Every travel experience carries inherent risks, including Traveler’s Diarrhea, a type of illness that occurs in travelers as a result of eating and drinking in a country with different sanitary conditions than the body is used to. According to the Center for Disease and Control Prevention (CDC), Traveler’s Diarrhea is the most common travel-related illness and can occur in any part of the world. It is, however, more prevalent in Central America, South America, Africa, the Middle East, and Asia (except Japan and South Korea).
As expected, Traveler’s Diarrhea almost always ruins a good vacation and often takes us by surprise. You may know how to travel like a pro and even know how to eat clean to make your trip easier and better, but sadly, Traveler’s Diarrhea typically starts at the wrong time and in the wrong place, and sometimes you might not be able to do much to prevent. Up to 30-70% of travelers will experience Traveler’s Diarrhea depending on their destination and the season during which they travel.
Unlike some other travel health disorders like motion sickness and jet lag, which you could somehow control, or at least can anticipate and plan ahead for, Traveler’s Diarrhea almost always takes you by surprise, typically after a bucket list meal or drink. The illness confines you to your accommodation and forces you to stay within a few feet of a toilet. Sufferers of Traveler’s Diarrhea have to pay constant attention to the noises and movements within their digestive system to avoid any embarrassing messes. All of these inconveniences can certainly ruin a good vacation.
What is Traveler’s Diarrhea
Traveler’s Diarrhea is a disorder of the digestive system characterized by stomach cramps and loose, watery stools. Even though it is not considered deadly, Traveler’s Diarrhea can be very inconveniencing, uncomfortable, and can last from 3 to 7 days.
What Causes a Traveler’s Diarrhea
Traveler’s Diarrhea results from drinking contaminated water and eating contaminated food. Though Traveler’s Diarrhea can sometimes be caused by a change in diet, it is most often caused by ingesting food or water that is contaminated with infectious pathogens such as a virus, bacteria, or parasites. Unlike some diseases that leave you with some sort of immunity, there is no immunity against getting Traveler’s Diarrhea for future infections. So, if you’re unfortunate, you could have a back-to-back episode. Interestingly, though, locals don’t often get sick from eating the same food that might have made you sick due to their immune system adapting to the pathogens.
Symptoms of Traveler’s Diarrhea
One of the symptoms associated with Traveler’s Diarrhea is pretty self-explanatory – loose, watery stool. Unfortunately, according to Cleveland Clinic, this is often abrupt and without warning. Other symptoms of Traveler’s Diarrhea include:
- Sudden urge to have a bowel movement
- Three or more episodes of loose stool per day
- Severe abdominal pain and cramps
- Bloating
- Nausea
- Vomiting
- Fever
- Dehydration
- Bloody stools
- Pain in the rectum
- Explosive and painful gas
When Should You Worry About Traveler’s Diarrhea?
Traveler’s Diarrhea is self-limiting, which means that even if you do not treat it, you will get better at some point. Sadly, it could last anywhere from 3 to 7 days. If your diarrhea lasts longer than 3-7 days or seems to be getting worse as the days' progress, please follow up with a doctor. Hopefully, you have travel insurance or have health insurance benefits outside of your country.
You should also see a doctor if the following occur:
- bloody stool
- worsening stomach cramps
- signs of dehydration like dry mouth, crying with no tears, reduced urination, thirst
- weakness, sleepiness, unusual tiredness, or incoherence
- fever higher than 102°F
If you suspect signs of dehydration, especially in babies and young children, get medical help immediately, as dehydration can lead to serious complications like shock, organ damage, and coma.
Who is at a Greater Risk of Traveler’s Diarrhea
Everyone who travels, especially international travel, is at risk of getting Traveler’s Diarrhea as long as they eat and drink in their travel destination, something that cannot be avoided. Some people, however, are more prone to being affected including:
- People with underlying stomach disorders - including inflammatory bowel disease (IBD) or liver problems
- People with weakened immune systems since their body’s defense system is compromised
- Seasonal Travelers – the weather or time of the year can affect the organisms and their risk for causing Traveler’s Diarrhea
- Young Adults – because they are bound to be more adventurous and less careful about where and what they eat and drink
- Antacid/Acid Blocker Users– taking antacid and acid blockers can reduce your stomach acidity and make the stomach more conducive for bacteria to grow
How Do You Prevent Traveler’s Diarrhea
Practice Clean Eating
The first and most important way to avoid Traveler’s Diarrhea is to eat right and eat clean when traveling. Once you feed your body with the right food before and during travel, you can strengthen your immunity and make it harder to fall sick.
Watch What You Eat
Unfortunately, clean eating alone does not reduce the risk of Traveler’s Diarrhea as the foods might be contaminated as well. You have to be vigilant about what you eat and where you eat. For instance, eating street food from every nook and corner on your trip might sound adventurous but could be the hard stop you don’t want to have on your vacations.
So, yes, do eat street food if you must in the spirit of adventure, but don’t just eat from anywhere. Perhaps ask the locals where they get the best and safest street foods from, or just do your homework. Some good and clean restaurants serve similar foods like you would find in the streets, so if possible, choose them over the street vendor if you are worried about getting sick.
