This may not be the most pleasant thought.

But all diarrhea is not the same.

One kind, induced by a condition known as Clostridioides difficile, or “C. diff,” for short, is a bacteria-based condition that could do long-term harm to you and, in extreme cases, kill you.

Health experts agree it’s nothing to mess around with. Even if your experience with C. diff isn’t quite so dramatic, it’s still likely to cause something more annoying than ordinary diarrhea and there’s a good chance – without proper treatment – it’ll keep coming back.

It’s contagious, which underscores the need for cleanliness.

To make this persistent, annoying condition a little easier to understand, let’s dial back to the basics of what’s in your colon and gut – namely two types of bacteria.

Good and bad.

“C. diff is in all of us. In most of us, it’s kept in check,” explained Dr. Sapna Reddy, a Toledo Clinic physician who specializes in gastroenterology.

It’s kept in check by the so-called “good bacteria” in our systems. But certain antibiotics – remember, all are not the same – destroy good bacteria. The result is an imbalance in favor of C. diff and an infection that causes an inflammation of the colon, according to Dr. Reddy and other medical experts.

“This is a bad diarrhea,” she added. “It’s impossible to live with.”

Dr. Antwan Atia, another Toledo Clinic physician who specializes in gastroenterology, agreed.

“It can become severe and people can die from it,” he said. “It can be life-threatening. You can get toxic inflammation of the colon.”

A slight decrease

About 500,000 people across the United States used to get it annually, but that figure is now down below 400,000, according to the Mayo Clinic.

The disease has been getting more attention because of how the use of antibiotics has been on the rise, Dr. Atia said.

Dr. Anne Macy, Mercy Health system director for infection prevention, said C. diff remains a concern even with a slight decrease in the number of people afflicted by it.

“We feel these numbers are dropping because of increased awareness,” she said.

Symptoms include the frequency and intensity of watery, loose stools. Anyone who’s had such persistent diarrhea at least three times a day for two or more days should get checked out, Dr. Macy said.

Other symptoms include abdominal cramping, stomach tenderness, a fever, nausea, loss of appetite, unexplained weight loss, kidney failure, and rapid heart beat.

Dr. Tom Colturi, a ProMedica physician who specializes in gastroenterology, said the battle against C. diff remains strong, even if there has been some progress.

The most common place to get C. diff is in a hospital or nursing home because of the number of antibiotics administered in those settings. The disease can attack all age groups, but tends to be harder to get under control for older people, he said.

While experts are encouraged by a slight decrease in hospital settings, they’re concerned about those improvements being offset by gains elsewhere.

“The frustrating thing is we’re seeing a slight increase outside of the hospital,” Dr. Colturi said. “By no means are we seeing an end to this.”

There is no vaccination to prevent C. diff.

“It still is a frustrating problem,” Dr. Colturi said. “This germ is all around us.”

The disease is relatively easy to diagnose with a stool sample, he said.

The best way to avoid spreading it is through diligent hand-washing, especially after every bathroom stop, and through good body hygiene and household cleaning habits in general, experts said.

It can come back because of incidental contact with an infected person.

About one of every six C. diff patients will get the disease again within two to eight weeks. Those who are 65 years of age or older have a greater risk factor, the U.S. Centers for Disease Control and Prevention said.

“In the gut, there are probably trillions of normal bacteria,” Dr. Colturi said. “It’s almost impossible to say when things are back to normal.”

Unusual new treatment

Even though C. diff can be killed off by two types of antibiotics in particular that are known to be effective on it, that doesn’t always mean the end of the problem.

And when a greater commitment to cleanliness doesn’t do the trick after such regimens are completed, there’s an unusual treatment that physicians can do which can, in many cases, do the trick.

It’s called a fecal transplant.

Yep, it’s just what it sounds like: A fecal sample packed with good bacteria from a donor, often a blood relative, is introduced to the person battling C. diff, usually through a colonoscopy.

Strange as it sounds, doctors have been pleased by the results. The good bacteria multiply and control the C. diff.

“Right now, that’s been life-saving for some people,” Dr. Colturi said. “The FDA allows us to do fecal transplants because they’re so effective.”

He said the procedure “has some risk, but the success rate is so high and sometimes it’s absolutely essential.”

One in 11 people over age 65 who are diagnosed with C. diff die within a month, the CDC said.

According to the Mayo Clinic, about 200,000 people a year are still infected by C. diff in a hospital or care setting.

“These numbers are lower than in previous years because of improved prevention measures,” the Mayo Clinic states.

People also should avoid unnecessary use of antibiotics as a precaution.

“The infection usually occurs when people, particularly the elderly who are also receiving medical care, take antibiotics over a long period of time,” according to the Cleveland Clinic. “The germ is able to survive for a very long time on a variety of surfaces.”

First Published May 29, 2022, 4:00 a.m.