Oh Crap! – Coping with Traveller’s Diarrhea

There are few things more dreadful than experiencing a bout of diarrhea while travelling abroad. The frequent trips to the bathroom, bloating, gas, and cramps are not the experiences people hope for when they are planning their travels. Fortunately for most, traveller’s diarrhea, while a literal pain in the butt, tends to only last a few days. Here’s what you need to know about preventing and coping with traveller’s diarrhea.

Who’s at risk?

Traveller’s diarrhea can hit any traveller anywhere in the world but tends to be more common in places with poor hygiene practices and limited sanitation infrastructure. It is the most common health issue for travellers with an estimated that 30%-70% of them experiencing traveller’s diarrhea at some point during their trip. Traveller’s diarrhea tends to be more common in young adult travellers compared to older adults. It’s possible to experience more than one episode of traveller’s diarrhea on the same trip, as an episode of traveller’s diarrhea does not provide protection against future episodes.

What’s the cause?

Traveller’s diarrhea is usually caused by bacteria, but can also be caused by viruses, parasites, or toxins. It is spread when ingested food or water is contaminated with fecal particles.Most travellers are careful to avoid drinking untreated water, so contaminated food is one of the main causes of traveller’s diarrhea.

The most common bacteria that cause traveller’s diarrhea are:

1. Escherichia coli (ETEC and EAEC)
2. Campylobacter
3. Shigella
4. Salmonella

How do I know if I have traveller’s diarrhea?

Trust me, you’ll know. Symptoms usually start very suddenly, with uncomfortable diarrhea starting within 6-72 hours after eating or drinking the contaminated item. The diarrhea can also be accompanied by abdominal pain or cramps, vomiting, and fever. Symptoms are usually self-limited and resolve within 3-4 days. This is the typical presentation of traveller’s diarrhea caused by bacteria or viruses.

If traveller’s diarrhea is caused by a parasite, symptoms usually have a more gradual onset and start 1-2 weeks after eating or drinking the contaminated item. Symptoms are usually more mild, with diarrhea occurring 2-5 times per day. Symptoms of traveller’s diarrhea caused by a parasite can last weeks to months if it is not treated.

How to cope

Travellers should be prepared for the possibility of diarrhea on their trip by packing treatments for traveller’s diarrhea in their toiletry kit. The main goal of treating traveller’s diarrhea is to prevent dehydration. Treatments can include:

Oral rehydration solution

• Dissolvable tablets or powder
• Formulated to replenish lost glucose and electrolytes from diarrhea, vomiting, or excessive sweating to prevent dehydration
• g., Hydralyte, Pedialyte, Gastrolyte

Anti-diarrheal medication

• Reduces diarrhea frequency and duration of diarrhea due to its anti-motility effect
• Useful when diarrhea interferes with a busy schedule or finding a toilet is problematic
• g., Immodium, Loperimide

Pepto Bismol (bismuth subsalicylate)

• Reduces diarrhea frequency by reducing intestinal secretions
• Relieves symptoms like nausea and cramping but does not treat the infection

Antibiotics

• Can be considered for moderate or severe diarrhea
• Resolves the diarrhea if the infection is caused by a bacteria
• If diarrhea does not improve after self-treatment with antibiotics, the traveller should seek medical attention

When to seek medical attention

Medical attention should be sought if diarrhea is bloody, or if symptoms are severe such as extreme cramping, fever and chills, or severe thirst without being able to keep liquids down. If an infant or child has severe diarrhea or vomiting seek medical attention immediately.

Prevention

There are several approaches that can reduce your risk of getting traveller’s diarrhea:

Hand hygiene

• Wash hands with soap where available
• Carry small container of alcohol-based hand sanitizer

Food and water precautions

• Drink only treated or bottled water
• Avoid ice, raw fruits and vegetables, and food from street vendors
• Eat food that is well cooked and hot

Dukoral vaccine

• Dukoral is an oral vaccine that prevents diarrhea caused byenterotoxigenic coli (ETEC) and cholera. ETEC is the most common cause of traveller’s diarrhea.
• Recommended for anyone 2 years of age and older desiring maximum pre-travel preparation.

Dukoral vaccine schedule:

• Two doses are needed when taking Dukoral for the first time:
  • The first dose should be taken no later than 2 weeks before departure
  • The second dose should be taken at least 1 week after the 1^st dose and at least 1 week before departure

• If Dukoral has been taken in the last 3 months to 5 years only a single booster dose is needed:
  • The booster dose should be taken at least 1 week prior to departure

There are other vaccines available to prevent illnesses spread through contaminated food and water, such as hepatitis A and typhoid. To learn more about traveller’s diarrhea, hepatitis A or typhoid, call us at 604-251-1975 or email us at info@travelsafeclinic.ca to book your appointment today