Diarrhea is defined as the passing of more than 200ml or 200g of stool in day usually in 3 or more bowel movements. However, the term ‘diarrhea’ is applied to a number of changes in stool and bowel movement patterns that may deviate from the norm but do not fit strictly into the definition of diarrhea. The term ‘explosive diarrhea’ is attributed to violent expulsion of stool that is often watery and accompanied by excessive flatulence (bowel gas). It is a subjective term but is usually indicative of acute diarrhea.
Normal Stool and Diarrhea Stool
Stool is usually firm but soft, well formed and brown in color. Although most of the stool is composed of water, it is a soft solid material. Normal bowel movements can vary from twice a day to three times in a week and depends on the individual’s normal patterns.
Diarrhea is a result of deranged motility, or more specifically hypermotility, where the contents in the gut move faster than normal. Water is either ‘dumped’ into the gut (secretory diarrhea) or is not absorbed to the extent that it normally is (osmotic diarrhea). Gas in the lower parts of the gut which is passed out through the anus (flatus) is primarily a byproduct of bacterial action in the bowels, chemical reactions caused by the digestive enzymes and to a lesser extent from air swallowed through the mouth.
With explosive diarrhea, all these mechanisms of diarrhea are exaggerated. Watery stool, or sometimes almost entirely water on its own, is propelled out with such a violent force that it sounds ‘explosive’, sputtering that may soil the person’s bottom and mess the toilet bowel and is usually accompanied by excessive flatus.
Causes of Explosive Diarrhea
Explosive diarrhea is more likely to be seen in acute diarrhea or acute aggravations of chronic diarrhea. Typically the diarrhea lasts for only a few days and resolves spontaneously or with minor medical treatment.
The most common of the acute causes are infectious diarrhea. This is primarily viral in origin and is accompanied by nausea, vomiting, abdominal cramping and sometimes fever, similar to the influenza. Hence, it is often referred to as the stomach flu. Bacterial and parasitic infections may also cause explosive diarrhea. Parasitic infections tend to be longer lasting.
Food poisoning is caused by the ingestion of food that is tainted with bacterial toxins. This irritates the lining of the bowel. Diarrhea is often preceded by severe upper abdominal pain, intense nausea and violent vomiting. If the causative tainted food is expelled entirely before it enters the intestines, it is possible that diarrhea will not ensue.
Certain drugs and substances can also cause explosive diarrhea, particularly if these compounds act specifically on the bowels. This includes laxatives and large doses of magnesium-containing antacids. Antibiotic-associated diarrhea arises with an overgrowth of Clostridium difficile bacteria. It is a common causes of explosive diarrhea following the use of antibiotics. Poisoning with toxic compounds and heavy metals may also cause violent diarrhea.
Malabsorption that leads to explosive diarrhea is largely chronic in nature but may present occasionally with acute exacerbations. This is primarily seen in foods intolerance like with lactose intolerance, gluten intolerance, sorbitol malabsorption and fructose malabsorption. The causative food substance is not well tolerated and cannot be digested or absorbed fully thereby leading to explosive diarrhea. Other causes of malabsorption are seen with structural defects of the bowel, deficiency or lack of certain digestive enzymes and the use of certain drugs.
Although less common, any other cause of diarrhea may also present with acute episodes of explosive diarrhea and this includes conditions like inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and excessive ingestion of certain foods that serve as an irritant to the bowel.