Traveler’s diarrhea leads to frequent diarrhea three to 10 times a day, often with vomiting, abdominal cramps, bloating, and gas. This scourge, also known as “Montezuma’s revenge,” is common among travelers to Mexico and other Latin American countires, as well as to the semitropical regions of Africa, Asia, and the Middle East. Between 30 to 70 percent of people traveling to developing countries are laid low with diarrhea, depending on season and destination as well as individual susceptibility. However, some people get traveler’s diarrhea when entering the United States or other industrialized nations, or when traveling on cruise ships. Any change of locale and eating habits can make you more vulnerable.
What causes traveler’s diarrhea?
Eighty to 90 percent of traveler’s diarrhea is caused by bacteria, including certain strains of E. coli found in fecal matter, as well as other bacteria that are transmitted via contaminated food or water. It can also be caused by viruses such as norovirus and by parasites such as Giardia lamblia. Symptoms usually appear within six to 72 hours, with sudden attacks of loose watery stools, often accompanied by abdominal cramps and nausea.
What if you do nothing?
Traveler’s diarrhea is not life threatening in otherwise healthy people. If you drink plenty of water, you may be uncomfortable, but the condition will clear up on its own—often within two to seven days. In some cases, mild symptoms may last for weeks. However, if a parasite such as Giardia lamblia is to blame, symptoms may last for months.
Home remedies for traveler’s diarrhea
- Replace lost fluids. Your goal is to prevent dehydration, which occurs often with diarrhea because the body loses more fluids and electrolytes than it takes in. The most important self-care measure is to rehydrate yourself as soon as you can keep down fluids. Bottled water, flat soft drinks, sports drinks, or tea will help. Some travelers carry a powdered hydration mix with them—you can buy these online or in drug stores—and mix it with bottled water. You can also make your own rehydration drink by adding four teaspoons of sugar and ½ teaspoon salt to a quart of bottled water. Note: Children under age two should drink a commercial rehydration solution, which contains the correct amounts of fluid, salts, and carbohydrates to prevent dehydration.
- Avoid coffee and alcohol. Caffeine and alcohol can increase dehydration.
- Eat. If you have no diarrhea after 12 hours, salted crackers are a good way to begin eating again, and the salt helps restore fluid balance. Other foods to consider include dry toast, bread, and clear soup. When the number of stools decreases and your stools have shape, you can add rice, baked potatoes, clear soup, poultry, applesauce, and bananas. Avoid raw fruits and salads.
- Self-treat with medication, if necessary. If you are otherwise healthy, it’s generally best if you give your body a chance to eliminate the germ or parasite causing the diarrhea. However, if you are in a situation where diarrhea is inconvenient, you can decrease symptoms with over-the-counter medications. Loperamide (such as Imodium) reduces the duration of diarrhea by up to 80 percent. Bismuth subsalicylate (Pepto-Bismol, which is also sold in generic forms) reduces the number of loose stools by about 60 percent. But people who are aspirin-sensitive, have kidney disease or gout, or are taking anticoagulants should not use bismuth subsalicylate. Nor should children under age 12. (If you are on aspirin therapy, talk with your doctor before taking any anti-diarrhea medications.)
- Get a prescription for antibiotics before you travel. If you’re traveling to areas without doctors close by, ask your own doctor to write you a prescription for antibiotics, and fill it before you leave on your trip. Your doctor can give you directions as to when and how to take the antibiotic. These drugs are generally reserved for when you have fever and bloody stool.
- If you have high fever or bloody stools on your trip, seek immediate medical attention. These symptoms can be signs of a serious infection. Don’t take anti-diarrhea medicines if you have a high fever or bloody stools—the medications may make your condition worse.
How to prevent traveler’s diarrhea
When traveling in developing countries, follow these recommendations.
- Find out about health precautions. The Centers for Disease Control and Prevention (CDC) travel page can supply you with information about health risks in different countries. It’s also a good idea to get advice from a doctor who specializes in travel medicine before you go, especially if you are pregnant, nursing, traveling with a small child, or have chronic health problems. Also consult with a travel medicine specialist if you’re taking a critically important business trip that would be compromised if you developed traveler’s diarrhea.
- Take diarrhea medications with you. If you’re traveling to an out-of-the-way place, take a diarrhea treatment along. If you have any health concerns, consult your doctor, who can recommend an over-the-counter product or a prescription medication such asdiphenoxylate/atropine (brand name Lomotil).
- Consider taking Pepto Bismol once you arrive. Many travel medicine professionals advise taking Pepto Bismol prophylactically throughout your trip. It can cut the risk of traveler’s diarrhea by as much as 50 percent. But the protocol is precise, requires taking a lot of chewable tables, and must be followed exactly to gain benefit. Chew two tablets right before each meal and at bedtime. The drug may temporary stain your tongue and stool black. (Again, if you are on aspirin therapy, talk with your physician first.)
- Don’t rely on antibiotics or anti-diarrheal drugs other than Pepto Bismol to prevent traveler’s diarrhea. It’s certainly a good idea to carry antibiotics and anti-diarrhea medicine with you when you travel, along with instructions on how to use them should the need arise. But with the exception of Pepto Bismol (see bullet above), using them prophylactically is generally not recommended, and some medications can produce severe side effects. In addition, taking them can give a false sense of security to travelers who might otherwise be cautious in their choice of food and drink. Note: If you have a health problem, your doctor may want you to take antibiotics before you travel. Follow your doctor’s advice.
- Once you’ve arrived, drink only bottled or canned beverages. Be sure you’re the one who breaks the seal. Or stick to hot drinks like tea or coffee made with boiling water. Bottled wine and beer are safe. Avoid fresh juice because tap water or ice may have been added. Also avoid unpasteurized milk. If in doubt, stick to piping hot tea and coffee.
- Never use tap water. Use bottled or boiled water instead, even for brushing your teeth. Don't swallow water in the shower.
- Pass up all ice cubes. The cubes may have been made with contaminated water, and freezing does not kill most microbes. Avoid ice cream if it’s been made with unsafe water.
- Don’t eat anything raw—particularly salad greens. Raw fruit is okay only if it can be peeled and if you do the peeling. Be certain not to wash the fruit in tap water. Pass on salsa sauces and chutneys, as well as any sauce or topping made from raw fruit or vegetables. Avoid rare meats, undercooked eggs, fish or shellfish, and all dairy products because you can’t be sure they’ve been pasteurized.
- Stick with food served piping hot. That means avoiding buffets where the food is left standing at low temperatures, where it may have been exposed to flies carrying germs.
- Don’t buy food from street vendors. Even if it’s served hot, it still may be contaminated.
- Wash your hands carefully. To prevent the spread of diarrhea and eliminate all chances of reinfection, be sure to wash your hands with soap and water after using the bathroom and before eating. Disinfecting alcohol wipes are useful when you have no clean water to wash with.
What your doctor will do
Contact a doctor if you have diarrhea that lasts more than four days without improvement, a fever of 101?F or higher that lasts more than 24 hours, or if there is blood in your stool. A doctor also should be contacted immediately if severe diarrhea occurs in infants, elderly people, or people with heart disease.
The doctor will review all your symptoms and perhaps take a stool sample to detect the organism causing your problem. If you have frequent diarrhea and painful cramps, the doctor may prescribe medications to relieve symptoms, especially if you have serious heart disease or a weakened immune system. Treatment will stop the diarrhea in about a day, compared to two to four days without medication. Anti-diarrhea medicine can slow your body’s ability to eliminate the germ from your digestive tract, so the doctor may not recommend it if you are otherwise healthy.
Also see Anal Itching: Causes and Treatments.