Avoiding traveller’s diarrhoea

Clinical Fellow at Bupa UK
17 May 2018

Traveller’s diarrhoea is really common. Up to six in every 10 people travelling to high-risk parts of the world get it ... I’ve certainly had my fair share of it!

So here I’ll provide some helpful tips to help you try and avoid traveller’s diarrhoea, as well as describe some simple treatments to keep you hydrated and improve your symptoms. I’ll also cover off some common questions such as: ‘what can I eat?’ and ‘do I need antibiotics?’

Image of some prawns being sold on a food market

What is traveller’s diarrhoea?

Traveller’s diarrhoea develops during or shortly after travelling abroad. It’s when you get diarrhoea (loose and watery bowel movements) three or more times over the course of 24 hours. You may also get other symptoms too such as a fever, tummy cramps, feeling sick and vomiting. Most of the time the illness is mild and gets better on its own within three to five days.

What causes traveller’s diarrhoea?

Traveller’s diarrhoea most often happens when you eat or drink food or water that’s contaminated with bacteria (such as E. coli), viruses (such as norovirus) or parasites (such as Giardia). These can also spread through touching contaminated surfaces and then touching your mouth.

You might also get tummy problems when travelling because you’re eating unfamiliar foods or you’re feeling anxious. But most of the time it’s caused by an infection.

You’re more likely to get traveller’s diarrhoea if you travel to less developed countries. But it’s also possible to get poorly on cruise ships or at holiday resorts where germs can spread from person to person easily.

How can I avoid traveller’s diarrhoea?

Food and drink

Traveller’s diarrhoea is difficult to prevent when you can’t prepare your own food and drinks. These simple steps may reduce your chances of becoming unwell, but don’t offer full protection.

  • Wash your hands regularly, especially before preparing food or eating. Carrying antibacterial hand gel is a good idea if there’s a chance soap and water may not be available.
  • Avoid uncooked foods, particularly meat, shellfish or eggs. Avoid fruits that have already been peeled and salads. Don’t eat ice cream from unreliable sources.
  • Drink safe drinking water. Avoid tap water, even as ice cubes. Be particularly careful with fruit juices, which may be mixed with unclean water.
  • Pick reputable establishments. Often, asking local people for advice will enable you to locate hygienic options. Take care when consuming food or drinks from markets, street vendors or buffets if hygiene standards are unclear, or food may have been left unrefrigerated.

Having been ‘burnt’ so many times with traveller’s diarrhoea, I’ve now taken to packing snacks and bottled water for long journeys, as sometimes hygienic eating establishments can be limited. Having an emergency supply allows you to wait until a more reputable establishment becomes available.

What are the risk factors?

There are several factors that might affect your chances of getting traveller’s diarrhoea.

Destination

Although most of us wouldn’t chose our destination based on our risk of getting traveller’s diarrhoea, you could consider this if you have several potential places in mind. Even if your heart is set on somewhere, it’s worth being aware of the risks and taking steps to reduce your chances of becoming unwell.

Common travel destinations are split into three categories depending on the level of risk:

Low-risk zones (less than 7 per cent risk)   Western Europe, USA, Canada, Japan, Australia and New Zealand  
Intermediate-risk zones (up to 20 per cent risk) Southern Europe, Israel, South Africa, some Caribbean islands and the Pacific
High-risk zones (more than 20 per cent risk)  Africa, Latin America, the Middle East and most parts of Asia
                                   

For more information about individual countries where you need to take strict food, water and personal hygiene precautions, see the fitfortravel website.

Swimming

Swimming pools, the sea and freshwater rivers and lakes may also be a source of infection. In swimming pools, there’s a risk of infection if disinfection methods aren’t good enough. Try to avoid swallowing any water while you swim.

Treatment

Most episodes of traveller’s diarrhoea are mild and resolve on their own within three to five days. The main treatment options include rehydration and tablets to reduce the frequency of loose movements. It’s also important to know when to seek medical help.

Rehydration

Drink plenty of clear fluids, such as oral rehydration solutions. Make sure you prepare any rehydrating drinks with safe water.

Antidiarrhoeal medicines

These aren’t usually necessary. However, you may want to reduce the number of trips that you make to the toilet, particularly if you have a long journey ahead! Take these according to the instructions that come with your medicine.

The effect is not immediate; they may take an hour or two to work. Taking too much can cause constipation, so make sure you follow the dosage instructions carefully.

Do I need to take antibiotics?

You may benefit from antibiotics if you have moderate or severe traveller’s diarrhoea. In these cases, antibiotics have been shown to reduce the number of days and severity of symptoms.

It’s worth speaking to your doctor in advance and to consider packing a course of antibiotics to pack just in case. This may be appropriate if you’re travelling to remote areas, have had severe traveller’s diarrhoea before or have a pre-existing medical condition such as inflammatory bowel disease or kidney disease. This will ensure that you can quickly take a course of antibiotics if needed.

Other common questions

Should I use probiotics?

Doctors don’t recommend probiotics for trying to prevent traveller’s diarrhoea. There’s not enough evidence that they’re effective for this.

What can I eat?

Doctors no longer suggest that you ‘starve’ yourself for a while if you have diarrhoea. Eat small, light meals if you can. Be guided by your appetite; if you’re hungry, avoid fatty, spicy or heavy food, and aim to eat plain foods such as rice and bread.

When should I seek medical help?

Seek medical assistance if:

  • you notice blood in your poo
  • you have a fever
  • you become dehydrated
  • the diarrhoea persists for more than three or four days

Is it contagious?

Yes. Whatever the bug, it must be considered contagious. When you’re unwell, wash your hands with soap regularly (particularly after each time you go to the toilet) to reduce the chances of passing it on to someone else.

My top tips

As always, preparation is key. If you’ve had traveller’s diarrhoea before or you have pre-existing medical conditions, speak to your doctor before you go. My travel bag always includes a supply of oral rehydration salts and loperamide.

Try to build a buffer of time and money into any trip, particularly if you’re travelling somewhere with a high risk of diarrhoea. I’ve found that moving into your own room with your own bathroom certainly makes the symptoms more manageable! Having a spare day or two also means you may not have to miss key attractions if symptoms develop unexpectedly.

Dr Tom Charlton
Clinical Fellow at Bupa UK

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