Nobody wants to talk about diarrhea—until they can't think about anything else. This summer's multistate Cyclospora outbreak has a lot of people suddenly paying closer attention to their guts. Unlike the typical 24-hour stomach bug, the parasite can keep people sick for weeks—but once it's identified and treated with the right antibiotic, most people start feeling better within days.
Regardless of whether your misery traces back to contaminated produce or a garden-variety stomach bug, gastroenterologists and infectious-disease doctors say the same handful of missteps tend to make a bad situation worse—and drag it out longer than necessary. Here's what to avoid if you're stuck making endless trips to the bathroom.
Your instinct might be to slam the brakes on diarrhea—but if it's being caused by an infection like Cyclospora, norovirus, salmonella, or certain strains of E. coli, that can backfire. “Imodium is a bowel paralytic,” says Dr. Svetang Desai, a gastroenterologist at Houston Methodist Sugar Land Hospital. “It stops the bowel from moving, so if you have a toxin-producing infectious disease, you’re basically just stopping the colon from its normal mechanism, which is to try to clear the toxin.”
Slowing everything down can keep the offending germ—and the toxins some produce—in your gut longer, rather than helping your body clear it. If you need relief in the first day or two, Desai says a bismuth-based product like Pepto-Bismol or Kaopectate is generally the best choice. “It kind of helps soothe irritation,” he says. “It actually has some antimicrobial properties.” Just know it can turn your stool dark, almost black—a startling but harmless side effect.
Imodium is better reserved for noninfectious diarrhea—or after a doctor has ruled out an infection.
2. Trying to tough it out
Most diarrhea resolves on its own within a couple of days. But not every case follows the usual script. "The No. 1 mistake people make is ignoring the red flags," says Dr. Saurabh Sethi, a gastroenterologist in Fremont, Calif., who often posts about gut health on social media. Watch for a fever above 101°F, blood in your stool, dizziness and other signs of dehydration, severe abdominal pain, or diarrhea that lasts beyond two to three days. "That's the time when they should stop self-diagnosing and self-treating," Sethi says.
When you have diarrhea, hydration is critical—but plain water can only take you so far. You'll lose salt, potassium, and other electrolytes along with fluid, so what you're drinking needs to replace more than just water. Instead, reach for an oral rehydration solution, like Pedialyte, and skip sugary sodas and juices. “When your bowels are inflamed, they don’t absorb sugar as well as they normally do, and sugar triggers more fluid output,” says Dr. Adam Mezoff, a pediatric gastroenterologist and chief medical officer at Dayton Children's Hospital in Ohio. You may also want to skip coffee, energy drinks, and other caffeinated beverages for a few days. “Caffeine triggers your bowels to be stimulated,” Mezoff says. “It can make it worse.”
How you drink matters too: Rather than forcing down a big glass and feeling queasy, take small sips often—Mezoff suggests a tablespoon every five or 10 minutes. “Small amounts frequently is much easier to tolerate than saying, ‘OK, suck down that big glass,’” he says.
Don't ignore the signs that you're falling behind, either. Dark urine, peeing less than usual, a dry mouth, increasing thirst, and feeling lightheaded when you stand up are all clues that you're becoming dehydrated. “Dehydration is the way you're going to get real sick real fast,” Mezoff says. “If you can't keep up [with liquids], then that's another reason you need to go [to the doctor].”
4. Raiding the medicine cabinet for old antibiotics
Found some random leftover antibiotics in the medicine cabinet? Don't take them. “There are certain forms of E. coli where, when it gets exposed to antibiotics, it releases all of its toxins, and those toxins can affect the kidneys, cause seizures, and cause bleeding issues,” says Dr. Daniel Egan, an infectious diseases physician at Orlando Health.
Cyclospora, meanwhile, is one of the infections that does need a specific prescription antibiotic: a seven-day course of the antibiotic trimethoprim-sulfamethoxazole (sold as Bactrim or Septra). You won’t feel better simply by taking whatever you have in your medicine cabinet.
Your gut has enough work to do already. Loading it up with heavy, hard-to-digest foods can make recovery even harder. “The diet needs to become bland, low in fat and low in fiber, and it should also be dairy-free,” Sethi says. “Once your intestine is inflamed, we need less of the things that can irritate our gut further.” For a few days, ease off fatty and fried foods, high-fiber choices, and dairy, and stick with bland foods your system can digest more easily. Once you're feeling better, you can gradually work your way back to your normal diet.
6. Not eating anything at all
The opposite mistake is just as common—going long stretches without food because nothing sounds good. Your gut can't heal on an empty tank. “Your bowel depends on that nourishment, because it needs energy to fix itself,” Mezoff says. If you don't feel like eating for the first day, that's OK. But any more than that can prolong the whole ordeal. “You shouldn’t go much longer than a day without getting some kind of food in you,” Mezoff says.
When you're ready to eat again, keep it simple. Sethi recommends sticking to bland, low-fat, low-fiber foods that are easy on your digestive system, like toast, rice, bananas, applesauce, crackers, and plain pasta. Wait until you're feeling better to gradually reintroduce richer, fattier, and higher fiber foods, he advises.
If your diarrhea has dragged on for days—especially if you've eaten fresh produce or live in an area affected by the outbreak—don't assume it's just a stubborn stomach bug. Unlike most stomach illnesses, which are over in a day or two, Cyclospora can, in some people, take three weeks to completely clear, says Dr. Alan Bulbin, director of infectious disease at Catholic Health’s St. Francis Hospital and Heart Center in Roslyn, N.Y.
Even if you do see a doctor, don't assume a stool test automatically checks for everything. “The general stool testing that’s ordered is only for bacterial infections like Shigella, salmonella, and E. coli,” Sethi says. “So if someone is suspecting Cyclospora, they need to request this special test.” The good news is that once it's identified, treatment with an antibiotic is relatively straightforward.
8. Thinking all stomach bugs spread the same way
Cyclospora behaves differently than many of the more common stomach bugs. Unlike norovirus, it isn't immediately contagious after it leaves the body—it has to mature in the environment before it can infect someone else. “Cyclospora is not person-to-person,” Bulbin says, which is why contaminated food and water—not close contact—drive outbreaks.
That means you don't need to isolate yourself at home. But don't skip good hygiene: If you're sick, don't prepare food for other people, and wash your hands thoroughly. “For Cyclospora and norovirus, you're better off just with good old soap and water,” Bulbin says. “Alcohol hand sanitizer does not work very well.”
Even though Cyclospora does not generally spread directly from one person to another, experts still recommend staying out of pools while you have diarrhea. You may not actually know what's causing your illness, and many other diarrheal infections—including norovirus and Cryptosporidium—can contaminate recreational water. “Nothing will clear a pool faster than somebody who has diarrhea while they’re in it,” Mezoff jokes.
10. Rushing back to normal the moment you feel better
Feeling human again doesn't mean you’re back to 100%. “You want to go gentle,” Egan says. “To jump right back into your regular diet is a little bit hard on the GI system, so you want to ease into it and gradually reintroduce foods.”
The same goes for exercise. “You need to understand how much trouble this created for your body before you launch back into all your normal stuff,” Egan says. Even if the diarrhea has stopped, you may still be catching up on hydration, so don't assume you're ready for a hard workout—or a return to business as usual. Give yourself a few days to ease back into your normal routine.
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