Diarrhea is when you have frequent, watery bowel movements – three or more loose stools in a day. Many things can cause it, including:

• Virus
• Bacteria and parasites
• Medications, such as antibiotics
• Lactose intolerance
• Fructose or artificial sweeteners
• Digestive disorders such as celiac disease or irritable bowel syndrome

This is a common condition that most of the time does not require treatment. It usually only lasts a couple of days, whether you treat it or not. But medicine can help you feel better. It’s especially helpful if you also have stomach cramps or pain. If you have a history of frequent or chronic constipation, be careful about using antidiarrheal medications.
If you have diarrhea with severe abdominal pain that is not cramping, contact your doctor.

Over-the-counter (OTC) medications are medications that can be purchased without a doctor’s prescription. Some over-the-counter medications can help you feel better if you have diarrhea. These are called anti-diarrheal medications. Anti-diarrheal medications include:

• Loperamide (1 brand name: Imodium)
• Bismuth subsalicylate (2 brand names: Kaopectate, Pepto-Bismol)

Path to improved health

How do over-the-counter anti-diarrheal medications work?

Loperamide slows the speed at which things move through your intestines. This allows your body to absorb more fluid. It helps you have less diarrhea and more formed stools. Bismuth subsalicylate balances the way fluid moves through your intestines and reduces inflammation. It prevents bacteria and viruses that cause diarrhea from growing in the stomach and intestines.

How can I safely take over-the-counter anti-diarrheal medications?

Before taking an over-the-counter anti-diarrheal medication, read the instructions on the medication information label. This will tell you how much medicine to take and how often to take it. If you have any questions, call your family doctor or pharmacist. Keep track of the over-the-counter medications you use and when you take them. If you need to go to the doctor, take that list with you. Follow these tips to make sure you are taking the right amount of medication:

• Take only the amount recommended on the label. Do not assume that more medication will work better or faster. Taking more than the recommended amount can be dangerous.
• If you take prescription medications, ask your doctor if it is okay to take over-the-counter anti-diarrheal medications.
• Do not take more than one over-the-counter anti-diarrheal at a time, unless your doctor says it is okay. They may have similar active ingredients. They could mean excessive medication intake.

How can I safely store over-the-counter anti-diarrheal medications?

Store all medications out of the reach and sight of small children. Keep medications in a cool, dry place. This will help prevent them from becoming less effective. Do not store medications in the bathroom or bathroom cabinets. They are often hot and humid places.

Things to consider

Healthy adults generally do not experience side effects from anti-diarrheal medications. But side effects may be a concern if you are older or have health problems. Call your doctor if you notice any side effects.

Side effects of loperamide may include:

• Abdominal pain
• Constipation
• Dizziness
• Nausea or vomiting

Side effects of bismuth subsalicylate may include:

• Constipation
• Blackened stools and/or tongue
• Ringing in the ear (called tinnitus)

Who should not take over-the-counter antidiarrheal medications?

Talk to your doctor before taking an anti-diarrheal medication if:

• You have diarrhea and severe abdominal pain that is not cramping.
• Your diarrhea lasts more than 2 days
• You have a fever
• You have mucus or blood in your stools
• You have a history of liver disease
• Are taking prescription medications

Questions to ask your doctor

• What is the cause of my diarrhea?
• How long will it last if I don’t treat it?
• Does taking an over-the-counter anti-diarrheal medication shorten the duration of diarrhea?
• What can I do to treat my diarrhea besides taking over-the-counter medications?
• Will anti-diarrheal medications cause constipation?
• What side effects should I be aware of if I take anti-diarrheal medications?

Resources

International Foundation for Gastrointestinal Disorders: Antidiarrheal Agents

National Institutes of Health, MedlinePlus: Loperamide

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Bringing your baby home from the hospital is a very exciting time. But having a newborn around can be stressful for lots of reasons. One of these is concern about the new baby getting sick. How will you know? It can be hard to tell when a newborn is sick. You may not know what your baby’s normal behavior is yet. This makes it difficult to tell if your baby’s behavior is not normal. Signs of serious illness in newborns can be subtle. They aren’t always easy to spot.

