Question: “A few days after I left the hospital, I started to get diarrhea that is getting worse. I am on the toilet all the time, it is like water. This has been going on for about a week. I have no energy and I feel dizzy. What should I do?”

Answer:

• See your doctor or go back to the hospital as soon as possible. Have someone else drive you or call 911. Sounds like you are not save to drive ("no energy... feel dizzy")
• Diarrhea is a serious condition.
• Diarrhea can lead to dehydration and electrolyte imbalances.  This is likely the cause of your weakness/dizzyness.
• Severe diarrhea can lead perforation of the colon, which is a real big problem.
• Thousands of people die every year just from diarrhea.
• Different types of diarrhea are treated differently.
• Regardless of the etiology (cause), keep hydrated. With severe diarrhea, your electrolites are likely out of wack. Some sort of sport drink with help with your electrolytes.
• Call/see your doctor today!

What is the cause?

• There are many different causes of diarrhea. However, given your type of symptoms and recent hospital visit, Clostridium difficile colitis would be at the top of my list.

Background terms:

• Colitis: Any time you add –itis to the name of something it means that body part is irritated, inflamed or infected. Therefore, col-itis = colon- irritated/inflamed/infected.
• Clostridium difficile is a species of bacteria. This bacterium, like many other bacteria, can be found all over the place. However, when conditions are right, it can cause a nasty infection.  
• Clostridium difficile colitis is also known by a few other names. You can see the name shortened to c-diff colitis or C. difficile. However, sometimes the disease is called pseudomembranous colitis because of how the colon looks when it is infected by it.  Antibiotic-associated colitis is another name given to the same disease because of how you get it.

How do you get Clostridium difficile colitis?

• Some places have more C. difficile than others. High volume areas are hospitals and nursing homes. However, many people carry it in their colon already.
• Oftentimes C. difficile is living in balance with millions of other species of bacteria in your colon without apparent symptoms. Your colon has its own ecosystem of bacteria. Each species has its own way of living. They share/compete for space and generally live in balance. This ecosystem is known as your flora. (Flora seems like a bit of a misnomer to me because in botany, flora refers to the plant life occurring in a particular region. Bacteria are not plants. None the less this is the term used).
• As you know from looking at our planet, if you dramatically disturb an established ecosystem, all kinds of bad things can happen. For your colon, dramatic things happen when you take antibiotics. Some antibiotics can kill just about everything.
• However, C. difficile has a super tough spore stage of its life cycle and therefore it is sometimes the last survivor after an environmental catastrophe from antibiotics. After the other bacteria have been killed off, there is no competition for space and resources and C. difficile multiplies unchecked. In a short amount of time, the entire colon is overpowered by this one bug. C. difficile produces a toxin that inflames and damages the colon.
• C. difficile can occur after the use of any antibiotic, although clindamycin and cephalosporin's are among the most common offenders.  
• Most cases of C. difficile colitis in the US are caused by antibiotics. However, C. difficile colitis can also occur in patients without exposure to antibiotics. Patients with ulcerative colitis and Crohn's are particularly susceptible.
• Of note, antibiotics can sometimes cause diarrhea that is not due to C. difficile infection.

How do you know C. difficile is the cause of the diarrhea?

• See your doctor. There are specific tests that can be done to confirm my suspicions. Specifically there is a test for the C. difficile toxin A and B.

How do you treat C. difficile colitis?

• There are several treatments. Generally the first line treatment is 10 days of the antibiotic metronidozole taken orally.