Dear Doctor,                                                                                                

I have got stomach cramps, diarrhoea and vomiting. Could it be something to do with food or it’s a tummy virus doing the rounds?

Mbabazi

Dear Mbabazi,

Many different conditions can cause stomach cramps, diarrhea and vomiting. You have not specified your age, how long you have had this problem, whether it is intermittent or persistent and the frequency of vomiting and passing stool among others

The most common cause of abdominal cramps with diarrhea and vomiting (gastroenteritis) is infections. Various kinds of microbe can enter the stomach and intestines through the mouth, due to bad personal and/or food hygiene. This implies poor personal hygiene and poor hygiene maintained during cooking, serving and/or eating food. Infection can also be acquired through water contaminated with fecal matter containing microbes.  Protozoal infections like amoeba and giardia can cause similar symptoms but the stool passed would be semi-liquid. Bacterial infections as that by salmonella, shigella, mostly cause liquid diarrhea and may sometimes be associated with fever. Severe life threatening diarrhea and vomiting can occur with infections like cholera. Viral infections like Rota virus can cause acute self subsiding diarrhea with or without vomiting and fever. Viral gastroenteritis is more common in children and elderly and occurs more in crowded places like day care centres and schools.

As for the virus doing rounds, there can be a common source of infection for many people like contaminated water or many can be affected due to lack of hygiene. Diagnosis of infection can be made by simple microscopic examination of the stool, which shows protozoa or bacteria. Viral infection is diagnosed on the basis of excluding these infections. Usually acute infections subside by themselves. But if symptoms are severe and there is fever, antibiotics may be needed. One can have this problem repeatedly if hygiene is not improved. Treatment given cures the current infection, but it does not prevent future infection.

One can also have abdominal cramps with diarrhea and vomiting as a result of indigestion. Taking binge of food one time or taking fatty/spicy diet to which one is not accustomed puts more load on the stomach and intestines, which exceeds their capacity to digest. This can manifest as diarrhea and vomiting.  If somebody has chronic constipation, i.e. stool is passed after 2, 3 days; he/she can have increased frequency of hard or semi liquid stools and abdominal pain. This happens because the colon loaded with fecal matter may evacuate it number of times. Abdominal pain and bilious vomiting may be associated with it.

On rare occasions, one may have these symptoms due to allergy to some kind of food ingested.  Diseases of intestines like TB or cancer can cause diarrhoea but usually there is no vomiting. Hormonal disorders like hypo thyrodism, diabetes can cause indigestion.