It is important to be aware of what signs could mean that your newborn is sick. Their immune system is not as strong after birth, so it’s harder for them to fight off infections. And once they do get an infection, it can get worse quickly. That’s why you should know what to look for.

Path to improved health

One of the main things to look for in your newborn is if they look or act in any way that seems abnormal to you. If this happens, call your baby’s doctor right away. Some of the ways they could look or act abnormal include:

• Any symptoms of illness. These include crying more often, irritability, coughing, diarrhea, or vomiting. If your newborn vomits green (bile), call the doctor right away.
• Changes in feeding. Newborns usually eat frequently. If you have to wake your newborn to eat or they can’t finish their feedings, they could be sick.
• If your newborn has a fever, especially over 100.4 F (38 C), call the doctor.
• Low body temperature. If your baby’s temperature falls below 96.8 F (36 C), call the doctor.
• Changes in how they cry. Their cry could be weak, sound strange, or be frantic without stopping.
• Weak sucking or not being able to suck for very long
• Sweating while they eat
• Sleeping more than normal (needing to be woken up to eat, for example)
• Decreased muscle tone or floppy limbs.
• Moaning or grunting noises when they breathe.
• Decreased urination (fewer wet diapers) and dry mouth (dehydration).
• Any change in color, such as pale, bluish, or gray arms and legs

It can be hard to tell if your newborn is sick. Pay attention and watch them closely for any of these signs of illness. If you have any question at all about your newborn, call their doctor.

Things to consider

While illness is not normal for a newborn, there are some conditions that are common in the first few weeks after birth. Watch your newborn for signs of any of these conditions and call their doctor if you see symptoms.

Abdominal distension. Your baby’s abdomen (stomach) should feel soft between feedings. If it feels swollen or hard, there could be a problem. It might be gas or constipation. But if they haven’t had a bowel movement for more than a day or two, or if they are vomiting, a swollen stomach could be a sign of an intestinal problem.

Blue baby. Your newborn may show mildly blue hands and feet if they are cold. They may go a little blue around the face, tongue, or lips if they are crying hard. But if they have persistent blue coloring plus breathing or feeding difficulties, it is an emergency. It could be a sign that the heart or lungs are not working correctly. Call the doctor or go to the emergency room right away.

Coughing during feeding. Your newborn may cough or sputter a bit as they learn and adjust to a feeding routine. But if they cough or gag regularly when they are trying to eat, there could be a problem in the lungs or digestive system.

Excessive crying. Newborns cry, sometimes for no reason. If your baby won’t stop crying, make sure they are fed, burped, warm, and have a clean diaper. Then try to hold them and soothe them. You can’t “spoil” a newborn with too much attention, so don’t hesitate to pick them up when they are crying. Soon you’ll get used to your newborn’s crying patterns. But if their crying sounds different, such as shrieking, or it goes on for an unusually long time, call your doctor.

Jaundice. Many healthy newborns have a yellowish tinge to their skin. This is called jaundice. It happens when a chemical called bilirubin builds up in the baby’s blood. Mild cases of jaundice are harmless. But if the buildup gets to be too much and it isn’t treated, it can cause problems. Jaundice normally appears on the face first, followed by the chest and abdomen, and finally it spreads to the arms and legs. Sometimes the whites of the eyes can become yellowish, as well. If you notice your baby developing jaundice, call the doctor.

Respiratory distress. In most cases, if your newborn is having trouble breathing, it’s because their nasal passages are blocked. This is normally easy to remedy by using saline nasal drops and a bulb syringe to suck the mucus out. But there are other signs that could mean your baby is having serious breathing problems. These include

• Fast breathing (more than 60 breaths in one minute). Remember, though, that babies breathe faster than adults.
• This is when the stomach muscles between the ribs get sucked in with each breath, making the ribs stick out.
• Flaring of the nose.
• Grunting while breathing.
• Persistent blue coloring.

