Here are some real world tips to prevent and treat travelers’ diarrhea (“TD”), which is the most predictable travel-related illness, with an estimated infection rate of 30% to 70% of travelers, depending on the destination and season.

Okay, so this isn’t the most romantic entry in a travel blog, but let me just say, I can remember every country where I experienced TD, which is not a good memory but a memory nevertheless and a memory never captured in photos. The last two instances of TD for me occurred in Cambodia and Peru. To resolve those issues, I took my normal Immodium AD, a must have in the traveler’s kit. The bacteria in Cambodia probably came from the salads I craved and shoveled into my mouth at breakfast and dinner at our hotel buffet. The hotel appeared clean and well kept and they had a daily spread out all day long. I stupidly ignored the articles warning travelers to not eat the fresh vegetables and fruit unless you could peel the fruit yourself. In Peru, I couldn’t tell if my TD was related to the altitude sickness or the strain of having just hiked the Inca Trail and not having a bowel movement the entire four days on the trail.

The definition of diarrhea is having more bowel movements than normal but the real experience of this condition is that you’re rushing to the toilet as you’re tightening your anus to prevent brown water from shooting out like water from a fire hose in public. The wetter bowel movements, signifying diarrhea, are due to the excess fluid which is not absorbed by the large intestine. And in order to prevent TD, we should understand what causes it. Often, the ingestion of bacteria, such as the campylobacter bacteria, causes diarrhea, which can lead to bloody stools, stomach cramps and a fever. These symptoms usually start two to five days after the person ingests the bacteria and last about one week.

DESTINATION AND THE CHANCES OF TRAVELER’S DIARRHEA

Don’t think you’re safe just because your resort appears to be clean and has modern amenities, or that your cruise ship is populated with seemingly healthy individuals – tan and ready for an off ship excursion. I stayed in a four star resort in Siem Reap, Cambodia and ended up with three days of TD.

Destination is the most significant risk factor for developing traveler’s diarrhea. And regions with the highest risk of exposure to such bacteria are Africa, South Asia, Latin America, and the Middle East, destinations with larger numbers of people who do not have access to plumbing or toilets, thus increasing the likelihood of stool contamination. E. coli is the predominant cause of traveler’s diarrhea in Latin America, the Caribbean, and Africa. Enterotoxigenic E. coli and enteroaggregative E. coli may be responsible for up to 71 percent of cases of traveler’s diarrhea in Mexico. In contrast, the Campylobacter bacteria is a leading cause of TD in Thailand and Nepal.

Inadequate electrical capacity may lead to poor refrigeration, which can result in unsafe food storage and an increased risk for disease. Lack of safe water lead to contaminated foods and drinks prepared with such water. An inadequate water supply may lead to shortcuts in cleaning hands, surfaces, utensils, and foods such as fruits and vegetables. In some cultures, hand washing is considered bad luck. Plus without running water, hand washing is an extra expense. In most countries there may be no hand washing stations in food preparation areas.

Some people are more susceptible to TD than others

A traveler’s unique gut microbiome may predispose him to greater or lesser chances of infection. The diversity of a gut microbiome can prevent and limit pathogenic colonization and growth. There are some travelers who will always get TD when they travel and those who are less susceptible. Travelers who are immuno-compromised and those with lowered gastric acidity are more susceptible to traveler’s diarrhea.

Market in Siem Reap, Cambodia

A few tips when eating abroad:

  • Always sanitize and wash your hands before you eat. I always carry a small hand sanitizer bottle in my fanny pack or backpack.
  • Only eat cooked foods or fruit you can peel and eat the inside of
  • Don’t get ice cubes in your drink.
  • Drink bottled or boiled water. In many countries around the world you are not supposed to drink the water from the tap. And in some countries, like Nairobi, they recommend you brush your teeth with bottled water.
  • Eating at a well known fast food chain may be touristy, but they provide better food handling.
  • Keep your mouth closed while showering.
  • Don’t swim in bodies of water that may be contaminated. How can you tell? I would ask a local, your guide, or look online for complaints from other travelers.
  • Some say taking Pepto-Bismol helps prevent traveler’s diarrhea. However, this can also lead to constipation and should not be done for extended periods of time.
  • Maintain as normal of a diet as possible when traveling.
  • Avoid salads, unpeeled fruits, raw or poorly cooked meats and seafood, unpasteurized dairy products, and tap water.
  • Consider eating probiotics
  • Prebiotics are linked to reduced bouts of diarrhea

Treating Traveler’s Diarrhea

Most people recover from TD and bacterial infections without antibiotic treatment. Some people with, or at risk for, severe illness might need antibiotic treatment. These people include those who are 65 years or older, pregnant women, and people with weakened immune systems, such as those with a blood disorder, with AIDS, or receiving chemotherapy.

Antibiotics are effective in reducing the duration of diarrhea by about a day in cases caused by bacterial pathogens that are susceptible to the particular antibiotic prescribed. However, there are concerns about adverse consequences of using antibiotics to treat TD, such as the effects of antibiotic use on travelers’ microbiota, and the potential for adverse consequences such as related bacterial infections. These concerns have to be weighed against the consequences of TD and the role of antibiotics in shortening the period of suffering and possibly preventing another TD event. Unless a physician tests the culture of your stool and finds bacteria that can be treated with antibiotics, antibiotics should be avoided. Of note, antibiotics do not protect against nonbacterial pathogens causing TD. Researchers and the Center for Disease Control say travelers should avoid prophylactic antibiotics because they can remove protective microflora from the bowel, creating resistant bacteria.

Dukoral is an oral vaccine I’ve taken for prevention of cholera. Some travelers take it every time they travel and it has been also utilized to prevent a bacterial infection enterotoxigenic E. Coli, which is a cause of TD. I’m not sure if physicians will prescribe this to you if you’re not going to a risky country but you should always discuss with them the negative effects of a vaccine or medication you’re taking. It may negatively impact how you feel while you’re traveling.

I always bring Immodium AD with me when traveling, enough to control at least two incidents, and if it takes more than a few tablets to plug up the leak. It is a reactive method of treatment versus proactive like probiotics or the vaccine.

If you feel your antibiotics are not working, you may want to get checked for parasites.