Code Brown: Traveller’s Diarrhoea
Everyone loves a holiday, a new adventure, the chance to see new and exciting cultures the uncertainty of if your next bowel movement is just air or something more productive. It’s a sad fact but traveller’s diarrhoea affects over 20% of travellers (some literature puts it as high as 90%) with younger travellers being more at risk. For some it’s a minor inconvenience confining you to your hotel room for others it’s trying to find a suitable place to ‘let it go’ on a sparse mountain side having spent the night laughing at your now recovered friend (this may be based on personal experience).
What, Why and How?
Traveller’s Diarrhoea (TD), is officially classified as three or more unformed stools in a 24 hr period with at least one of the following:
- Fever
- Nausea
- Cramps
- Blood in your stool
Although TD/changes in bowel habits can be caused by stress of travel and or changes to diet, most cases are caused by infection (viruses, bacteria or protozoa). In nearly half of cases no causative agent can be identified. Often infection is acquired through contaminated food or water. The good news is most infections are self-limiting within 3-5 days, although symptoms can persist longer.
Whilst you can be unlucky enough to contract TD anywhere in the world, cases are more common in low-income countries/those with poor food hygiene standards or lack of access to clean water.
Prevention is better than cure
It can be difficult to prevent TD especially if you aren’t in charge of your own food prep but the advice below may reduce your chances of getting an infection:
- Good hand hygiene – soap and water is best, use alcohol gel if hand washing facilities aren’t available.
- Water – avoid tap water if sanitation is poor (even for teeth cleaning), bottled water with an intact seal should be safe. Everyone loves a brew and if made with boiling water and served hot it shouldn’t cause you a problem.
- Sterilisation – If bottled water isn’t available, then you’re going to need to make sure it’s safe yourself. Various methods are available from chlorine through to UV light or simply boiling for 1 minute (increase this time at altitude). Chlorine dioxide tablets are quick and simple method but which ever one you pick, you’ll need to make sure your water doesn’t have anything floating around in it so you may need to filter it as well (more on this in a separate post).
- Food – Stuff you can peel is good, be wary of unpasteurised diary products (especially ice creams with the kids). Food stalls aren’t a no if the food is served hot and cooked in front of you but can pose a risk. Salads are prone to contamination (now you’ve got valid reason to not be healthy), and food that has been left standing and uncovered such as buffets are best avoided.
Whilst taking precautions is advisable no one method is guaranteed. As well as the general pointers above, having a full travel assessment that considers the country, activities and your individual medical history helps you understand the risk and what precautions you need to take.
You’ve got the runs, what now?
As we’ve said luckily most episodes of TD are self-limiting in 3-5 days, your main worry is going to be staying hydrated and ensuring minimal disruption to your holiday.
- Hydration- ensure you’re keeping your fluid intake up (with clean safe fluids), you may need to add in some rehydration salts to keep your electrolytes topped up, if you don’t have any to hand you can make up your own with six level teaspoons of sugar and 1 of salt in 1 litre of water. Diluting some fresh apple juice can be a good option for kids.
- Antimotility agents – These can be used for symptom control, if it’s inconvenient (long bus journeys, stuck on the side of a mountain etc), but the general advice would be to ensure you remain hydrated and let nature take it’s course. In children under 12 these should be avoided and early medical advice should be sought, especially if you have concerns or issues maintaining hydration levels.
- Food – Small quantities of easily digestible foods such as rice or bananas (other plain food is available) should be consumed. Avoid alcohol and spicy foods.
- The other bits – Take regular paracetamol if needed, ensure good hand hygiene. Antibiotics aren’t needed for most people and may make you more susceptible to conditions like C-diff.
Red Flags.
There are a few things to look out for which means you should seek some further medical help.
- A fever of >38°C
- Any blood or mucus in your stool
- Symptoms are not settling as expected.
- Jaundice (you’ve gone yellow like one of the Simpsons)
- Severe abdominal pain
- Reduced urine output, despite good fluid intake.
Its probably best to have a lower threshold for seeking medical advice with younger travellers, the elderly or those with pre- existing medical conditions.
The Bottom Line.
TD is a common illness, taking preventative measures can help lower your risk but may not be completely effective. Your best bet is to travel with a plan to deal with it should you become unwell. Knowing the risk for the country you are travelling to helps you to plan for this and ensures you are appropriately equipped with medications and sterilisation equipment if needed. The good news is if you are unwell the symptoms are normally self-limiting in 3-5 days. Stay hydrated, take pain relief if needed and if you aren’t able to sit it out and have to travel then options like loperamide for most people are a safe bet. If things aren’t going to plan or you have any of the red flags listed above or concerns its best to seek some medical advice.
*The information in this blog is not meant to replace an individual travel assessment. Those intending to travel should ensure they have such an assessment to take into account individual risk factors and medical history. The Travel Medic takes no responsibility should you become ill whilst away.