Traveler's diarrhea: prevention and treatment

What is Traveler’s Diarrhea? Is getting diarrhea abroad dangerous?  How do you prevent diarrhea while traveling? As many as 40% of travelers from developed countries get diarrhea while traveling, but knowing what to watch for can help speed up your recovery.


What is Traveler’s Diarrhea?

Traveler’s diarrhea is loose, watery stools caused by contaminated food or water when traveling in a developing country. It is most commonly caused by the bacteria E coli, but it can also be due to campylobacter or norovirus.  Other symptoms can include cramping, abdominal discomfort, and lack of appetite. The risk of contracting travelers diarrhea is greatest in the first week of your trip and gradually decreases over time as you become acclimated to the local flora.  Typically, it resolves on its own, but not before completely derailing your trip. Don't fear, below are some strategies to help make the best of this bad situation.


Is getting diarrhea while traveling dangerous?

In the majority of cases, travelers diarrhea is more of an annoyance than a danger.  Most people recover without complications or any long term effects, although there does appear to be an association between infectious diarrhea and developing IBS.  That said, any etiology of diarrhea can be serious if you’re not being diligent about staying hydrated (details below), and aggressively drinking fluids is easily half the battle in improving your symptoms.  Signs of a more serious infection, such as blood in your stool, fever, or lightheadedness with standing should prompt you to seek medical attention.


Preventing diarrhea while abroad

As with many health issues, the best approach is to prevent it from ever occurring.  You can do this by washing your hands frequently, drinking bottled water, avoiding uncooked vegetables, and steering clear of ice because freezing does not kill bacteria.  It’s also important to remember that while alcohol is sometimes used for cleaning and sterilization, it does not make beverages with contaminated ice or water safe to drink.   Unfortunately, even the most vigilant globetrotters can still find themselves with a case of traveler’s diarrhea, so what should you do if it's already too late?


How to treat diarrhea when traveling abroad

If you find yourself abroad and having loose bowel movements, it is important to stay well hydrated.  As discussed in our post on GI basics, your colon is largely responsible for absorption of water.  In traveler’s diarrhea, a bacteria or virus causes your colon to secrete water, and you can quickly become dehydrated and lose important electrolytes.  In mild cases of traveler’s diarrhea (1-3 bowel movements per day), hydration with water, juices, or broths is adequate. In more severe cases (>5 bowel movements per day or infrequently urinating), it is helpful to drink fluids known as oral rehydration solution (ORS).  ORS packets can be found for cheap in most pharmacies around the world and can even be made from scratch with just water, sugar and salt. Of course, you have to be sure you’re using clean water or your homemade remedy might do more harm than good.  

Does it matter what you eat? There is not much consensus on diet in regards to traveler’s diarrhea but there is limited evidence to suggest diet does not have a great effect on duration of symptoms.  For the most part, common sense and tradition rule. Starting out with bland foods like broths and crackers, then slowly broadening your diet based on how you feel is your best bet.

Do antidiarrheals help?  Medications like loperamide (often sold as Immodium but generics are no less efficacious) can decrease your symptoms but do not decrease the overall duration of illness.  Fewer trips to the bathroom means more time to spend checking off boxes on your itinerary, and a better chance at rehydrating, so loperamide is a worthy addition to your travel kit.

Do antibiotics help?  Many studies show that antibiotics decrease the duration of symptoms.  In fact, combining an antibiotic with an antidiarrheal works even better. However, despite their effectiveness in shortening symptoms, do not use antibiotics to prevent diarrhea, only to treat it. If you are traveling abroad and don’t have diarrhea, antibiotics can actually be the cause rather than the cure of new diarrhea, and you should avoid using unless you already have symptoms (see our post on antibiotics and the microbiome). Make sure to talk to your doctor about bringing an antibiotic along on your trip - it will pay dividends while you’re on the road.

A common mistake is to stop rehydrating once the diarrhea starts to settle out. This is actually the most important time to be aggressive about fluid repletion, and will help you feel better faster.


The bottom line: traveler’s diarrhea

Being vigilant about hand washing, and watching what you eat or drink while traveling abroad can prevent a world of trouble.  If you do find yourself with traveler’s diarrhea, be aggressive about re-hydrating as much as you can, and consider a combination of an antidiarrheal as well as an antibiotic if you’re in a developing country. Be prepared, and don’t hesitate to seek medical attention if your symptoms include bloody stools, fevers, or lightheadedness when standing.


-The Gut Docs*

*This was a guest post co-written by a doctor passionate about medicine and travel


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