It is not a foregone conclusion that you will have diarrhoea when you go on holiday but the likelihood in some destinations is greater than in others.
Diarrhoea is a disorder of the gastrointestinal system and tends to be a result of eating and drinking food and water that your body is not accustomed to. If you are visiting a destination where the conditions are not as sanitary as they are at home or the climate is different from what you are used to then the chances of getting diarrhoea increase.
What causes diarrhoea?
Diarrhoea can be caused by bacteria, viruses, or parasites that have contaminated food and drink although nonspecific causes such as jet lag, stress and change of eating habits can be the culprits.
Symptoms of diarrhoea
There are a number of symptoms that are common to travellers' diarrhoea although some symptoms will depend on what is causing the problem. Symptoms include:
- Watery diarrhoea
- Abdominal cramps
- Fever
- Bloating
- Excessive gas
- Nausea
- Vomiting
- Urgent defecation
Whilst all these symptoms are quite normal, there are a number of symptoms that may indicate that the condition is more serious than first thought and so indicates that you must seek medical attention as a matter of urgency:
- Intolerable abdominal pain or rectal pain
- High fever, temperature exceeding 39 degrees celsius
- Bloody stools
- Persistent vomiting in excess of four hours alongside the inability to keep any fluids down
- Dehydration
Diagnosis
If the travellers' diarrhoea has not eased within three days or symptoms become worse, it is important that you seek medical advice.
It is important that the doctor knows that you have been travelling and they will then perform a physical examination including temperature and palpation (pressing on) of the abdomen. They will take stool and blood samples; they will test for parasites, infections and whether or not you are dehydrated.
Types of diarrhoea
Diarrhoea can be caused by infection with different types of micro organisms and the type of diarrhoea can vary as different bugs affect the body in different ways.
- Watery diarrhoea – this kind of diarrhoea is most common when you are travelling. It is usually caused by bacteria although this will vary according to where you are the most common bacteria is Escherichia coli (E Coli). There are relatives that live in your intestines that are harmless but this strain is not harmless. The normal turn of events when you are infected with this is that it starts a few days after arrival and will involve up to six attacks of diarrhoea per day. There may be an accompanying low grade fever but it is unlikely that you will be unwell, just a bit inconvenienced! You may also have bloating, stomach cramps and gas! This kind of diarrhoea is rarely dangerous posing the greatest risk to young children and the elderly. It is rare that mediation will be needed; it will resolve itself in a few days and just needs you to keep your fluid levels up in order to prevent dehydration.
- Bloody diarrhoea or dysentery – dysentery is any type of diarrhoea that has blood in it. This type of diarrhoea can be more severe and last longer than the common watery type; it usually needs treatment with antibiotics. This is less common and will make up about ten per cent of travellers who get diarrhoea. It is usually caused by a bacterium, commonly salmonella or shigella. Dysentery tends to begin with non-specific ‘flu like’ symptoms with high fever, headache and aches and pains making this a very unpleasant condition. The faeces begin as being very watery and come in copious quantities; after this the quantity reduces and the stool contains blood and mucous. Stomach cramps can also be painful and indicate that a toilet is needed as a matter of urgency. It is important that you seek medical advice if you have dysentery as you will need a course of antibiotics. You must also rest and take in plenty of fluids.
- Vomiting and diarrhoea – a sudden attack of nausea that causes profuse vomiting after eating, is commonly caused by food poisoning. Largely this occurs if you have eaten food in an eatery of some kind and the level of food hygiene may not be up to scratch; seafood is a common culprit. This can be accompanied by stomach cramps and watery diarrhoea as the food passes from the stomach into the intestines. The only real remedy for this is to rest and take fluids on board to rehydrate the system. It should last between 12 and 24 hours. It is best not to prevent vomiting as this is the way the body rids itself of the toxic food. If it continues for more than 224 hours however you will need to seek medical advice as a matter of urgency, especially if you have a fever or severe stomach pains and severe headache.
How to prevent travellers diarrhoea?
It is, without doubt, preferable to avoid getting diarrhoea in the first place. As we know, unhygienic food preparation and contaminated water both for drinking and washing foodstuffs are the primary cause of travellers' diarrhoea. Contamination of food can be caused by unsanitary preparation areas, unsanitary preparers who may not keep themselves as clean as they ought and flying insects, particularly flies which land on food and preparation surfaces. You can also catch diarrhoea from someone who has it but does not wash their hands properly; in addition swimming in contaminated water or even chlorinated water as Giardia can survive the chlorine.
