How can I stop diarrhea?

How to Stop Diarrhea

For otherwise healthy adults with uncomplicated acute diarrhea, start loperamide 4 mg initially, then 2 mg after each loose stool (maximum 16 mg daily), while maintaining adequate fluid intake with glucose-containing drinks or electrolyte-rich soups. 1, 2

Immediate Assessment: Determine If Self-Treatment Is Safe

Before starting treatment, check for warning signs that require immediate medical attention rather than self-medication 1, 2:

• High fever (>38.5°C/101.3°F) 1
• Frank blood in stools (dysentery) 1
• Severe vomiting preventing fluid intake 1
• Signs of dehydration: decreased urination, dizziness when standing, dry mouth, confusion 1
• Severe abdominal pain or distention 1, 2

If any of these are present, seek medical care immediately rather than attempting self-treatment. 1

Step 1: Rehydration (Most Critical)

Maintain adequate fluid intake guided by thirst—this is more important than stopping the diarrhea itself. 1, 2

For Mild Diarrhea Without Dehydration:

• Drink glucose-containing beverages (lemonades, sweet sodas, fruit juices) or electrolyte-rich soups 1, 2
• Formal oral rehydration solutions (ORS) are not necessary for otherwise healthy adults 1, 2
• Aim for clear fluids to match ongoing losses 1

For Moderate Dehydration (dry mouth, decreased urination, dizziness):

• Use oral rehydration solutions (Pedialyte, CeraLyte, or WHO-ORS formula) 1
• Adults should consume 2-4 liters over 3-4 hours 1
• Popular sports drinks and sodas are not adequate for moderate dehydration 1

For Severe Dehydration (confusion, inability to drink, shock):

• This is a medical emergency requiring intravenous fluids—go to emergency department immediately 1

Step 2: Antidiarrheal Medication

Loperamide is the drug of choice and should be started promptly in uncomplicated cases. 1, 2

Dosing:

• Initial dose: 4 mg (2 tablets) 1
• Then 2 mg after each loose stool 1, 2
• Maximum: 16 mg (8 tablets) in 24 hours 3
• Evidence shows loperamide reduces symptoms and shortens duration without prolonging illness 1

Critical Contraindications—DO NOT Use Loperamide If:

• Bloody diarrhea develops 2, 3
• High fever appears (>38.5°C) 2
• Abdominal distention occurs 3
• You develop inflammatory diarrhea (suspected bacterial invasion) 2

Alternative: Bismuth Subsalicylate (Pepto-Bismol)

• 2 chewable tablets every 30-60 minutes 4
• Maximum: 8 doses (16 tablets) in 24 hours 4
• Less effective than loperamide but safe option 1
• Stop if ringing in ears develops 4

Step 3: Dietary Management

Resume eating based on appetite—fasting does not help and may delay recovery. 1, 2

Recommended Foods:

• Small, light meals guided by appetite 1, 2
• Starches, cereals, rice, bananas, toast 1
• Yogurt, fruits, vegetables 1

Foods to Avoid:

• Fatty, heavy, or spicy foods 1, 2
• Caffeine (including cola drinks) 1, 2
• Lactose-containing foods (milk, ice cream) if diarrhea is prolonged 1

When to Seek Medical Attention

Stop self-treatment and see a physician if: 1, 2, 4

• No improvement within 48 hours 1, 2
• Symptoms worsen or overall condition deteriorates 1, 2
• Diarrhea persists beyond 2 days on treatment 4
• Warning signs develop: fever, bloody stools, severe vomiting, dehydration, abdominal distention 1, 2

Common Pitfalls to Avoid

• Don't skip rehydration: Dehydration is more dangerous than the diarrhea itself 1
• Don't use loperamide with fever or bloody stools: This can worsen bacterial infections 2, 3
• Don't rely on sports drinks for moderate dehydration: They lack adequate electrolytes 1
• Don't restrict food unnecessarily: Early refeeding aids recovery 1
• Don't use antibiotics without medical evaluation: They are rarely needed and can cause harm 1

Special Populations Requiring Medical Supervision

Do not self-treat if you: 1, 2

• Are elderly or frail 1
• Have significant chronic illnesses 1
• Are immunocompromised or taking immunosuppressive medications 1
• Have inflammatory bowel disease 1
• Recently took antibiotics (risk of C. difficile) 1