Diarrhoea - vomiting, loose/watery stools, tummy bug, gastroenteritis, food poisoning

Infection of the guts by virus or bacteria can cause vomiting and / or diarrhoea. Usually vomiting starts first then the diarrhoea comes, but you might have one or the other only.

• Most times the infection settles without medication regardless if it is a bug or food poisoning. Antibiotics are not needed.
• Vomiting lasts for 1-3 days average and diarrhoea lasts for 3-7 days average.
• You will feel rough and unwell for the first few days with stomach cramps coming and going, no appetite and you might have temperature. Take rest.
• CALL THE DOCTOR IF
  1. if  there is blood mixed with your stools. This could be a sign of a more violent bug and you might need medical treatment, especially if you are returning from tropical areas.
  If you vomit violently you might see streaks or specs of blood in the vomit or the mucus you bring up, this is normally harmless. If there is more than that of blood, seek medical attention.
  2. if you don’t pass urine at least twice in 24 hours (or less than 2 wet nappies in 24 hours), as you could be dehydrated;
  3. if your stomach pain is severe and continuous for longer than 4 hours without breaks;
  4. if you have temperature above 38.5 for longer than 3 days (it is always a good idea to have a working thermometer at home);
  5. if the diarrhoea lasts for longer than 2 weeks and not improving as your doctor might want to arrange a stool sample
  6. if you are in ill health with kidney, heart or endocrine disease, or you are on certain medication that might need to be stopped or increased during an acute illness.

7. if you have severe diarrhoea with or after an antibiotic course (risk of C.difficile infection)

• DO sip water between vomiting episodes even if you feel it all comes back, some will get absorbed. Once you can tolerate water well, drink pressed 100% apple juice diluted half-and-half with water to replace the minerals you have lost. You can choose to drink oral rehydration fluids, like Dioralyte, but the taste might put you off, apple juice is just as good.*
  Avoid squash that contains artificial sweeteners.
  Continue breastfeeding your baby on demand or offer formula milk as normal.
  If your child (over the age of 6 months) refuses to drink and you are concerned about them getting dehydrated, you can administer water or other fluids via a syringe (like the ones that come with medication) directly to the child’s mouth. Try 5-10ml every 10 minutes and record it on a chart. This is what nurses do in the hospital to avoid the need for an IV drip.
• Only eat when you are hungry, do not force yourself. Your appetite is gone as your guts are inflamed and not ready to digest food. Give them a break to recover.  Not eating for a few days is not harmful for your or your child’s body, just carry on drinking.
• When you are hungry again only eat small amounts of very BLEND food, like white toast with jam, no butter; cooked rice, cooked potato, apple, bananas, clear vegetable or chicken soup. AVOID meat, dairy, fibres and fat (bevare crisps and crackers are rich in fat, avoid!) until your stools are normal again. Otherwise you risk another diarrhoea episode.
• DO take paracetamol and Buscopan if you need relief from pain and cramps. These medications do not cure you or shorten the disease but provide symptom relief. Absorbents, like Smecta, might shorten the diarrhoea duration (by half to one day), available without prescription.**
• The use of Imodium (loperamide) is controversial, several studies showed safety and efficacy, however we GPs still advise against it.***
• DO wash your hands regularly especially after toileting and before meals.
• Children can return to school 48 hours after the last diarrhoea or vomiting episode.
  https://www.gov.uk/government/publications/health-protection-in-schools-and-other-childcare-facilities/chapter-3-public-health-management-of-specific-infectious-diseases
• Further advice on the NHS website: https://www.nhs.uk/conditions/diarrhoea-and-vomiting/
  * https://pubmed.ncbi.nlm.nih.gov/27131100/ **https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132498/ **https://pubmed.ncbi.nlm.nih.gov/11943957/#:~:text=Conclusions%3A%20Smecta%20significantly%20reduced%20the,with%20mild%20and%20moderate%20dehydration ***https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-rich-settings