Montezuma’s revenge, Delhi belly, Turkey trot, and Casablanca crud. Such colorful names give you a good idea of the misery to expect from traveler’s diarrhea, a disease that can spoil an expensive and eagerly anticipated vacation.
It was once believed to be caused by a change in water, indulgence in spicy foods, or too much sun. Not so anymore. Researchers have found specific bacteria to blame. These bugs take up residence in the upper intestine and produce toxins that cause fluids and electrolytes (minerals like sodium and potassium that help regulate many body functions) to be secreted in a watery stool.
If you visit nearly any developing country in Latin America, Africa, or Asia, you have got 30 to 50 percent chance of spending a few days in close contact with your bathroom. Less risky are countries such as southern Spain and Italy, Greece, Turkey, and Israel, where some 10 to 20 percent of tourists come down with traveler’s diarrhea. Posing the lowest risk are Canada and northern Europe.
Your actions, however, can help influence that risk. If you really want to try food from the local street vendor or insist on drinking tap water, you are increasing your chances of coming down with traveler’s diarrhea.
If you do get sick, it will probably last for two to four days, although some ten percent of cases can last for more than a week. And you may also experience as if the diarrhea weren’t enough – abdominal pain, cramps, gas, nausea, fatigue, loss of appetite, headache, vomiting, fever, and bloody stools.
Most common is watery diarrhea, sometimes accompanied by vomiting and a fever under 101 degrees Fahrenheit. If you actually get bacillary dysentery (caused by the Shigella bacteria), you will have a fever over 101 degrees Fahrenheit, much more abdominal pain and cramping, and, often, blood in your stools.
The following are prevention and treatment options that can help save your vacation or business trip.
Prevention strategies
Here is what you can do to try to prevent a case of traveler’s diarrhea from spoiling your trip. A lot of if involved using your head about your eating or drinking.
- Give up ice cubes for the duration of travel: They are made with tap water, and despite some people’s beliefs, freezing will not kill the bacteria. Neither will floating those cubes in an alcoholic drink; the alcohol isn’t strong enough to kill the bugs.
- Drink bottled water: Don’t drink water delivered to your table in a glass and don’t drink water straight from a tap. And if you don’t like the looks of the water in the bottle, if it looks scummy, don’t drink it.
- Open your own bottles: Whether it’s water, a soft drink, or beer, open the bottle yourself. Otherwise, you don’t know whether someone took an empty bottle and filled it up at the back sink. What’s more, some people are not terribly clean and may rub their grimy hand or a dishtowel over the top of a bottle that’s been opened to theoretically clean it.
- Use caution with other beverages: Fresh lemonade may sound appealing, but you don’t know the source of the water. Boiled beverages are OK – that means tea and coffee can be safe.
- Know your dairy products: Don’t drink unpasteurized milk and dairy products.
- Stick to cooked foods: This is not the time to indulge in raw oysters. You will have to pass on that green salad, too. Avoiding raw vegetables is one of the most important things you can do, stresses Sack.
- Eat your cooked foods while they are hot: If they have time to sit around and cool off, bacteria carrying flies have time to visit your food before you eat it.
- Eat only fruits you peel yourself: Pass up that pretty grapefruit salad and get a grapefruit you can peel yourself. The same advice goes for hard-boiled eggs. The bacteria isn’t in the food, it’s on the food.
- Take your own care package: Bring along some granola bars, tea bags, packets of instant cocoa. You can make your own tea, for example, if you boil the water thoroughly. You can ruin a vacation with one bad meal. You are entitled to be careful.
Coping Tips
If, despite all your precautions, you still get sick, don’t despair. Simply follow the same instructions for diarrhea that you would at home:
- Beware of becoming dehydrated: The danger in diarrhea is in losing both fluids and electrolytes, minerals like sodium and potassium that regulate many different functions in the body.
- Try oral rehydration therapy: You can usually buy a packet of oral rehydration solution to mix with water in a drugstore in any country except in the United States. Mix it with the best water available, but don’t worry if you have to mix it with tap water. It’s important to get fluids, and besides, the horse is already out of the barn at this stage.
- Make your own ORT: If you can’t get to a drugstore, you can use common kitchen ingredients to make your own oral rehydration therapy solution. Mix four tablespoons of sugar, one-half teaspoon of salt, and one-half teaspoon of baking soda in one liter of water. Be sure to eat lots of oranges and bananas for potassium with this. There is no common kitchen ingredient with potassium to include.
- Drink a combination of fluids: Remember, the bigger danger in diarrhea is becoming dehydrated. You are also losing electrolytes, so drink a combination of liquids besides water, such as weak tea with sugar, broth, moderate amounts of fruit juices (be careful – some have a laxative effect), defizzed non-diet and noncaffeinated soda pop, or Gatorade.
- Sip, don’t guzzle: Try to take frequent small drinks; it’s less irritating to your gut that way.
- Eat a bland diet: Forget the enchiladas and salsa. This is the time for the toast, rice, noodles, bananas, gelatin, soups, boiled potatoes, cooked carrots, and soda crackers.
- Pack the pink stuff: Pepto-Bismol is definitely the first choice when it comes to treating traveler’s diarrhea. It actually has a mild antibacterial effect, so it’s especially useful in traveler’s diarrhea.
- Don’t rely on over-the-counter medicines that decrease motility: In plain English, avoid Imodium and Kaopectate; they slow down the movement of the bowel. That can have serious consequences, especially if you have got dysentery.
- Bring along an antibiotic – just in case: Visit your Doctor before you leave on vacation and get a prescription antibiotic such as doxycycline, sulfamethoxazole, or quinolones. If you start taking it early in the disease, you will shorten the duration (the average duration is four to five days) to one to two days.