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.

How does it occur?

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 the human intestine. 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?

You may have the following symptoms:

• loose stools, as many as 3 to 10 a day
• stomach cramps
• bloating and gas
• nausea and vomiting
• fever
• weakness
• headache (sometimes).

Your symptoms may be mild and not require seeing a healthcare provider during your travels. But in some cases you may keep having diarrhea and other symptoms after you return home.

How is it diagnosed?

Your healthcare provider will ask about your symptoms, including:

• the amount of diarrhea
• if you also have blood or mucus in your stool,
• if you are having a lot of gas
• if you have had vomiting, nausea, high fever, or weight loss.

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 used.

Your provider will examine you. 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. These tests help find what is causing the diarrhea.

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.

To replace lost fluids and salts, you can make a drink with packets of oral rehydration salts. You can buy the packets at a drugstore. You can also make a rehydration solution 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.

Or you can buy a solution that is already made. One brand is Pedialyte.

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 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 do not 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.

Be cautious about taking antidiarrheal medicines. Nonprescription medicines such as loperamide (sold as Imodium and other trade names) or the prescription medicine Lomotil can make you sicker, especially if you have fever or the diarrhea is bloody. If you take one of these medicines, make sure you use only the dose recommended on the package. Do not use these medicines every day to control diarrhea. They can keep the germs causing the diarrhea in the intestine. Do not give antidiarrheal medicine to small children. If you have chronic health problems, always check with your healthcare 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:

• You may want to let your bowel rest for a few hours by drinking only clear liquids such as water, weak tea, broth, apple juice, or sports drinks or other oral rehydrating solutions. All of these drinks should be made with boiled or sealed, bottled water. You may also drink soft drinks without caffeine (such as 7 UP) after letting them lose some of their carbonation (go flat). Make sure you drink often so that you do not become dehydrated. Suck on ice chips or Popsicles if you feel too nauseated to drink fluids.
• It is OK to keep eating as long as it does not seem to worsen the diarrhea or stomach cramps. Foods that are easiest to digest are soft starchy foods, such as bananas, cooked cereal, rice, potatoes, plain noodles, plain gelatin, toast or bread, and applesauce. Avoid milk products for a few days. Return to your normal diet after 2 or 3 days, but for several days avoid raw fruit (other than bananas), alcohol, greasy or fatty foods such as cheeseburgers, pizza, or bacon, spicy foods, and most raw vegetables. Cooked carrots, potatoes, and squash are fine. 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.

How can I prevent traveler's diarrhea?

Follow these guidelines:

• Do not 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.

You may discuss with your healthcare provider the pros and cons of taking antibiotics with you on your trip. Most current recommendations are to start antibiotics only if you have diarrhea. Doxycycline, Bactrim, Septra, and ciprofloxacin (Cipro) have been used in the past. However, bacteria are getting resistant to these medicines. The usual antibiotic prescription is for 3 days only. The medicines may cause side effects, including an increased risk of sunburn and allergic reactions. Ask your provider about side effects.

The US Centers for Disease Control and Prevention (CDC) does not recommend preventive antibiotics. Taking antibiotics throughout your trip to try to prevent infection puts you at risk for infection with germs that are resistant to most antibiotics. The CDC does recommend the use of bismuth subsalicylate, as described above for prevention and treatment, if you need it for prevention in addition to the other safety steps.