Traveller's Diarrhoea - Prevention, Diagnosis & Management
- Helen
- Mar 5, 2019
- 5 min read
Updated: Jun 4, 2019
One of the joys of travelling for many is to experience cuisines from around the world, discovering the local delicacies and immersing in the culture you have travelled to enjoy.
However, this part of travel is also one of the riskiest, with 'traveller's diarrhoea' (TD) being the most common travel related illness.
All too often, enjoying local cuisines comes with a miserable price....
It is time therefore, to put embarrassment and yuck factors to one side and talk about poo!
If you are going to be travelling, particularly to high or moderate risk countries, how can you protect against contracting traveller's diarrhoea or if it does strike, how do you manage it?
Let's go through a quick run down of all you need to know about traveller's diarrhoea...
including what it is, how to prevent it and how to manage it (hopefully you haven't just had lunch!)...
(**Disclaimer before I continue - I did work as a nurse for many years, in which travel health was a large part of my role so feel reasonably informed to write this post... However, always take the advice of your own health care provider over the information I am offering here!)....
Risky Areas for contracting Traveller's Diarrhoea
For those travelling to higher risk destinations of the world, 20-60 % contract some form of traveller's diarrhoea (TD) infection.
To deem your potential level of risk at your intended destination here is a quick breakdown of low and high risk areas by world region...
Low risk areas for traveller's diarrhoea:
Western Europe, USA, Canada, Australia, Japan & New Zealand
High risk areas for traveller's diarrhoea:
Most of Asia, the Middle East, Latin America and Africa
(with other parts of the world not mentioned here deemed a 'moderate risk')
What Causes Traveller's Diarrhoea?
Most TD is caused by infection from consuming contaminated food or water.
Swimming in inadequately treated swimming pools or in the sea, rivers or lakes can also be sources of contraction.
A variety of organisms can be the cause, with various types of bacteria the main culprits but some viruses (such as norovirus) or protozoa (such as Giardia) are not uncommon.
What are the symptoms of Traveller's Diarrhoea?
Officially, TD is diagnosed when there are three or more episodes of diarrhoea in 24 hours; associated with at least one of the following symptoms:
- abdominal cramping, fever, nausea, vomiting or bloody stools.
Most cases of TD are self limiting, lasting 2-4 days but in some more extreme cases symptoms can last a month (occasionally more).
On the whole, TD does not need specific treatment or investigations...
However, if symptoms are persisting longer than expected or a person has other health conditions, is very young or very old then further investigations or medical treatment might be necessary (see more below).
Managing Traveller's Diarrhoea
If you are unlucky and do end up with a dose of the dreaded TD then the most important thing is to ensure you stay well hydrated.
For most otherwise healthy adults hydrating by drinking plenty of (safe) water is usually adequate to prevent dehydration.
Also continue to eat - bland foods but consumed regularly to keep the gut working are usually advised.
In severe cases, rehydration powders mixed into water might be used (being prepared and carrying some of these with you in your luggage if you are travelling to high risk areas is often a good idea).
Paracetamol can help with any stomach cramps or fever symptoms.
Drugs that work to stop diarrheoa (such as Imodium or loperamide) are on the whole only advised if the diarrhoea is acute and if it is interrupting imminent travel plans (e.g. you are about to board a flight).
These drugs do help stop the diarrhoea symptoms for a time but are generally not recommended as a treatment as they tend to merely delay the inevitable!
Depending on where you are travelling, what the likely source of infection is or if your symptoms have persisted, antibiotics might be used to treat certain cases of TD.
Occasionally, if you are going to be travelling to remote destinations where TD risk is high and medical care provision poor, travel health clinics or primary care doctors at home will consider issuing antibiotics to carry with you to take in the event of TD infection.
Speak to your health provider before you go if you will be visiting high risk and remote regions.
When to seek medical help with TD
Seek medical support in the following situations:
- symptoms have lasted more than 3 days
- you have a high fever
- blood or mucus is present in the stool
- you have severe abdominal pains
- you develop rashes or signs of jaundice (yellowing to the skin or eyes).
Very young children, the elderly, pregnant women or people with other significant health problems should seek medical help sooner.
How To Prevent Traveller's Diarrhoea
Food & Drink
Most of the time we cannot see that the food or drink we are about to consume is infected. Therefore, to reduce the risks of becoming unwell when travelling, it is safer to follow some general principles in terms of what you eat or drink.
Drinking Water Safely:
- avoid drinking tap water or water from public water fountains & other sights unless you are sure it is clean and safe (just because locals drink it without issue does not mean it will not cause you a problem!).
- use bottled water (ensuring it has a sealed cap when you buy it) for drinking and where the risk is greater for teeth cleaning.
- avoid ice in your drinks, unless you know it has come from bottled or disinfected water.
- choose soft drinks that are bottled and ideally carbonated.
- choose hot drinks where the water has been boiled first.
- avoid beer or wines on tap.
Eating Safely When Travelling:
- choose fruit and vegetables you have either washed yourself in clean or bottled water, can peel yourself or that are cooked.
Avoid salads or uncooked fruit or vegetables where you do not know if / how they have been washed.
- avoid cold foods: ensure food is served hot and well cooked.
- avoid meats that are not well cooked and eggs that are runny.
- avoid buffets where food has been sitting for longer periods of time at room temperature (ripe for bacterial growth!).
- choose dairy products that are pasteurised.
- choose dry foods - breads, crackers or factory sealed foods (cans, packages or bottles).
Other General Preventative Measures
In addition to applying the above food and water practices, also ensure the following:
- hand-wash with soap and water after using the toilet, and before eating or drinking.
- carry alcohol hand gel for times when hand-washing facilities might not be available.
- when swimming in pools or sea / freshwater, avoid ingesting the water as far as possible.
- avoid swimming if you have diarrhoea.
- before travelling see a travel health professional for advice on whether you need vaccinations for your destination against diseases such as hepatitis A or typhoid (these are also spread through contaminated food and water, although they do not specifically cause TD).
Conclusion
Unfortunately, try as we may to prevent it, TD is always going to be a risky part of travelling when visiting certain parts of the world.
If you are visiting high or moderate risk areas then really ensure you are following safe eating and drinking practices and be prepared in terms of knowing what to do if TD does strike and carry appropriate remedies in case they are needed.
TD can make a great trip miserable, but in most cases, even if it is contracted, it is generally short lived.
I am hoping you don't ever need the information here but if you do I hope it has helped a little!
**To make my travels possible and affordable I do so through international house-sitting, using both Trusted Housesitters and Kiwi Housesitters**
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