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Traveler's Diarrhea

What is traveler's diarrhea?

Traveler's diarrhea is a sudden intestinal infection that you may get when you travel to another country. Other names for this problem are gastroenteritis, Montezuma's revenge, turista, or the GI trots.

Up to half of the people who travel internationally get traveler's diarrhea. High-risk areas include some parts of Latin America, Africa, the Middle East, and Asia. Problems with the water supply and sanitation facilities are more likely in these areas.

What is the cause?

Traveler's diarrhea occurs when you have food, ice, water, or other drinks that contain germs from human or animal bowel movements. The germs may be in cooked or uncooked food. The germs may be a virus, parasite, or bacteria.

Escherichia coli (E. coli) bacteria are often a cause of traveler's diarrhea. E. coli bacteria are normally found in human and some animal intestines. There are many varieties of E. coli bacteria. Usually your body becomes used to the E. coli in your environment and the bacteria do not cause problems. However, exposure to new varieties of E. coli in new places may cause diarrhea.

Sometimes diarrhea while you are traveling is caused by the stress of traveling, jet lag, a different diet, or other things, like stomach flu.

What are the symptoms?

Symptoms may include:

  • Loose stools, as many as 3 to 10 a day
  • Stomach cramps
  • Bloating and gas
  • Nausea and vomiting
  • Fever
  • Weakness
  • Headache

Your symptoms may be mild and not require seeing a healthcare provider during your travels. But in some cases your symptoms may be severe. For example, if you have vomiting and diarrhea for several days, you need to see a healthcare provider.

In other cases your symptoms may not be severe, but they continue for several days or even weeks after you return home.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you.

Your provider will also ask about your travels:

  • Where you have been
  • If you drank well water
  • If you were camping and drank water from streams
  • What food or drinks you have had.

Your provider will also ask about any medicines you may have taken.

A sample of bowel movement may be tested to look for signs of infection and to try to identify the germ. You may also have blood tests.

How is it treated?

You may become dehydrated by the diarrhea. Dehydration happens when your body loses more fluids and salts than it takes in. Dehydration can cause serious problems. It is very important to try to prevent it.

Sports drinks or other oral rehydration solutions (ORS) can help you replace lost salts as well as fluid. You can make a rehydration solution with packets from the drugstore or you can make the drink by mixing:

  • 1 quart or liter of clean water (boil the water 5 minutes if you are not sure it is safe to drink)
  • 2 tablespoons of sugar
  • 1/4 teaspoon salt
  • 1/4 teaspoon of baking soda

Drinking other nonalcoholic drinks made with clean water (boiled or bottled) will also help prevent dehydration, but you may not get all the salts you need. Avoid using ice (especially if you are still out of the US), unless you know it’s made from boiled or bottled water. Try to drink at least 8 ounces of fluid (an ounce or two at a time) for each watery stool you have.

Taking bismuth subsalicylate (for example, Pepto-Bismol or Kaopectate) 4 times a day may help prevent or treat traveler's diarrhea. Do not take it longer than 3 weeks. You don’t need a prescription to get this medicine, but it can have some serious interactions with other medicines. Check with your healthcare provider before you leave on your trip about using it. You should not use it if:

  • You are taking other medicines that interact with it.
  • You are allergic to aspirin.
  • You are pregnant.

You can buy nonprescription medicine to treat diarrhea at the drugstore. If you use it, make sure you use only the dose recommended on the package. Don’t use the medicine for more than 2 days without checking with your healthcare provider. If you have chronic health problems, always check with your provider before you use any medicine for diarrhea.

See a healthcare provider as soon as possible if:

  • You have a fever of 101.5°F (38.6°C) or higher.
  • There is blood in your diarrhea.
  • Your symptoms last more than 2 days.
  • You have severe vomiting or diarrhea.
  • You are feeling faint.

Do not try to treat these serious symptoms on your own.

How long will the effects last?

Traveler's diarrhea usually does not last long. It often stops without treatment in 1 to 5 days. Rarely, it lasts 2 to 3 weeks.

How can I take care of myself?

If you are traveling to a place where you think you might get traveler's diarrhea:

  • Talk to your healthcare provider about your plans.
  • Take several packets of oral rehydration salts with you.
  • Carry a few Kaopectate, Imodium, or Lomotil tablets with you for emergencies (for example, to avoid toilet accidents while you are on an airplane).

If you get diarrhea:

  • It’s OK to keep eating as long as it doesn’t seem to make the diarrhea or stomach cramps worse. Foods that are easiest to digest are bananas, cooked cereal, plain rice or noodles, gelatin, eggs, toast or bread, crackers, cooked potatoes or carrots, and applesauce. Don’t add butter or margarine to these foods. Avoid milk products and caffeine for a few days. If the diarrhea seems to get worse after you eat, stop eating for a few hours and drink just clear liquids. This will give your bowel a rest.
  • If you would like to let your bowel rest for a few hours, don’t eat anything and drink only clear liquids. Clear liquids include water, weak tea, broth, apple or grape juice mixed with water, and sports drinks or other oral rehydration drinks. You may also drink light-colored soft drinks without caffeine (like 7 UP) after stirring until the bubbles are gone. Drink enough clear fluids to keep your urine light yellow in color. If you don’t drink enough, you may get dehydrated. Getting dehydrated can be very dangerous, especially for children, older adults, and some people who have other medical problems. Suck on ice chips or Popsicles if you feel too sick to drink fluids.

How can I prevent traveler's diarrhea?

Follow these guidelines:

  • Don’t drink untreated water. This includes avoiding ice cubes in drinks.
  • If you are camping or won’t be where you can buy bottled water, bring a way to purify water, such as a filter or purifier, chlorine or iodine tablets, or a pot and stove for boiling water. If you need to buy a water filter or purifier, buy one that can filter out organisms as small as the ones that cause giardiasis, cholera, and amoebic diarrhea.
  • Carry a liter of purified water.
  • Avoid food and drinks from street vendors.
  • Eat only foods that are cooked and still hot, or fruits and vegetables that you peel yourself.
  • Do not eat raw or partially cooked fish or shellfish, including such dishes as ceviche. Fully cooked fish and shellfish are safe.
  • Brushing your teeth with toothpaste and untreated water is usually safe. Most toothpastes contain antibacterial substances. Do not swallow the water.
  • Carbonated water and soft drinks, bottled water, wine, and beer are usually safe without ice. Do not add ice that has been made from tap water.
  • Avoid uncooked dairy products.

If your healthcare provider recommends it, you can also take bismuth subsalicylate to help prevent diarrhea. Be sure to follow the instructions carefully.

You may discuss with your healthcare provider the pros and cons of taking antibiotics with you on your trip. The US Centers for Disease Control and Prevention (CDC) does not recommend taking an antibiotic to keep you from getting diarrhea. Most current recommendations are to start antibiotics only if you have diarrhea. The medicines may cause side effects, including an increased risk of sunburn and allergic reactions. Ask your provider about side effects.

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Published by RelayHealth.
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