Traveler's Diarrhea: Symptoms, Causes, Treatment & Prevention

The digestive tract disorder known as traveler's diarrhea frequently results in loose stools and cramping in the stomach. Eating infected food or drinking contaminated water are the causes. Fortunately, traveler's diarrhea is typically not life-threatening for most individuals; it's uncomfortable.

You run a higher chance of getting traveler's diarrhea if you go somewhere with a different climate or hygienic standards than you are used to.

Be mindful of what you eat and drink when traveling to lower your chance of developing traveler's diarrhea. The likelihood is that if you do have traveler's diarrhea, it will go on its own. When visiting high-risk places, it is advisable to carry prescription medications recommended by a doctor. In this manner, you'll be ready if your diarrhea worsens or disappears.

Traveler's diarrhea: What Is It?

An intestinal infection known as "traveler's diarrhea" is brought on by eating or drinking tainted food or water. While traveler's diarrhea can occur anywhere, it is more common in locations with drastically different food sources, weather patterns, and hygiene standards than in your home country. This is common in places like Southeast Asia, sections of Africa, and Central and South America.

There are precautions you may take to avoid getting sick, such as boiling all of your food and drinking bottled water. In most cases, traveler's diarrhea is not a serious condition that will go away on its own without treatment.

Also Read: Shigella Infection (shigellosis): Symptoms, Causes, Treatment & Prevention

 Symptoms:

Diarrhea may strike unexpectedly during your travel or soon after you get back home. Without therapy, the majority of patients get well in 1 to 2 days and recover fully in a week. On the other hand, you may experience several bouts of traveler's diarrhea in a single journey.

The following are the most typical signs of traveler's diarrhea:

• Gaining the ability to pass three or more loose, watery stools in a day
• A pressing necessity to pass stool
• Stomach cramps
• Nausea
• Vomiting
• Fever

Causes

Traveler's diarrhea could result from a shift in diet or from the stress of traveling. However, infectious organisms like viruses, bacteria, or parasites are typically at fault. Traveler's diarrhea usually occurs when food or water contaminated with organisms from feces is consumed.

Why then aren't citizens of high-risk nations experiencing the same effects? Their bodies have frequently grown immune to the germs as a result of acclimation.

Between 80% and 90% of episodes of diarrhea among tourists are brought on by germs, including:

• Salmonella 

• Shigella

• Campylobacter

• E. Coli

Other viruses that can cause travelers' diarrhea include:

• Rotavirus

• Astrovirus

• Norovirus

Another cause is parasites. The most prevalent of them is Giardia intestinalis, however, several other parasites can also induce diarrhea.

Risk factors:

Millions of tourists from other countries get traveler's diarrhea every year. Areas with a high incidence of traveler's diarrhea include:

• Central America.
• South Americas.
• Mexico.
• Africa.
• South Asia and southeast Asia.

There is also some risk involved with visiting the Middle East, some Caribbean islands, South Africa, Central and East Asia, and Eastern Europe. However, countries in Northern and Western Europe, Japan, Canada, Singapore, Australia, New Zealand, and the United States generally have low rates of traveler's diarrhea.

The likelihood of contracting traveler's diarrhea is primarily influenced by your intended location. However, the illness is more likely to affect some groups of people than others. Among them are:

• Youthful grownups. Young adult visitors had a slightly higher prevalence of the condition. Young adults may not have acquired immunity, the exact causes are unknown. Additionally, they might travel and eat more daringly than older folks, or they might be less cautious about avoiding tainted foods.

• Those whose immune systems are compromised. Infection risk is increased by a compromised immune system brought on by an underlying disease or immuno-suppressive medications like corticosteroids.

• Individuals suffering from diabetes, inflammatory bowel disease, or serious heart, liver, or renal illness. These illnesses may make you more vulnerable to infection or raise the possibility of a more serious infection.

• Individuals suffering from diabetes, inflammatory bowel disease, or serious heart, liver, or renal illness. These illnesses may make you more vulnerable to infection or raise the possibility of a more serious infection.

• Those who use antacids or acid blockers. Since stomach acid tends to kill organisms, less acid in the stomach could provide bacteria with a better chance of surviving.

• Those who go during specific times of the year. In some places of the world, the risk of traveler's diarrhea fluctuates with the season. For instance, in South Asia, risk is greatest in the sweltering months before the monsoon season.

Complications:

A case of traveler's diarrhea can cause you to lose essential fluids, salts, and minerals; this can lead to dehydration, particularly in the summer. Children, the elderly, and those with compromised immune systems are particularly vulnerable to the dangers of dehydration.
Diarrhea can lead to dehydration, which can result in major consequences such as organ damage, shock, or coma. Excessive weakness, severe thirst, little to no urination, excessive dry mouth, and dizziness are signs of dehydration.

How Should Traveler's Diarrhea Be Treated?

Though most cases of traveler's diarrhea go away on their own, there are a few things you may take to control your symptoms and get better more quickly.

