question: Why can diarrhea be so painful?
comment: Your digestive tract is basically just one long series of muscles and sometimes diarrhea causes those muscles to spasm or even cramp up just like what happens to your legs sometimes, causing very acute pain and discomfort.
passages: Section::::Definition.:Exudative.
  
  Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and other severe infections such as "E. coli" or other forms of food poisoning.
  
  Section::::Definition.:Inflammatory.
   One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human pathogens.
  
  Section::::Causes.:Infections.:Nutrition.
   Section::::Management.:Eating.
   Diarrhea is most commonly caused by a myriad of viral infections but is also often the result of bacterial toxins and sometimes even infection. In sanitary living conditions and with ample food and water available, an otherwise healthy patient typically recovers from the common viral infections in a few days and at most a week. However, for ill or malnourished individuals diarrhea can lead to severe dehydration and can become life-threatening without treatment.
  
  Section::::Diseases and conditions.:Constipation.
   Section::::History.
   There are many causes of infectious diarrhea, which include viruses, bacteria and parasites. Infectious diarrhea is frequently referred to as gastroenteritis. Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections. Shiga-toxin producing Escherichia coli, such as , are the most common cause of infectious bloody diarrhea in the United States.
   Section::::Cause.:Post-infectious.
   BULLET::::- Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (plantar palmar syndrome). This may cause tingling, numbness, pain and dryness
  
  BULLET::::- Diarrhea happens to 6 out of 10 people (60%) – tell your doctor or nurse if it becomes severe, if you can't drink to replace the lost fluid, or if it carries on for more than 3 days.Your nurse may give you anti diarrhea medicine to take home with you after chemotherapy
  
  BULLET::::- A sore mouth (stomatitis) happens to 4 out of 10 people (40%)
   The Rome IV criteria includes recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
  
  BULLET::::- Related to defecation
  
  BULLET::::- Associated with a change in frequency of stool
  
  BULLET::::- Associated with a change in form (appearance) of stool.
   Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting; respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; bowel ischemia or perforation from prolonged distension or pressure from a foreign body.
  
  In small bowel obstruction, the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting may occur before constipation.
   Visceral hypersensitivity is hypersensitive visceral pain perception, which is commonly experienced by individuals with functional gastrointestinal disorders.
  
  Section::::Epidemiology.
   Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.
  
  Section::::Definition.:Dysentery.
   BULLET::::- the pain must be located in the upper part of the abdomen and/or the right upper quadrant of the abdomen
  
  BULLET::::- episodes of pain must last at least 30 minutes
  
  BULLET::::- the symptoms must be recurrent, and occur at differing intervals
  
  BULLET::::- the pain must incrementally increase to a "steady level"
  
  BULLET::::- the pain must be severe enough the patient's daily activities are affected, or that the patient must attend the emergency department
  
  BULLET::::- the pain must not be relieved by any of bowel movements, change in posture, or antacids; and,
   BULLET::::- Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is called toddler's diarrhea.
  
  BULLET::::- Environmental enteropathy
  
  BULLET::::- Radiation enteropathy following treatment for pelvic and abdominal cancers.
  
  Section::::Causes.:Medications.
  
  Some medications, such as the penicillum can cause diarrhea. Over 700 medications are known to cause diarrhea. The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements.
  
  Section::::Pathophysiology.
  
  Section::::Pathophysiology.:Evolution.
   Section::::Causes.
  
  Acute diarrhea is most commonly due to viral gastroenteritis with rotavirus, which accounts for 40% of cases in children under five. In travelers, however, bacterial infections predominate. Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea.
  
  Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include ulcerative colitis, Crohn disease, microscopic colitis, celiac disease, irritable bowel syndrome, and bile acid malabsorption.
  
  Section::::Causes.:Infections.
   "C. difficile" diarrhea is estimated to occur in eight of 100,000 people each year. Among those who are admitted to hospital, it occurs in between four and eight people per 1,000. In 2011, it resulted in about half a million infections and 29,000 deaths in the United States.
   If properly treated, typical cases of surgically correctable peritonitis (e.g., perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about 10% in otherwise healthy patients. The mortality rate rises to about 40% in the elderly, or in those with significant underlying illness, as well as cases that present late (after 48 hours).
   The outlook for intussusception is excellent when treated quickly, but when untreated it can lead to death within two to five days. It requires fast treatment, because the longer the intestine segment is prolapsed the longer it goes without bloodflow, and the less effective a non-surgical reduction is. Prolonged intussusception also increases the likelihood of bowel ischemia and necrosis, requiring surgical resection.
  
  Section::::Epidemiology.
   Section::::Diagnosis.:Investigations.
  
  Investigations are performed to exclude other conditions:
  
  BULLET::::- Stool microscopy and culture (to exclude infectious conditions)
  
  BULLET::::- Blood tests: Full blood examination, liver function tests, erythrocyte sedimentation rate, and serological testing for coeliac disease
  
  BULLET::::- Abdominal ultrasound (to exclude gallstones and other biliary tract diseases)
  
  BULLET::::- Endoscopy and biopsies (to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, and malignancies)
  
  BULLET::::- Hydrogen breath testing (to exclude fructose and lactose malabsorption)
  
  Section::::Diagnosis.:Misdiagnosis.
   Other infectious agents, such as parasites or bacterial toxins, may exacerbate symptoms. In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening.
  
  Section::::Causes.:Infections.:Sanitation.
  
  Open defecation is a leading cause of infectious diarrhea leading to death.
   Dysentery
  
  Dysentery is an inflammatory disease of the intestine, especially of the colon, which always results in severe diarrhea and abdominal pains. Other symptoms may include fever and a feeling of incomplete defecation. The disease is caused by several types of infectious pathogens such as bacteria, viruses and parasites.
  
  Section::::Signs and symptoms.
   Section::::Definition.
  
  Diarrhea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person.
  
  Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organization.
  
  Section::::Definition.:Secretory.
   Rotavirus infections rarely cause other complications and for a well managed child the prognosis is excellent.
  
  Section::::Epidemiology.
  
  Rotavirus A, which accounts for more than 90% of rotavirus gastroenteritis in humans, is endemic worldwide. Each year rotavirus causes millions of cases of diarrhoea in developing countries, almost 2 million resulting in hospitalisation and an estimated 453,000 resulting in the death of a child younger than five. This is about 40 per cent of all hospital admissions related to diarrhea in children under five worldwide.
   BULLET::::- Avoid ice, which may not have been made with safe water.
  
  BULLET::::- Avoid green salads, because the lettuce and other uncooked ingredients are unlikely to have been washed with safe water.
  
  BULLET::::- Avoid eating raw fruits and vegetables unless cleaned and peeled personally.
  
  If handled properly, thoroughly cooked fresh and packaged foods are usually safe. Raw or undercooked meat and seafood should be avoided. Unpasteurized milk, dairy products, mayonnaise, and pastry icing are associated with increased risk for TD, as are foods and beverages purchased from street vendors and other establishments where unhygienic conditions may be present.
  
  Section::::Prevention.:Water.
   A suspected case of wilderness-acquired diarrhea may be assessed within the general context of intestinal complaints. During any given four-week period, as many as 7.2% of Americans may experience some form of infectious or non-infectious diarrhea. There are an estimated 99 million annual cases of intestinal infectious disease in the United States, most commonly from viruses, followed by bacteria and parasites, including Giardia and Cryptosporidium. There are an estimated 1.2 million U.S. cases of symptomatic giardiasis annually. However, only about 40% of cases are symptomatic.
  
  Section::::Prevention.
  