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Before you go: Traveller's diarrhea

Traveller's Diarrhea is the most common ailment amongst travellers to the tropics. It goes by several names, depending upon where you succumb, such as Montezuma's Revenge, Delhi Belly and Seeping Slickness! Your risk of developing diarrhea depends upon:

  • your destination (some places are worse than others)
  • the precautions you take
  • your style of travel
  • luck (some people are luckier than others)

Fruit standThe Causes
You may become infected through the water you drink, the ice cubes you use, the food that is washed by water such as fruits and vegetables, people handling your food, the flies landing on your food, and food that is not adequately cooked.

There are many causes of diarrhea, most of which are infectious. The commonest causative organisms are bacteria, such as E. coli, Salmonella, Shigella and Campylobacter. Parasites or protozoa such as Giardia lamblia, Entamoeba histolytica, Cyclospora and cryptosporidium occur much less frequently. Cholera, a bacterium, is a very rare cause of diarrhea amongst travellers. Sometimes, diarrhea is not due to infection, but perhaps too much sun, fruit or booze.

Diarrhea may be mild with just some cramps and a few loose bowel movements per day, or much more severe. Dysentery refers to diarrhea associated with blood and pus and fever, and it is usually caused by one of the bacteria. This is the sort of experience that makes some people choose Florida over Mexico!

Prevention

Your best bet is to follow the Mexican proverb "Boil it, bottle it, peel it, cook it .... or forget it" Having said that, this is not always practical, affordable, or polite, depending upon your situation.
meat standTo purify water, the best method is to boil it. It is probably not necessary to boil it for 10 minutes, which might result in you losing most of the water. Rather, just bringing it to a rolling boil is sufficient. Not everyone is completely trusting of bottled water in the tropics. You should ensure that there is an unbroken seal on the bottle. Iodine, which is available as drops or crystals, will adequately purify your water, but might leave an unpleasant taste. Adding some Coolade (it was around in the 60s) will help eliminate that taste. Pristine (chlorine dioxide)  works well against all of the offending organisms and does not leave an aftertaste.
There are several water "purifiers" on the market. They vary in size, price, mechanism and duration of action. For a good selection, you might consider visiting Mountain Equipment Coop or some other well-equipped camping store.

Vegetables can be cooked, or washed in iodine (bleach) and then rinsed with safe water. Meat should be well-cooked, as undercooked beef, pork or fish can be the source of tapeworms, which may grow to thirty feet in length.
Patients ask if they can eat street food. I say sure, as long as it is cooked, well cooked, and cooked before your very own eyes. It’s part of the fun of travelling!

Treatment

In spite of the above advice and precautions, up to 40% of travellers to the tropics will get the runs. So let's talk about self treatment.

  1. Replace your fluid losses, with oral rehydration salts (ORS, Gastrolyte, Pedialyte), flat carbonated drinks, soups (add salt), tea (add sugar) or water, if it is clean.
  2. Lighten your diet, avoid milk products, try bananas, rice water, soda biscuits. When things are getting better, try rice and boiled potatoes. It may be a little while before you can visit the Indian buffet again!
  3. Antiperistaltics (they slow down your bowel) such as Imodium, can safely be used for mild to moderate non-bloody diarrhea. Do not use too much Imodium, or your next bowel movement might not be until the next millennium. Pepto Bismol may also provide some symptomatic relief. There certainly are those who feel that is unadvisable to use antiperistaltics, as they keep the offending bacteria in contact with your bowel for longer. This view is OK, as long as you have time to get over your diarrhea, and have a good source of toilet paper. It is not OK if you have a plane to catch, a camel to ride, or one day to see the Taj Mahal.
  4. Antibiotics, such as Zithromax or Cipro may help, considering that most cases of acute diarrhea are caused by bacteria. For the fastest relief, a combination of Imodium plus the antibiotic is recommended. For those travelling to Southeast Asia, Zithromax would be the preferred choice. For pregnant women and children, again, choose Zithromax. Some people think you need to be on death’s door with bloody diarrhea before reaching for the antibiotic. In my opinion, if you’re uncomfortable, inconvenienced or have a desire to get better quickly, take the antibiotic, even for a day!
  5. Some cases, especially the more chronic, may be assumed or proven to be parasitic infections such as giardiasis or amebiasis, which may be treated with drugs such as metronidazole (Flagyl) or tinidazole (Fasigen).
  6. Xifaxim (rifaximin) is a nonabsorbed antibiotic (available in the USA) which can be used for mild diarrhea likely caused by E. coli.
  7. Probiotics (acidophilus, lactobacillus, saccharomyces, etc.) may also be useful in helping your bowels return to normal. Some people advise taking them prophylactically.

Hopefully after some of the above treatment, you are all better. But this is not always the case.

Remember,
"Travel expands the mind.... but loosens the bowels!"

 
Content (c) Mark Wise
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