Call your newborn’s doctor right away if he or she develops any of these signs of respiratory distress.

Questions to ask your doctor

• What signs should I look for that my newborn may be sick?
• How do I know what’s normal when I just brought him or her home?
• How do I know if my baby is vomiting or just spitting up?
• My baby cries all the time. Could they have colic?

Resources

National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development: What are some of the basics of infant health?

National Institutes of Health, MedlinePlus: Common Infant and Newborn Problems

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What is a urinary tract infection?

A urinary tract infection (UTI) affects the kidneys, bladder, and urethra. Infection occurs when bacteria builds in the urinary tract when waste isn’t removed or the bladder isn’t emptied. When the bladder is involved in the infection, it is called cystitis. If the kidneys are involved, it is a more serious condition called pyelonephritis.

In general, UTIs are more common in girls. They can occur more often when children are potty training. Boys who have not been circumcised by the age of 1 are at risk of UTIs as well. Kids who have vesicoureteral reflux (VUR) may get UTIs more often. VUR is a condition in which urine can flow back into the urinary tract. VUR typically is present at birth.

Path to improved health

The sooner you detect a UTI, the quicker treatment can begin. It is important to know the symptoms. Common UTI symptoms include:

• Burning feeling or pain when you urinate
• Feeling like you need to urinate more often than usual
• Feeling the urge to urinate but not being able to
• Stomach pain
• Low back pain

Your child may not be able to communicate these symptoms. You should look for the following warning signs:

• Cloudy, dark, smelly, or bloody urine
• Fever or chills
• Vomiting
• Diarrhea
• Fussiness
• Poor appetite or less active
• Going through more diapers than usual
• Wetting clothes even though they are potty trained

Contact your doctor right away if you think your child has a UTI. The doctor will review symptoms and do a physical exam. The doctor also will do a urine test (urinalysis) to confirm the diagnosis. Getting a sample of urine can be hard in young children. There are several ways a doctor can collect urine.

• Catheterized specimen urine culture: The doctor places a thin plastic tube (catheter) into the child’s bladder.
• Subrapubic urine collection: The doctor inserts a thin needle through the child’s lower stomach into their bladder. This is usually a last resort when other methods have failed.
• Urine collection bag: The doctor places a plastic bag beneath the child’s vagina or penis to collect urine. This method is the least reliable.

Based on the test result, the doctor may perform other tests to rule out conditions similar to UTIs or determine the cause.

If your child has frequent infections, your family doctor may order an ultrasound or voiding cysto-urethrogram (VCUG) before referring you to a specialist. A VCUG allows your doctor to evaluate your child’s bladder and urethra using contrast and X-rays.

Treatment for a UTI depends on the cause and your child’s age. Infants often require treatment in the hospital. This is because they need antibiotics through an IV (intravenous) or catheter. Older children can take medicine at home.

Things to consider

There are several things you can do to help prevent UTIs in children.

• Keep your child’s genital area clean. This helps prevent bacteria from forming or spreading.
• Have your child drink plenty of non-sugar-sweetened fluids, especially water.
• Teach your child not to hold it too long when they need to go to the bathroom. A backup of urine in the bladder can lead to bacteria growth.
• Teach your child to wipe from front to back when they go to the bathroom. This is especially important for girls.
• Do not dress your child in clothes that are too tight.
• Always bathe your child after swimming or being active.

When to see a doctor

Call the doctor if your child’s symptoms don’t improve or get worse with medicine. If your child gets a UTI more than once in 6 months, the doctor may want to switch treatments.

Questions to ask your doctor

• How did my child get a UTI?
• How long will my child need to take antibiotics?
• What is the risk of my child getting more UTIs in the future?
• Does treatment vary if my child gets UTIs often?
• What conditions are related to UTIs?

Resources

Urology Care Foundation: Urinary Tract Infections in Children

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Should I go to the doctor? Most of us have asked that question at one time or another. Whether it’s a bad cold, a funny-looking mole, or a nagging pain that just won’t go away, it can be hard to know when you should see your doctor. There are no set rules that tell you when to go or when to wait. But some general guidelines might help you the next time you’re trying to decide.

