Traveler’s diarrhea, long known as "Montezuma’s revenge" among other names, is something of a misnomer. Though it has been defined in the pages of the New England Journal of Medicine as diarrhea that occurs when a person living in an industrialized country travels to developing or semitropical regions (Latin America, Africa, Middle East, Asia), some people get traveler’s diarrhea when entering the United States or other industrialized nations. Any change of locale and eating habits can make you more vulnerable to it.
Nevertheless, traveler’s diarrhea is still more common among travelers from low-risk to high-risk areas—40 to 60 percent of Americans traveling to developing countries are laid low with diarrhea. Wherever you contract it, the illness usually appears within four to six days after arrival, with sudden attacks of loose watery stools often accompanied by abdominal cramps and nausea.
Symptoms of Traveler’s Diarrhea
- Diarrhea, as much as 3 to 10 times a day, often in combination with nausea, vomiting, bloating, gas, and abdominal cramps
- Fever and bloody stools (in severe cases)
- Dehydration (occasionallyand usually not severe)
What Causes Traveler’s Diarrhea?
Up to 80 percent of traveler’s diarrhea cases are triggered by bacteria, including the ubiquitous E. coli found in fecal matter as well as other bacteria that are transmitted via contaminated food or water. Less common agents are viruses and parasites such as Giardia lamblia. Often it’s impossible to identify the exact culprit.
What If You Do Nothing?
Traveler’s diarrhea is not life-threatening in otherwise healthy people. If you drink plenty of water, you may be uncomfortable, but the condition will clear up on its own—often within two to five days, though in some cases mild symptoms may last for weeks.
However, if a parasite such as Giardia lamblia is to blame, giardiasis, an infection of the small bowel, may develop. Symptoms may persist for four weeks or more if antibiotics are not taken.
Home Remedies for Traveler’s Diarrhea
- Replace lost fluids. Your goal is to prevent dehydration, which occurs often with diarrhea because the body loses more fluids and salts than it takes in. The most important self-care measure is to rehydrate yourself as soon as you can keep down fluids. Bottled water, flat soft drinks, sports drinks, or tea will help. You can also make your own rehydration drink by adding four teaspoons of sugar and a pinch of salt (a half teaspoon) to a quart of bottled water. Avoid coffee and alcohol, which can increase dehydration. For a child who becomes sick, try sweetening water with honey, and add a pinch of salt. Children under age two should drink a commercial rehydration solution, which contains the correct amounts of fluid, salts, and carbohydrates to prevent dehydration.
- Eat. If you have no diarrhea after 12 hours, salted crackers are a good way to begin eating again, and the salt helps restore fluid balance. Other foods to consider include dry toast, bread, and clear soup. When the number of stools decreases and your stools have shape, you can add rice, baked potatoes, clear soup, poultry, applesauce, and bananas—or any food, really, that appeals to you, as long as you observe the precautions noted below.
- Self-treat with medication, if necessary. If you are otherwise healthy, it’s generally best if you give your body a chance to eliminate the diarrhea-causing organism. However, if you are in a situation where diarrhea is inconvenient, you can decrease symptoms with over-the-counter medications. Loperamide (such as Imodium) is an antimotility drug that works against loose stools, reducing both the passage of stool and the duration of diarrhea by up to 80 percent. Bismuth subsalicylate (Pepto-Bismol, which is also sold in generic forms) reduces the number of loose stools by about 60 percent, but people who are aspirin-sensitive or take aspirin for other reasons, as well as children under the age of 12, should not use bismuth subsalicylate. Moreover, you should not take any of these drugs if you have high fever and bloody stools; these two symptoms can be signs of a serious infection that requires immediate medical attention, and the medications may make the condition worse.
When traveling in developing countries, follow these recommendations.
- Find out about health precautions. The Centers for Disease Control and Prevention (CDC) can supply you with information about health risks in different countries. It’s also a good idea to get a doctor’s advice before you go if you are traveling to developing countries and are pregnant or nursing, are accompanied by infants or small children, or have chronic health problems. Do so as well if you’re taking a critically important business trip that would be compromised if you developed traveler’s diarrhea.
