Enteral feeding does not tend to cause diarrhoea - if the patient had previously tolerated the feed and then developed diarrhoea, the cause is likely to be something else. Enteral feed may increase diarrhoea and might need to be withheld for a short time to reduce output. Please contact the Community dietitian for advice. 

Causes and Treatment:

Antibiotics:

  • Especially oral and broad-spectrum antibiotics can cause diarrhoea. 
  • Diarrhoea worsens or begins on introduction and can last up to 2 weeks after discontinuation.
  • Specific, well absorbed or IV antibiotics could be tried.
  • Review Medication.

Rate of Infusion:

  • Feed may be being administered too rapidly, especially if diarrhoea is present with nausea, vomiting and bloating.
  • Try reducing the feeding rate to 60ml/hour (this may need to be lower in children) until diarrhoea resolved.
  • Once the symptoms have resolved the feed rate can then be increased.  In an adult it is suggested this is done by 10ml increments every 4 hours to toleration.
  • Bolus volume and rate of delivery- reduce volume or change to a continuous feed.

Feed:

  • Check temperature of formula (too cold can cause diarrhoea).
  • Ensure the feed and feed system has not got microbial contamination. Remember to always check the expiry date of the feed before administration.
  • Check osmolarity of feed. Diarrhoea may sometimes be cased by hyperosmolar formula. Consider changing to an iso-osmolar formula e.g. Fresubin Original®, Nutrison®, Osmolite® or an appropriate children's feed.
  • Try switching to a fibre containing feed to see if this would help.

Any change in feed will only be done by the Community Dietitian.

Infection:

  • Consider the possibility of a gastrointestinal infection - a stool sample should be sent for analysis and patient treated accordingly.
  • Check patient's temperature.

Medication:

Medications known to possibly cause diarrhoea are:

  1. H2 Antagonists increase gastric pH and may allow enteropathic bacteria to survive in the duodenum allowing gastrointestinal infections to develop.
  2. Excessive consumption of sorbitol and magnesium containing medications.
  3. Proton Pump Inhibitors (PPIs), Anti-arrhythmics, Anti-hypertensives and Non-Steroidal Anti-inflammatories.
  4. Liquid medications may have a high osmolality, which may cause diarrhoea.
  5. Laxatives.
  6. Consider use of anti-diarrhoeals if the patient is not suffering from infective diarrhoea
  7. Liaise with the patient's pharmacist to see if medication can be adapted.
  • In liaison with Dietitian and/or GP try a prescribable fibre supplement such as 'Resource Optifibre® (Nestle), HyFibre® (NutriNovo) or a feed containing fibre. This may stimulate colonic production of short chain fatty acids.
  • Ensure fluid and electrolyte losses are replaced.
  • Consider probiotics or a prebiotic such as fructo-oligosaccharide (FOS).
  • With prolonged diarrhoea, consider a short-term trial with a semi elemental or elemental formula.
  • Consider fat malabsorption, especially with pancreatic deficiency, biliary obstruction, or extensive ileal resection. Using feeds containing Medium Chain Triglycerides in these situations may help. Patient may need pancreatic enzyme replacement therapy (PERT) to address this - contact the community dietitian for advice.
  • Low serum albumin may lead to osmotic pressure in the bowel and therefore more water in the bowel.  This can lead to diarrhoea. 

If you would like this information in another format, for example large print or easy read, or if you need help communicating with us, please contact:

First Community (Head Office)

Call: 01737 775450 Email:    fchc.enquiries@nhs.net    Text: 07814 639034

Address: First Community Health and Care, Consort House, 5-7 Queensway, Redhill, Surrey, RH1 1YB.

For office use only: Version 4 GU_TS003 Publication date: May 2026