Path to improved health

Below are some common illnesses and problems we may deal with from time to time. Many of them can be managed at home. But sometimes they can progress or change, and then it’s best if they are addressed by a doctor. If you aren’t sure what to do, call your doctor. He or she, or even a nurse in the office, can tell you if you should make an appointment.

Common cold or flu

Many symptoms can be managed with plenty of rest, fluids, and over-the-counter medicine. But if you experience any of these symptoms, call your doctor:

• Painful swallowing (more than a sore or dry throat).
• Earache.
• A cough that lasts more than 2 or 3 weeks.
• Persistent or severe vomiting.
• A fever that doesn’t go down or go away.
• Symptoms that last more than 10 days or get worse instead of better.

Diarrhea

Occasional diarrhea isn’t uncommon. It’s usually harmless and doesn’t mean something is wrong. But there are signs to look for that could indicate a problem. These include:

• Diarrhea that lasts more than 3 days.
• Black, tarry stools.
• Blood in your stool.
• Severe abdominal pain.
• Signs of dehydration (very dry mouth or skin, fatigue, decreased urination, confusion, or irritability).

Headache

We all get headaches every once in a while. They usually go away with rest or over-the-counter medicine. But headache can also be a sign of a serious condition, such as stroke or meningitis. If you have a high fever, stiff neck, confusion, or trouble speaking or walking along with a headache, go to the emergency room. If you have any of the following, schedule an appointment with your doctor:

• Headaches that are different than normal (more often or more severe).
• Headaches that get worse or don’t get better after taking over-the-counter medicine.
• Headaches that keep you from working, sleeping, or participating in activities.

Digestive issues

Digestive issues can include problems in the upper digestive tract (esophagus and stomach) and the lower tract (intestines). If you experience any of the following, call your doctor:

• Feeling like food is caught in your throat or chest.
• Heartburn that doesn’t go away, gets worse, or doesn’t get better with medicine.
• Difficult or painful swallowing.
• Hoarseness or sore throat that doesn’t go away.
• Nausea that won’t go away.
• Vomiting blood or bile (green).
• Severe or persistent abdominal pain.
• Constipation or diarrhea that won’t go away.
• Stools that are black or bloody.

Back pain

Most back pain will go away in a few weeks without treatment. It often gets better by using over-the-counter medicine. You can also apply heat or cold to the area that hurts. But sometimes it’s a sign of a problem. Call your doctor if you experience:

• Constant pain.
• Pain that spreads down one or both legs, especially if it goes past your knee.
• Pain with weakness, numbness, or tingling in one or both legs.
• Pain plus unexplained weight loss.
• Pain with swelling or redness on your back.
• Pain with a fever.

Head injury

Getting a bump on the head could be minor. But it also could cause a concussion. Look for these signs of concussion and call your doctor if you have any of them after hitting your head:

• Dizziness and balance problems.
• Nausea and vomiting.
• Confusion.
• Concentration and memory problems.
• Feeling sluggish or foggy.
• Sensitivity to light or noise.
• Sleep problems.
• Mood changes.

Menstrual problems

A woman’s monthly period can have a big impact on her life, especially if there are problems. Call your doctor if you’re experiencing any of these symptoms:

• Your period suddenly becomes irregular.
• You don’t have a period for 3 months or more.
• You have bleeding between periods.
• You have a period that lasts much longer than usual or is much heavier than usual.
• You have severe or disabling cramps.

Mental health issues

Mental health is an important part of our overall health and should never be ignored. Having issues with mental health is common and treatable. Call your doctor if you’re experiencing any of these signs of trouble with your mental health.

• Feelings of depression or sadness that don’t go away.
• Feeling extreme highs and lows.
• Having excessive fear, worry, or anxiety.
• Withdrawing from social interactions.
• Changes in eating or sleeping.
• Inability to cope with daily problems.
• Delusions or hallucinations.
• Substance abuse.
• Thoughts of hurting yourself or others.