The best approach to ensure that the food and drink you take on board is sanitary is to follow a few guidelines including:
- Avoid local water, do not drink it.
- Be aware that ice cubes in drinks may be made from local water
- Use bottled water for brushing teeth and rinsing
- Avoid food being sold by street vendors
- Remember some foodstuffs will be washed in local water so should be avoided when possible
- Only eat pasteurised dairy products – beware of local ice cream
- Only eat foods that are hot and well cooked – avoid the salads that may be washed in contaminated water
- Avoid food that is stored at room temperature
In general, it is important that you are aware of the risks. Wash or sanitise hands often, in particular, this is important before you eat or touch your face. As far as possible try to ensure that children do not put anything in their mouths, even their hands.
If you are using a sanitiser it is important that it is 60% alcohol or higher.
What should you do when you get travellers' diarrhoea?
I think the best thing to do is to avoid medication that stems from the flow of diarrhoea as this ‘paralyses’ the intestines and so prevents it from being expelled from the body. Some basic steps which you can take include:
- Rest as this gives the body the opportunity to fight whatever microorganism is attacking it; staying put is usually a good idea if you have urgent diarrhoea!
- Drink plenty of fluids to prevent dehydration
- Take your temperature to ensure that the illness is not getting worse
- This is not a pleasant job but necessary; it is important that you check the stool to ensure they do not contain any blood or mucous.
- Ensure that your urine is not becoming dark; if it is you are becoming dehydrated so you must drink more fluids.
- Make a note if you have other symptoms. This is because other more serious illnesses can also present with diarrhoea such as malaria and hepatitis.
- Diarrhoea is very contagious so in order to keep it to yourself, you must be fastidious about cleanliness.
What fluids should you have if you have diarrhoea?
When you have diarrhoea or are vomiting you not only lose water but also lose salts including potassium, sodium and chloride. Alongside replacing the water you have lost it is important to replace the salts and packets of oral rehydration salts are available which contain the salts and sugar that you require. It is always a good idea to include these in a travel first aid kit.
The drinks which are best avoided are those which are diuretics, they make you urinate more, and these include caffeinated drinks (coffee, tea and cola).
How to treat diarrhoea?
Remedies to relieve the symptoms of diarrhoea
Whilst we have explained why it is best not to stem the flow of diarrhoea, however, if you need to do this because you have to travel, for instance, there are some remedies you can consider; they are called antimotility drugs:
- Loperamide (Imodium)
- Diphenoxylate with atropine and codeine phosphate will slow the guts down so you do not have to visit the toilet so frequently.
Do not overdo it with these medications otherwise, you may become constipated.
Self help remedies can also help if you have diarrhoea. Eating bland foods is one remedy and foods to try include:
- Toast
- Broth
- White rice
- Crackers
- Bananas
- Apples that have been washed in bottled or boiled water
Antibiotics to treat diarrhoea
If the condition is serious and the diarrhoea is not subsiding, as mentioned earlier you may need antibiotics. If this is the case you will need to seek the advice of a doctor.
Possible complications from travellers diarrhoea
What can become a dangerous situation that arises as a result of diarrhoea is dehydration. It is easy for a person to become dehydrated when they have severe diarrhoea and the body is losing fluid more quickly than it can be replaced. If you have vomiting to accompany the diarrhoea this can be particularly risky, especially if a person is failing to keep fluids down. This can potentially be a real problem for young children.
Symptoms of dehydration include:
- Headache
- Dizziness
- Confusion
- Dry mouth
- Increased thirst
- Decreased urine output
- Dry skin
If a case of diarrhoea is caused by a parasite it is important that it is treated with medication. The reason for this is that it may easily become more severe and parasitic infections can cause:
- Seizures
- Allergic reaction
- Bacterial infection
- Fever
In particular, tapeworms typically lay eggs that embed into the intestinal wall but they can also lay eggs that move to other parts of the body which may cause some very serious problems depending on the species of tapeworm involved.
Fluke worms can cause fatigue. Hook worms can cause anaemia and fatigue. Trichinosis worms can cause the following:
- Fever
- Headache
- Conjunctivitis
- Muscle pain
- Swelling of the face
Conclusion
At the end of the day, the best thing to do when it comes to diarrhoea is to avoid it if at all possible. If however you are attacked by what is commonly known as ‘delhi belly’ we have included some guidance as to the best way to deal with it.
It may be wise to stock up on medication, both over the counter treatments and even antibiotics if you are planning a trip to somewhere particularly exotic or where medical help may not be found easily.
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