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Traveler's diarrheaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/travelers-diarrhea/DS00318
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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:
- Increased frequency, volume and weight of stool
- Frequent loose stools — usually about four to five loose or watery bowel movements each day
- An urgent need to defecate
- Abdominal cramps
Sometimes, people experience moderate to severe dehydration, bloody stools, persistent vomiting or a high fever. 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
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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 battle traveler's diarrhea. High-risk destinations for traveler's diarrhea include developing countries in Latin America, Africa, the Middle East and 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 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 monsoon season.
Because you lose vital fluids, salts and minerals during a bout with traveler's diarrhea, you may become dehydrated. Children are especially vulnerable to dehydration, and it can be severe.
Preparing for your appointment
Call a doctor if you have diarrhea that is severe, lasts more than a few days or is bloody. If you are traveling, call an embassy or consulate for help locating a doctor. Other signs that you should seek medical attention include a fever of 102 F (39 C) or higher, persistent vomiting, and signs of severe dehydration, including dry mouth, muscle cramps, decreased urine output or fatigue.
If you've just returned home from a trip abroad, share that information with your doctor when you call to make an appointment.
Here's some information to help you get ready, and what to expect from your doctor.
Information to gather in advance
- Pre-appointment instructions. At the time you make your appointment, ask whether there are immediate self-care steps you can take to help recover more quickly.
- Symptom history. Write down any symptoms you've been experiencing and for how long.
- Medical history. Make a list of your key medical information, including other conditions for which you're being treated and any medications, vitamins or supplements you're currently taking.
- Questions to ask your doctor. Write down your questions in advance so that you can make the most of your time with your doctor.
The list below suggests questions to ask your doctor about traveler's diarrhea.
- What is causing my symptoms?
- Are there any other possible causes for my symptoms?
- What kinds of tests do I need?
- What treatment approach do you recommend?
- Are there any possible side effects from the medications I'll be taking?
- What is the safest way for me to rehydrate?
- What dietary restrictions should I follow and for how long?
- How soon after I begin treatment will I begin to feel better?
- How long do you expect a full recovery to take?
- Am I contagious? How can I reduce my risk of passing my illness to others?
- What can I do to reduce my risk of this condition in the future?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:
- What are your symptoms?
- When did you first begin experiencing symptoms?
- Have you traveled recently?
- Where did you travel?
- Have your symptoms been getting better or worse?
- Have you noticed any blood in your stools?
- Have you experienced symptoms of dehydration, such as muscle cramps or fatigue?
- What treatments have you tried so far, if any?
- Have you been able to keep down any food or liquid?
- Are you pregnant?
- Are you being treated for any other medical conditions?
Treatments and drugs
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), medications containing diphenoxylate (Lomotil), and opiates, such as paregoric and codeine — 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. They 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 severe symptoms or three or more loose stools within eight hours, a doctor may prescribe a three- to five-day 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.
Dehydration is the most likely complication of traveler's diarrhea, so it's important to try to stay well hydrated.
An oral rehydration solution (ORS) 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 or another carbohydrate, such as rice powder, 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 solution, labeled 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
- 6 teaspoons 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.
Lifestyle and home remedies
If you do get traveler's diarrhea, avoid alcohol, 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.
Watch what you eat
The general rule of thumb when traveling to another country is this: Boil it, cook it, peel it or forget it. Unfortunately, most travelers don't stick to these guidelines 100 percent of the time. Remember these tips:
- Don't buy food from street vendors.
- Avoid unpasteurized 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 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
When visiting high-risk countries, keep the following tips in mind:
- Avoid unsterilized water — from tap, well or stream. If you need to consume local water, boil it for five to 10 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.
If it's not possible to buy bottled water or boil your water, bring some means to purify water. Consider a water-filter pump with a microstrainer filter that can filter out small microorganisms. Look in camping stores for a filter that's certified by the National Science Foundation. Or chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but is best reserved for short trips, as too much iodine can be harmful to your system. You can purchase iodine tablets or crystals at camping stores and pharmacies. Be sure to follow the directions on the package.
Follow additional tips
Here are other ways to reduce your risk of traveler's diarrhea:
- 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 sanitizer with at least 60 percent 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.
- Tie a colored ribbon around the bathroom faucet to remind you not to drink — or brush your teeth with — tap water.
Other preventive measures
Public health experts generally don't recommend taking antibiotics to prevent traveler's diarrhea, because doing so can contribute to the development of antibiotic-resistant bacteria. Besides, antibiotics provide no protection against viruses and parasites, but they can give travelers 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 diarrhea. However, don't take this medication for longer than three weeks, and don't take it at all if you're allergic to aspirin, pregnant or taking certain medications, such as anticoagulants. Common harmless side effects include a black-colored tongue and dark stools. In some cases it can cause constipation, nausea and, rarely, ringing in your ears (tinnitus).
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