Gastroenteritis recovery and how to stop a stomach bug spreading

It started with your youngest on Tuesday night. By Thursday your partner was off work, and this morning you woke with that unmistakable churning feeling and a cold sweat across your back. Stomach bugs do this. They move through a household in a fairly predictable relay, and the relay is the part you can actually interfere with.

Gastroenteritis is inflammation of the stomach and bowel, usually viral, and in adults it is mostly a short and thoroughly horrible illness that resolves without any treatment. Knowing the usual course genuinely helps, because most of the worry comes from not knowing whether what is happening to you is normal.

So: what a stomach bug typically does, how to stop it going round the house again, and why your gut may feel wrong for a fortnight after you are technically better.

The usual course, day by day

It tends to begin abruptly. One minute you are fine, the next you are nauseated and cold, and vomiting often starts before any diarrhoea appears. The first 12 to 24 hours are usually the worst of it: repeated vomiting, cramping, aching limbs, sometimes a mild fever, and a complete loss of interest in food.

Vomiting normally settles before the diarrhoea does. By the second day most adults can keep sips down, and by the third the sickness has gone while the bowels are still loose. That sequence is why people go back to work too early, feel fine until mid morning, then spend the afternoon regretting the decision.

Loose stools trailing off across roughly a week is ordinary. Most healthy adults are through the acute phase in two to three days. Older people and anyone with a long-term condition tend to take longer and dehydrate faster, so the identical illness is simply a bigger event for them.

Why it goes round a household so efficiently

Norovirus, the usual winter culprit, is remarkably good at this. It takes only a tiny quantity of virus to infect someone. It survives on hard surfaces for days. And vomiting sends it into the air as a fine mist that settles on everything within a few metres of the toilet.

Then there is the timing. You are infectious before you feel ill, most infectious while you are symptomatic, and you carry on shedding virus for days after you feel entirely normal. Meanwhile the household shares one bathroom, a towel rail, a fridge door and a kettle. The relay more or less runs itself.

Alcohol hand gel is not reliable against norovirus. Soap, warm water and twenty seconds of proper scrubbing, thumbs and fingernails included, is what removes it. Use the gel by all means, but not instead of the sink.

Breaking the chain

• Wash hands with soap and water after every trip to the bathroom, before touching food, and before touching anyone else. This is the one that matters most.
• Give the ill person one bathroom if the house has two, and their own hand towel rather than the shared one.
• Clean the toilet, flush handle, taps, light switches, door handles and fridge door daily with a bleach-based product while somebody is ill, because many everyday sprays do not deal with norovirus.
• Deal with vomit promptly. Cover it, clean it up with disposable cloths and a bleach-based cleaner, ventilate the room, then wash your hands.
• Wash soiled bedding and clothing separately on a hot wash, and carry it without shaking it out, since shaking launches the virus straight back into the air.
• Whoever is ill should not cook for anybody else, and should stay off work, school and nursery until 48 hours after the last episode.
• No swimming for a fortnight after the diarrhoea stops.

None of that is glamorous and all of it works. If the illness is following shared meals rather than a shared bathroom, the cause may be contaminated food rather than a virus, and prevention then looks quite different.

When to get urgent help

Most stomach bugs need patience and fluids and nothing else. Get medical help if you see:

• Dehydration that is not improving despite drinking: very little urine, dizziness on standing, a dry mouth, sunken eyes
• Blood in the stool, or black tarry stools
• Pain that is severe or unrelenting, as opposed to cramps that come and go
• Symptoms in someone frail, elderly, pregnant or immunosuppressed
• No improvement at all after several days, or symptoms still present after a week
• A high fever with shaking chills
• Confusion or drowsiness, which in an older person can appear before any obvious dehydration
• Vomiting so persistent that nothing has stayed down for 24 hours

Call 999 if the abdominal pain is severe and unrelenting, if there is blood in the vomit, or if somebody is drowsy and difficult to wake. Call 111 for urgent advice short of an emergency, including an elderly relative who has stopped drinking, or a bug showing no sign at all of turning the corner. The practical rehydration detail, what to drink and what to avoid, is set out in our guide to managing diarrhoea and vomiting.

How an online consultation works for this

A video appointment suits this well, for the obvious reason that nobody with gastroenteritis wants a bus ride and a waiting room, and nobody in that waiting room wants you in it either. A UK registered doctor will take the timeline, ask what the stool and the vomit look like, check how much you are drinking and how often you are passing urine, and ask who else at home is affected.

What you get is an assessment rather than a guaranteed prescription. Most gastroenteritis is viral and antibiotics do nothing against a virus, so for many people the right outcome is a clear plan and a specific list of things to watch for. Where treatment is clinically appropriate the doctor may prescribe it, and if you need examining in person they will tell you and can write a referral letter. Details of how an appointment is arranged and the price of a consultation in pounds are both on the site, or you can get seen by a doctor online without leaving the house.

Why your gut still feels wrong two weeks later

The lining of your bowel has taken a beating and needs time to rebuild, and the bacteria that normally live there have been thoroughly disrupted. That combination produces a familiar set of after-effects: bloating, wind, food passing through faster than usual, sudden urgency, and a bowel habit that swings between loose and constipated before it settles.

Temporary difficulty digesting lactose is common, so milk, cream and cheese may disagree with you for a week or two even if they never have before. Appetite returns slowly. Tiredness is the part people underestimate, and feeling drained for a week or so after a gut infection is expected, although if it drags on well past that then persistent fatigue and what causes it is a sensible next read.

Give it two to four weeks. Most after-effects fade on their own within that window. What should not be brushed aside is a change that persists: blood, unintentional weight loss, diarrhoea that wakes you in the night, or a bowel habit that simply never comes back to your normal. Those need assessing as an ongoing gut problem rather than being filed away as that bug you had.

Whether you are in the thick of it or three weeks past it and still not right, a doctor can tell you which of those you are dealing with. Arrange a consultation with a doctor and have your symptoms, your recovery and anything still lingering looked at properly.