Travelers’ Diarrhea – The Risk Travelers Always Fail to Anticipate

Travelers’ diarrhea is a common malady that afflicts those who travel. It may happen more frequently when traveling to developing nations, but no traveler is completely immune, regardless of destination. The primary symptom is repeated watery bowel movements. This is accompanied by abdominal pain and cramping, shivering, dehydration, weakness, and blurry vision.

Salient Points About Travelers’ Diarrhea

It might be that you came upon this page since you feel are suffering from a bout of travelers’ diarrhea. Here are a few things to understand about what you’re experiencing:

  • Travelers’ diarrhea is not caused by one single pathogen, but several of them.
  • If you are in good health and otherwise fit, there is usually no cause for alarm. Traveler’s diarrhea rarely causes serious issues, and is more of a nuisance than anything else. 
  • You most likely will not require medical treatment unless you experience severe symptoms, or become extremely dehydrated.
  • By taking the right steps, you can be back on your feet in as little as 48 hours.

Why Does Travelers’ Diarrhea Happen to Travelers?

When you travel to a new location, you expose your body to new germs and pathogens. Since your body is unfamiliar with these germs and pathogens, it has not yet developed antibodies to fight them. Without these antibodies, you can become sick. This same thing happened when European settlers first met indigenous American people. Smallpox brought from Europe decimated entire populations in less than a decade. In modern times, exposure to new pathogens has less-extreme effects, but they’re still uncomfortable.

The reason you’re more likely to be afflicted with traveler’s diarrhea in developing nations is because water sanitation and food preparation standards are typically not as high. This allows pathogens to still be present that are eliminated through sanitation in more developed nations.

How Do You Contract It?

Most people afflicted with travelers’ diarrhea contract it by consuming contaminated food and water. An overwhelming number of cases are due to the Escherichia coli (E. coli) bacteria from food. When food is prepared by someone who is contaminated by the pathogen, there is a great likelihood they will pass it on.

The food items at most risk of carrying this pathogen include salads, syrups, sauces, chopped and diced raw vegetables, confectionaries such as pastries, and anything else made or served without heating. It is less likely to be infected when eating a hot dish, since the process of cooking kills germs.

The reason you may be afflicted with diarrhea after eating one of these foods – and the locals are not – is because they have developed the antibodies to make them immune. You have not yet developed these antibodies, so you get sick.

Symptoms of Travelers’ Diarrhea

Usually, you will fall ill within a day or two of consuming tainted food or water. If your immune system is strong, you might not become sick until a week or maybe two afterwards.

The symptoms start with sudden, watery bowel movements that require you to visit the restroom frequently. These can happen once an hour or more, and it’s not uncommon to have a dozen episodes per day.

You may experience nausea. Abdominal cramps are almost inevitable, and can progressively become worse. Dehydration occurs within the first few hours. You might also have cold sweats and shivering. The sudden loss of water causes the body to feel sore and tired. Fever is rare and is not a primary indicator. A low-grade fever might be brought on by weakness and stress.

Pathogen Species

Travelers’ diarrhea might be caused by bacteria, viruses, and protozoa. The last two account for only 20% of the cases.

Bacteria species:

  • E. Coli
  • Shigella
  • Salmonella
  • Campylobacter jejuni

Virus species:

  • Norovirus
  • Enterovirus
  • Rotavirus

Protozoa species:

  • Giardia
  • Entamoeba histolytica
  • Cryptosporidium

Treatment of Travelers’ Diarrhea

The severity of the event may vary. If you feel less discomfort after a day, then it is probably not necessary to get a medical opinion. Many cases subside on their own after a couple of bouts and some cramping.

One of the first and best treatments for travelers’ diarrhea is rehydration. You need to replenish the fluids and minerals your body has lost due to the illness. Oral Rehydration Solution (ORS) is widely available in travelers’ diarrhea hotspots. Follow the directions on the bottle and drink immediately. Electrolyte replenishment drinks such as Gatorade and Pedialyte can also be suitable.

Soft drinks such as Coke and Pepsi should be consumed sparingly. Remember, you need to replenish electrolytes, not just the simple carbohydrates and sugars these drinks primarily consist of. In addition, caffeinated drinks such as these, as well as energy drinks like Red Bull, can worsen your anxiety.

If you are traveling to a part of the world where travelers’ diarrhea is common, it may be a good idea to bring ORS with you. This way, you will not have to make a separate trip to the store if you are afflicted. However, it is important to note that too much ORS is not good for your health. Too much sodium and potassium can cause heart palpitations and arrythmia.

If you have no access to ORS or Gatorade, mix a pinch of salt and a tiny spoon of sugar into a glass of water, stir well and drink. If you can put in different types of salt (black/rock), it is even better. But a pinch, no more. Very light tea made without milk can also help. Coffee, on the other hand, is not recommended.

Another option that can help reduce the symptoms of travelers’ diarrhea is by taking an over-the-counter antidiarrheal medication such as Bismuth subsalicylate, which is the main ingredient found in medication brands like Pepto-Bismol and Kaopectate. Always clear any new over-the-counter treatment you may plan to take with your doctor to ensure it will not cause any health complications, or interfere with medications you are taking.

Medical Treatment

If you experience a case of travelers’ diarrhea that is severe, or does not subside using over-the-counter remedies after several days, you may have to seek medical treatment. Use your travel medical insurance or travel insurance to see a doctor and get a diagnosis. If the cause is bacterial, antibiotics can help, but a stool test is needed to determine this.

Bacterial diarrhea is treated with the following antibiotics:

Mild cases:

  • Norfloxacin
  • Ofloxacin

Severe cases:

  • Rifaximin
  • Cefixime

Often, they are combined with an antiprotozoal drug such as Ornidazole.

To reduce abdominal pain, an antispasmodic (such as Drotaverine) may be prescribed. To prevent nausea, the drug of choice is Ondansetron.

At times, doctors might employ an SOS medication such as Loperamide to stop the bowel movement instantly. Loperamide (Imodium) is available as an over-the-counter drug in most nations.

How Do You Prevent It?

  • Be wary of what you eat. Choose fully cooked, hot food over cold, uncooked foods such as salads or sushi.
  • If you do choose food that’s served at room-temperature, it must be handled only by individuals wearing sanitary gloves. If the restaurant refuses to do this, find a different restaurant.  
  • Watch what you drink. Water-borne pathogens are a primary cause of travelers’ diarrhea. It is recommended that you drink bottled water, or water that you know has been properly filtered. If bottled or treated water is unavailable, you can boil your water before drinking to kill any pathogens.
  • Wash your hands thoroughly and frequently. It is also a smart idea to utilize alcohol-based hand sanitizer regularly.

A Note of Caution…

For a week following the episode, eat light food. Your gastrointestinal tract will need time to recover, so avoid heavy or spicy meals. You should also cut back on alcohol for about a week, as it can contribute to abdominal soreness and discomfort.  

Another good idea is to have at least three spoons of yogurt each day for a week. Probiotic yogurt is best, but any yogurt will work. Yogurt will help replenish the good bacteria in your gut, and aid in healthy digestion.

Finally, remember that if you are concerned that you might need medical treatment, do not hesitate to seek it. It is better to get a professional diagnosis and treatment to help you recover than it is to suffer in your hotel room. Plus, with travel medical insurance, you will have less to worry about in terms of the bill.

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