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 people from industrialized nations who travel to less developed countries get traveler's diarrhea. High-risk destinations include countries in Latin America, Africa, the Middle East, and Asia.

How does it occur?

Traveler's diarrhea occurs when you have food or drinks that are contaminated with 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, when you are exposed to new varieties of E. coli bacteria, your body may react to substances produced by the bacteria. These toxins may interfere with your intestine's ability to absorb water. This causes 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
• dehydration (excessive loss of body fluids)
• 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.

If you have had diarrhea for more than several days or it is causing other symptoms, your health care provider may examine you. A sample of bowel movement may be tested. You may also have blood tests. These tests may 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 use 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 (or boiled) water, 2 tablespoons of sugar, 1/4 teaspoon salt, and 1/4 teaspoon of baking soda. Drinking other nonalcoholic drinks made with clean water will also help prevent dehydration, but they may not restore all the salts you need. Try to drink at least 8 ounces of fluid for each watery stool you have.

Traveler's diarrhea is usually a short-lived problem and will often stop without treatment. Nonprescription medicines such as Kaopectate are of little help and can actually be worse than nothing, especially if the diarrhea is bloody. If you have a high fever (102°F, or 39°C), blood in your stool, or symptoms that last for more than 48 hours, do not try to treat your symptoms with medicine. See a health care provider as soon as possible.

Do not give antidiarrheal medicine to small children.

How long will the effects last?

The diarrhea usually stops on its own within 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.
• 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 and several packets of oral rehydration salts.
• Carry a few Imodium or Lomotil tablets with you for emergencies (for example, to avoid toilet accidents while you are traveling).
• If you get diarrhea, avoid alcohol, coffee, and all milk products (milk, cheese, cream, pudding, etc.), most fresh vegetables and fruits (citrus, tomatoes, etc.), red meats, and heavily seasoned foods. If you have no diarrhea after 6 to 12 hours, slowly begin to eat clear soup, salted crackers, dry toast or bread, and milk-free sherbet.

  Over the next few hours to 1 to 2 days, slowly add bananas, applesauce, rice, baked potato, and low-fat chicken soup with rice or noodles, and any plain noodles or pasta to your diet. After about 3 days your stools will begin to have shape and you may resume your normal diet, cautiously adding milk products and high-fiber foods.

How can I prevent traveler's diarrhea?

Follow these guidelines:

• Do not drink untreated water, including ice cubes in drinks.
• 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), but do not swallow the water.
• Carbonated soft drinks and water, bottled water, wine, and beer are usually safe as long as you 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, but more organisms are becoming resistant to these medicines. Your health care provider may prescribe ciprofloxacin or norfloxacin instead. The usual prescription is for 3 days only. These medicines can cause side effects, including sensitivity to the sun.