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.

About 20 to 50% of international travelers get traveler's diarrhea. High-risk destinations include low-income countries in Latin America, Africa, the Middle East, and Asia.

How does it occur?

Traveler's diarrhea occurs when you have food, ice, water, or other drinks that contain organisms from human bowel movements. Cooked or uncooked food may be contaminated. The cause of the infection can 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 intestinal problems. However, exposure to new varieties of E. coli may cause diarrhea.

Sometimes traveler's diarrhea is caused by the stress of traveling, jet lag, a different diet, or other factors.

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).

How is it diagnosed?

Your health care provider will ask about your symptoms, including:

• the amount of diarrhea
• if you also have blood, mucus, or bad-smelling 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 or spring water
• what locally prepared food and drink you 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. 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 occurs when your body loses more fluids and salts than it takes in. Dehydration can cause serious problems, so it is very important to try to prevent it.

To replace lost fluids and salts, you can make a rehydration solution with packets of oral rehydration salts, which you can buy 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.

Drinking other nonalcoholic drinks made with clean water will also help prevent dehydration, but you may not get all the salts you need. Try to drink at least 8 ounces of fluid for each watery stool you have.

Taking bismuth subsalicylate (for example, Pepto-Bismol) 4 times a day may help treat and prevent traveler's diarrhea. Do not take it longer than 3 weeks. Bismuth subsalicylate can have some serious interactions with other medicines. Check with your health care provider before using this method. You should not use this nonprescription medicine if:

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

Be cautious about taking nonprescription antidiarrheal medicines such as loperamide (Kaopectate or Imodium) or the prescription medicine Lomotil. These medicines can actually make the illness more severe, especially if the diarrhea is bloody. Do not use these medicines every day to control diarrhea. Do not give antidiarrheal medicine to small children.

See a health care provider as soon as possible if you have:

• a high fever (102°F, or 39°C)
• blood in your diarrhea
• symptoms that last more than 48 hours.

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

How long will the effects last?

Traveler's diarrhea is usually a short-lived problem and will often stop 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 health care provider about your concerns.
• 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 traveling).

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, bouillon, apple juice, or sports drinks or other oral rehydrating solutions. 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 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, plain noodles, plain gelatin, toast or bread with jelly, and applesauce. Avoid milk products for a few days. Return to your normal diet after 2 or 3 days, but for several days avoid fresh fruit (other than bananas), alcohol, greasy or fatty foods such as cheeseburgers or bacon, and spicy foods. Avoid most fresh vegetables. Cooked carrots, potatoes, and squash are fine. If eating seems to worsen the diarrhea, let your bowel rest for a few hours by drinking just clear liquids.

How can I prevent traveler's diarrhea?

Follow these guidelines:

• Do not drink untreated water, including ice cubes in drinks.
• Bring some means to purify water, such as a filter or purifier, chlorine or iodine tablets, or a pot and stove for boiling water. If you are buying a water filter or purifier, buy one that can filter out organisms as small as those that cause giardia, cholera, and amoebic diarrhea.
• Carry a liter of purified water.
• Avoid food and beverages 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 untreated water is usually safe. Most toothpastes contain antibacterial substances. Do not swallow the water.
• Carbonated soft drinks and water, 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 health care provider the pros and cons of taking antibiotics with you. Most current recommendations are to start antibiotics only if you develop symptoms of diarrhea. Doxycycline and Bactrim or Septra have been used in the past. However, bacteria are becoming resistant to these medicines. Your provider may prescribe other medicines. The usual prescription is for 3 days only. The medicines may cause side effects, including an increased risk of sunburn and allergic reactions.