Overview

Traveler's diarrhea is a digestive tract disorder that commonly causes loose stools and abdominal cramps. It's caused by eating contaminated food or drinking contaminated water. Fortunately, traveler's diarrhea usually isn't serious — it's just unpleasant.

When you visit a place where the climate or sanitary practices are different from yours at home, you have an increased risk of developing traveler's diarrhea.

To reduce your risk of traveler's diarrhea, be careful about what you eat and drink while traveling. If you do develop traveler's diarrhea, chances are it will resolve without treatment. However, it's a good idea to have doctor-approved medications with you when you travel to high-risk areas in case diarrhea persists.

Symptoms

Traveler's diarrhea usually begins abruptly during your trip or shortly after you return home. Most cases improve within one to two days without treatment and clear up completely within a week. However, you can have multiple episodes of traveler's diarrhea during one trip.

The most common signs and symptoms of traveler's diarrhea are:

  • Abrupt onset of passage of three or more loose stools a day
  • An urgent need to defecate
  • Abdominal cramps
  • Nausea
  • Vomiting
  • Fever

Sometimes, people experience moderate to severe dehydration, persistent vomiting, a high fever, bloody stools, or severe pain in the abdomen or rectum. If you or your child experiences any of these signs or symptoms or if the diarrhea lasts longer than a few days, it's time to see a doctor.

When to see a doctor

Traveler's diarrhea usually goes away on its own within several days. Signs and symptoms may last longer and be more severe if the condition is caused by organisms other than common bacteria. In such cases, you may need prescription medications to help you get better.

If you have severe dehydration, persistent vomiting, bloody stools or a high fever, or if your symptoms last for more than a few days, seek medical help. The local embassy or consulate may be able to help you find a well-regarded medical professional who speaks your language.

Be especially cautious with children because traveler's diarrhea can cause severe dehydration in a short time. Call a doctor if your child is sick and exhibits any of the following signs or symptoms:

  • Persistent vomiting
  • Bloody stools or severe diarrhea
  • A fever of 102 F (39 C) or more
  • Dry mouth or crying without tears
  • Signs of being unusually sleepy, drowsy or unresponsive
  • Decreased volume of urine, including fewer wet diapers in infants

Causes

It's possible that traveler's diarrhea may stem from the stress of traveling or a change in diet. But almost always an infectious agent is to blame.

You typically develop traveler's diarrhea after ingesting food or water that's contaminated with organisms from feces. These organisms are infectious agents — including various bacteria, viruses and parasites — that enter your digestive tract and overpower your defense mechanisms, resulting in signs and symptoms of traveler's diarrhea.

The most common cause of traveler's diarrhea is enterotoxigenic Escherichia coli (ETEC) bacteria. These bacteria attach themselves to the lining of your intestine and release a toxin that causes diarrhea and abdominal cramps.

So why aren't natives of high-risk countries affected in the same way? Often their bodies have become accustomed to the bacteria and have developed immunity to them.

Risk factors

Each year millions of international travelers experience traveler's diarrhea. High-risk destinations for traveler's diarrhea include many areas of Central and South America, Mexico, Africa, the Middle East and most of Asia.

Traveling to Eastern Europe and a few Caribbean islands also poses some risk. However, your risk of traveler's diarrhea is generally low in Northern and Western Europe, Japan, Canada, Australia, New Zealand and the United States.

Your chances of getting traveler's diarrhea are mostly determined by your destination. But certain groups of people have a greater risk of developing the condition. These include:

  • Young adults. The condition is slightly more common in young adult tourists. Though the reasons why aren't clear, it's possible that young adults lack acquired immunity. They may also be more adventurous than older people in their travels and dietary choices, or they may be less vigilant in avoiding contaminated foods.
  • People with weakened immune systems. A weakened immune system increases vulnerability to infections.
  • People with diabetes, inflammatory bowel disease or cirrhosis of the liver. These conditions can leave you more prone to infection or increase your risk of a more-severe infection.
  • People who take acid blockers or antacids. Acid in the stomach tends to destroy organisms, so a reduction in stomach acid may leave more opportunity for bacterial survival.
  • People who travel during certain seasons. The risk of traveler's diarrhea varies by season in certain parts of the world. For example, risk is highest in South Asia during the hot months just before the monsoons.

Complications

Because you lose vital fluids, salts and minerals during a bout with traveler's diarrhea, you may become dehydrated. Dehydration is especially dangerous for children, older adults and people with weakened immune systems.

