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The new SARS-Cov-2 virus is highly contagious, especially its mutated strains. It enters the body through mucous membranes. You can get infected with it not only by airborne droplets, but also from dirty hands, if you touch the surfaces where the virus has settled. Therefore, in some patients, the virus may penetrate the mucous membranes of the digestive tract.1. This leads to the appearance of intestinal symptoms of infection.
However, the manifestations of the gastrointestinal tract are not the main ones in the clinic of coronavirus infection, and they are far from being manifested in everyone. Therefore, when diarrhea appears, you should not make a similar diagnosis for yourself and practice self-medication, you need to see a doctor.
What is diarrhea
By definition, diarrhea (or scientifically diarrhea) is a change in the nature of the stool: an increase in the number of bowel movements, an increase in the volume of the stool, its thinning up to type 6 – 7 of the Bristol stool scale2. With coronavirus, diarrhea is infectious, that is, it occurs due to the effect of viruses on the mucous membranes of the digestive tract. Often it is accompanied by nausea, bouts of vomiting and periodic cramping pain in the abdomen. In COVID-19, the manifestations of infectious diarrhea predominate. Its symptoms occur before or in parallel with the onset of respiratory symptoms.
However, diarrhea is possible during treatment for coronavirus infection and after illness. Often, diarrhea is associated with massive antibiotic therapy and the negative effect of drugs on the intestinal microflora, a violation of the enzymatic activity of the intestine and a side effect of the drugs themselves. In this case, they are already talking about post-covid diarrhea.
Information on the incidence of diarrhea in coronavirus is very contradictory. According to Chinese researchers (at the beginning of 2020), the frequency of diarrhea is from 3,8 to 6% at the onset of the disease, if the infection has a mild to moderate course, and with the duration of the manifestations of COVID-19, diarrhea was in 34% of patients3.
In other studies that were conducted later, as new information became available, diarrhea was recorded in 14% of people with an identified virus. Most had diarrhea no more than 3 times a day, did not lead to significant dehydration, and there was no association between diarrhea and worsening of COVID-194.
The latest works note that the manifestations of intestinal symptoms were noted in one way or another in almost 81,4% of patients, which some attribute to the emergence of new strains and more thorough fixation of patients’ complaints. Data were also released that in people with intestinal damage, the course of infection was more severe twice as often.
In addition, researchers are also looking into the detection of the virus in stool samples. According to Chinese scientists, 23% of patients with diarrhea had a virus in their feces. But while these data require additional confirmation5.
The development of diarrhea in COVID-19 is associated with damage to the intestinal ACE2 receptors, similar to those in the lung tissue. In addition, chronic digestive pathologies are risk factors for the appearance of intestinal manifestations of infection. So, people with gastritis, Crohn’s disease or ulcerative colitis often suffer from diarrhea.
The number of receptors in the intestine varies from person to person, so the risk of developing an intestinal form of infection varies. There is no data yet on what level of viral load provokes nausea and diarrhea, and how quickly the immune system can suppress the virus in the intestine.
Often, intestinal manifestations occur among the first, especially against the background of existing digestive problems. Against the backdrop of the development of the pandemic, the number of people with the intestinal form of the disease is steadily increasing.
In adults, diarrhea occurs with a frequency of bowel movements up to 5-8 times per day, on average, diarrhea lasts up to 3-5 days. Gradually, the frequency of emptying is reduced. In parallel, appetite decreases, after 2-3 days respiratory symptoms appear, constipation may occur instead of diarrhea.6.
Usually, intestinal manifestations occur 3-4 days after infection, some patients do not have other symptoms, and covid occurs under the guise of food poisoning or indigestion.
Based only on complaints and the presence of intestinal disorders, accompanied by other signs of the disease, it is impossible to make a diagnosis.
The diagnosis can be confirmed with laboratory tests. Express tests for the detection of antibodies by ELISA or PCR test (nasopharyngeal swab) can be carried out. Blood is taken to determine antibodies, but doctors believe that stool tests may also be required.
For the treatment of diarrhea, intestinal antiseptics are mainly used (Enterofuril, Stopdiar, Ersefuril), probiotics to restore intestinal microflora (BakSet, Normoflorin, Bifiform, Lineks). Antidiarrheals, sorbents (Smecta, White Coal, Polysorb, Enterodes), antispasmodics and enzyme preparations can also be used.
– Medications should be prescribed by a doctor, you do not need to self-medicate, as you can cause even more harm to yourself, – warns doctor Valery Trapeznikova.
Diet for diarrhea
“Compliance with certain dietary rules in the event of diarrhea against the background of a coronavirus infection can alleviate the patient’s condition,” says doctor Valery Trapeznikova. – Naturally, in each case, there should be an individual approach to nutrition, depending on the presence of concomitant pathology. But there are general provisions that it is advisable to follow: for a while, exclude from the diet foods that can provoke diarrhea: fresh vegetables, fruits and berries, spicy seasonings, smoking, pickles, sour-milk products, fatty foods, fast food. Products must be subjected to heat treatment (stewing, boiling, baking in the oven, etc.).
Drinking regimen for diarrhea
Doctors emphasize that with diarrhea, the body loses a large amount of water. To avoid dehydration, it is necessary to restore the water balance. During the day, a person needs approximately 2,5 – 3 liters of water (these figures may vary and depend on the person’s gender, habitat, physical activity), so when diarrhea occurs, the need for water increases.
It is best to choose clean water, but it is also allowed to use weak tea, unsweetened fruit drinks, mineral water without gas.
Popular questions and answers
We discussed with gastroenterologist Valeria Trapeznikova some questions regarding diarrhea in coronavirus infection and dealing with unpleasant symptoms.
Sources:
- Pavlov A.I., Khovanov A.V., Bakirova V.E. On the issue of treatment of intoxication and diarrheal syndrome in coronavirus infection // Effective Pharmacotherapy. 2020. V. 16. No. 24. S. 92–98. DOI 10.33978/2307-3586-2020-16-24-92-98
- Zakharova I.N., Sugyan N.G., Moskvich I.K. Russian and international guidelines for the management of children with constipation // VSP. 2014. No. 1. https://cyberleninka.ru/article/n/rossiyskie-i-mezhdunarodnye-rekomendatsii-po-vedeniyu-detey-s-zaporami
- Xiao F. et al. Gastroenterology. 2020;158(6):1831–33.
- Lu R et al. Lancet. 2020;395(10224):565–74.
- Zhang C. et al. Lancet Gastroenterol Hepatol. 2020;5(5):428–30.
- Diarrhea with coronavirus – full information. Coronavirus control. February 2021 https://coronavirus-control.com/diareya-pri-koronaviruse/