Other symptoms

Some symptoms are hard to categorize, but it’s still important to know if they occur. The following could be signs of a problem that may need be addressed by your doctor:

• Dizziness or feeling like you are going to faint.
• Shortness of breath.
• Irregular heartbeats or rapid heartbeats.
• Unexplained weight loss.
• Fatigue that won’t go away.
• Severe sweating, especially cold sweats.
• Swelling in the ankles or legs.
• Rash along with a fever (100.4 C or higher).
• A new or changing mole or other skin change that concerns you.

Things to consider

Most people don’t go to the doctor unless they’re sick or have a problem. But you should start by seeing your doctor when you’re well. By seeing your doctor routinely, you can stay on top of your health. He or she can provide preventive health screenings and monitor your health over time. This allows them to catch diseases early and help you manage them before they progress into more serious conditions.

How often you routinely see your doctor depends on your health. Many doctors recommend you come in once a year for a check-up. But if you have problems or a chronic condition, such as heart disease or diabetes, you will likely be seen more often.

When deciding whether to call the doctor when you’re experiencing symptoms, you should also consider the state of your health and any risk factors you may have. For example, if you have asthma and you get a respiratory infection, you may need to see your doctor sooner than someone who doesn’t have asthma. In addition, if you’re having new symptoms after having a procedure, surgery, immunization, injection, or starting a new medicine, you should call your doctor.

Questions to ask your doctor

• I have a chronic condition. How often should I be seen?
• What risk factors do I have that could determine whether or not I need to be seen?
• Are there any specific symptoms I need to watch out for?

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Bioterrorism is the use of bacteria, viruses, or germs to purposely harm large quantities of people or communities. These “weapons” are spread through air, water, or food sources. Bioterrorism is rare and is used to threaten people, governments, and countries. In bioterrorist attacks, usually only a small number of people may be injured or affected. However, many more become afraid. They change their behavior because of their fear.

Path to improved health

There are some things you can do to prepare for a bioterrorist attack. For example, take reasonable steps to prepare, just as you would for a tornado or hurricane. It is a good idea to have enough food, water, money (cash), and supplies (including any regular medications you may need) on hand to last you 3 or 4 days. You should also keep emergency contact information at home, work, and school.

Do not take antibiotics unless your doctor tells you to. Antibiotics prevent very few illnesses. They can have serious side effects. Overuse of antibiotics can actually make certain forms of bacteria difficult to treat. Also, antibiotics may interfere with medicines you are already taking.

While toxic gasses are used in bioterrorist attacks, you do not need to buy gas masks. They are intended only for short-term use when a deadly gas is released. They are not practical for use at all times. They are effective only if properly fitted. When not used properly, the masks can be dangerous. They can result in injury or suffocation, especially in people who have heart or lung problems.

Things to consider

Certain bioterrorism “weapons” include:

Anthrax. Anthrax is an infection caused by bacteria. Anthrax most commonly occurs in cattle and sheep. It is rare in humans. It is usually seen only in people who have contact with infected animals or who work with animal products such as wool, or hides. Anthrax can be a form of bioterrorism if someone deliberately spreads the bacteria in public places.

Anthrax takes 3 forms in humans, all of which are caused by the same bacteria. The form of anthrax infection depends on how the bacteria enter the body:

• Cutaneous (skin) infection caused by touching infected animal products, contaminated soil containing anthrax bacteria or the bacteria itself. It is the most common form of anthrax.
• Gastrointestinal (stomach and intestine) infection is caused by eating undercooked meat that is contaminated with anthrax bacteria.
• Inhalation infection is caused by breathing in anthrax bacteria.

