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Bali Belly, Delhi Belly, The Pharaoh's Curse, Montezuma's Revenge, The Rangoon Runs – it doesn't matter what you call it, and where you are in the world, traveler's diarrhea can leave you stuck on the toilet – or worse, in a hospital bed.
There are different causes of traveler's diarrhea, but it's mainly spread through contaminated food and water and/or poor hygiene practices e.g. restaurant cleanliness etc.
Bacterial - E.Coli, Salmonella, Shigella and Campylobacter tend to be the main culprits of bacterial traveler's diarrhea.
Viral - this type of diarrhea is usually caused usually by norovirus or rotavirus.
Parasitic- parasites such as Giardia and Cryptosporidium, which can be found in contaminated water, cause gut issues which can give you a long-lasting souvenir of your trip.
Dysentery - usually caused by the Shigella sp. of bacteria, this is the severe end of the diarrhea scale and a medical emergency.
The risk of contracting traveler's diarrhea is higher in places where sanitation and hygiene standards aren't high e.g. in parts of Asia, Africa, South America, Central America and the Middle East. However, you can get traveler's diarrhea anytime, anywhere.
Traveler's diarrhea usually resolves itself within a few days, however, if you have had traveler's diarrhea for more than 48hrs, or are experiencing severe symptoms, seek medical help immediately. A few signs that you've reached this stage include the presence of blood in diarrhea (dysentery), high fever, chills, skin lesions and severe abdominal cramping. These are all signs that the bacteria are invading the body by penetrating the intestinal lining and there is a good chance you will need antibiotics and/or intravenous fluids.
The symptoms of traveler's diarrhea include:
The biggest problem with diarrhea is dehydration, and the first step in treating it is oral rehydration. Not only does rehydration often require more water than you might think, but it also requires electrolytes in that water. If you are experiencing traveler's diarrhea, you will need to drink at least three quarts (3 liters) a day, to replace lost fluids.
A sports drink (Gatorade, Powerade, Lucozade, etc) often works well, and several glasses of this should be drunk each day you are experiencing symptoms. If you can't find a sports drink, you can make your own with a pinch of salt and a few spoons of sugar mixed into a glass of clean water. Even if you're vomiting up all the liquids, keep drinking! Some of the fluid is getting into your body.
If you are in a hot climate, you may need to seek medical treatment for intravenous fluids. Avoid caffeinated drinks and alcohol.
There is no vaccination available for traveler's diarrhea.
The use of loperamide (Imodium) is controversial. While loperamide does prevent diarrhea, that may not always be a good thing. If a traveler has an invasive and especially strong infection you are essentially trapping the bacteria in the intestine/colon where it can do the most amount of damage. Diarrhea is the body's way of excreting these damaging microbes. Travelers who don't know the cause of their diarrhea should use loperamide with caution as they may be doing more harm than good.
Medications to treat traveler's diarrhea include the quinolone family, especially ciprofloxacin. Some parts of the world are developing resistance to this antibiotic and azithromycin is considered a good alternative. Speak to your doctor prior to departure about taking a supply of antibiotics with you in case you develop a severe case of traveler's diarrhea. These medications should not be taken as prevention, instead, hang on to them to be taken if symptoms strike.
If you cannot afford to be slowed down by diarrhea (business meetings, honeymoons, sporting events, etc) speak to your doctor about using bismuth subsalicylate (Pepto Bismol) as a preventative measure. Taking two tabs every morning and two tabs each night has been shown to decrease rates of traveler's diarrhea, however, this can only be taken fin the short term i.e. up to three weeks duration. Severe constipation can also result. This option may not be for everybody, so speak with your doctor prior to using this.
Good personal hygiene and taking precautions when eating or drinking can help you avoid getting traveler's diarrhea. Always wash your hands with clean water and soap. Where that isn't possible, use an antibacterial hand gel. The mantra "boil it, cook it, peel it or forget it" should never be forgotten.
Street food is something everyone should try while traveling but there are things to look out for. If the place looks dirty, chances are the food will be contaminated, too. Ensure your food is properly cooked, and only drink clean water you know has been treated, purified or come from sealed bottles or cans. Watch out for pre-cut fruits and veggies that may have not been washed with clean water before sale. Skip ice in drinks unless you know where the water to make it comes from.
Tip: If you aren't certain about the cleanliness of cutlery or chopsticks, give them a wipe with a small amount of antibacterial gel and a napkin or tissue before use. Or BYO your own reusable cutlery.
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