Patient education: Travelers' diarrhea (The Basics)

What is travelers' diarrhea? — Travelers' diarrhea is runny or watery bowel movements in people who are traveling. It is usually caused by bacteria but can also be caused by a virus or parasite.

You are more likely to get travelers' diarrhea if you travel in:

●Asia (especially South and Southeast Asia)

●Africa

●South America, Central America, and Mexico

●Countries around the Mediterranean Sea, including Israel

●Caribbean islands

What are the symptoms of travelers' diarrhea? — The main symptom is runny or watery bowel movements. These usually start about 4 to 14 days after arriving. Other symptoms can include:

●Feeling sick

●Loss of appetite

●Cramps in the lower belly

●Nausea and vomiting

●Fever

●Gas and bloating – Feeling like the belly is full, with pain in the middle or top of the belly.

●Blood in the bowel movements

●Feeling as though you need have a bowel movement even if you just did, or like you need to get to the toilet in a hurry

Travelers' diarrhea usually lasts 1 to 5 days, but some people are sick for a week or longer.

Should I see a doctor or nurse? — You might need to see a doctor or nurse if:

●You are sick for 10 to 14 days or longer

●You have a fever of 102ºF (40ºC) or higher

●You have severe belly pain

●You have bloody diarrhea

●You cannot eat or drink anything

Will I need tests? — Probably not. If you see a doctor or nurse, they will ask where you traveled and what you did. If the doctor thinks a certain type of bacteria or parasite might be causing the diarrhea, they might ask for a bowel movement sample. Testing the sample can sometimes show the cause of the diarrhea. But this is not usually needed.

How is travelers' diarrhea treated? — The most important treatment is getting enough fluid. That's because diarrhea can cause the body to lose fluid. Adults with mild diarrhea can drink lots of fluids with water, salt, and sugar. Soup broth and water mixed with juice are good choices. If you are drinking enough, your urine will look light yellow or almost clear.

If you have very frequent diarrhea, you can drink an "oral rehydration solution." You can buy this in a packet at the pharmacy. Mix it with bottled or boiled drinking water.

Other treatments are not necessary for everyone. They might include:

●Antibiotics – These medicines fight infections. They are usually only used to treat severe diarrhea.

●Medicines that ease diarrhea – These medicines include loperamide (brand name: Imodium), diphenoxylate-atropine (sample brand name: Lomotil), and bismuth subsalicylate (sample brand names: Pepto-Bismol, Kaopectate). They can help, but they can also cause other health problems. Bismuth salicylate might not be safe for pregnant women or people who take aspirin for another condition. You can take loperamide or diphenoxylate if you have mild diarrhea. If you have very bad diarrhea, you should only take loperamide or diphenoxylate if you are also taking antibiotics and if you do not have bloody diarrhea. You should stop loperamide or diphenoxylate if your symptoms get worse when you take them.

Can travelers' diarrhea be prevented? — You can reduce your chances of getting travelers' diarrhea by being careful about what and how you eat and drink. While you are traveling:

●Do not drink tap water. Drink bottled carbonated drinks, beer, wine, or hot tea or coffee instead. Brush your teeth with bottled water.

●Do not use ice in drinks. Ice is usually made from tap water.

●Do not eat food from carts or stands in the street.

●Do not eat sauces set out on restaurant tables. These include salsa and ketchup.

●Do not eat fresh foods at room temperature. These include guacamole, fruit or chicken salads, and buffet food on a steam table.

●Do not eat foods or drinks made with unpasteurized milk.

●Ask for drinks in the bottle, without ice. If you drink from a glass, use a straw.

●Do not eat fruits unless they have a peel and you have peeled them yourself.

●Make sure meat and seafood are well done and eggs have a firm yolk.

If you can't find bottled water or soft drinks, you can make your drinking water safe by doing one of the following:

●Boiling it for 3 minutes (let it cool before drinking)

●Adding 5 drops of tincture of iodine to 4 cups of water and waiting 30 minutes – Tincture of iodine is a liquid you can buy at most pharmacies or camping goods stores.

●Using a water treatment filter from a camping or sports store

Wash your hands after going to the bathroom, changing diapers, blowing your nose, touching animals, or taking out the trash.

If you have a serious health condition, travelers' diarrhea could cause you to lose too much water. This can be dangerous and even cause death. If you are going on a trip, talk to your doctor or nurse ahead of time.

More on this topic

Patient education: Staying healthy when you travel (The Basics)
Patient education: Diarrhea in adolescents and adults (The Basics)

Patient education: Acute diarrhea in adults (Beyond the Basics)
Patient education: Foodborne illness (food poisoning) (Beyond the Basics)
Patient education: General travel advice (Beyond the Basics)