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Traveler’s diarrhea

Traveler’s diarrhea is a digestive tract disorder that commonly causes loose stools and abdominal cramps. It’s caused by eating contaminated food or drinking contaminated water. Fortunately, traveler’s diarrhea usually isn’t serious — it’s just unpleasant.

When you visit a place where the climate, social conditions, or sanitary standards and practices are different from yours at home, you have an increased risk of developing traveler’s diarrhea.

Being careful about what you eat and drink while traveling can reduce your risk of traveler’s diarrhea. If you do develop traveler’s diarrhea, chances are it will resolve without treatment. However, it’s a good idea to have doctor-approved medications with you when you travel to high-risk areas in case diarrhea persists.

Traveler’s diarrhea usually begins abruptly 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 traveler’s diarrhea during one trip.

The most common signs and symptoms of traveler’s diarrhea are:

  • Abrupt onset of passage of 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. If you or your child experiences any of these signs or symptoms or if the diarrhea lasts longer than a few days, it’s time to see a doctor.

When to see a doctor

Traveler’s diarrhea usually goes away on its own within several days. Signs and symptoms may last longer and be more severe if the condition is caused by organisms other than common bacteria. In such cases, you may need prescription medications to help you get better.

If you have severe dehydration, persistent vomiting, bloody stools or a high fever, or if your symptoms last for more than a few days, seek medical help. The local embassy or consulate may help you find a well-regarded medical professional who speaks your language.

Be especially cautious with children because traveler’s diarrhea can cause 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 or severe diarrhea
  • A fever of 102 F (39 C) 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
It’s possible that traveler’s diarrhea may stem from the stress of traveling or a change in diet. But almost always an infectious agent is to blame.

You typically develop traveler’s diarrhea after ingesting food or water that’s contaminated with organisms from feces. These organisms are infectious agents — including various bacteria, viruses and parasites — that enter your digestive tract and overpower your defense mechanisms, resulting in signs and symptoms of traveler’s diarrhea.

The most common cause of traveler’s diarrhea is enterotoxigenic Escherichia coli (ETEC) bacteria. These bacteria attach themselves to the lining of your intestine and release a toxin that causes diarrhea and abdominal cramps.

So why aren’t natives of high-risk countries affected in the same way? Often their bodies have become accustomed to the bacteria and developed immunity to them.

Each year millions of international travelers experience traveler’s diarrhea. High-risk destinations for traveler’s diarrhea include many areas of Central and South America, Mexico, Africa, the Middle East and most of Asia.

Traveling to Eastern Europe and a few Caribbean islands also poses some risk. However, your risk of traveler’s diarrhea is generally low in Northern and Western Europe, Japan, Canada, Australia, New Zealand and the United States.

Your chances of getting traveler’s diarrhea are mostly determined by your destination. But certain groups of people have a greater risk of developing the condition. These include:

  • Young adults. The condition is slightly more common in young adult tourists. Though the reasons why aren’t clear, it’s possible that young adults lack acquired immunity, they may be more adventurous in their travels and dietary choices, or they may be less vigilant in avoiding contaminated foods.
  • People with weakened immune systems. A weakened immune system increases vulnerability to infections.
  • People with diabetes or inflammatory bowel disease.These conditions can leave you more prone to 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.
  • People who travel during certain seasons. The risk of traveler’s diarrhea varies by season in certain parts of the world. For example, risk is highest in South Asia during the hot months just before the monsoon.
Because you lose vital fluids, salts and minerals during a bout with traveler’s diarrhea, you may become dehydrated. Dehydration is especially dangerous for children, older adults and people with weakened immune systems.

Extreme fluid loss caused by diarrhea 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.

Because traveler’s diarrhea tends to resolve itself, you may get better without any intervention. It’s important to try to stay hydrated with safe liquids, such as bottled water or canned juice. If you don’t seem to be improving quickly, you can turn to several medications to help relieve symptoms.

  • Anti-motility agents. These agents — which include loperamide (Imodium A-D) and drugs containing diphenoxylate (Lomotil, Lonox) — provide prompt but temporary relief by reducing muscle spasms in your gastrointestinal tract, slowing the transit time through your digestive system and allowing more time for absorption.Anti-motility medications aren’t recommended for infants or people with fever or bloody diarrhea, as they can delay clearance of the infectious organisms and make the illness worse.Also, stop using anti-motility agents after 48 hours if you have abdominal pain or your signs or symptoms worsen and your diarrhea continues. In such cases, see a doctor.
  • Bismuth subsalicylate (Pepto-Bismol). This over-the-counter medication can decrease the frequency of your stools and shorten the duration of your illness. However, it isn’t recommended for children, pregnant women or people who are allergic to aspirin.
  • Antibiotics. If you have more than four loose stools a day or severe symptoms, including fever or blood, pus or mucus in your stools, a doctor may prescribe a course of antibiotics.

Before you leave for your trip, talk to your doctor about appropriate medications to take with you so that you don’t have to buy diarrhea medications while traveling. Some of the drugs available in other countries may be unsafe. Some may even have been banned in the United States.

Avoiding dehydration

Dehydration is the most likely complication of traveler’s diarrhea, so it’s important to try to stay well hydrated.

An oral rehydration salts (ORS) solution is the best way to replace lost fluids. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose to enhance absorption in the intestinal tract.

Bottled oral rehydration products are available in drugstores in developed areas, and many pharmacies carry their own brands. You can find packets of powdered oral rehydration salts, labeled World Health Organization (WHO)-ORS, at stores, pharmacies and health agencies in most countries. Reconstitute the powder in bottled or boiled water according to the directions on the package.

If these products are unavailable, you can prepare your own rehydrating solution in an emergency by mixing together:

  • 1/2 teaspoon salt
  • 1/2 teaspoon baking soda
  • 4 tablespoons sugar
  • 1 liter safe drinking water

You or your child can drink the solution in small amounts throughout the day as a supplement to solid foods or formula, as long as dehydration persists. Small amounts reduce the likelihood of vomiting. Breast-fed infants also can drink the solution but should continue nursing on demand. If dehydration symptoms don’t improve, seek medical care right away. Oral rehydration solutions are intended only for urgent short-term use.

If you do get traveler’s diarrhea, avoid caffeine and dairy products, which may worsen symptoms or increase fluid loss. But keep drinking fluids.

Drink canned fruit juices, weak tea, clear soup, decaffeinated soda or sports drinks to replace lost fluids and minerals. Later, as your diarrhea improves, try a diet of easy-to-eat complex carbohydrates, such as salted crackers, bland cereals, bananas, applesauce, dry toast or bread, rice, potatoes, and plain noodles.

Once diarrhea goes away, you may return to your normal diet. Just be sure to add dairy products, caffeinated beverages and high-fiber foods cautiously.