can be drunk, it is important you also replace lost electrolytes with properly formulated electrolyte replacement drinks (not sugary sports drinks that you can buy from a supermarket). Herbal teas and nutritious soups (such as chicken soup) are also good for providing antioxidants and extra minerals.

Avoid alcohol, caffeine, fruit, or spicy food until 48 hours after all symptoms have disappeared. Stay away from chewing gum or products with sweeteners such as sorbitol or xylitol as these can make your diarrhea worse.

Try to avoid milk and milk products until three days after your symptoms have gone because many diarrhea-causing viruses can make your gut sensitive to milk products. If you have a baby with diarrhea, you should talk to your pediatrician about how you should feed your baby, as withholding milk from babies is not recommended. Greasy foods are also usually not well tolerated.

Begin eating mild, bland type foods (such as bread, crackers) as soon as you fell up to it. Stay away from foods that are likely to cause bloating (for example, legumes, corn, prunes, chickpeas, broccoli).