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Traveler's diarrhea is perhaps the most common health problem faced by travelers. Learn more about the symptoms, treatment and most importantly, how to avoid it.
Photo © Getty Images/FlavioAlmeida
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.
- How it spreads
- Where it's found
- Duration
- Symptoms
- Rehydration tips
- Vaccination
- Diarrhea medications
- Prevention
How it spreads
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.
Where you can contract it
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.
Duration
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.
Symptoms
The symptoms of traveler's diarrhea include:
- Abdominal pain
- Cramping
- Feeling bloated
- A continual feeling of needing to use the bathroom
- Nausea
- Loose, watery stools
- Fatigue
- Slight fever
Rehydration tips
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.
Vaccination
There is no vaccination available for traveler's diarrhea.
Diarrhea medications
Anti-diarrheal medications
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.
Antibiotics
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.
Prevention tips
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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15 Comments
Good luck finding any of those drinks whilst travelling ????????
I've been travelling Asia for a month and have bought loads of sachets of electrolyte powders, a lot better than the sports drinks because they don't have loads of sugar heaped into them, sugar is very dehydrating and you don't need the amount that's In those bottles. It'll only make you more thirsty.
I always have Travelan. They're the only OTC which can prevent it. I can swear by that product. Still recommend doing your research from www.travelan.com.au before.
In India , look for electrol- every pharmacy has it ; if not they will give you a good alternative - it’s great to replenish salts in body due to diarrhea or excess sweating which can lead to cramps.
pst ask for the oral cholera vaccine. it's not perfect, but it does have cross-protectivity against some of the TD bugs too. Not the injectable one, mind, it has to be the oral cholera one.
If you need an electrolyte and can't find any. Get a fizzy soft drink (with real sugar not a sweetener) and add some salt. It works a treat as an electrolyte. Or add salt and sugar to freshly made black tea. It was actually a doctor in Yogyakarta that advised us to to use this. Worked a treat.
In Thailand I found relief from the runs with a fairly simple thing. Available at some 7/11s (everywhere in Thai cities and on the southern islands), and some supermarkets:
Yakult.
Brown or plain rice
Veggies (steamed)
Tofu
Avoid fruit and fruit juices unless you want to go raw organic vegan. Now I have a fridge free probiotic tablet to take once a day. I don’t usually endorse dairy products, but it was the cheapest and quickest solution. I fasted, only drinking fluids and yakult. Then when my hunger got the better of me, I ate some rice.
Moctezuma, not Montezuma lol....
Dukeral is great too - https://www.dukoralcanada.com
While I usually avoid drinking Coke or Pepsi, I do drink it while travelling. It comes bottled or canned, so there’s a big chance it’s not contaminated. And the phosphoric acid it contains kills almost everything. Phosphoric acid is a colorless, odorless crystalline liquid. It gives soft drinks a tangy flavor and prevents the growth of mold and bacteria, which can multiply easily in a sugary solution. If it can be used to clean toilets it can clean my guts as well :) But seriously, it helped me on multiple occasions during my trips abroad if I was experiencing stomach/guts issues.
Activated charcoal is one of the best oral remedies for travellers diarrhea that I've ever found.
You can buy it in capsule form from the pharmacy or 7/11 in some countries.
It's a natural product that soaks up the bad bacteria and takes it to the toilet with everything else. (Don't panic if your shit looks black)
Probiotics are a great preventative and also a great way of getting good microbes back in your stomach after a dodgy bout. Get a bottle of tablets from your chemist before leaving home.
Naturally fermented drinks like plain lasi and ayran can help. Coke is not only generally bad for your health, but does nothing to help and can often make matters worse. B,R,T, banana, rice, toast, are good plain foods that dodgy tummies handle a lot better than others.
I got violently I'll and ended up in hospital for nine days on a drip....in Bolivia.
I had eaten some bad street food in Puno Peru....on my way to the Amazon And onto Puerto Velho Brasil. I returned via The Beni river district Bolivia from Brasil.....and during that trip I tried out River fish, Piranha and also iguana......upon getting back to Sucre via La Paz....I got really sick with dysentery. A raft of tests, and $4000 later, it still took me a month or so to recover......I've never eaten anything exotic, or street food ever since!
I have a World Nomads policy for 9 months of travel. When I called the emergency line for stomach issues they warned me that I would probably only be able to make one claim for stomach issues for the duration of the trip with the world nomads policy. I emailed World Nomads to confirm, and World nomads stated: "when traveling they have an incident related to a specific condition then normally the plan only covers for one instance of that condition, and one follow up treatment, but nothing past that". Is this correct? World Nomads would only cover one claim for an instance of, for example, travellers diarrhea in 9 months? This is ludicrous, especially for a company that markets itself to long term travellers!
World Nomads has confirmed, they only cover one instance of stomach Issues: "If you were to develop a new stomach condition not related to the previous stomach issue but a similar condition you would not be covered due to it would be considered pre-existing unless it was due to an injury or something totally unrelated".