Travel abroad is booming. Tens of millions of Americans travel outside of the U.S. every year—eager to feed their curiosity and hunger for different countries and cultures.
Traveling can enrich your life by exposing you to new experiences, ways of thinking and people. While you may be excited about exploring new places and tasting unique flavors, your stomach may not be as thrilled about this culinary journey.
When traveling overseas, it’s important to be prepared for the possibility of traveler’s diarrhea. Yes … diarrhea.
Nothing is more of a blow to a vacation than spending your time in the confines of a hotel or Airbnb bathroom praying to the porcelain gods while your family is out learning about the Greek gods in Athens.
What is traveler’s diarrhea?
Traveler’s diarrhea is a common issue that affects 30% to 70% of international travelers depending on the region of the world they visit, according to the Centers for Disease Control & Prevention (CDC).
“Traveler’s diarrhea is the most common travel-related ailment, and prior infection does not provide protection,” said Karen Volpe, MD, an infectious disease specialist at Banner Health Clinic in Greely, CO. “It is more common in warmer climates, in areas with poor sanitation and sewage systems and is due to limited refrigeration and improper handling of food through contaminated water.”
There is a higher risk of traveler’s diarrhea if you travel to Asia (except Japan and South Korea), the Middle East, Africa, Mexico and Central and South America. You have a low risk if traveling within the U.S., Canada, Australia, New Zealand, Japan, South Korea and Northern and Western Europe.
The most common cause of traveler’s diarrhea is infection with bacteria, viruses or parasites, such as enterotoxigenic Escherichia coli (or E. coli), Campylobacter infection, Shigella infection and Salmonella.
Is traveler’s diarrhea serious?
“Traveler’s diarrhea occurs equally in men and women, but is more common in young adult travelers,” Dr. Volpe said. “In otherwise healthy adults, diarrhea is non-life-threatening and usually improves with supportive care or treatment.”
The risk for severe disease is higher in those who are immunocompromised, including those with HIV, organ transplants or who are on long-term immunosuppression medication. Those who take stomach acid-suppressing medications or have chronic diseases, including kidney disease and diabetes, are also at higher risk.
Most cases of traveler’s diarrhea occur within two weeks of arriving at a destination and could occur within two weeks after returning home. Mild cases usually include loose stools along with at least one of the following symptoms: abdominal cramping, the feeling (urgency) you have to go, nausea or vomiting.
In severe cases, travelers may experience fever and/or bloody stools (poops). If you find yourself experiencing bloody diarrhea, you should get checked out by a health care provider. Some more aggressive organisms can cause more severe health issues like dysentery or typhoid fever.
Five tips to reduce your risk for traveler’s diarrhea
Although diarrhea is a common health problem faced by travelers, here are five tips to help you prevent traveler’s diarrhea.
1. Stick to only factory-sealed drinks or boiled water.
“Water in developing countries tends to have a higher load of gastrointestinal pathogens, such as E. coli, so you should avoid any contact that could potentially be an entry for bacteria, such as your mouth and eyes,” Dr. Volpe said.
A good rule of thumb is to only drink from bottled water or factory-sealed drinks. This means no ice or diluted juices.
While showering, avoid getting water in your eyes and mouth. Use bottled water when you brush your teeth.
If you must use tap water, boil it for at least three minutes. Dr. Volpe doesn’t recommend water purification tablets like chlorine dioxide because success rates can vary.
2. Avoid raw vegetables and fruits.
It’s best to eat only foods that are cooked or served hot. If you want to eat raw fruits and vegetables, wash them with clean water (bottled, not tap) and peel them with clean hands.
“Raw, unwashed fruits and vegetables are more likely to be contaminated with pathogens,” Dr. Volpe said. “Avoid any roadside fruits, but if you bring fruits home, wash them vigorously with clean water and eat after peeling off the skin. When in doubt, throw them out.”
3. Eat thoroughly cooked meats and fish.
Now isn’t the time to try out steak tartare, kibbeh nayyeh or sushi. It’s also not the time to enjoy some street food. These can put you at high risk of exposure.
Look for reputable places that use good hygiene practices and serve food piping hot.
4. Wash your hands thoroughly with soap and clean water.
Practice proper hygiene. Before you eat, wash your hands. After you use the bathroom, wash your hands.
Pack an antibacterial soap or bring hand sanitizer wipes or gels with you wherever you go. And, as a general rule, keep your hands away from your mouth and eyes to reduce the spread of any bacteria or germs.
5. Don’t make major food changes.
“You can get diarrhea from any major changes in your diet, so be mindful of what you’re eating,” Dr. Volpe said. “Don’t go from a healthy diet to eating nothing but fried food and ice cream. You are bound to get sick.”
Ways to treat traveler’s diarrhea
If you happen to get traveler’s diarrhea—even after doing everything to prevent it—make sure you take proper care and seek medical attention when appropriate.
Here are some tips if you are down and out with diarrhea:
Hydrate. Drink plenty of clean water to stay hydrated.
Take other-the-counter medications. Anti-motility meds, such as loperamide (Imodium), can reduce the symptoms of diarrhea by slowing down the movements (muscular contractions) of your intestines. However, it’s not recommended in the early stages of infection and not for children 2 years of age and younger.
Over-the-counter bismuth subsalicylates (Pepto-Bismol) can reduce the duration of diarrhea, as well as the frequency of your stools. However, it’s not recommended for pregnant people or children
Call your health care provider. If you are still experiencing diarrhea beyond three to five days or notice blood in your stool and/or have a fever, find a local health care provider or call your own for additional guidance.
Only take antibiotics when needed. Antibiotics may be used in moderate to severe cases but have only been found to reduce the duration of diarrhea by a day in cases caused by susceptible bacterial pathogens.
“In addition, taking an antibiotic prophylactically (to guard against or prevent the spread), isn’t recommended,” Dr. Volpe said. “It gives no protection against nonbacterial pathogens and can remove normally protective microflora from your bowels, increasing your risk of infection with resistant bacterial pathogens.”
[Learn more about antibiotic resistance.]
Traveler’s diarrhea is caused by drinking or eating food contaminated with bacteria, viruses or parasites when vacationing in a developing country. Food and water can be infected by people due to improper handwashing, improper food storage, handling and preparing food unsafely and not cleaning surfaces and utensils properly.
You are more at risk for diarrhea while traveling overseas if you are taking certain ulcer medicines or are immunosuppressed.
Most cases of traveler’s diarrhea are mild but contact a health care provider if you’re experiencing diarrhea for more than three to five days and/or have a fever.
If you’re traveling overseas soon, don’t hesitate to reach out to your health care provider to discuss how you can best keep your family safe when you’re away from home. To find a Banner Health specialist near you, visit bannerhealth.com.