Diarrhea, or loose bowel movements, can occur for many reasons. Food poisoning and infections are the most common causes of acute (short-lived) diarrhea. Chronic diarrhea may be caused by ongoing illnesses of the digestive tract, such as inflammatory bowel disease and irritable bowel syndrome .
Conventional treatment for diarrhea involves addressing the cause, if possible, and, in some cases, treating symptoms with medications that slow down the action of the digestive tract.
Supplements called probiotics have shown considerable promise for safely preventing or treating various kinds of diarrhea. The following section summarizes much of the evidence regarding this treatment. For more information, see the full Probiotics article.
Certain bacteria and fungi play a helpful role in the body. For this reason, they are known collectively as probiotics (literally, "pro life"). Some of the most common include the yeast Saccharomyces boulardii and the following bacteria:
The digestive tract is like a rain forest ecosystem, with billions of bacteria and yeasts instead of trees and frogs. Some of these internal inhabitants are more helpful to your body than others. Probiotics not only help digestive tract function, they also reduce the presence of less healthful organisms by competing with them for the limited available space. For this reason, use of probiotics can help prevent infectious diarrhea.
Antibiotics being taken to treat an infection can disturb the balance of the "inner ecosystem" by killing friendly bacteria. When this occurs, harmful bacteria and yeasts can move in and flourish, which can lead to diarrhea. Probiotic therapy may help prevent this problem. Probiotics also appear to be helpful for preventing or treating forms of diarrhea with different causes.
According to some but not all studies, it appears that regular use of various probiotics can help prevent traveler's diarrhea, an illness caused by eating contaminated food, usually in developing countries. 2-7,76
For example, one double-blind, placebo-controlled study followed 820 people traveling to southern Turkey and found that use of a probiotic called Lactobacillus GG significantly protected against intestinal infection. 53
An even larger double-blind, placebo-controlled study found benefits from using the yeast product S. boulardii . 55 This trial enrolled 3,000 Austrians traveling to a variety of countries. The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted that the benefit depended on consistent use of the product, and that a dosage of 1,000 mg daily was more effective than 250 mg daily.
Substances called prebiotics are thought to enhance the growth of probiotics. On this basis, a prebiotic called fructo-oligosaccharides (FOS) has been suggested for preventing traveler’s diarrhea. However, in a 244-participant, double blind study, FOS at a dose of 10 g daily offered only minimal benefits. 67
Children frequently develop diarrhea caused by infectious viruses. Probiotics may help prevent or treat this condition and may also be useful for viral diarrhea in adults.
A 2001 review found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children. Ten of these trials involved treatment, and three involved prevention. 28 Benefits have been seen in subsequent studies as well, including one that included almost 1,000 infants. 60 Overall, the evidence strongly suggests that use of probiotics can significantly reduce the severity and duration of diarrhea and perhaps help prevent it.
Another, more recent review of 63 trials involving over 8,000 people (mainly infants and children) found that probiotics reduced how long the episode of diarrhea lasted. 90 The authors concluded, however, that more research needs to be done to determine which probiotics work best for infectious diarrhea.
In a subsequent smaller review focusing on persistent diarrhea (lasting for 2 weeks or longer), researchers concluded that probiotics are capable of reducing both the duration of the diarrhea episode as well as the stool frequency. 91 Another study that was part of this same review suggested that probiotics may help to reduce how long a child is hospitalized due to diarrhea.
One double-blind, placebo-controlled trial of 269 children (ages 1 month to 3 years) with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given placebo. 8 The best results were seen among children with rotavirus infection. (Rotavirus can cause severe diarrhea in children.) In another double-blind, placebo-controlled study, Lactobacillus GG helped prevent diarrhea in 204 undernourished children. 9 In addition to Lactobacillus GG , the probiotics B. bifidum , S. thermophilus , L. casei , L. reuteri , S. boulardii , and Escherichia coli Nissle (a safe strain of E. coli ) have also shown promise for preventing or treating diarrhea in infants and children. 28,68-69,83,84,94
L. reuteri reduced the frequency, duration, and relapse rate of acute diarrhea compared to placebo in a randomized trial of 74 children receiving oral rehydration solution for mild to moderate dehydration. 97
Prophylactic use of probiotics was found to be effective at preventing C. difficile -induced diarrhea in a review of 20 randomized trials with 3,421 patients (including three trials with 605 children) when compared to placebo or no treatment. The most effective probiotics were S. boulardii and L. acidophilus combined with L. casei . 96 However, probiotic therapy is probably not helpful for acute, severe, dehydrating diarrhea. 10,80 Keep in mind that diarrhea in young children can be serious. If it persists for more than a couple of days or is extremely severe, it would be wise to contact the child’s physician.