Always remember to eat hot, well-cooked food, avoid cold food, don’t use open sauces and condiments, don’t eat undercooked meat and seafood, and eat only fruits you can peel off the skin. Avoid sliced fruits as they may have been washed with contaminated water. Overall, try to eat foods that require little handling and make sure all utensils are clean.
Watch What You Drink
Be careful with what you drink, and when possible, stick to bottled water or drinks. Just like with food, be careful where you drink from. For instance, unbottled water, ice, and fresh fruit juices are easier to be contaminated, and drinking them without being extra careful might keep you in the bathroom longer than you really planned. And in some countries, like the Netherlands and Iceland, tap water is encouraged even in big hotels but remember that your body is not used to the water, so even though the tap water might be safe, if your stomach is sensitive, you might still end up with bad stomach upset. So, when possible, drink bottled water or canned drinks.
If you think you won’t have 24/7 access to bottled water, then travel with a portable water filter. Or if you must drink unsterilized water, boil it for at least 3-5 minutes. Always remember to wipe off any bottles or cans before drinking from them. Avoid unpasteurized milk and dairy products and be aware that adding alcohol to a drink does not kill pathogens, and so doesn’t protect you. And when possible, use bottled water for brushing your teeth.
Watch Where Your Swim
It’s easy to forget that swimming is another risk factor for getting Traveler’s Diarrhea. If the weather is nice, most people will swim on a vacation, even if it’s just in the hotel pool. Some might have access to the beach and to other swimming places like swimming holes, etc. Just like with drinking water, watch where you swim and avoid contaminated water. Also, don’t forget to keep your mouth closed when showering to avoid accidentally drinking contaminated water.
When Traveling with Children
Children, especially younger children, tend to put everything in their mouths. And, no matter how often you wash their hands, they always find a way to make it dirty and put it right back in their mouth. Make sure they wash their hands often, especially after playing.
Other Methods
Other Preventative Methods include washing your hand with soap and water, and when not available, using a hand sanitizer with at least 60% alcohol content.
Preventative Medication
Though experts do not recommend medication for prevention unless necessary, Bismuth Subsalicylate, an Over-The-Counter (OTC) drug, has shown some effectiveness in reducing diarrhea. It does, however, come with the scary but common side effects of dark stools and sometimes, black-colored tongue.
How Do You Treat Traveler’s Diarrhea
There are different ways to treat Traveler’s Diarrhea, but like other illnesses that are self-limiting, the first-line approach is natural methods. When treating Traveler’s Diarrhea, the first step is to stay hydrated with clean water, rest, and stay as close to a bathroom as possible. Every person affected by Traveler’s Diarrhea is someone on a trip who most often, does not have time to be sick and require an effective and safe over-the-counter or prescription medications to help them get back to their trip.
Non-Drug Treatment
As discussed, Traveler’s Diarrhea can be treated with rest, lots of clean water, and proximity to the bathroom.
Over-The-Counter Treatment
Bismuth Subsalicylate – this can prevent but also treat Traveler’s Diarrhea. It works to shorten the duration of diarrhea as well as decrease the frequency by which it occurs. It is not recommended for people with aspirin allergy.
Antimotility Agents – These are drugs you already know and use, including Imodium (loperamide) that relaxes the muscle spasms in your stomach, allows food to spend more time in the stomach, increasing the absorption of the food, which reduces diarrhea. These drugs are not recommended to be used for infants or in situations of bloody diarrhea and fever. The antimotility drug usually works within 2 days, and if the diarrhea is worse or not getting any better while on these drugs, see a doctor.
Prescription Medications
When OTC medications fail, or you have more than 4 loose stools in a day or have a fever with severe symptoms like bloody stool, stool with mucus, or pus, an antibiotic might be indicated. Consider asking your doctor for a prescription of antibiotics (with full instructions of how and when to take it) if you plan to travel to a place with a moderate risk of Traveler’s Diarrhea.
Complications of Traveler’s Diarrhea – Dehydration
Loose stools are no-fun, but dehydration is especially not fun since it can be deadly when severe. Although you can drink water to replenish lost fluids, the best way to hydrate yourself is by using oral rehydrating salts (ORS). Depending on where you’re visiting, you should be able to buy an ORS solution in the pharmacies, and you could also find packages of powered ORS made by the World Health Organization (ORS). If you don’t have access to an already-made ORS package or solution, you could use this simple ORS formula:
• 1(one) liter safe drinking water
• ½ teaspoon salt
• ½ teaspoon baking soda
• 3 tablespoon sugar
Traveler’s Diarrhea is not pleasant and can make or break a vacation. But there are simple ways to prevent it as well as easy ways to treat it. Even though Traveler’s Diarrhea is typically self-limiting and uncomplicated, it can get serious enough to require medical attention. It might even appear after you’ve returned home. Knowing the difference between your country’s healthcare insurance when you’re outside of your home country will go a long way to making sure you’re prepared for any emergencies, such as severe dehydration that might come with a bout of Traveler’s Diarrhea.
Casey Barbles 
Jeff Yelton 