Common Conditions

Nobody likes getting diarrhoea or vomiting, but it is rare for somebody to reach adulthood without having had at least one of these conditions once.

The most common reason for getting diarrhoea and vomiting together is gastroenteritis – a highly infectious viral infection which quickly spreads through households and daycare centers. There are many other reasons why diarrhoea or vomiting occur.

Diarrhoea

Diarrhoea is when your bowel movements (stools) become watery, foul smelling and you need to go to the toilet both urgently and frequently.

Diarrhoea is usually more disruptive than dangerous and in most cases will clear up by itself within a few days. However, it is very important to make sure the person with diarrhoea does not become dehydrated. People can become dehydrated very quickly if they do not drink enough fluids when they have diarrhoea, and children and elderly people are more at risk. Always seek immediate medical attention if a person has any of the symptoms of dehydration listed below.

Common causes of diarrhoea include viruses, such as rotavirus in children, or bacteria, such as from traveller’s diarrhoea or food poisoning. Other causes include stress, alcohol, spicy food, medical conditions such as inflammatory bowel disease, or changes to your diet. Sometimes intolerances to food or medicines can be the cause. If diarrhoea is caused by food poisoning, it can start a few hours or more after eating contaminated food, and may last up to three days.

Vomiting

Vomiting (throwing up) is when the contents of your stomach are forcefully expelled by your body through your mouth and sometimes out your nose. Nausea is a term used to describe the feeling that you are about to vomit.

Vomiting may result from a number of different causes, such as gastroenteritis, overindulgence in alcohol, food allergies, food poisoning, travel sickness, migraines, pregnancy, flu and some medicines.

Antiemetics are medicines that can be used to control vomiting, in circumstances where the vomiting lasts for a long time, or is a regular occurrence. Like diarrhoea, it is important to make sure the person with the vomiting does not become dehydrated. In severe cases where dehydration develops, intravenous fluids may be needed to replace fluids lost through vomiting.

Dehydration – see a health professional immediately

if the person with diarrhoea is unable to drink enough fluids to replace those lost, they may become dehydrated. Seek immediate medical help if any of the following signs of dehydration occur:

• a very dry or sticky mouth, lips or tongue
• drowsiness or ‘floppiness’ in children, or difficulty waking them
• confusion (especially in the elderly) 
• passing little or no urine (or unusually dry nappies), or the urine is a very dark colour 
• sunken fontanelle (soft spot on a baby's head), sunken eyes or no tears
• cold hands or feet, or mottled bluish skin
• loss of skin elasticity – it does not flatten after being pinched.

Also see a pharmacist

If you have other medical conditions, take regular medication for any reason, are elderly or frail, you should always talk to a pharmacist. Also talk to a pharmacist if:

• your diarrhoea or vomiting lasts more than 48 hours in adults or 24 hours in children
• the person with diarrhoea or vomiting is a child aged under five
• the person with the diarrhoea or vomiting refuses to drink fluids or is unable to keep them down
• your stools are dark and tarry or contain mucus or blood 
• your stools are fatty, or pale and greasy, and difficult to flush
• your vomit contains blood, or dark brown material, or smells like faeces 
• you have a fever or stomach cramps, or feel generally unwell
• you have recently travelled overseas, especially to developing countries
• your diarrhoea alternates with constipation
• you have started new medicines, such as antibiotics
• you have diarrhoea regularly or at particular times of the day
• you are pregnant or breastfeeding, as some medicines may not be suitable
• you have allergies to any medicines.

• oral rehydration fluids (see 'Treatment Options' below) are best for preventing dehydration since water alone will not replace the salts lost by the body
• do not drink undiluted full-sugar soft drinks or fruit juices because the high sugar content in these drinks can make diarrhoea worse
• continue to breastfeed and formula feed babies normally – do not dilute formula
• eat bland, dry foods containing carbohydrate – such as mashed potatoes, pasta, rice, bread – as soon as you feel you can
• avoid grains, uncooked fruit and vegetables, tea and coffee, fatty foods or dairy food for two days
• children and some adults may be unable to tolerate dairy foods, even after diarrhoea has settled, so reintroduce milk products gradually (this does not apply to babies)
• always wash your hands before eating or preparing food, before and after tending to children, and thoroughly after using the toilet. Alcohol-based hand gels are also effective
• avoid sharing towels (especially hand towels) if diarrhoea is thought to be from an infectious source (eg, rotavirus, giardia)
• be particularly careful with food hygiene, especially during the summer months and when cooking barbeques –remember to Clean, Cook, Cover, Chill
• consider vaccinating babies aged 6-24 weeks against rotavirus – this virus is highly infectious and can cause severe diarrhoea. It is responsible for almost half of all hospitalisations for gastroenteritis in children aged less than five.

Always discuss treatment options with a pharmacist to ensure the best outcome.

Products used to rehydrate and prevent dehydration

[GENERAL SALE]
eg, Enerlyte, Gastrolyte, Hydralyte, Pedialyte

[PHARMACY ONLY]
eg, Rapid Restore Gastro Pack (contains electrolytes AND loperamide - see cautions under anti-diarrhoeal medicines)

• oral rehydration fluids prevent and treat dehydration by replacing water and electrolytes (salts) lost through diarrhoea.
• oral rehydration fluids should be the first choice to prevent and treat dehydration, especially in children and the elderly
• they are available in sachets, effervescent tablets, ice blocks and pre-mixed solutions, which contain a special mixture of electrolytes that water alone cannot replace
• oral rehydration products replace fluids, but do not treat diarrhoea or its cause
• follow instructions on products exactly
• sipping small amounts frequently is better than drinking large amounts
• once made up, the solution should be thrown away after one hour, or 24 hours if refrigerated.

Products used to stop diarrhoea – to reduce the number of bowel movements

[PHARMACY ONLY]
eg, Diamide, Diastop, Imodium, Imodium Advanced (contains simethicone as well), Nodia

• these medicines slow the gut to reduce bowel movements
• allows more time for fluid to be reabsorbed by the body which makes the stool less watery 
• they should be used with oral rehydration fluids
• some products (eg, Diastop) may cause drowsiness, so avoid alcohol when taking
• constipation can be a side effect of these medicines
• these medicines are not recommended for use in children or pregnant women.

Availability of medicines

• GENERAL SALE available through pharmacies and possibly other retail outlets.
• PHARMACY ONLY available for sale through pharmacies only.
• PHARMACIST ONLY may only be sold by a pharmacist.

Consumer Medicine Information on some medicines is available at the government website www.medsafe.govt.nz