- As a precaution, take diarrhea medications with you. If you’re traveling in out-of-the-way places, beyond the reach of a druggist, it’s advisable to take a diarrhea treatment along. If you have any health concerns, consult with your doctor, who can recommend an over-the-counter product or a prescription medication such as Lomotil.
- Once you’ve arrived, drink only bottled or canned beverages. Be sure you’re the one who breaks the seal. Or stick to hot drinks like tea or coffee made with boiling water. Bottled wine and beer are safe. In some areas locally bottled water and soft drinks may not be safe. If in doubt, stick to tea and coffee.
- Never use tap water. Use bottled or boiled water instead, even for brushing your teeth. Don't swallow water in the shower.
- Pass up all ice cubes. The cubes may have been made with contaminated water, and freezing does not kill most microbes.
- Treat your own water. If necessary, take along a small electric immersion coil heater and boil your own water. Or add to it a purifying tablet such as Halazone—two and a half tablets per quart for at least 30 minutes.
- Don’t eat anything rawparticularly not salad greens. Raw fruit is okay only if it can be peeled and if you do the peeling. Be certain not to wash the fruit in tap water. Avoid rare meats, undercooked eggs, and all dairy products, since it’s hard to be sure they’ve been pasteurized.
- Do not drink milk that has not been pasteurized.
- Don’t buy food from street vendors. Even if it’s served hot, it still may be contaminated.
- Wash your hands carefully. To prevent the spread of diarrhea and eliminate all chances of reinfection, be sure to wash your hands with soap and water after using the bathroom and before eating. Disinfecting alcohol wipes are useful when you have no clean water to wash in.
- Don’t rely on drugs. It’s certainly a good idea to carry antibiotics with you when you travel, along with instructions on how to use them should the need arise. But some travelers take antibiotics before they leave home in order to ward off traveler’s diarrhea. Using antibiotics or any other medication prophylactically is generally not recommended. Some medications can produce severe side effects. In addition, taking them can give a false sense of security to travelers who might otherwise be cautious in their choice of food and drink.
- People with health problems, however, should check with their doctors before they travel, since some of them will benefit from taking medications prophylactically.
What To Take Along
Here is a checklist of items for prevention and treatment of traveler’s diarrhea:
- An electric immersion coil to boil water if bottled water is unavailable or unsafe. You’ll need a conversion plug as well.
- Purifying tablets to add to tap water if you can’t boil it and have no alternative.
- Alcohol wipes for hand-washing (when clean water isn’t available).
- Antidiarrhea medication—something containing loperamide (Imodium, for example) or diphenoxylate (Lomotil). Pepto Bismal (bismuth salicylate) and its generics are good, too. (Be sure not to dose yourself if you have a high fever or bloody stools—seek medical help.)
- Antibiotics and directions for their use.
Beyond Home Remedies: When To Call Your Doctor
The condition is uncomfortable but seldom life-threatening. However, contact a physician if you have diarrhea that lasts more than four days without improvement, a fever of 101°F or higher that lasts more than 24 hours, or if blood is in your stool.
A doctor also should be contacted immediately if severe diarrhea occurs in infants, elderly people, or people with heart disease.
What Your Doctor Will Do
A history will be taken, including how much diarrhea has occurred, whether it is accompanied by blood, mucus, or pus, and if it occurs in combination with nausea, vomiting, or a high fever. The exact cause of the diarrhea may be difficult to determine, but a stool sample can be taken to detect the organism producing the problem.
If diarrhea is frequent and cramps are painful, your doctor may prescribe medications to relieve symptoms, especially if you have serious heart disease or a weakened immune system. Treatment will stop the diarrhea in about a day, compared to two to four days without medication. However, since antidiarrheal medication can delay the elimination of the organism from the digestive tract, it may not be recommended for healthy individuals.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media