Everything you need to know about traveller’s diarrhoea

Traveller’s diarrhoea is a disease that commonly causes watery stools and abdominal cramps, caused by eating contaminated food or drinking contaminated water. It is not normally deadly, unless there is significant dehydration.

A person is at increased risk of getting it if they visit a place where the climate or sanitary practices are different from what they have at home. To reduce risk of the disease, be careful about what you eat and drink while travelling. It is also a good idea to have doctor-approved medications with you when you travel to high-risk areas, in case diarrhoea persists.

Signs and symptoms may last longer and be more severe if the condition is caused by organisms other than common bacteria. If you have severe dehydration, persistent vomiting, bloody stools or a high fever, or if your symptoms last for more than a few days, see a doctor urgently. Children are most at risk of severe dehydration in a short time.

Call a doctor if your child is sick and exhibits any of the following signs or symptoms:

• Persistent vomiting
• Bloody stools
• severe diarrhea
• A fever of 390C or more
• Dry mouth or crying without tears
• Signs of being unusually sleepy, drowsy or unresponsive
• Decreased volume of urine, including fewer wet diapers in infants.

Causes

Most of the time it is due to the infection from eating food or drinking water contaminated with organisms from faeces. Basically, various bacteria, viruses or parasites enter your digestive tract and overpower your immune system, resulting in signs and symptoms of traveller’s diarrhoea. The most popular cause is the bacteria E Coli, which attaches itself to the lining of your intestine and releases a toxin that causes diarrhoea and abdominal cramps.

It can also be because of the stress of travelling or a change in diet.

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Symptoms of traveller’s diarrhoea

The symptoms usually begin during your trip or shortly after you return home. Most cases improve within one to two days without treatment and clear up completely within a week. However, you can have multiple episodes of traveller’s diarrhoea during one trip.

The most common signs and symptoms of traveller’s diarrhoea are:

• Three or more loose stools a day
• An urgent need to defecate
• Abdominal cramps
• Nausea
• Vomiting
• Fever

Sometimes, people experience moderate to severe dehydration, persistent vomiting, a high fever, bloody stools, or severe pain in the abdomen or rectum. For these please see a doctor.

Risk factors

High-risk destinations for traveller’s diarrhoea include many areas of Central and South America, Mexico, Africa, the Middle East and most of Asia. This does not mean you are definitely not at risk if you go to more modernised parts of the world. But certain groups of people have a greater risk of developing the condition.

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They include:

• Young adults. Mainly because they can be more adventurous than older people in their travels and dietary choices, or may be less vigilant in avoiding contaminated food.
• People with weakened immune systems. A weakened immune system increases vulnerability to infections
• People with diabetes, inflammatory bowel disease or cirrhosis of the liver. These conditions can leave you more prone to infection or increase your risk of a more-severe infection
• People who take acid blockers or antacids. Acid in the stomach tends to destroy organisms, so a reduction in stomach acid may leave more opportunity for bacterial survival.

Complications

Dehydration is the main complication and can be dangerous for children, older adults and people with weakened immune systems. Dehydration caused by diarrhoea can cause serious complications, including organ damage, shock or coma.

Signs and symptoms of dehydration include a very dry mouth, intense thirst, little or no urination and extreme weakness.

How to prevent traveller’s diarrhoea

• The golden rule of travel is: boil it, cook it, peel it or forget it
• Avoid food from street vendors
• Avoid unpasteurised milk and dairy products, including ice cream
• Avoid raw or undercooked meat, fish and shellfish
• Steer clear of moist food at room temperature, such as sauces and buffet offerings
• Eat foods that are well-cooked and served piping hot
• Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados
• Stay away from salads and unpeelable fruits, such as grapes and berries
• Be aware that alcohol in a drink won’t keep you safe from contaminated water or ice
• Don’t drink the water. Use bottled water that must be properly sealed. If you need to consume local water, boil it for three minutes
• Avoid locally made ice cubes or mixed fruit juices made with tap water
• Beware of sliced fruit that may have been washed in contaminated water
• Don’t swim in water that may be contaminated
• Keep your mouth closed while showering
• Feel free to drink canned or bottled drinks in their original containers – including water, carbonated beverages, beer or wine – as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring
• Use bottled water to brush your teeth
• Use bottled or boiled water to mix baby formula
• Order hot beverages, such as coffee or tea, and make sure they’re steaming hot
• Make sure dishes and utensils are clean and dry before using them
• Wash your hands often and always before eating. If washing isn’t possible, use an alcohol-based hand sanitiser with at least 60% alcohol to clean your hands before eating.
• Seek out food items that require little handling in preparation.
• Keep children from putting things – including their dirty hands – in their mouths. If possible, keep infants from crawling on dirty floors.

Other preventive measures

Do not take antibiotics as a preventative measure, because doing so can contribute to the development of antibiotic-resistant bacteria. Antibiotics provide no protection against viruses and parasites, but they can give travellers a false sense of security about the risks of consuming local foods and beverages. They can also cause unpleasant side-effects, such as skin rashes, skin reactions to the sun and vaginal yeast infections.

As a preventive measure, some doctors suggest taking bismuth subsalicylate (Pepto-Bismol), which has been shown to decrease the likelihood of diarrhoea. However, don’t take this medication for longer than three weeks, and don’t take it at all if you’re pregnant, allergic to aspirin, or taking certain medications, such as anticoagulants. Common harmless side-effects are a black-coloured tongue and dark stools.