What is the cause of overflow diarrhea?

From the Guidelines

Overflow diarrhea should be investigated with radiological imaging to rule out abdominal or rectal masses that may be causing the condition, as indicated by the presence of liquid stool passing around an obstruction 1. When evaluating a patient with overflow diarrhea, it is essential to perform a thorough physical examination, including lying and standing blood pressure, heart rate, oxygen saturation, skin turgor, and dry mucous membranes to assess the degree of dehydration 1.

• The general nutritional status and overall appearance of the patient can also provide valuable information about their resistance to this complication.
• Abdominal auscultation should be performed to determine the presence of hyperactive, normal, or absent bowel sounds, and palpation for tenderness or rebound tenderness may lead to the diagnosis of peritonitis or peritoneal involvement 1.
• A rectal examination is crucial to exclude perianal abscess formation and to detect the presence of blood or mucus in the stool 1. The treatment of overflow diarrhea involves addressing the underlying cause, such as an impacted mass of hardened feces in the rectum, through digital disimpaction if necessary, followed by enemas or osmotic laxatives.
• Prevention of overflow diarrhea is key and can be achieved through adequate hydration, increased dietary fiber, regular physical activity, and scheduled toileting habits.
• In some cases, maintenance laxatives may be needed to prevent the recurrence of the condition. It is essential to differentiate overflow diarrhea from true diarrhea, as the treatment approach differs significantly, with the former requiring treatment of the underlying constipation rather than the diarrhea symptoms 1.

From the FDA Drug Label

OVERDOSAGE There have been no reports of accidental overdosage. In the event of overdosage, diarrhea would be the expected major event. If an overdose of drug occurred without concomitant ingestion of fluid, dehydration due to diarrhea may result. Taking more than the prescribed dose may cause loss of fluid due to severe diarrhea. High doses may produce diarrhea and excessive stool frequency, particularly in elderly nursing home patients. Occasionally, Polyethylene Glycol 3350 NF may cause nausea, stomach fullness, cramping, diarrhea and/or gas.

The polyethylene glycol 3350 (PO) can cause overflow diarrhea, especially if taken in high doses or without adequate fluid intake 2, 2, 2. Severe diarrhea may lead to dehydration if not managed properly. It is essential to follow the prescribed dose and stay hydrated to minimize the risk of diarrhea. If unusual cramps, bloating, or diarrhea occur, patients should consult their physician.

From the Research

Definition and Types of Diarrhea

• Diarrhea is defined as the passage of loose stools and increase in stool frequency, weight, or volume 3
• It can be acute, persistent, or chronic, with acute diarrhea usually being infectious in nature 3
• Chronic diarrhea has a diverse etiology, with the majority of patients having self-limiting symptoms or functional gastrointestinal disorders 3

Causes and Pathophysiological Mechanisms

• A wide array of causes and pathophysiological mechanisms underlie acute and chronic forms of diarrhea 4
• Infectious agents, including bacteria, viruses, and protozoa, can cause chronic bloody/inflammatory diarrhea 4
• Osmotic diarrhea can result from malabsorption or maldigestion, leading to steatorrhea 4
• Secretory diarrhea is due to an increase of fluid secretion in the small bowel lumen, often identified in gastroenteropancreatic neuroendocrine tumors 4

Evaluation and Treatment

• The evaluation of fecal osmotic gap can help characterize whether a chronic diarrhea is osmotic or secretory 4
• Individualized diagnostic workups tailored to pathophysiological and clinical features can reduce costs for patients with chronic diarrhea 4
• Therapy in acute diarrhea consists of early oral refeeding, antidiarrheal medications, antibiotics, and probiotics 3
• Therapy in chronic diarrhea is possible when the underlying cause of symptoms is identified 3

Relationship to Fecal Impaction

• Fecal impaction can cause overflow diarrhea, although this is not directly addressed in the provided studies 5
• Fecal impaction is a common digestive disorder and is considered an acute complication of chronic and untreated constipation 5
• Treatment options for fecal impaction include manual disimpaction, enemas, suppositories, and oral or nasogastric tube placement for polyethylene glycol solutions 5