The 11 types of diarrhea (classified and explained)

Although in the first world they are not considered too serious a problem, the truth is that diarrhea is quite dangerous if they are not properly treated.

These clinical pictures can cause not only fluid and electrolyte loss, but also organic problems such as abdominal pain, fatigue and even hyponatremia.

can we talk about different types of diarrhea depending on what causes them, something we are going to delve into next.

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What is diarrhea?

Although in developed countries it is rather a lesser evil, in developing countries diarrhea is a real public health problem. When you have a diarrheal episode, you lose a lot of electrolytes and water, which can lead to dehydration, malnutrition and, in the case of children, stunted growth.

Diarrhea is especially dangerous in childhood, attesting to the chilling fact of being the second cause most common death rate in children under 5 years of age worldwide, according to the WHO (World Organization of Health).

About 525,000 very young children die annually from diarrhea of ​​bacterial origin, cases many of which could have been avoided if the disease that caused them had been adequately treated and had a stable health infrastructure. The WHO also indicates on its website on diarrhea that about 1.7 billion children suffer from clinical pictures of this type.

Having understood this, we can understand that diarrhea is not simply the sporadic temporary indisposition that more than one of us have suffered from eating something in bad condition. In the western world it is a problem that can be easily solved, but outside it, on many occasions, it can become a life-threatening condition. For this reason, from this point on, we are going to take a closer look at what types of diarrhea there are, how they are produced and what effects they can have on the health of patients.

Diarrhea is defined as the appearance of pasty or liquid stools, evacuated three or more times a day for at least three days. It is difficult to establish a uniform criterion to determine what is a case of diarrhea and which is not sometimes, since there is a lot of individual variability in terms of intestinal rhythm and motility.

However, pathological diarrhea is considered to be one in which the provisions weigh 225 grams per day, with a water content greater than 70% of the total mass of the faeces.

We have all had diarrhea and we know from experience that when you suffer from one of them you can lose a lot of water. But not only are fluids lost, nutrients and electrolytes are also lost. In addition, diarrhea can be accompanied by clinical signs such as fever, abdominal pain, nausea, vomiting, loss of appetite, and other gastrointestinal complaints in addition to fatigue.

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The main types of diarrhea

According to its severity we can talk about three types of diarrhea:

• Acute watery diarrhea: lasts several hours or days (eg. g., cholera).
• Acute bloody diarrhea: Also called dysentery or dysentery diarrhea.
• Persistent diarrhea: lasts 14 days or more.

But beyond how bad the diarrhea is, it is possible to classify it according to its causes. Next we are going to see the types of diarrhea according to the type of pathophysiological mechanism that produces them.

1. Exudative diarrhea

In exudative diarrhea there has been damage to the intestinal mucosa, which has caused alterations in the way of absorbing nutrients from food. This type of diarrhea persists during fasting and is also accompanied by blood and pus in the stool.

This type of diarrhea is also known as inflammatory diarrhea, as it is usually the result of an infection. It can also be caused by pathologies not necessarily associated with a bacterial or viral infection, such as food allergy, celiac disease, Crohn's disease and various types of colitis.

It usually happens that exudative diarrhea becomes chronic because the diseases that cause it are, in many cases, also chronic or with long-term effects. For inflammatory diarrhea to be considered chronic, the following symptoms must occur for a minimum of 14 days:

• Emission of blood or pus in the stool
• Systemic symptoms: persistent fever, weight loss ...
• Elevation of typical reactants of the acute phase: C-reactive protein, erythrocyte sedimentation rate, and platelet count, among others.

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2. Secretory diarrhea

In secretory diarrhea, as its name indicates, there is an alteration related to mucosa secretion, being either by increased secretion or by decreased absorption of it.

This type of diarrhea also persists with fasting. The loss of water is equivalent to that of sodium, and also the volume of stool produced can be greater than one liter per day.

What happens to the body when secretory diarrhea occurs is that there is an increased secretion of electrolytes (especially sodium,> 70 mmol / liter) into the intestinal lumen. This substance carries water with it because the transport channels through the intestinal epithelium are altered.

Generally, abdominal pain is not felt when this condition occurs, but the loss of bicarbonate with bowel movements can cause generalized metabolic acidosis, which can cause fatigue and rapid breathing.

It is this type of diarrhea that most of us are used to and it is usually caused by pathogens. Almost 70% of the clinical pictures of secretory diarrhea are caused by a virus (p. g., norovirus and rotavirus). The rest of cases can be caused by infections by bacterial strains, such as Campylobacter (2.3%), Salmonella (1.8%), Shigella (1.1%) or Escherichia coli (0.4%). Bacteria are usually transmitted orally from contaminated food or unpurified water.

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3. Osmotic diarrhea

Osmotic diarrhea characterized by the presence of non-absorbable solutes, or that they cannot be adequately absorbed due to injury to the intestinal mucosa. These solutes are osmotically active causing fluid retention within the intestinal space and thus reducing water absorption. This results in the stools becoming more liquid.

Unlike exudative and secretory diarrhea, the osmotic one does stop manifesting with fasting because it is totally linked to the patient's diet.

In this type of diarrhea the loss of water is greater than that of sodium (<70 mmol / liter), which can cause episodes of hypernatremia in the most severe cases, that is, a high concentration of sodium in the blood. As a consequence of this, the affected person feels very thirsty but, in addition, there may be affectation at the system level central nervous system since brain cells can shrink due to alterations in sodium levels.

Osmotic diarrhea is typical in disorders that prevent the digestion of certain foods, either due to intolerance to it or due to other mechanisms, such as lactose or gluten intolerance.

For example, in the specific case of people with lactose intolerance, dairy products are not adequately metabolized due to the absence of lactase enzyme, which causes these to remain in the intestine and the accumulation of fluids in the intestine is altered, also causing gas and bloating abdominal.

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4. Diarrhea due to impaired intestinal motility

Diarrhea due to impaired intestinal motility it is due to systemic problems that, as the name suggests, alter the movement of the digestive tract. It is not caused by food or infectious agents, but by some organic problem.

When food passes through the digestive tract too quickly, there is not enough time for nutrients and water to be absorbed, which can lead to very liquid stools. It is common in chronic digestive diseases, such as irritable bowel syndrome.

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Types of diarrhea according to the degree of dehydration

Although the four types of diarrhea that we have just seen could be considered the main ones, it is also true that there are other types of classifications. One of them is the one that classifies diarrhea according to the degree of dehydration that the affected person presents, which we will see briefly below.

1. No traces of dehydration

There is a loss of less than 3% of the body mass of the patient suffering from diarrhea. There are no signs associated with dehydration.

2. Mild dehydration

In this case the patient has a loss of between 3 and 5% of body mass. You are thirsty and your mouth is dry.

3. Moderate dehydration

There is a 5 to 9% loss of body mass. In addition to thirst and dry mouth, the patient may present dark circles, less urine output, orthostatic hypertension and momentary less skin elasticity.

4. Severe dehydration

Is given a loss of more than 9% of body mass. The first signs of hypovolemic shock begin to appear, that is, the heart is unable to pump blood and the organs begin to stop working.