Dear Alice,

How do you eliminate diarrhea, especially from traveling in another country?

Dear Reader,

Getting the runs on the road is no way to enjoy a trip, whether you are traveling for pleasure, school, or work. What you're referring to is "traveler's diarrhea," which affects approximately 20 to 50 percent of all globetrotters, according to the World Health Organization (WHO). It's difficult and sometimes impossible to prevent — but the information might help you prevent and, if necessary, treat any traveler's diarrhea. 

Often lasting for several days, traveler's diarrhea is identified by having at least three loose bowel movements in a 24-hour period. It can range from a mild nuisance (having loose stools but feeling fine otherwise), to serious diarrhea that requires a prescription, and possibly medical attention. Serious traveler's diarrhea, when you feel sick and are having diarrhea, means having any or some of the following symptoms (varying in severity and/or frequency):

  • Vomiting
  • Abdominal cramps
  • Bloating
  • Nausea
  • Fever and chills
  • Blood in stool
  • Dehydration (symptoms include feeling thirsty, peeing less often, dry skin, exhaustion, wooziness or faintness)

Although traveler's diarrhea is hardly ever fatal, infants, children, the elderly, immunocompromised persons, and pregnant women need to be particularly cautious.

Some people experience traveler's diarrhea when visiting developing countries in particular due to inadequate hygiene and public sanitation. Food or beverages contaminated with bacteria, viruses, and/or parasites (such as protozoa) that visitors are unaccustomed to are the usual culprits, with bacteria accounting for the majority of infections. Avoiding these possibly infectious foods or beverages is your best bet at preventing diarrhea in the first place. Here are some tips to aid your prevention efforts:

  • Don't drink tap water (unless you know that it has been boiled sufficiently). Some beverages that are probably safe to drink include hot tea, coffee, and other hot drinks made with boiled water, as well as bottled or canned water, soda, beer and wine. Note that condensation on canned or bottled beverages may be contaminated, so clean before drinking from them.
  • Omit ice cubes in drinks and foods. This means no shaved ice or popsicles as well.
  • Pass up foods that were rinsed under tap water or that you can't peel yourself, such as raw fruits and veggies (i.e., salads). If you can peel the fruit yourself, it's probably safe to eat.
  • Avoid consuming meals that may not have been cooked or reheated enough to kill microorganisms, or are not served piping hot, such as lasagna, quiche, casseroles, and cold soups.
  • Don't eat any raw or inadequately cooked food, such as meat, seafood, and eggs. Note that some kinds of fish and shellfish still may not be safe to eat even when fully cooked because they can contain poisonous biotoxins.
  • Stay away from unpasteurized milk and other dairy products.
  • Steer clear of food and drinks from street food vendors.
  • Avoid brushing your teeth with tap water — use bottled or carbonated water instead.
  • Keep your mouth closed while showering, bathing, or swimming to prevent accidental ingestion of tap water.
  • Always wash your hands before meals.

It's useful to talk with your health care provider about traveler's diarrhea and other travel health-related concerns, including required immunizations, before your trip. Make sure to discuss detailed information about the signs and symptoms of bacterial, viral, and parasitic traveler's diarrhea, prevention and preparation tips, and various treatments (antidiarrheal and antimicrobial drugs) to alleviate the symptoms and/or shorten the duration of the illness. For example, many travel medicine programs or clinics will give a prescription for antibiotics to take with you on your trip. This has been shown to lessen the severity of diarrhea in 80 percent of people who get it. After meeting with your health care provider, you'll be informed and prepared in case it's not possible for you to see a provider or visit a health care facility, as the quality of medical care varies from country to country. Of course, if you're feeling extremely unwell, or if you do not feel better after several days, find a hospital for medical attention as soon as possible.

Dehydration is the main concern when traveler's diarrhea climbs on board, but it can be prevented. If you happen to get traveler's diarrhea, drink plenty of fluids, even if you're not thirsty, to avoid the dehydrating effects of diarrhea. Bottled or canned carbonated water or other soft drinks that do not contain caffeine (as it can exacerbate diarrhea) are usually safe to drink. Avoid any alcoholic beverages. If you have no appetite, don't eat; if you're hungry, first try non-greasy, low fiber foods that are not too sweet. As you get better, switch to some soft, bland foods, such as bananas, (plain) rice, applesauce, and toast (a.k.a., the BRAT diet). Boiled potatoes, salted soda crackers, cooked carrots, and skinless and de-fatted baked chicken are other good possible options.

If you do become dehydrated, you may need to drink a special oral rehydration solution (ORS) beverage to restore your water and electrolyte (salts, such as sodium and potassium) balance. You may want to bring along some pre-prepared packages of ORS powder with you on your trip; they are available at some drug stores. For more specific information about ORS, talk with your health care provider.

For more detailed information on traveler's diarrhea, and travel health in general, check out the following web sites:

Hope you have a wonderful and healthy trip,


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