Travellers’ Diarrhea

It is finally springtime, plans made, resort booked, airline tickets purchased, bags getting packed.  Finally you can hit the beach, and sunshine after a two year hiatus. So exciting! A glorious week of sun, relaxing, exploring awaits. Nothing must go wrong.

Southern shores of some countries are enticing with fine sand beaches, palm trees, warm Caribbean waters, sunshine and great food. However, these places also come with risk of in the form of Travellers’ Diarrhea.

Travellers‘ diarrhea is a condition caused in people travelling to places with poor water filtration systems. The water will be contaminated with bacteria, virus or parasites that can cause a change in bowel movements from normal to three or more loose watery stools. 

You can contract Travellers’ diarrhea by drinking contaminated water, eating fruit or vegetables washed with unpurified water. It can also be transmitted person to person by poor hygiene practices, like not washing hands after going to the bathroom. 

Travellers’ diarrhea can come on suddenly either during your trip or upon return home.  You can also experience more than one episode on a trip if you are not careful. 

Symptoms of Travellers’ Diarrhea:

When Travellers’ diarrhea sets in; most common symptoms experienced are: 

• Abrupt onset of passage of three or more looser watery stools a day
• Urgency to defecate
• Abdominal cramps
• Nausea
• Vomiting
• Fever

Most people will experience milder symptoms for 1-2 days without medication.  Some people will experience more severe abdominal pain, an increased number of loose watery stools, vomiting, blood in the stools. Dehydration from frequent watery stools and vomiting can occur. If symptoms last beyond two days and are severe then, medical assistance should be sought.

Travellers’ Diarrhea Treatment

Most symptoms clear up on their own after a few days, with the most important measure is to maintain good hydration with bottled water or oral rehydration solutions like Gatorade®

For severe diarrhea you may need anti-motility medication like Imodium® which slows down the movement of bowels and prevents dehydration.  However, if there is blood in the stool or you have a fever, do not use Imodium®. Pepto-Bismol® is recommended to help decrease diarrhea by re absorbing the water and adsorbing the bacteria/virus causing the infection.  

Travellers’ Diarrhea can be treated with antibiotics. Before you travel speak with your doctor about the antibiotic best for you to take on your trip. 

Preventing Travellers’ Diarrhea:

The best way to prevent Travellers’ Diarrhea is to avoid contaminated water, drinking or eating foods washed with the water. When it comes to fruit and vegetables, remember this phrase, ‘Boil it, cook it, peel it or leave it!’ If staying in a resort, you might want to enquire if they have filtered water to wash the vegetables and fruit served fresh, as well as bottled water in rooms to drink and brush teeth.  If renting house, always boil the water that you will be using to clean your fresh produce. 

Tips on preventing ingestion of contaminated water:

• Always wash your hands before eating or preparing food remember to wash after using the bathroom, changing diapers, or having contact with animals or sick people.  Bring along alcohol based (70%) hand sanitizer.
• Only eat foods that are well cooked and served hot.  
• Avoid raw or undercooked (rare) meats and fish, including shellfish.
• Only eat fruits and vegetables washed in safe water or you peeled 
• Avoid salads, or other items that are made with fresh produce and you are not certain of the water used for cleaning.
• Do not eat food from street vendors.
• Drink water only if it has been boiled or disinfected or is in a commercially sealed bottle.
• Make sure all ice cubes are made of water that is purified.
• It is safe to drink hot steaming drinks like coffee and tea, as well as all commercially available drinks in sealed bottles or cans
• Brush your teeth with purified or bottled water
• Avoid unpasteurized dairy products and fruit juices.

Probiotics like Florastor® can help in the prevention of Travellers’ Diarrhea.  Studies of the impact of Florastor® containing probiotic strain, Saccharomyces boulardii, demonstrated in clinical trials to be effective in preventing Travellers’ diarrhea. It is recommended to start taking Florastor® 5 days before the trip and continue through the duration. Florastor probiotics can help you by strengthening and restoring your gut microbiota. Here are the proven mechanisms of actions: 

• Act directly on harmful bacteria and other microbes
• Enhance immune response to these microbes
• Reduce inflammatory response
• Restore the balance between good and bad bacteria in the digestive tract
• Positively influence normal gut functioning

Taking probiotic Florastor®, using good hygiene practices and avoiding contaminated water is the best way to ensure a healthy vacation free of Travellers’ Diarrhea. 

Travellers’ Diarrhea Medication

When travelling by airplane, remember to carry on all medication that you need to keep healthy.  If you have a medication that may be a painkiller, ask your pharmacy for a copy of the prescription. Persons carrying narcotic/controlled substances to other countries may be detained at the border if they do not have proof of prescription.  

Packing checklist for carry on luggage:

• Medication you take regularly
• Hand sanitizer
• Probiotics- Florator®
• Pepto Bismol
• Imodium
• Antibiotics

References:

Parry S, Forgacs I. Intestinal infection and irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2005;17:5–9.

Alexander KC Leung, Amy AM Leung, Alex HC Wong, Kam L Hon.  Traveller’s Diarrhea: A Clinical Review.  Recent Pat Inflamm Allergy Drug Discov.  2019, May; 13(1): 38-48.

https://travel.gc.ca/travelling/health-safety/food-water

Product Monograph Pepto Bismol 

Product Monograph Imodium

Lynne V McFarland.  Meta-analysis of probiotics for the prevention of traveler’s diarrhea.  Travel Med Infect Dis 2007 Mar;5(2):97-105.