Diarrhea with a cold

Question

The last three times I have caught a cold, it seems to have gone straight to my stomach, giving me diarrhoea that lasts for at least three days. I have to go to the loo every 20-30 minutes.

I was hoping you could explain why this is happening and if there is anything I could do to prevent it.

Answer

From the medication that you are taking, I imagine that you suffer from irritable bowel syndrome (IBS), or have similar symptoms.

This could be why you are having episodes of diarrhoea when viral infections, such as colds, get you down.

The infection could be acting as a trigger for the bowels to become temporarily overactive, resulting in the unpleasant symptoms of diarrhoea.

The cold virus could also be spreading from your ear, nose and throat passages to your stomach, and from there into the bowels.

This happens in children who get sickness and diarrhoea with coughs and colds: their immune systems are not as well-developed as those of adults.

The fact that you have had three such attacks recently might point to the fact that your poor old immune system is a bit worn out after a long winter of coughs and colds.

If that is the case, then it should make a normal recovery over the summer and you shouldn’t be troubled further.

There is nothing much that you can do to prevent catching coughs and colds other than the common sense things like avoiding people who are coughing their germs all over you and trying to keep generally fit.

Vitamin and herbal supplements such as high dose vitamin C and echinacea may help, as would giving up smoking.

Yours sincerely

The NetDoctor Medical Team

Last updated 08.03.2015

Are there different types of flu viruses?

Researchers divide flu viruses into three general categories: types A, B, and C. All three types can mutate, or change into new strains, and type A influenza mutates often, yielding new strains of the virus every few years. This means that you can never develop a permanent immunity to influenza. Even if you develop antibodies against a flu virus one year, those antibodies are unlikely to protect you against a new strain of the flu virus the next year.

Type A mutations are responsible for major flu epidemics every few years and for the major pandemics that can occur, though rarely. Type B is less common and generally results in milder cases of flu. However, major flu epidemics can occur with type B every three to five years.

Type C causes infection but does not cause typical flu symptoms. Both influenza A and B have been linked to the development of Reye’s syndrome, a potentially fatal complication that usually affects children and teens under age 18. Widespread outbreaks of Reye’s syndrome have occurred with influenza type B and also with chickenpox, but other viruses have been implicated. The risk of Reye’s syndrome is increased when taking aspirin, so anyone under age 18 should not take aspirin if they have any viral symptoms or are recovering from the flu or any other virus.

Most influenza viruses that infect humans seem to originate in parts of Asia, where close contact between livestock and people creates a hospitable environment for mutation and transmission of viruses. Swine, or pigs, can catch both avian (meaning from birds, such as poultry) and human forms of a virus and act as hosts for these different viral strains to meet and mutate into new forms. The swine then transmit the new form of the virus to people in the same way in which people infect each other — by transmitting viruses through droplets in the air that people breathe in.

For in-depth information, see WebMD’s Types of Flu.

Is It a Cold Or a Flu?

You wake up Monday morning and you feel it, instantaneously. No, not the gut-wrenching dread of a five day succession of nine-to-fivers. But the raspy-throat-type-of-sensation, combined with the feeling that someone punched you, over and over, in your face during your sleep.

How do you know if it’s the flu, and if you should stay home from work? Or, if it’s a cold, and you should take some meds and head into the office, avoiding having to take a sick day?

According to Sean Oser, M.D., M.P.H., assistant professor of Family and Community Medicine at Penn State Hershey Medical Center, those who are sick — with either the cold or the flu — should limit their exposure to others, whether that means staying home or taking precautions when in public. If around other people, for instance, sneezing or coughing into the crook of your elbow as well as sanitizing your hands will help to limit the spread of infection.

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“Soap and water are great, but hand sanitizers work at least as well at killing germs. And by all means, stay away from those most at risk of complications…the elderly, the very young, people with chronic diseases and anyone with a compromised immune system,” he said.

Symptoms expressive of a cold tend to develop more slowly over time and include headaches, muscle aches, sore throat, fever and fatigue. Sneezing, coughing and having a runny nose are further indicative of colds.

In addition, experts of MedlinePlus, of the National Institutes of Health, point out that colds are generally contagious the first two to three days of inception and aren’t typically contagious after the seventh day of duration.

“It can be hard to tell for sure if you have a cold, but some clues might include a low-grade fever, cough, congestion, sore throat, headache, fatigue and body aches,” said Dr. Oser. “Or especially a combination of these. Having been around others you know with similar symptoms increases the odds as well.”

