Diarrhoea and vomiting
Diarrhoea and vomiting are common symptoms that often happen because of a stomach or intestinal infection, sometimes called gastroenteritis. They may occur together or separately. Most mild cases improve within a few days, but the main danger is dehydration, especially in babies, young children, older adults, pregnant people, and people who are already unwell.
Diarrhoea means passing loose or watery stool more often than normal. Vomiting means forcefully bringing up stomach contents. Causes include stomach viruses, food poisoning, contaminated water, cholera, typhoid, dysentery, medicines, pregnancy, migraine, motion sickness and other infections. In Nepal, diarrhoea and vomiting may increase during monsoon, flooding or local outbreaks linked to unsafe water, poor sanitation or contaminated food. EDCD has a national preparedness and response plan for acute gastroenteritis and cholera outbreaks in Nepal.
Symptoms
Possible symptoms include:
Loose, watery or frequent stool
Nausea or vomiting
Stomach cramps or abdominal pain
Fever or chills
Loss of appetite
Bloating or feeling generally unwell
Headache, body aches or tiredness
Thirst, dry mouth or dizziness
Passing less urine than usual
Dark urine
Weakness or light-headedness
Vomiting often settles sooner than diarrhoea. In many mild infections, vomiting improves within 1-2 days, while diarrhoea may take several days to settle. Symptoms lasting longer, becoming worse, or occurring with blood, severe pain or dehydration need medical assessment.
Red flags
Go to the nearest hospital urgently if diarrhoea or vomiting occurs with:
Very little or no urine
Repeated vomiting or inability to keep fluids down
Severe thirst, very dry mouth, sunken eyes or extreme weakness
Drowsiness, confusion, fainting or collapse
Blue, grey, very pale or blotchy lips, tongue or skin
Severe difficulty breathing or very fast breathing
Blood in stool or bleeding from the bottom
Black, tar-like stool
Vomit containing blood or looking like coffee grounds
Green vomit, especially in children or if persistent
Sudden or severe abdominal pain
A swollen, hard or very tender abdomen
Stiff neck, severe headache, light sensitivity or rash
High fever or appearing seriously unwell
Suspected poisoning or chemical ingestion
Diarrhoea during pregnancy with weakness, dehydration, fever or abdominal pain
A baby or young child who is unusually sleepy, not feeding, has no tears, has fewer wet nappies, or is difficult to wake
These signs may indicate severe dehydration, shock, bowel obstruction, meningitis, sepsis, severe infection or another serious condition. Do not wait for a stool test before seeking help if the person is very unwell.
Self-care
Mild diarrhoea and vomiting can often be managed at home only if there are no red flags and the person can drink safely.
Rest and drink frequent small sips of fluid.
Use oral rehydration solution (ORS), especially if diarrhoea or vomiting is more than mild.
Continue breastfeeding babies.
Offer small, frequent feeds or fluids to children.
Eat when you feel able; simple foods may be easier at first.
Avoid alcohol.
Avoid fruit juice and fizzy drinks, especially in children, as they can worsen diarrhoea.
Wash hands with soap and safe water after using the toilet and before preparing food.
Clean toilets, taps, door handles and surfaces regularly.
Wash contaminated clothes or bedding separately.
Avoid preparing food for others while ill.
Stay away from school, work, food handling and caring for vulnerable people until at least 48 hours after diarrhoea and vomiting have stopped.
Use ORS exactly as directed on the packet, mixed with the correct amount of safe water. Do not make ORS stronger or weaker, and do not mix it with milk, juice, soft drinks or extra sugar. ORS helps replace both water and essential salts lost through stool and vomit.
In Nepal, use boiled, filtered or properly treated water if water safety is uncertain. Eat freshly cooked food served hot, avoid food that has been kept at room temperature for a long time, wash fruit and vegetables with safe water, and avoid raw or undercooked meat, fish or eggs.
Do not give children medicine to stop diarrhoea unless a qualified clinician advises it. Do not use leftover antibiotics. Do not force food, drink or tablets into someone who is confused, very drowsy, repeatedly vomiting or unable to swallow safely.
Treatment
Treatment depends on the cause and severity. The most important treatment is replacing lost fluid and salts.
Many cases improve without antibiotics. ORS is usually the first treatment when the person can drink. Severe dehydration, shock or inability to drink safely may require urgent intravenous fluids in hospital.
A healthcare professional may check:
Level of dehydration
Temperature, pulse, blood pressure and breathing
Abdominal tenderness or swelling
Urine output
Blood or mucus in stool
Recent food, water, travel, antibiotic use or contact with others who are ill
Whether there is a local outbreak
Tests are not always needed, but stool testing, blood tests, urine tests or pregnancy testing may be arranged if symptoms are severe, prolonged, bloody, recurrent, part of an outbreak, or affecting a high-risk person.
Antibiotics are only useful for selected causes, such as some bacterial or parasitic infections, cholera, dysentery or severe disease after clinical assessment. Children with acute diarrhoea may be advised zinc treatment by a healthcare professional, as WHO notes that zinc can reduce the duration and severity of diarrhoea.
Questions to ask your doctor
Is this likely to be gastroenteritis, food poisoning, cholera, dysentery, typhoid or another condition?
How dehydrated is the person?
Is ORS enough, or are intravenous fluids needed?
Does this need stool testing or blood tests?
Is an antibiotic needed, or would it be unnecessary?
Should anti-diarrhoeal medicine be avoided?
Can breastfeeding and normal food continue?
What should we do if vomiting continues?
Which signs mean we should go to hospital urgently?
Could this be linked to unsafe water, food from an event, or a local outbreak?
Do other household members need advice or assessment?
Nepal pathway
In Nepal, start with your nearest health post, PHC, clinic, or hospital if symptoms are worrying, severe, worsening, or not improving. Take previous prescriptions, test reports, allergy information, and current medicines with you. Seek urgent care immediately if there are red flag symptoms.
Disclaimer
This is general health information only and does not replace medical advice, diagnosis, treatment, or emergency care.
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