Traveller’s diarrhea is an unpleasant and fairly common problem. Many people who travel say they are quite cautious and don’t understand why they still get sick. But sometimes all it takes is a few small dietary mistakes – like drinking milk or eating raw vegetables – to increase the risk of diarrhea.
When you travel to a place where the climate, social conditions, and health standards or practices are different from what you are used to at home, you are at increased risk of developing traveler’s diarrhea. The areas most at risk are countries in Latin America, Africa, the Middle East, Asia and some European countries.
Traveler’s diarrhea is a digestive disorder that often causes loose, watery stools and abdominal cramps. It occurs after consuming contaminated food or water. Fortunately, traveler’s diarrhea is not a serious illness, but rather an unpleasant one. It often starts suddenly during travel or immediately after returning home. In most cases, symptoms improve within a day or two without treatment and disappear completely within a week.
Why does traveler's diarrhea occur?
The condition can occur as a result of travel stress or a change in diet. But an infectious agent is almost always the cause.
You get traveler’s diarrhea by ingesting food or water contaminated with fecal organisms. These infectious organisms (bacteria, viruses and parasites) enter your digestive tract and overwhelm local defense mechanisms, causing diarrhea and abdominal pain. People living in these areas do not get sick because their bodies are used to these infectious agents.
Escherichia coli or E. coli is the name of the bacteria that is the most common cause of traveler’s diarrhea. This bacteria attaches itself to the lining of the intestine and releases a toxin that causes diarrhea and abdominal cramps.
Probably the most important thing to remember when you have diarrhea is the need to rehydrate. Your body loses large amounts of water and, in addition, important electrolytes, such as salt, potassium and the bicarbonate. For this reason, diarrhea is a problem. The person becomes dehydrated and an electrolyte balance disorder develops, which may sometimes require intravenous treatment. Signs and symptoms of dehydration include dry mouth, intense thirst, production of a small amount of dark urine and extreme fatigue. Dehydration is especially dangerous for children, the elderly, or people with weakened immune systems.
An oral rehydration solution is the best way to replace fluid losses. These solutions contain water and salt in a specific ratio to replace both lost fluids and electrolytes. They also contain glucose to increase absorption in the digestive tract. You can also find these oral rehydration salts in powder form that must be reconstituted with boiled or bottled water, according to the instructions on the package.
If you cannot find these products, you can prepare your own oral rehydration solution by mixing:
- ½ teaspoon of salt
- ½ teaspoon baking soda
- 4 tablespoons of sugar
- 1 liter of bottled or boiled water (3 minutes)
You or your child should drink this solution in small amounts throughout the day if dehydration persists. To avoid vomiting, it is recommended to drink small amounts often.
Other liquids you can safely consume are: bottled fruit juices, tea and decaffeinated beverages. Avoid coffee and milk which may worsen symptoms and increase fluid loss.
What can you do to stop diarrhea?
Because traveler’s diarrhea often goes away on its own, you will feel better without any further intervention. It is important to continue to rehydrate. However, when you want to avoid going to the toilet so often (for example, when traveling by bus, during business meetings or on foot trips, etc.), you can use a drug that slows down peristalsis, the mechanism by which food is moved through the intestine. The drug is Loperamide (Imodium) and reduces watery diarrhea. It is a very effective drug that can be used in some cases.
However, the presence of blood in the diarrheal stool means that the inner layer of the intestine has been affected. In this case, antibiotics will be needed and Loperamide will no longer be used, as it is important that the bacteria are eliminated from the intestine as soon as possible.
A soft diet containing rice, toast or old bread, salted pretzels, bananas and ripe apples will help reduce the number of loose stools and abdominal pain. Avoid milk and other dairy products because the enzymes that digest lactose have been destroyed during diarrhea. Thus, the lactose will remain in the intestines and carry even more fluid from the body into the intestine, producing even more diarrhea. After a few days, these enzymes will recover. Once the diarrhea is gone, you can resume your normal diet. But add dairy products, caffeinated beverages, and high-fiber foods with caution.
Should I take antibiotics?
This is one of the important questions. An antibiotic is needed in certain circumstances, such as the presence of blood or mucus in the stool or fever. Because it is not always possible to have access to medical care, it is a good idea to discuss this with us before your trip to prescribe an antibiotic to take if you have severe or invasive diarrhea. Alternatives are quinolones Ciprofloxacin or Biseptol.
How can I prevent traveler's diarrhea?
When traveling, use common sense rules. Here are mostly the advice your mother used to tell you when you were a child:
- wash your hands often and always before eating! This natural habit can reduce traveler’s diarrhea by more than 50%. When you can’t wash your hands, use an alcohol-based hand rub.
- don’t eat in a place that looks dirty! When you travel, it all comes down to risk management. Suppose if you eat at this place there is a high chance of getting sick. Are you still taking the risk? It is an individual choice.
- make sure food is well cooked. Be careful when eating seafood or shellfish or avoid them. Eat hot, well-cooked foods (heat kills bacteria). But don’t eat food that has been left out for a long time.
- remember the 2 hour – 1 hour rule. Cooked foods left at room temperature for more than two hours should be discarded. If the ambient temperature is above 32 degrees C, food left outside for more than an hour should be discarded.
- only eat raw fruits and vegetables if you can peel them yourself (like bananas, oranges or avocados). Don’t eat fruits that can’t be peeled, such as grapes or strawberries. Do not eat green vegetables (salad, spinach, cabbage) because they are difficult to wash.
- finally, only drink bottled water. Local/sink, fountain or river water can be dangerous. If you must still use local water, boil it for 3 minutes. Use bottled water to brush your teeth and keep your mouth closed when showering. Do not use ice cubes, as the water may come from the sink. Alcohol in a drink will not protect you from contaminated water or ice. Fruits and vegetables that cannot be peeled should be washed with clean water or avoided if in doubt.