On the other hand, the Centers for Disease Control and Prevention details that adults may be contagious with the flu one day before symptoms even develop, as well as five to seven days even after having been sick. In other words, the contagion period of the flu is much longer than that of a cold, and sick individuals should take further precaution to avoid exposing others to the virus.

In terms of the flu, symptoms are similar to those of a cold, but nausea, chills, bouts of sweating and an upset stomach are more so associated with the illness. Further, the development of symptoms tends to be rather immediate.

“Also, flu symptoms are more likely to come on rather suddenly, in contrast to the more gradual onset of most colds. You may not be able to tell the difference between a cold, the flu and other infections without seeing your family doctor, who can help diagnose you accurately, identify any potential complications and prescribe appropriate therapy,” explained Dr. Oser.

If you think you have the cold or the flu, it’s best to rest up. Cool mist humidifiers, saline nasal sprays and sinus rinses may help to alleviate symptoms.

“For adults and older children, over the counter medications like guaifenesin can help reduce congestion and dextromethorphan can help suppress cough. Pain medications like acetaminophen and ibuprofen can be helpful for body aches, and sore throats may respond especially well to anesthetic lozenges with numbing medicine in them, like Cepacol or Chloraseptic,” Dr. Oser said.

He also mentions that pseudoephedrine and phenylephrine can relieve congestion, but that those types of medications may raise blood pressure and interact with other medications.

Finally, Dr. Oser emphasizes that if you think you have the flu and are at risk of complications, see a physician immediately.

“Complications can include pneumonia, inflammation of the lungs, respiratory failure, dehydration and even death,” stated Dr. Oser. “Those most at risk include the elderly, young children and anyone with chronic diseases like diabetes or lung or heart disease, like COPD and asthma.”

The workplace poses as a surefire environment that can house strain after strain of the flu and of colds. If you wouldn’t want your coworker coming into the office, hacking and sneezing while having a fever, it’s best that you avoid shuffling into the workplace when sick as well.

Therefore, stay home when sick, wash or sanitize your hands thoroughly and often, and for the sake of office productivity, get better — fast.

Do this: If your doctor thinks that laxatives might help, follow her orders about what kind to use, and try your best to limit your use.

Take certain drugs. Many medicines can trigger constipation by slowing down stools as they travel through the body. These include sleeping pills, painkillers, some drugs for high blood pressure, and antidepressants.

Do this: Ask your doctor if one of your meds might be causing your constipation.

Avoid the toilet. When you’re constipated, your body may need more time in the bathroom, not less. Try to sit on the toilet for 15 minutes at the same time each day, even if you can’t “go.” It can relax your digestive system and cue your body for a bowel movement.

Do this: While on the toilet, you can try to rest your feet on a low stool or raise your knees above your hips.

Ignore your body’s signals. If you ignore that feeling that you need to go, those clues will get weaker over time. Your bowels should be most active first thing in the morning as well as about 30 minutes after you eat.

Do this: Listen to your body’s messages and head to the bathroom, even if you’re busy or feel awkward using a toilet outside your home.

Fast. You may think that cutting back on food will help “clear out” your colon. That’s not the case.

Do this: Eating, especially healthy whole foods that contain fiber, helps your body move stool.

Forget to manage your stress. Your colon is partly managed by your nervous system, which is like your body’s electrical wiring. If you feel stressed or anxious, your gut may feel it, too.

Do this: Talking to a therapist or learning relaxation techniques may help you feel better.

Brush off other symptoms. Sometimes constipation can be a sign of a more serious health problem, such as colorectal cancer. Also, not dealing with constipation early can lead to hemorrhoids, fissures or cuts in your bottom, and other complications.

Do this: If you have blood in your stool, are losing weight and don’t know why, or you’ve been constipated for more than 3 weeks after having more fluids and fiber, call your doctor.

You are all stopped up and can’t find an obvious reason. Look over your medication list, and you may find the source. Constipation has many causes, but medications are among the most common.

First, if your stools are too hard or too small, or pooping is too difficult or infrequent, you are constipated. Officially, constipation is defined as a stool frequency of fewer than 3 times per week. It can be miserable and medications prescribed by us, your physicians, are frequently to blame.

Here are the constipation-causing champions.

1) NSAIDs like ibuprofen (Motrin) and naproxen (Aleve)

Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin) and naproxen (Aleve) are the constipation winners. These medications are often used on a daily basis for pain and inflammation and when they are used daily, they can really stop you up.

