Traveler's diarrhea: Preventing and treating runs on the road

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're traveling for pleasure, school, or work. What you're referring to is "traveler's diarrhea," which is one of the most common illnesses among travelers. It's difficult and sometimes impossible to prevent, but taking actions such as being thoughtful about the food and drink choices and regularly washing your hands can help reduce the risk. 

Often lasting for several days, traveler's diarrhea is identified by having loose bowel movements in a within several days of beginning travel or returning home. 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 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 people need to be particularly cautious.

Some people experience traveler's diarrhea when visiting countries with inadequate hygiene and public sanitation. Food or beverages contaminated with bacteria, viruses, 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:

  • Always wash your hands before meals.
  • Stay away from unpasteurized milk and other dairy products.
  • Avoid drinking tap water (unless you know that it has been boiled sufficiently). Some beverages that are lower-risk to drink include hot tea, coffee, and other hot drinks made with boiled water, as well as bottled or canned beverages. Note that condensation on canned or bottled beverages may be contaminated, so clean before drinking from them.
  • Omit ice cubes in drinks and foods if you're unsure if it's been made with clean water. 
  • Keep your mouth closed while showering, bathing, or swimming to prevent accidental ingestion of tap water.
  • Avoid brushing your teeth with tap water — use bottled or carbonated water instead.
  • 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 aren't served piping hot.
  • 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.
  • Steer clear of food and drinks from street food vendors.

It may be 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 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 in case you need them. 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, availability, and cost of medical care varies from country to country. Of course, if you're feeling extremely unwell or if you don't feel better after several days, it's recommended to seek 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 don't 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 aren't too sweet. As you get better, switch to some soft, bland foods, that are easy to digest such as bananas, (plain) rice, applesauce, and toast (also known as the BRAT diet). 

If you do become dehydrated, you may need to drink an 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. You can also make your own with salt, sugar, and clean water.

Hope you have a wonderful and healthy trip,

Last updated Apr 08, 2022
Originally published May 05, 2000

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