Dysentery

Overview

Dysentery is a type of diarrhoea (loose, watery poo) that contains blood or mucus, and it usually comes with stomach cramps and fever. It happens when germs infect the bowel (the intestines) and irritate its lining, so it bleeds and produces mucus. Most cases are caused by bacteria or, less often, by tiny parasites, and the infection is usually picked up from contaminated food or water or from unwashed hands. Dysentery can make you lose a lot of fluid quickly, so replacing fluids is the most important part of looking after yourself.

Dysentery is much less common in countries with clean water and good sanitation, but it still happens — often in small outbreaks linked to food, nurseries, schools or travel. Worldwide it is a common cause of illness, especially in places where clean water and toilets are harder to access.

Anyone can get dysentery, but it is seen most often in young children, people travelling to areas with less safe water and sanitation, people living in crowded or poor-sanitation settings, and people whose immune system is weakened. Older adults and very young children are more likely to become dehydrated, so they need closer watching.

Symptoms

Common symptoms

• Diarrhoea (loose poo) that contains visible blood, mucus, or both
• Belly cramps or pain, often coming in waves before you need the toilet
• An urgent need to go to the toilet, sometimes with very little coming out
• Fever and feeling generally unwell or tired
• Feeling sick or being sick
• A headache or aching muscles
• Signs of dehydration such as a dry mouth, dark urine, or feeling light-headed

Symptoms in children

• Lots of watery or bloody poos, sometimes many times a day
• Being sleepy, floppy, or more irritable than usual
• Fewer wet nappies, or no urine for several hours
• A sunken soft spot on the head in babies, or sunken eyes
• Refusing drinks, or being sick so often that fluids don't stay down
• Crying with few or no tears, or a dry mouth and tongue

Symptoms in older adults

• Dehydration can build up quickly and may cause confusion or dizziness on standing
• Feeling very weak or unsteady, with a higher risk of falls
• Fewer trips to the toilet for a wee, or dark, strong-smelling urine
• Symptoms that seem milder than expected but still lead to serious fluid loss
• Existing long-term conditions (like kidney or heart problems) becoming harder to manage

Causes

Main causes

• Bacteria such as Shigella, certain types of E. coli, Campylobacter and Salmonella — these are the most common causes
• Parasites, especially Entamoeba histolytica (amoebic dysentery) and Giardia, which are more common in some parts of the world
• Viruses can cause diarrhoea with some blood or mucus, though this is less typical
• Drinking water or eating food that has been contaminated with human or animal waste
• Touching surfaces, hands or objects that carry the germs, then putting hands near your mouth

Risk factors

• Travelling to, or living in, areas with limited clean water and sanitation
• Caring for someone with diarrhoea, or living in close contact with others (households, nurseries, care homes)
• Not being able to wash hands easily with soap and clean water
• Sexual practices that involve contact with the anal area
• A weakened immune system, for example from some medical treatments or conditions
• Very young age or older age, which raises the risk of dehydration
• Swimming in, or drinking, untreated water from lakes, rivers or wells

When to see a doctor

See a doctor urgently if:

• Blood or mucus in your poo — get medical advice the same day
• You cannot keep fluids down, or you feel very thirsty with a dry mouth and dark urine
• A high fever, severe belly pain, or feeling very unwell
• A baby, young child or older adult who is becoming sleepy, floppy or passing very little urine
• You have recently travelled abroad or been in contact with someone with similar symptoms
• You are pregnant, have a weakened immune system, or have a long-term bowel condition

Book a routine appointment if:

• Diarrhoea that lasts more than a few days or keeps coming back
• Symptoms that started after a course of antibiotics or a hospital stay
• You want advice on what to eat and drink while you recover
• You are worried about work, school, childcare or travel while you are unwell

Diagnosis

A doctor will usually start by asking about your symptoms, how long you have had them, what you have eaten and drunk, and whether you have travelled recently. They will check how hydrated you are by looking at your mouth, eyes, skin and how much urine you are passing, and they may feel your tummy. If the cause matters for your treatment — for example if symptoms are severe or lasting — they may ask for a stool (poo) sample to find out which germ is responsible.

Tests that may be done

• A stool (poo) sample sent to a laboratory to look for bacteria or parasites
• Blood tests to check for dehydration, salt balance or signs of infection
• A urine test or pregnancy test if relevant to your care
• In some cases, a sample tested for specific germs using molecular tests (which look for the germ's genetic material)
• Rarely, a scan or a camera test of the bowel (endoscopy) if symptoms are unusual or persistent

What to expect at your appointment

The appointment is usually quick and simple. You will be asked questions, may be asked to provide a stool sample in a small pot at home or at the clinic, and will get advice on fluids straight away. Results from a stool sample can take a few days. The doctor may give you general advice while you wait, and you should go back or seek urgent help if you get worse in the meantime.