The over-the-counter (OTC) medication

Pepto-Bismol, also known as bismuth subsalicylate, reduces diarrhea and shortens the illness's course. If you have an aspirin allergy, are pregnant, or are a youngster, it is not safe for you. If you take this medication on a regular basis both before and during your trip, it can also help avoid traveler's diarrhea. However, you shouldn't use it for longer than three weeks in a row.

How do healthcare providers treat diarrhea in tourists?

Medical professionals treat cases of traveler's diarrhea cautiously. For both adults and children, rest and hydration should be the first lines of treatment. Oral rehydration formulas (ORS) and certain sports drinks can assist in restoring electrolytes that have been lost. Traveler's diarrhea usually goes away on its own in a few days, but if your symptoms are severe or lingering, they may recommend treatment.

Which medication works the best for diarrhea caused by travel?

When doctors do recommend medication for traveler's diarrhea, they do so in two varieties.


Antidiarrheals:

Antidiarrheal medications treat your diarrhea, not the underlying infection. Although they might relieve your discomfort, they may make the sickness worse. They function by decreasing your motility, or the speed at which your bowels move due to the contraction of your muscles, which allows your intestines to absorb more water from your waste. This implies, however, that the pathogenic microorganisms remain in your intestines for an extended period of time.
Typical antidiarrheal medications include:

• Imodium, or loperamide.
• Lomotil, or atropine diphenoxylate.

Antibiotics:

In these circumstances, your practitioner prescribes antibiotics to treat the illness. Antibiotics may be necessary for parasite infections. Antibiotics are also useful in the treatment of more serious bacterial infections. If you have a fever, more than three loose stools in a day, or mucus or blood in your stools, your symptoms are deemed "severe." Antibiotics may also be administered to those with weakened immune systems.

Antibiotics that are often administered include:

• Cipro (ciprofloxacin).
• Leviquin, or levofloxacin.
• Zmax, or azithromycin.
• Xifaxan, or Rifaximin.
• Flygyl (metronidazole).
• Alinia nitazoxanide.

How should I care for my child or myself while I have traveler's diarrhea?

Drink plenty of water, Pedialyte, or specific sports drinks to stay hydrated.
Clear soups and popsicles are good options if you or your child are still too young to eat solid foods.

When you're prepared to go on to solid foods, begin with high-fiber, bland carbs.
For diarrhea, the BRAT diet—bananas, rice, applesauce, and toast—is frequently advised.
Eat often in modest portions as opposed to large meals.
If you see any of the following: fever, bloody stools, or dehydration, call the doctor.

Prevention:

Watch what you eat.

When visiting a foreign nation, it's often advised to boil, cook, peel, or forget about it. But even if you abide by these guidelines, you could still become sick.


Additional advice that could lower your chance of getting sick is as follows:

• Eat nothing that comes from street vendors.
• Avoid consuming unpasteurized dairy products, such as ice cream, and milk.
• Avoid consuming raw or undercooked seafood, shellfish, and meat.
• Recommendations and buffet items that are moist should not be eaten at room temperature.
• Eat hot, properly cooked food when it is served.
• Limit your intake to produce that you can peel yourself, such as avocados, bananas, and oranges. Steer clear of salads and fruits that require peeling, like berries and grapes.

The following advice should be remembered when visiting high-risk areas:

• Never drink unsterilized water from a stream, well, or tap. If you must drink local water, give it a three-minute boil. Once the water has naturally cooled, transfer it to a sanitized, covered container.
• Avoid drinking blended fruit drinks that contain tap water and using ice cubes manufactured locally.
• Watch out for fruit slices that might have been cleaned in tainted water.
• Baby formula should be mixed with boiled or bottled water.
• Make sure to get steaming hot tea or coffee when placing an order for hot beverages.
• You can consume water, carbonated drinks, beer, and wine in their original cans or bottles as long as you break the seals on the containers yourself.
• Before pouring or drinking from any can or bottle, wipe it clean.
• Brush your teeth with bottled water.
• Never swim in possibly contaminated water.
• When taking a shower, keep your mouth closed.

References:

• Travelers' diarrhea. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea. Accessed April 28, 2023.

• Centers for Disease Control and Prevention. Traveler’s Diarrhea (https://wwwnc.cdc.gov/travel/page/travelers-diarrhea). Accessed 4/24/2022.

• Feldman M, et al., eds. Infectious enteritis and proctocolitis. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 25, 2021.

• Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed April 27, 2023.

• Merk Manual Consumer Version. Traveler’s Diarrhea (https://www.merckmanuals.com/home/digestive-disorders/gastroenteritis/travelers-diarrhea). Accessed 4/24/2022.

• LaRocque R, et al. Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment. https://www.uptodate.com/contents/search. Accessed May 26, 2021.

• National Institutes of Health, National Library of Medicine. Traveler’s diarrhea diet (https://medlineplus.gov/ency/article/002433.htm). Accessed 4/24/2022.

• Centers for Disease Control and Prevention. CDC Yellow Book - Chapter 2 - Preparing International Travelers - Traveler’s Diarrhea (https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea). Accessed 4/24/2022.

• Khanna S (expert opinion). Mayo Clinic. May 29, 2021.