In addition, a large (211-participant), double-blind, placebo-controlled study found that adults with infectious diarrhea can also benefit from probiotic treatment. 1
The results of most (but not all) double-blind and open trials suggest that probiotics, especially S. boulardii and Lactobacillus GG , may help prevent or treat antibiotic-related diarrhea (including the most severe form, Clostridium difficle diarrhea). 11-19,61,62,70,75, 77,79,84,88-89,92
One study found Lactobacillus rhamnosus effective in children, 81 and another study found that L. casei was effective in hospitalized patients. A review of 16 randomized trials also found evidence that probiotics may prevent antibiotic-related diarrhea. 93 This review included many different strains of probiotics (eg, Lactobacilli , Lactococcus , Bifidobacterium ), which were used alone or in combination. Bacteria that appeared to lack evidence of benefit included Lactobacillus rhamnosus , Lactobacillus sporogenes , Bifidobacterium lactis , and Streptococcus thermophilus . Like the earlier review, the pooled results of 34 randomized trials also found evidence to support the use of probiotics for the prevention of antibiotic-associated diarrhea in both children and adults. Like the earlier review, the pooled results of 34 randomized trials also found evidence to support the use of probiotics for the prevention of antibiotic-associated diarrhea in both children and adults. 95
In contrast, prophylactic use of Lactobacillus acidophilus LA-5 plus Bifidobacterium BB-12 (in combination with antibiotic treatment) was not associated with reduced incidence of diarrhea when compared to placebo. However, the probiotics were associated with reduced duration of diarrhea.
It is sometimes said that it is useless to begin probiotic treatment until after the antibiotics are finished. However, evidence appears to indicate that it is better to begin treatment with probiotics along with the initial use of antibiotics, then continue probiotic treatment for a week or two afterwards.
Note : Diarrhea that occurs in the context of antibiotics may be dangerous. Be sure to talk to your doctor.
A double-blind trial of 116 people with ulcerative colitis compared a special probiotic treatment using E. coli to a relatively low dose of the standard drug mesalazine. 26 The results suggest that this probiotic treatment might be as effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials as well. 27
Preliminary evidence suggests that probiotics may be helpful for reducing diarrhea and other gastrointestinal side effects caused by cancer treatment (radiation or chemotherapy). 20,21
One study found that S. boulardii can increase the effectiveness of standard treatment for amoebic infections. 63
Premature infants weighing less than 2,500 grams (5.5 pounds) are at risk for a life-threatening intestinal condition called necrotizing enterocolitis (NEC). In a study that pooled the results of 9 randomized, placebo-controlled trials involving 1,425 infants, probiotic supplementation significantly reduced the occurrence of NEC and death associated with it. 82 A subsequent study found similar benefits in very low birth weight infants weighing less than 1,500 grams (3.3 pounds). 87
People suffering from irritable bowel syndrome (IBS) experience crampy digestive pain, alternating diarrhea and constipation, and other symptoms. In some people, diarrhea predominates. Although the cause of IBS is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS with diarrhea, but the results have been inconsistent. 25
A large (255-participant), double-blind, placebo-controlled study found that use of a product containing apple pectin combined with chamomile significantly improved symptoms of acute diarrhea in children aged 6 months to six years. 74
A small double-blind study found that an extract of tormentil root ( Potentilla tormentilla ) reduced the severity and duration of rotavirus infection in children. 64 Another study of the same herb found that it was approximately equally effective as the drug loperamide for the treatment of nonspecific diarrhea in adults. 65 The herbal extract was particularly effective for reducing symptoms of abdominal cramping.
A preliminary, double-blind study found that an extract of the Amazonian herb sangre de drago might be helpful for diarrhea associated with HIV infection . 46 The supplement medium-chain triglycerides (MCTs) has also shown promise for this purpose. 47
Wheat germ might enhance the effects of standard treatments for giardiasis. 48
The herb Eleutherococcus might be useful in the treatment of antibiotic-associated diarrhea. 49 Brewer’s yeast, a bitter-tasting product recovered from the beer-making process, might be helpful as well. 50,51
The herb goldenseal contains berberine, a substance with antimicrobial properties. One study suggests that berberine can help in diarrhea caused by E. coli bacteria. 52 However, it is not clear that goldenseal itself would have the same effect. The herbs barberry and Oregon grape also contain berberine.
Allergy to milk and other foods may trigger diarrhea. 53 Milk can also cause diarrhea in a completely different way—through lactose intolerance . This condition is the inability to digest milk sugar, and it occurs in many adults. Use of the enzyme lactase should help. 53
Weak (and in some cases inconsistent) evidence partially supports the use of the following as treatments for various forms of diarrhea: colostrum , 29-40 a special extract of egg yolk, 78 fiber, 45folate , 41,42 and green banana. 43Zinc has been shown to be beneficial for acute diarrhea in children, the most convincing evidence coming from studies done in developing countries. This suggests that zinc is most useful for this condition in the presence of a nutritional deficiency. 85,86
Other herbs that are suggested for diarrhea but have no meaningful supporting evidence include agrimony, bilberry , blackberry leaf, marshmallow , oak bark , red raspberry , slippery elm , and witch hazel . The supplement glutamine has been advocated for chronic diarrhea, but again there is no meaningful supporting evidence.