Treatment

The main treatment for dysentery is replacing the fluid and salts you have lost and letting your body clear the infection. Most people get better with fluids, rest and careful hand hygiene. Some people — for example those with more severe illness, a weakened immune system, or an identified parasite — may be offered specific treatment by a doctor. This is decided case by case, and your doctor will explain the options and whether they are needed.

Self-care at home

• Drink small amounts often — use an oral rehydration solution (a sachet of salts and sugar mixed with water, available from pharmacies) if you can, as it replaces salts as well as water
• Keep drinking even if you feel sick — take small sips every few minutes rather than large amounts at once
• Rest, and stay at home from work, school or nursery until you have been free of diarrhoea for at least 48 hours
• Wash your hands thoroughly with soap and water after using the toilet and before preparing or eating food
• Clean the toilet, taps and door handles regularly, and do not share towels or flannels
• Eat when you feel able — simple, plain foods are usually easiest, and there is no need to starve yourself
• Watch for signs of dehydration such as a dry mouth, dark urine or feeling dizzy
• Ask your pharmacist before using any anti-diarrhoea medicine — some are not suitable when there is blood in the poo or a fever

Medical treatments

Doctors may offer treatment aimed at the germ causing the infection, but only when it is likely to help — for example with certain bacterial or parasite infections found on testing, or if you are very unwell or at higher risk. Antibiotics do not work on viruses and are not needed for most mild cases. Your doctor may also give advice on rehydration, check your salt levels, and in some cases arrange fluids through a drip if you are very dehydrated. Always follow your doctor's or pharmacist's advice rather than using leftover medicines or someone else's.

When is surgery considered?

Surgery is very rarely needed for dysentery. It may be considered in unusual cases where a serious complication develops, such as a hole in the bowel or a severe build-up of infection in the abdomen. Your medical team would explain this clearly if it were ever relevant.

Living with this condition

While you are unwell, the priorities are simple: keep sipping fluids, rest, and keep your hands and surroundings clean so you do not pass the infection on. Symptoms usually start to settle within a few days. Plan for easy trips to the toilet, keep a jug of water and a rehydration drink nearby, and ask someone to help with shopping or childcare if you can.

Lifestyle tips

• Wash hands with soap and water for at least 20 seconds after the toilet, after nappy changes, and before cooking or eating
• Do not prepare food for other people until you have been symptom-free for at least 48 hours
• Avoid swimming pools until 2 weeks after your last episode of diarrhoea
• Keep separate towels and flannels for each person in the household
• If you are travelling, drink bottled or boiled water and avoid ice, raw salads and food that has been left out
• Return to work or school only when you feel well enough and following your local health advice

Diet and exercise

There is no special diet that cures dysentery, but eating little and often helps. Plain foods such as rice, bread, potatoes, crackers and bananas are often easier on the stomach. Avoid very fatty, spicy or sugary foods and too much caffeine or alcohol while your tummy is sore. Drink little and often throughout the day. Rest is more important than exercise while you are ill — wait until you have been well for a few days and your energy is back before returning to normal activity.

Mental health and emotional wellbeing

It is very common to feel embarrassed, worried or anxious about diarrhoea, especially if you need to be near a toilet or are missing work or school. You may also feel isolated or low while you recover. These feelings usually ease as you get better. If worry or low mood is lasting or getting in the way of daily life, tell your doctor — support is available and it is a normal thing to ask about.

Prevention

Yes, largely. Dysentery spreads through germs from poo getting into the mouth, so good hand hygiene, safe water and safe food handling are the most powerful protections. Washing hands with soap and water after the toilet and before eating or cooking, cleaning toilet areas, and avoiding untreated water all make a real difference. If someone in your household is ill, extra cleaning and separate towels help stop it spreading.

Vaccines

There is no routine vaccine that prevents dysentery in general. Vaccines do exist for some related infections, and if you are travelling your doctor or a travel health service can advise whether any are recommended for the places you are visiting. This is a good thing to ask about several weeks before you travel.

Screening programmes

There is no routine screening test for dysentery. Testing is done when someone has symptoms, or sometimes to check contacts during an outbreak, such as in a nursery, care home or food-handling workplace.

Complications

If left untreated

• Dehydration — losing more fluid than you take in, which can become serious quickly, especially in babies and older adults
• An imbalance of salts in the body, which can cause weakness, confusion or an irregular heartbeat
• Kidney problems, including a rare but serious reaction to some gut infections
• The infection spreading beyond the bowel into the bloodstream (sepsis)
• A build-up of infection or an abscess, especially with amoebic dysentery, which can affect the liver
• Longer-lasting bowel problems, such as ongoing loose stools or irritable bowel symptoms
• Joint pain or inflammation after some gut infections (reactive arthritis)

Long-term outlook

The outlook is good for most people. With plenty of fluids and rest, most cases settle within about a week, and serious complications are uncommon when people get advice early. Babies, young children, older adults and people with a weakened immune system need closer watching because they dehydrate faster — but with the right support, recovery is expected. Trust your instincts: if something feels wrong, contact a healthcare professional.

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