The Pharmaceutical Journal
Vol 269 No 7207 p97-101
20 July 2002

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  Drug names
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Letters to the Editor

Diarrhoea

Diarrhoea means different things to different people

From Dr M. Griffiths, MRPharmS

I must question a statement made in the article (PDF*, 105K) on diarrhoea and vomiting (PJ, 29 June, p914). Panel 3 states: "A yellowish stool may indicate the presence of bilirubin and possibly serious liver disease." Bile–intestine–faeces is the normal route of excretion of this pigment and yellow stool merely indicates that passage has been too rapid for bacterial degradation to the usual brown colour. The absence of yellow pigment, giving pale, greyish stools, indicates lack of bile flow and possible gall bladder or liver disease.

Experience in voluntary work with diverticular disease/ irritable bowel syndrome indicates that patients have not read the textbooks and "diarrhoea" has an individual meaning. Watery stools is an accepted definition but for many people diarrhoea is related solely to frequency and can mean several toilet visits struggling with small hard faeces, or clearing a constipation backlog triggered by something as simple as a change of routine or exercise. I have also come across diarrhoea caused by probiotics, an excess of bananas (women's magazines say they are good for diarrhoea) and herbal laxatives disguised in products to "benefit, calm, detoxify, balance", the digestive system.

Another type of "diarrhoea" is urgency and suddenness that can result from too much fibre in the diet. There are diverticular disease sufferers who are still being recommended to force-feed themselves with wheat bran. The resolution of a migraine attack can also give this effect.

I do not think these variations on "diarrhoea" are peculiar to people with known bowel complaints and these people are likely to seek advice. Health professionals would be well advised to make sure they and the patient are talking about the same thing and not assume that diarrhoea is microbial in origin.

Mary Griffiths

Macclesfield, Cheshire

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