In a nutshell: These common symptoms rarely have a significant underlying cause. Most will get better from rest and plenty of fluids.
This is a fancy way of saying your stomach (gastro-) and bowels (-enter-) are inflamed (-itis).
What can you expect?
- Feeling sick
- Mild abdominal pains that come and go
- Watery diarrhoea
- Mild temperature
What is the cause?
Irrespective of the cause, the early management remains the same. Stay hydrated, have plenty of rest, avoid close contact with other people to stop the disease spreading and contact your GP if the symptoms are not getting any better.
How long should I wait before seeing my GP?
Most patients will have short lived symptoms that will go away with simple measures in less than 7 days. There aren’t any useful tests in most cases. The problem rarely requires antibiotics. Anti-sickness and anti-diarrhoea agents are best avoided.
If your symptoms are mild and you are usually healthy, the advice in this article will hopefully make you better. As always, if you are growing concerned and this advice has not helped, please seek help from your GP.
Features that should prompt a GP appointment:
- Unable to keep any fluids down.
- Blood in your stools or vomit.
- Symptoms for over 7 days.
- Medical problems which may get worse. For example you are a diabetic on insulin.
- A rash, stiff neck, headache, or discomfort looking at lights.
The vomiting is usually a symptom in the first 24 hours and settles thereafter. For people who are generally well, with none of the abnormal features above, the main concern for GPs is dehydration.
How can I tell if I am dehydrated?
- Very dry mouth
- Passing minimal or very dark urine
- Not sweating
- Loss of consciousness / unable to stay awake
What should I do to?
- Drink little sips of fluid often
- Avoid close contact with other people such as kissing, hugging, handshakes
- Avoid sharing toothbrushes, cups, and towels
- If you have more than one bathroom in your house, try and use a different one to everyone else
- Eat bland food
What should I avoid?
- Don’t drink large amounts of fluid all at once. This will cause your stomach to stretch when it is inflamed and will likely cause nausea or vomiting to return.
- Don’t stop drinking all together to avoid vomiting. This can prolong nausea.
- Don’t eat dairy foods such as yoghurt, cheese, milk, and butter. This may make symptoms worse.
- Don’t eat spicy foods.
Am I drinking enough?
- Try one mouthful of fluid every 5 minutes.
- If vomiting returns, half the amount and continue.
- If you can drink more than this without vomiting then do.
The big take home message about dehydration is that people often stop drinking and eating to avoid vomiting. Then the lack of food and drink actually cause nausea. Having an empty stomach for long periods of time often makes people feel sick.
″Is the thing you are doing to stop you from being sick beginning to make you feel sick?″
At some point you need to challenge your stomach and put something in it to see if it will make you feel better.
I’m drinking enough fluid, but I haven’t eaten anything…
Don’t worry too much. Your appetite will return. It is not unusual for people to lose a little weight in these circumstances, but the body can go several days without food without any significant consequences. If you experience weight loss which is beginning to concern you, see your GP for advice.
Don’t expect to be able to eat a whole meal. A small snack, even a few bites, is good enough in the short term. If you can gain some energy from the fluids you drink this would be a good idea. Sugary drinks may help to this end but may make the diarrhoea worse. If it does, water down the drink to avoid making symptoms worse.
If you are diabetic these drinks may be best avoided in favour of something with a lower sugar content. Make sure you check your sugars regularly if you can.
An alternative is Dioralyte, however it is quite salty and younger patients often don’t like it. The taste alone may be enough to make nausea return. Ice pops may be a good source of calories, especially for children.
Work by trial and error. If you have something to eat or drink and your nausea or diarrhoea returns, try something else.
When can I return to work?
48 hours. That means if your last episode of diarrhoea was 6am on Monday you can go back to work from 6am on Wednesday.
Do I need tests?
Tests are not done routinely necessary.
Stool samples are sometimes useful in people who have abnormal symptoms or are not getting better. This test may tell your doctor if a bacteria is causing your symptoms. Even in cases where bacteria such as E.Coli, Salmonella and Shigella are found, most improve without any treatment.
Situations where a test may be useful is if there is a very clear history of exposure to food. For example, if you and several of your friends had symptoms immediately after eating at a particular restaurant. If a cause is found we can inform the public health department to investigate and hopefully stop others from being affected.
What about bacterial infections? Do I need antibiotics?
Even if you have a bacterial infection, most people will fight off the infection without the need for antibiotics. The reason to avoid antibiotics if possible is that the antibiotics often cause diarrhoea, and kill off the good bacteria living in your gut.
Do I need medication to settle my vomiting or diarrhoea?
I would advise against this if possible. This is because the process of vomiting and having diarrhoea can often make you feel better. Anti-sickness medication may be beneficial if you cannot stop being sick for several days. If your symptoms started in the last 24 hours, it should stop of its own accord. Anti-diarrhoea medication may be helpful if you absolutely must leave the house, to avoid a bathroom emergency, but otherwise proximity to the toilet is better. Once the diarrhoea has stopped patients often get a bit of constipation. Using these medications may make this symptom worse.
So should I take anything?
Fluids and Paracetamol are probably all you need. The Paracetamol may make stomach cramps better and can helps to settle your temperature if it is making you feel unwell.
What about Buscopan?
This can be used to treat stomach cramps it is best to avoid it. It relaxes your bowel muscles so that cramps are less severe. This can cause constipation. It was not intended to be used in people who have cramps with diarrhoea.
I just came back from overseas, is this relevant?
Yes. In particular if you have just returned from somewhere with unsanitary water or food preparation it may be best to consult your GP. Places where unsanitary water supply is common:
- Subcontinental Asia
- East Asia
- South America
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Best of the rest
Check out the NHS advice here.
This is a great resource with videos for parents dealing with children and babies suffering with diarrhoea and vomiting. Click here to visit the page.