What is it
Traveler’s diarrhea, long known as Montezuma’s revenge among other names, is something of a misnomer. Though it has been defined in the pages of the New England Journal of Medicine as diarrhea that occurs when a person living in an industrialized country travels to developing or semitropical regions (Latin America, Africa, Middle East, Asia), some people get traveler’s diarrhea when entering the United States or other industrialized nations. Any change of locale and eating habits, or even the stress of travel, can make you more vulnerable to it. Also, imported melons, fruit, and other produce, which occasionally are contaminated, have caused rare out-breaks of diarrhea in the United States.
Nevertheless, traveler’s diarrhea is still more common among travelers from low-risk to high risk areas 40 to 60 percent of Americans traveling to developing countries are laid low with diarrhea, although of course that doesn’t mean you can’t get the same bug in Kansas City, Palo Alto, or Niagara Falls. In whatever country you contract it, the illness usually appears within four to six days after arrival, with sudden attacks of loose watery stools often accompanied by abdominal cramps and nausea.
- Diarrhea, as much as 3 to 10 times a day, often in combination with vomiting, bloating, gas, and abdominal cramps.
- Fever and bloody stools (in severe cases).
- Dehydration (occasionally and usually not severe).
What causes it
Up to 80 percent of traveler’s diarrhea cases are bacterial in origin the ubiquitous E. coli found in fecal matter, plus some other bacteria that are transmitted via contaminated food or water. Less common agents are viruses and such parasites as Giardia lamblia. Many times it’s impossible to identify the exact culprit.
What if you do nothing
Traveler’s diarrhea is not life-threatening in otherwise healthy people. If you rest and drink plenty of water, you may be uncomfortable, but it should go away on its own in two to five days without treatment. However, if a parasite such as Giardia lamblia is to blame, giardiasis an infection of the small bowel, may develop. Symptoms may persist for two weeks or more if antibiotics are not taken.
Your goal is to prevent dehydration, which occurs often with diarrhea because the body loses more fluids and salts than it takes in. The most important self-care measure is to replace lost fluids as soon as you can keep them down. Bottled water, flat soft drinks, sports drinks, or tea will help. You can also make your own rehydration drink by adding four teaspoons of sugar and a pinch of salt (a half teaspoon) to a quart of water.
Avoid coffee and alcohol, which can increase dehydration.
For a child who becomes sick, try sweetening water with honey, and add a pinch of salt. Children under age two should drink a commercial rehydration solution, which contains the correct amounts of fluid, salts, and carbohydrates to pre- vent dehydration.
If you have no diarrhea after 12 hours, salted crackers are a good way to begin eating again, and the salt helps restore fluid balance. Other foods to consider include dry- toast, bread, and clear soup. When the number of stools decreases and your stools have shape, you can add rice, baked potatoes, chicken soup, poultry, applesauce, and bananas or any food, really, that appeals to you, as long as you observe the precautions noted below.
Self-treat with medication, if necessary
Consuming fluids and food is sufficient to clear up symptoms of traveler’s diarrhea in many people and if you are otherwise healthy, you also want to give your body a chance to eliminate the diarrhea-causing organism. However, if you are in a situation where diarrhea is inconvenient, you can also shorten the duration of the disorder with over-the-counter medications.
Loperamide (such as Imodium) is an anti- motility drug that works against loose stools, reducing both the passage of stool and the duration of diarrhea by up to 80 percent. Bismuth subsalicylate (Pepto-Bismol, which is also sold in generic forms) reduces the number of loose stools by about 60 percent, but people who are aspirin-sensitive or take aspirin for other reasons, as well as children under the age of 12, should not use bismuth subsahcylate.
Moreover, you should not take any of these drugs if you have high fever and bloody stools; these two symptoms can be signs of a serious infection that requires immediate medical attention, and the medications may make the condition worse.
When traveling in developing countries, follow these recommendations.
Find out about health precautions
The Centers for Disease Control and Prevention can supply you with information about health risks in different countries. It’s also a good idea to get a doctor’s advice before you go if you are traveling to developing countries and are pregnant or nursing, are accompanied by infants or small children, or have chronic health problems. Do so as well if you’re taking a critically important business trip that would be compromised if you developed traveler’s diarrhea.
Don’t rely on drugs
It’s certainly a good idea to carry antibiotics with you when you travel, along with instructions on how to use them should the need arise. But some travelers take antibiotics before they leave home in order to ward off traveler’s diarrhea. Using antibiotics or any other medication prophylactically is generally not recommended. Some medications can produce severe side effects worse than the diarrhea. In addition, taking them can give a false sense of security to travelers who might otherwise be cautious in their choice of food and drink.
People with health problems, however, should check with their doctors before they travel, since some of them will benefit from taking medications prophylactically.
As a precaution, take diarrhea medications with you
If you’re traveling in out-of-the-way places, beyond the reach of a druggist, it’s advisable to take a diarrhea treatment along. If you have any health concerns, consult with your doctor, who can recommend an over-the-counter product or a prescription medication such as Lomotil.
Once you’ve arrived, drink only bottled or canned beverages
Be sure you’re the one who breaks the seal. Or stick to hot drinks like tea or coffee made with boiling water. Bottled wine and beer are all right. In some areas locally bottled water and soft drinks may not be safe. If in doubt, stick to tea and coffee.
Never use tap water
Use bottled or boiled water instead, even for brushing your teeth.
Pass up all ice cubes
The cubes may have been made with contaminated water.
Treat your own water
If necessary, take along an immersion heater and boil your own water or add to it a purifying tablet such as Halazone two and a half tablets per quart for at least 30 minutes.
Don’t eat anything raw
Particularly not salad greens. Raw fruit is okay only if it can be peeled and if you do the peeling. Be certain not to wash the fruit in tap water. Avoid rare meats, undercooked eggs, and all dairy products, since it’s hard to be sure they’ve been pasteurized.
Don’t buy food from street vendors
Even if it’s served hot, it still may be contaminated.
Wash your hands carefully
To prevent the spread of diarrhea and eliminate all chances of reinfection, be sure to wash your hands with soap and water after using the bathroom and before eating.