For most cases of diarrhea, the two most effective over-the-counter options are loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol). Loperamide slows movement through the intestines, giving your body more time to absorb water and firm up stool. Bismuth subsalicylate reduces inflammation in the gut lining and has mild antibacterial properties. But medication is only part of the picture: what you eat, what you drink, and what you avoid can matter just as much.
Over-the-Counter Medications
Loperamide is the stronger of the two OTC options and works best for watery, non-infectious diarrhea. It’s the go-to if you need fast relief for a bout of stomach upset, travel-related symptoms, or a flare-up from a food sensitivity. It should not be used if you have a high fever or bloody stools, since those signs point to an infection your body may need to fight off rather than slow down.
Bismuth subsalicylate is gentler and also helps with nausea, heartburn, and stomach cramps that often come alongside diarrhea. It can turn your tongue and stool black temporarily, which is harmless but surprising if you’re not expecting it. Because it contains a compound related to aspirin, you should avoid it if you’re allergic to aspirin or taking blood thinners.
What to Eat During a Bout
The classic advice is the BRAT diet: bananas, rice, applesauce, and toast. These foods are easy to digest and unlikely to irritate your gut. That said, there’s no clinical evidence that limiting yourself to only those four foods speeds recovery. Harvard Health recommends treating them as a starting point for the first day or two, then broadening to other bland, easy-to-digest options like brothy soups, oatmeal, boiled potatoes, crackers, and unsweetened dry cereal.
Once your stomach starts to settle, gradually reintroduce more nutritious foods: cooked carrots, sweet potatoes without the skin, avocado, skinless chicken or turkey, fish, and eggs. Your gut recovers faster when it has adequate nutrition, so don’t stay on a restricted diet longer than necessary.
Foods and Drinks That Make It Worse
Certain beverages actively pull water into the intestines and worsen diarrhea. Fruit juices are a common culprit, especially apple juice, pear juice, and grape juice, because of their high fructose content. Soft drinks, particularly fruit-flavored ones, do the same thing. Coffee, tea, and cola drinks contain caffeine, which stimulates the gut and speeds up transit time.
On the food side, avoid dairy products (milk, cheese, yogurt, ice cream), fried or greasy foods, spicy dishes, acidic foods like citrus and tomato sauce, and high-fiber items like leafy greens, nuts, seeds, beans, and popcorn. These are all harder to digest and can trigger cramping or additional loose stools when your gut is already inflamed.
Staying Hydrated
Dehydration is the real danger with diarrhea, especially if it lasts more than a day. You lose water, salt, and potassium with every trip to the bathroom. Plain water helps, but it doesn’t replace lost electrolytes. Oral rehydration solutions like Pedialyte are specifically designed for this purpose and are a better choice than sports drinks, which tend to be high in sugar.
You can also make a simple rehydration drink at home: mix 4 cups of water with half a teaspoon of salt and 2 tablespoons of sugar. Sip it steadily throughout the day rather than gulping large amounts at once, which can trigger more cramping.
Probiotics for Diarrhea
Probiotics can shorten the duration and severity of certain types of diarrhea. A large meta-analysis published in The Lancet Infectious Diseases found that probiotics reduced the risk of antibiotic-associated diarrhea by 52% and acute diarrhea from various causes by 34%. The benefit was even more pronounced in children, with a 57% risk reduction compared to 26% in adults.
Several strains have been studied, including Saccharomyces boulardii and Lactobacillus rhamnosus GG, but the analysis found no significant difference in effectiveness between individual strains. If you’re taking antibiotics or recovering from a stomach bug, adding a probiotic supplement or eating fermented foods (once your stomach can tolerate them) is a reasonable step.
When Diarrhea Needs Prescription Treatment
Most diarrhea resolves on its own within a few days. But traveler’s diarrhea or bacterial infections sometimes need antibiotics. The CDC classifies severity by how much it disrupts your daily life rather than by stool frequency alone. Mild cases that don’t interfere with your plans don’t need antibiotics. Moderate cases, where symptoms are distressing or limit your activities, may benefit from a short antibiotic course. Severe or incapacitating diarrhea, and any case involving bloody stool (dysentery), calls for antibiotic treatment.
Diarrhea lasting longer than two weeks raises the possibility of a parasitic infection like Giardia, which requires specific prescription medication. This is especially worth considering if you’ve traveled internationally or consumed untreated water.
Safety for Children
Children get dehydrated much faster than adults, so fluid replacement is the top priority. Loperamide should never be given to children under 2 years old. For children ages 6 to 12, dosing depends on weight and should follow the package instructions carefully. Bismuth subsalicylate is generally not recommended for children or teenagers because of the aspirin-related compound it contains.
For a child with diarrhea, watch for these warning signs: no wet diaper in three or more hours, a fever above 102°F, bloody or black stools, sunken eyes or cheeks, unusual sleepiness or irritability, or skin that stays pinched when you press and release it (a classic sign of dehydration). Any of these warrants prompt medical attention. Even without those red flags, see a doctor if a child’s diarrhea doesn’t improve within 24 hours.
Red Flags for Adults
Adults should seek medical care if diarrhea lasts more than two days without improvement, if stools are bloody or black, or if fever exceeds 102°F. Signs of dehydration also warrant a visit: excessive thirst, dry mouth, dark urine, little or no urination, dizziness, or severe weakness. Severe abdominal or rectal pain is another reason not to wait it out. More than 10 bowel movements a day, or fluid losses clearly outpacing what you can drink, qualifies as severe diarrhea and needs medical evaluation.