Dehydration caused by diarrhea can cause serious complications, including organ damage, shock or coma. Signs and symptoms of dehydration include a very dry mouth, intense thirst, little or no urination, and extreme weakness.

Prevention

Watch what you eat

The general rule of thumb when traveling to another country is this: Boil it, cook it, peel it or forget it. Studies show, however, that you can still get sick even if you follow these rules. Remember these tips to decrease your risk of getting sick:

  • Don't consume food from street vendors.
  • Avoid unpasteurized milk and dairy products, including ice cream.
  • Avoid raw or undercooked meat, fish and shellfish.
  • Steer clear of moist food at room temperature, such as sauces and buffet offerings.
  • Eat foods that are well-cooked and served hot.
  • Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and unpeelable fruits, such as grapes and berries.
  • Be aware that alcohol in a drink won't keep you safe from contaminated water or ice.

Don't drink the water

When visiting high-risk countries, keep the following tips in mind:

  • Avoid unsterilized water — from tap, well or stream. If you need to consume local water, boil it for three minutes.
  • Avoid locally made ice cubes or mixed fruit juices made with tap water.
  • Beware of sliced fruit that may have been washed in contaminated water.
  • Don't swim in water that may be contaminated.
  • Keep your mouth closed while showering.
  • Feel free to drink canned or bottled drinks in their original containers — including water, carbonated beverages, beer or wine — as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring.
  • Use bottled water to brush your teeth.
  • Use bottled or boiled water to mix baby formula.
  • Order hot beverages, such as coffee or tea, and make sure they're steaming hot.

If it's not possible to buy bottled water or boil your water, bring some means to purify water. Consider a water-filter pump with a microstrainer filter that can filter out small microorganisms.

You can also chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but is best reserved for short trips, as too much iodine can be harmful to your system. You can purchase iodine tablets or crystals at camping stores and pharmacies. Be sure to follow the directions on the package.

Follow additional tips

Here are other ways to reduce your risk of traveler's diarrhea:

  • Make sure dishes and utensils are clean and dry before using them.
  • Wash your hands often and always before eating. If washing isn't possible, use an alcohol-based hand sanitizer with at least 60 percent alcohol to clean your hands before eating.
  • Seek out food items that require little handling in preparation.
  • Keep children from putting things — including their dirty hands — in their mouths. If possible, keep infants from crawling on dirty floors.
  • Tie a colored ribbon around the bathroom faucet to remind you not to drink — or brush your teeth with — tap water.

Other preventive measures

Public health experts generally don't recommend taking antibiotics to prevent traveler's diarrhea, because doing so can contribute to the development of antibiotic-resistant bacteria.

Antibiotics provide no protection against viruses and parasites, but they can give travelers a false sense of security about the risks of consuming local foods and beverages. They can also cause unpleasant side effects, such as skin rashes, skin reactions to the sun and vaginal yeast infections.

As a preventive measure, some doctors suggest taking bismuth subsalicylate (Pepto-Bismol), which has been shown to decrease the likelihood of diarrhea. However, don't take this medication for longer than three weeks, and don't take it at all if you're pregnant, allergic to aspirin, or taking certain medications, such as anticoagulants.

Common harmless side effects of bismuth subsalicylate include a black-colored tongue and dark stools. In some cases it can cause constipation, nausea and, rarely, ringing in your ears (tinnitus).

Oct. 04, 2016
References
  1. Wanke CA. Travelers' diarrhea: Microbiology, epidemiology, and prevention. http://www.uptodate.com/home. Accessed Aug. 21, 2016.
  2. Moore KS. Travelers' diarrhea: Risk reduction and management. The Nurse Practitioner. 2015;40:1.
  3. Travelers' diarrhea: Self-treatable conditions. Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/travelers-diarrhea.htm. Accessed Aug. 21, 2016.
  4. Steffen R, et al. Traveler's diarrhea: A clinical review. Journal of the American Medical Association. 2015;313:71.
  5. Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/diarrhea/Pages/facts.aspx#what. Accessed Aug. 24, 2016.
  6. Zaidi D, et al. An update on travelers' diarrhea. Current Opinion in Gastroenterology. 2015;31:7.
  7. Food and water safety. Centers for Disease Control and Prevention. Accessed Aug. 22, 2016.
  8. Wanke CA. Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment. http://www.uptodate.com/home. Accessed Aug. 21, 2016.
  9. Food and water precautions. Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/food-and-water-precautions.htm. Accessed Aug. 22, 2016.
  10. Water disinfection for travelers. Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/water-disinfection-for-travelers.htm. Accessed Aug. 24, 2016.
  11. Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 29, 2016.