Travel Health: Traveler's Diarrhea

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No TP for my TD? Photo © GettyImages/FlavioAlmeida

Bali Belly, Delhi Belly, The Pharoah's Curse, Montezuma's Revenge, The Turkey Trots, The Rangoon Runs. Doesn't matter where you are in the world, traveler's diarrhea can cause discomfort, leave you stuck on the toilet or worse, laid up in a hospital bed.

How It Spreads

There are different vectors for traveler's diarrhea, however, it's mainly spread via contaminated food and water plus poor hygiene practices e.g personal hygiene, restaurant cleanliness etc. 

Bacterial - E.Coli, Salmonella, Shigella and Camphylobacter tend to be the main culprits of bacterial traveler's diarrhea.

Viral - This type of diarrhea is caused usually by anorovirus or rotavirus.

Parasitic- Parasites such as Giardia and Cryptosporidium can be found in contaminated water and cause gut issues which can give you a long-lasting souvenir of your trip.

Dysentery - This is the severe end of the diarrhea scale and a medical emergency. Usually caused by the Shigella sp. of bacteria. 

Where It's Found

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 your condition hasn't improved after three days, you may need antibiotics so it's worth taking a trip to the doctor.

Symptoms

The symptoms of traveler's diarrhea include:

  • Abdominal pain
  • Cramping
  • Feeling bloated
  • Continual feeling of needing to go to the bathroom
  • Nausea
  • Loose, watery stools
  • Fatigue
  • Slight fever

If you have had traveler's diarrhea for more than 48hrs or 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.

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 the water you drink. If you are experiencing traveler's diarrhea, you will need to drink at least three quarts (3 liters) to replace lost fluids each day.

A sports drink (Gatorade, Powerade, Lucozade, etc) often works well, and several glasses of this should be drunk each day there are symptoms of traveler's diarrhea. If you get into a tight spot and cannot find a sports drink, you can make your own with a pinch of salt and a few spoons of sugar into a glass of clean water. Even if you're vomiting and throwing 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 the world-famous ciprofloxacin. Some parts of the world are developing resistance to this antibiotic and azithromycin is considered a good alternative. Travelers should speak with their doctor, prior to departure about taking a supply of antibiotics to be used if they develop a severe case of traveler's diarrhea. These medications should not be taken as prevention - better to hold them in reserve for when symptoms strike.

Those travelers who simply cannot afford to be slowed down by diarrhea (business meetings, honeymoons, athletes, etc) can speak with their doctor about using bismuth subsalicylate (Pepto Bismol) as preventative measures. Taking 2 tabs every morning and two tabs each night has been shown to decrease rates of traveler's diarrhea however this can only be taken for a short term trip 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" also applies here.

The local 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, only drink clean water if you know it's been treated or purified or better still stick to beverages in sealed bottles or cans. Watch out for pre-cut fruits and veggies that may have not been washed with clean water before sale. Skip the ice in drinks unless you know where the water came 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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