The 11 types of diarrhea (classified and explained)

A summary classification of the types of diarrhea, explaining how to recognize them and their causes.

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

We can speak of different types of diarrhea depending on what causes them, something we are going to go into in more detail below.

What is diarrhea?

Although in developed countries it is rather a minor ailment, in developing countries diarrhea is a real public health problem. When a diarrheal episode occurs, many electrolytes and water are lost, which can lead to dehydration, malnutrition and, in the case of children, stunted growth. can lead to dehydration, malnutrition and, in the case of children, stunted growth..

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

Nearly 525,000 very young children die annually from bacterial diarrhea, many of which could be prevented by the use of antibiotics.Many of these cases could have been prevented if the disease that caused them had been adequately treated and a stable health infrastructure had been in place. The WHO also indicates on its web page on diarrhea that about 1.7 billion children suffer from diarrhea.

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

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

However, pathological diarrhea is considered to be diarrhea in which the stool weighs 225 grams per day, with a water content of more than 70% of the total mass of the stool.

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

The main types of diarrhea

Depending on its severity we can speak of three types of diarrhea:

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

But beyond the severity of the diarrhea, it is possible to classify it according to its causes, it is possible to classify it according to its causes. The following are 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 nutrients are absorbed from food.. This type of diarrhea persists during fasting and is 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 often happens that exudative diarrhea becomes chronic because the diseases that cause it are, in many cases, also chronic or with long-term effects. or with long-term effects. For inflammatory diarrhea to be considered chronic, the following symptoms must be present for at least 14 days:

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

2. Secretory diarrhea

In secretory diarrhea, as its name indicates, there is an alteration related to mucous secretion, either due to increased secretion or decreased absorption of mucous..

This type of diarrhea also persists with fasting. The loss of water is equivalent to that of sodium, and in addition the volume of stool produced can be more 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 with it water 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 lead to generalized metabolic acidosis, which can result in fatigue, fatigue, and even death.which may cause fatigue and rapid breathing.

It is this type of diarrhea that most of us are accustomed to and it is usually caused by pathogens. Almost 70% of clinical pictures of secretory diarrhea are caused by a virus (e.g., norovirus). (e.g. norovirus and rotavirus). The remaining 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 transmitted orally, usually from contaminated food or unpurified water.

3. Osmotic diarrhea

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

Unlike exudative and secretory diarrhea, osmotic diarrhea does not manifest itself with fasting because it is totally linked to the patient's diet.

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

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

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

4. Diarrhea due to intestinal motility disturbance

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

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

Types of diarrhea according to the degree of dehydration.

Although the four types of diarrhea 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 present in the affected person, which we will see briefly below.

1. Without traits 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.. The patient is thirsty and the mouth is dry.

3. Moderate dehydration

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

4. Severe dehydration

There is a loss of more than a loss of more than 9% of body mass.. The first signs of hypovolemic shock begin to appear, i.e. the heart is unable to pump blood and organs begin to stop functioning.