None of the forms can spread from person to person. It is caused only by direct exposure to the anthrax bacteria. Anthrax symptoms can be similar to other illnesses. Symptoms include:

• Cutaneous anthrax starts as a red area on the skin, similar to an insect or spider bite. It may itch. Over a few days, the area becomes larger. Blisters may form, followed by a deep, black scab. The area is usually painless.
• Gastrointestinal anthrax typically causes vomiting, nausea, fever, and loss of appetite. It is followed by severe stomach pain, bloody diarrhea, and vomiting with blood.
• Inhalation anthrax starts out like the flu, with a fever, sore throat, dry cough, and muscle aches. Inhalation anthrax does not cause a runny nose. The symptoms are usually mild for a few days (and may even get better). The symptoms get much worse. People who have inhalation anthrax often have stomach pain. Within a few days, they will have difficulty breathing and go into shock.

If you have symptoms, call your doctor. If he or she thinks there is a possibility your symptoms are caused by anthrax, he or she will ask about your job and any travel. This information, plus an exam and possibly some lab tests or X-rays, will help your doctor decide whether you have anthrax infection. It is unlikely that the general public is in danger of anthrax exposure.

Fortunately, anthrax can be treated with antibiotics. The treatment and its success depend on the form of anthrax. Cutaneous anthrax is the least serious form. People can sometimes recover even without treatment. Gastrointestinal and inhalation anthrax are more serious and may cause death if not treated.

Anthrax gets the most news attention. However, other agents used in bioterrorism include botulism, plague, and smallpox. Some other agents have also been studied for use as biological weapons, such as tularemia, brucellosis, Q fever, and viral hemorrhagic fevers.

Smallpox: Smallpox is thought to be another more likely agent to be used in a bioterrorist attack. Smallpox is an illness caused by the variola virus.

Smallpox can be spread from person to person, once a fever and rash have developed. If you were vaccinated before 1972, you are not still protected. It is uncertain how long the vaccine is effective. There is no specific drug to treat smallpox. However, a vaccine given even a few days after exposure may prevent death. It’s important to get prompt medical attention if you think you’ve been exposed to smallpox.

• Fever.
• Headache.
• Fatigue.
• Diarrhea.
• Vomiting.
• A specific rash.

The rash starts out as flat red spots and turns into blisters. The blisters contain clear liquid and then progresses to pus. Routine vaccination for smallpox was stopped in 1972 in the U.S. The disease had been wiped out.

Botulism: This rare but serious illness is a bacterial poison that is often distributed through food sources. It forms in the soil.

Botulism symptoms include:

• Double or blurred vision.
• Drooping eyelids.
• Slurred speech.
• Difficulty swallowing.
• Dry mouth.
• Muscle weakness.

Ebola: Ebola is a severe and often fatal virus. It spreads from an infected animal to a human and then from human to human through direct contact with a patient’s blood or secretions.

Ebola symptoms include:

• Fever.
• Headache.
• Joint and muscle aches.
• Weakness.
• Diarrhea.
• Vomiting.
• Stomach pain.
• Loss of appetite.

Plague: Plague is a bacterial infection. The bacteria are found mainly in rats and in the fleas that feed on them. There are three types of plague. However, pneumonic plague is the most common bioterrorist agent. It can spread from person to person.

Plague symptoms include:

• Fever.
• Headache.
• Weakness.
• Chest pain.
• Cough.
• Bloody mucous discharge.

Vaccines for anthrax and smallpox are not available at this time. However, smallpox vaccines have been made so that supplies are available to high risk groups if needed. Because there are some risks with the smallpox vaccine, the Centers for Disease Control and Prevention (CDC) will decide if it should be given on an individual basis. The anthrax vaccine is controlled by the U.S. Department of Defense. It is only available for military personnel at high risk of exposure in combat settings. Also, it’s available to people who work with anthrax in a laboratory setting.

Questions to ask your doctor

• How quickly do symptoms appear after exposure to anthrax or smallpox?
• If I am pregnant and exposed, can it harm my unborn baby?
• Do all military personnel receive smallpox and anthrax vaccines?

Resources

Centers for Disease Control and Prevention: Bioterrorism

National Institutes of Health, MedlinePlus: Biodefense and Bioterrorism

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