Wood creosote is the principal ingredient in Seirogan. Seirogan is a widely used traditional herbal treatment for diarrhea. It has undergone a certain amount of safety testing and appears to be relatively safe, at least for short-term use. Efficacy, however, is unclear. 66
This topic is also discussed in the Homeopathy database, under the chapter on diarrhea.
6. Kollaritsch VH, Holst H, Grobara P, et al. Prevention of traveler's diarrhea with Saccharomyces boulardii . Results of a placebo-controlled double-blind study [translated from German]. Fortschr Med. 1993;111:152-156.
8. Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr. 2000;30:54-60.
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21. Unger C, Haring B, Kruse A, et al. Double-blind randomised placebo-controlled phase III study of an E. coli extract plus 5-fluorouracil versus 5-fluorouracil in patients with advanced colorectal cancer. Arzneimittelforschung. 2001;51:332-338.
23. Bleichner G, Blehaut H, Mentec H, et al. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind, placebo-controlled trial. Intensive Care Med. 1997;23:517-523.
24. Plein K, Hotz J. Therapeutic effects of Saccharomyces boulardii on mild residual symptoms in a stable phase of Crohn's disease with special respect to chronic diarrhea—a pilot study. Z Gastroenterol. 1993;31:129-134.
28. Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001;33(suppl 4):S17-S25.
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32. Freedman DJ, Tacket CO, Delehanty A, et al. Milk immunoglobulin with specific activity against purified colonization factor antigens can protect against oral challenge with enterotoxigenic Escherichia coli.J Infect Dis . 1998;177:662-667.
33. Greenberg PD, Cello JP. Treatment of severe diarrhea caused by Cryptosporidium parvum with oral bovine immunoglobulin concentrate in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;13:348-354.
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73. Leung WK, Wu JC, Liang SM, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol. 2006;101:1574-1580.
74. Becker B, Kuhn U, Hardewig-Budny B. Double-blind, randomized evaluation of clinical efficacy and tolerability of an apple pectin-chamomile extract in children with unspecific diarrhea. Arzneimittelforschung . 2006;56:387-393.
75. Szajewska H, Ruszczynski M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children: A meta-analysis of randomized controlled trials. J Pediatr. 2006;149:367-372.
76. Briand V, Buffet P, Genty S, et al. Absence of efficacy of nonviable Lactobacillus acidophilus for the prevention of traveler's diarrhea: a randomized, double-blind, controlled study. Clin Infect Dis. 2006;43:1170-1175.
77. Wullt M, Johansson Hagslatt ML, Odenholt I, et al. Lactobacillus plantarum 299v enhances the concentrations of fecal short-chain fatty acids in patients with recurrent Clostridium difficile -associated diarrhea. Dig Dis Sci . 2007 Apr 10 [Epub ahead of print].
79. Beausoleil M, Fortier N, Guenette S, et al. Effect of a fermented milk combining lactobacillus acidophilus Cl1285 and lactobacillus casei in the prevention of antibiotic-associated diarrhea: A randomized, double-blind, placebo-controlled trial. Can J Gastroenterol. 2007;21:732-736.
81. Ruszczynski M, Radzikowski A, Szajewska H. Clinical trial: effectiveness of Lactobacillus rhamnosus (strains E/N, Oxy, and Pen) in the prevention of antibiotic-associated diarrhea in children. Aliment Pharmacol Ther. 2008 Apr 13.
83. Henker J, Laass MW, Blokhin BM, et al. Placebo versus probiotic Escherichia coli Nissle 1917 for treating diarrhea of greater than 4 days duration in infants and toddlers. Pediatr Infect Dis J. 2008 May 8.
87. Lin HC, Hsu CH, Chen HL, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight preterm infants: a multicenter, randomized, controlled trial. Pediatrics. 2008;122:693-700.
88. Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ. 2007;335(7610):80.
89. Gao XW, Mubasher M, Fang CY, Reifer C, Miller LE. Dose-response efficacy of a proprietary probiotic formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea prophylaxis in adult patients. Am J Gastroenterol. 2010;105(7):1636-1641.
92. Cimperman L, Bayless G, Best K, et al. A randomized, double-blind, placebo-controlled pilot study of Lactobacillus reuteri ATCC 55730 for the prevention of antibiotic-associated diarrhea in hospitalized adults. J Clin Gastroenterol . 2011 May 5.
97. Francavilla R, Lionetti E, et al. Randomised clinical trial: Lactobacillus reuteri DSM 17938 vs. placebo in children with acute diarrhoea--a double-blind study. Aliment Pharmacol Therap . 2012;36(4):363-369.
98. Chatterjee S, Kar P, et al. Randomised placebo-controlled double blind multicentric trial on efficacy and safety of Lactobacillus acidophilus LA-5 and Bifidobacterium BB-12 for prevention of antibiotic-associated diarrhoea. J Assoc Physicians India. 2013;61(10):708-712.
Last reviewed August 2013 by EBSCO CAM Review Board
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