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, to use in case diarrhea persists or gets severe.
Traveler's diarrhea may begin abruptly during your trip or shortly after you return home. Most people improve within 1 to 2 days without treatment and recover 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 looser watery stools a day
- An urgent need to defecate
- Abdominal cramps
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 certain bacteria or parasites. In such cases, you may need prescription medications to help you get better.
If you're an adult, see your doctor if:
- Your diarrhea persists beyond two days
- You become dehydrated
- You have severe abdominal or rectal pain
- You have bloody or black stools
- You have a fever above 102 F (39 C)
While traveling internationally, a 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
- A fever of 102 F (39 C) or more
- Bloody stools or severe diarrhea
- Dry mouth or crying without tears
- Signs of being unusually sleepy, drowsy or unresponsive
- Decreased volume of urine, including fewer wet diapers in infants
It's possible that traveler's diarrhea may stem from the stress of traveling or a change in diet. But usually infectious agents — such as bacteria, viruses or parasites — are to blame. You typically develop traveler's diarrhea after ingesting food or water contaminated with organisms from feces.
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.
Each year millions of international travelers experience traveler's diarrhea. High-risk destinations for traveler's diarrhea include areas of:
- Central America
- South America
- South Asia and Southeast Asia
Traveling to Eastern Europe, South Africa, Central and East Asia, the Middle East, 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, Singapore, 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 due to an underlying illness or immune-suppressing medications such as corticosteroids increases vulnerability to infections.
- People with diabetes, inflammatory bowel disease, or severe kidney, liver or heart disease.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.
Because you lose vital fluids, salts and minerals during a bout with traveler's diarrhea, you may become dehydrated, especially during the summer months. 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, dizziness, or extreme weakness.
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. But, it's still possible to get sick even if you follow these rules.
Other tips that may help decrease your risk of getting sick include:
- 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 from fruits you can't peel, 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 areas, 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. Let the water cool naturally and store it in a clean covered container.
- 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.
- Use bottled or boiled water to mix baby formula.
- Order hot beverages, such as coffee or tea, and make sure they're steaming hot.
- 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.
- Don't swim in water that may be contaminated.
- Keep your mouth closed while showering.
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 water-disinfecting tablets containing chlorine, iodine tablets or crystals, or other disinfecting agents 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% 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, 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 or allergic to aspirin. Talk to your doctor before taking bismuth subsalicylate if you're 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).