Traveler's diarrhea, which may have a number of different causes, can make international travel, particularly to certain parts of the world, as daunting as it is exciting. Some foreign destinations present health issues not commonly faced in the United States. Since traveler's diarrhea is the most common medical complaint of those who venture abroad, wise travelers take precautions.
Causes of Traveler's Diarrhea
Some individuals who are especially susceptible may experience diarrhea simply as a result of dietary changes, allergies or stress. For most people, however, traveler's diarrhea is caused by one of a number of pathogens. Most cause other symptoms in addition to loose and frequent stools, including fever, nausea, vomiting and abdominal cramps. These symptoms are often severe enough to interfere with participation in planned activities and may even result in hospitalization. Infections causing traveler's diarrhea may be be airborne, present in contaminated food or water, or transmitted by animals or insects. They include:
- Bacteria, such as E.coli, Salmonella, and Shigella
- Viruses, such as Noroviruses and Rotavirus
- Parasitic diseases, like malaria and Cyclospora
Of these, E.coli is the most common cause of diarrhea in travelers generally, though norovirus is the most frequent cause of the condition on cruise ships. Typically, diarrhea caused by bacteria and viruses incubates within a few hours or a few days. Diarrhea from parasites can occur as much as a week or two after exposure, so some travelers do not become ill until they have returned home.
Before embarking on a trip out of the country, it is important to consult with a physician who is knowledgable about infectious diseases. Because some foreign destinations require more precautions than others, it is necessary to make the doctor aware of:
- Specific itinerary
- Types of accommodations
- Modes of transportation
- Anticipated activities
- Possible contacts with animals
- Possible contacts with patients
- Season of the year at destination
It is ideal to have an initial consultation with the doctor 4 to 6 weeks before your travel is scheduled to occur. This provides enough time to receive any necessary immunizations and any required documentation of inoculations. In addition, the doctor will make sure the traveler's routine vaccinations are up-to-date. This is important because certain diseases that have been eradicated here are still prevalent elsewhere.
Prevention of Traveler's Diarrhea
There are several precautions that may help to prevent traveler's diarrhea.
Protection From Insect-Borne Illness
Doctors recommend that patients protect themselves from various insect-borne diseases by using an insect repellent with DEET. The product should be applied to all exposed skin, but washed off as soon as it is possible to do so safely. Permethrin should be used to protect clothing and bedding from insects.
Protection From Contaminated Food and Water
Generally speaking, bottled water and canned juices and fruits can be safely consumed. Doctors normally recommend that travelers avoid the following when visiting areas where sanitation is questionable:
- Tap water and ice cubes
- Unpeeled fruits or raw vegetables
- Fresh juices
- Unpasteurized dairy products
- Food from street vendors
Where the water quality is questionable, be aware that sliced fruit being served may have been rinsed in contaminated water. In certain areas, swimming should be avoided and travelers should keep their mouths closed while showering. Travelers should brush their teeth only with bottled water.
Treatment of Traveler's Diarrhea
Physicians typically recommend that traveler's go abroad equipped with an anti-motility agent, such as lomotil or imodium, antibiotics in case of infection, and Pepto-Bismol (bismuth subsalicylate). Pepto-Bismol not only coats the intestinal tract to relieve symptoms, but may also be taken prophylactically for up to 3 weeks to assist in staving off infection.
If a traveler develops diarrhea abroad, it is extremely important to keep the patient well-hydrated and restrict the diet temporarily to salted crackers, dry toast, rice, potatoes, noodles, bananas and applesauce.
Complications of Traveler's Diarrhea
Although traveler's diarrhea is rarely life-threatening, it can be extremely debilitating, especially in children, older adults and those with compromised immune systems. Apart from the weakness it brings, diarrhea can result in dehydration. Symptoms of lightheadedness, reduced urine output, or cognitive impairment require immediate intervention since dehydration can lead to seizures and coma.