Diarrhea

Traveler’s diarrhea is a digestive tract disorder characterized by loose stools and stomach cramps. It’s typically caused by consuming contaminated food or water. While traveler’s diarrhea can be unpleasant, it’s usually not serious. The risk of developing traveler’s diarrhea increases when visiting regions with different climates or sanitary practices than your home country. To minimize the risk of traveler’s diarrhea, be cautious about what you eat and drink while traveling. In most cases, mild traveler’s diarrhea will resolve on its own. However, it’s advisable to have doctor-approved medications with you when traveling to high-risk areas to be prepared for severe or persistent diarrhea.

Symptoms

Sudden passing of three or more looser watery stools a day An urgent need to pass stool Stomach cramps Nausea Vomiting Fever In some cases, individuals may experience moderate to severe dehydration, ongoing vomiting, a high fever, bloody stools, or severe pain in the belly or rectum. If you or your child exhibits any of these symptoms or if the diarrhea persists for more than a few days, it’s advisable to consult a healthcare professional.  

Causes

While stress and changes in diet may contribute to traveler’s diarrhea, the primary culprits are typically infectious agents such as bacteria, viruses, or parasites. These organisms are often introduced through contaminated food or water. Why aren’t locals affected in the same way? Natives of high-risk countries have often developed immunity to the bacteria and parasites prevalent in their region due to repeated exposure over time. Their bodies have adapted to these organisms, reducing their susceptibility to traveler’s diarrhea.

Risk Factors

Central America South America Mexico Africa South Asia and Southeast Asia While traveling to Eastern Europe, South Africa, Central and East Asia, the Middle East, and certain Caribbean islands also carries some risk, the likelihood of traveler’s diarrhea is generally lower in Northern and Western Europe, Japan, Canada, Singapore, Australia, New Zealand, and the United States. While your destination primarily determines your risk of traveler’s diarrhea, certain groups of people are more susceptible: Young adults: This age group may be slightly more prone to traveler’s diarrhea due to a lack of acquired immunity, a more adventurous approach to travel and dietary choices, or less caution regarding avoiding contaminated foods. People with weakened immune systems: Underlying illnesses or immune-suppressing medications can increase the risk of infections. Individuals with diabetes, inflammatory bowel disease, or severe kidney, liver, or heart disease: These conditions can make you more susceptible to infections or increase the severity of infections. People taking acid blockers or antacids: Reduced stomach acid can create a more favorable environment for bacterial survival. Travelers during certain seasons: The risk of traveler’s diarrhea may vary by season in specific regions. For instance, the risk is highest in South Asia during the hot months preceding the monsoons.

Complications

Dehydration is a significant concern with traveler’s diarrhea due to the loss of vital fluids, salts, and minerals. This can be particularly dangerous for children, older adults, and individuals with weakened immune systems. Dehydration caused by diarrhea can lead to serious complications, including organ damage, shock, or coma. Symptoms of dehydration include: A very dry mouth Intense thirst Little or no urination Dizziness   Extreme weakness Sources and related content

Prevention

Food and Water Safety: Follow the “Boil it, cook it, peel it, or forget it” rule: This general guideline helps minimize the risk of consuming contaminated food or water. Avoid street food: Street vendors may not have the same hygiene standards as established restaurants. Opt for pasteurized dairy products: Avoid unpasteurized milk and dairy products. Cook meat and seafood thoroughly: Ensure meat and seafood are cooked to a safe internal temperature. Avoid moist food at room temperature: Be cautious of sauces and buffet offerings that have not been kept hot. Choose peeled fruits and vegetables: Opt for fruits and vegetables that you can peel yourself, such as bananas, oranges, and avocados. Avoid salads and unpeeled fruits like grapes and berries. Beware of alcohol: Alcohol does not protect against contaminated water or ice. Water Safety: Avoid unsterilized water: Do not drink tap, well, or stream water unless it has been boiled for at least three minutes. Avoid local ice and mixed fruit juices: These may be made with tap water. Beware of sliced fruit: Fruits may have been washed in contaminated water. Use bottled or boiled water for essential tasks: Use bottled or boiled water for preparing baby formula, brushing teeth, and mixing beverages. Opt for hot beverages: Order steaming hot beverages like coffee or tea. Consume canned or bottled drinks carefully: Ensure the seals on canned or bottled drinks are unbroken and wipe off the containers before drinking or pouring. Personal Hygiene: Maintain clean dishes and utensils: Ensure dishes and utensils are clean and dry before use. Practice good hand hygiene: Wash your hands frequently, especially before eating. Use an alcohol-based hand sanitizer with at least 60% alcohol if handwashing is not possible. Handle food with care: Minimize handling of food items during preparation. Protect children: Prevent children from putting dirty hands or objects in their mouths and avoid letting infants crawl on dirty floors. Avoid tap water: Tie a colored ribbon around the bathroom faucet as a reminder not to drink or brush your teeth with tap water. Medication: Avoid unnecessary antibiotics: Public health experts generally do not recommend taking antibiotics to prevent traveler’s diarrhea, as this can contribute to antibiotic-resistant bacteria. Consider bismuth subsalicylate: Some doctors suggest taking bismuth subsalicylate as a preventive measure, as it has been shown to reduce the likelihood of diarrhea. However, consult your doctor before taking it, especially if you are pregnant, allergic to aspirin, or taking certain medications

When to see a doctor

While traveler’s diarrhea often resolves on its own within a few days, it may last longer or be more severe if caused by certain bacteria or parasites. In such cases, prescription medications may be necessary. If you’re an adult, consult a doctor if: Diarrhea persists for more than two days You become dehydrated You experience severe stomach or rectal pain You have bloody or black stools Your fever rises above 102°F (39°C) When traveling internationally, a local embassy or consulate can assist in finding a reputable medical professional who speaks your language. Be especially cautious with children, as traveler’s diarrhea can lead to severe dehydration quickly. Contact a doctor if your child is sick and exhibits any of the following symptoms: Ongoing vomiting Fever of 102°F (39°C) or higher Bloody stools or severe diarrhea Dry mouth or crying without tears Unusual sleepiness, drowsiness, or unresponsiveness Decreased urine output (fewer wet diapers in infants)