2) Antihistamines like Benadryl and Zyrtec

Certain antihistamine drugs like Benadryl, Zyrtec, Allegra, and Claritin that are available over the counter to treat allergy symptoms may stop you up. They belong to an even larger class of medications known as anticholinergics, which all have the possible side effect of causing constipation. Think of any medication that gives you a dry mouth as an anticholinergic.

3) Tricyclic antidepressants like Elavil and Pamelor

In addition to the allergy medications above, tricyclic antidepressants like amitriptyline (Elavil) and nortriptyline (Pamelor) are also anticholinergics and can cause constipation.

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4) Medications for urinary incontinence

Ditropan XL and Detrol, used to treat urinary incontinence (difficulty urinating), commonly cause constipation as well as diarrhea, nausea, upset stomach, and stomach pain. These medications are also classified as anticholinergics.

5) Iron supplements

Of all the dietary supplements, iron is the gold medal winner for causing constipation. Whether you are taking straight iron (like ferrous sulfate, for example) or a multivitamin that contains iron, it may very well cause problems. Other possible gastrointestinal side effects from iron supplements include nausea, upset stomach, and gas.

6) Opioid pain relievers

If you take medications such as Vicodin, Norco, Tylenol with codeine, or Dilaudid after surgery or for major pain, you are likely to have constipation as well as nausea and possibly vomiting.

7) Blood pressure medications

This will depend on which one you are taking, but calcium channel blockers like diltiazem and verapamil and beta-blockers (drugs ending in “–ol” like atenolol) may very well constipate you and cause nausea and diarrhea.

8) Nausea medications like Zofran

We’re talking about nausea medications known as selective serotonin 5-HT3 antagonists here. This class of medications mainly includes those used to prevent nausea and vomiting after surgery or chemotherapy, like ondansetron (Zofran). While these work very well for nausea, they commonly result in constipation.

What you can do for constipation

Stool softeners are an option. You can also add more fiber to your diet through foods such as beans, fruits, grains, and vegetables. Staying hydrated can help, too. Talk to your provider about options for easing constipation caused by your medications.

– – –

Hope this helps.

Dr O.

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  • What to do when medication makes you constipated

    Antidepressants and opioids are common offenders.

    Updated: October 22, 2019Published: August, 2017

    It’s frustrating when you feel the urge to move your bowels but can’t seem to go. Before blaming your diet, consider whether medication side effects are causing your constipation.

    Possible suspects

    Many medications can contribute to constipation, including the following:

    • Antidepressants, such as the selective serotonin reuptake inhibitor fluoxetine (Prozac) or tricyclic antidepressants such as amitriptyline (Elavil). “A lot of antidepressants that treat the nerve endings in the brain also affect nerve endings in the gut. That can lead to significant side effects,” says Dr. Braden Kuo, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.
    • Opioids, such as oxycodone (OxyContin) and hydrocodone (Vicodin). “The narcotic effect can cause nerves in the gut to ‘sleep,’ inhibiting movement,” explains Dr. Kuo.
    • Calcium-channel blockers, such as diltiazem (Cardizem). These drugs relax the smooth muscles in blood vessels to lower blood pressure. But they also relax the muscles in the gut and may cause constipation.
    • Anticholinergics, a large class of medications found in many over-the-counter and prescription medications. These include treatments for urinary incontinence, such as oxybutynin (Ditropan), and allergies, such as diphenhydramine (Benadryl). These medications block the effects of acetylcholine, a chemical that helps the muscles move. Less movement in the gut can lead to constipation.

    A higher risk

    Older adults can be more susceptible to the constipation side effect of medications because of a digestive system that’s off balance. “That can be caused by natural aging, or by a defect you might have been able to compensate for when you were younger, but can’t now that you’re older,” says Dr. Kuo. Taking several medications can make constipation worse. Symptoms include having bowel movements too infrequently (typically fewer than three times a week); having hard or small, lumpy stools; having stools that are hard to pass; straining; having painful bowel movements; or having the sensation of incomplete emptying after a bowel movement.

    What you can do

    Adding foods with more fiber, such as beans and leafy greens, and staying well hydrated helps prevent constipation. So can using a fiber supplement with psyllium seed or methylcellulose. Other options for constipation relief include over-the-counter remedies, such as polyethylene glycol (Miralax, GlycoLax, and many others).
    Image: © robeoGetty Images

    Disclaimer:
    As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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