5 Tips on Travellers' Diarrhoea

 
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One of the most common issues affecting travellers relates to gastrointestinal problems. Yes, not the most glamorous topic, but it does affect a lot of people. Although seldom severe, it can very significantly affect how you enjoy your trip and every second is precious! So The Explorer Doc is here to help. I came up with 5 tips on travellers diarrhoea that will help you stay in the clear! 

Tip n. 1 - Know your symptoms

Traveller's Diarrhoea is a common ailment for all wanderlusters out there. It can vary from a mild  to severe disease but thankfully it is self-limiting most of the times.

When people suffer from diarrhoea they tend to think about infections straight away. In fact that is only part of the possible causes. Most commonly, travellers diarrhoea is actually triggered by changes in diet, changes in water supply, just different schedules (jet lag) or even the stresses of foreign travel. 

It is classified as four or more loose or liquid stool per day. It usually starts within the first 3 days of your travel and usually lasts up to 10 days. Symptoms such as abdominal cramps and pain and urgency to open your bowel are the most common. 

More rarely, your diarrhoea might have blood, green mucous and you might have a high temperature (measured temperature above 38 degrees Celsius). 

Identifying these symptoms will be important when you are managing your illness abroad. 

Tip n. 2 - Evaluate risk of your travel

The risk of suffering severe infectious diarrhoea depends where you plan to travel. This is due to different aspects regarding your trip. There are countries where you'll be more at risk just due to lesser standards and availability in sanitation and water treatment facilities. In other cases it relates to the remoteness and inability to reach medical help in case you develop serious symptoms. 

If you travel in Europe for example, and are still planning a couple of days trek, you shouln't worry too much in taking all the medicine and support for a more severe episode as you should not be far from accessible good quality medicine. 

But if you are planning a 15 day trek along Patagonia wilderness, you might want to take a good stash of supportive medication such as dehydration salts and even antibiotics in case you cannot easily assess medical support. 

High risk countries destinations are South and South East Asia, Central America, West and North Africa, South America and East Africa.  

Activities that increase risk are backpacking/trekking and all-inclusive holidays (although you should be able to access medical support on this one). 

Make sure you discuss all these with your travel medicine advisor. 

Tip n. 3 - Prevent 

The cases which cause significant disease are usually caused by infections. These infections are most usually transmitted hands to mouth unwillingly or by contaminated food or water. 

Before you travel you can be vaccinated against cholera if you are travelling to a higher risk country. You can check current travel recommendations here.

Tips to prevent infectious travellers' diarrhoea include: 

a) Use soap to wash your hands frequently (alcohol hand gel has got less evidence but theoretically should be effective as well)

b) Use bottled water or reusable water bottles and good purification tablets or other methods. (such as Katadyn water purification bottles). Boil your water if trekking and cooking. Use purified water to brush teeth as well. 

c) Avoid ice in drinks

d) make sure the food is steaming hot when served to you

d) Avoid raw or undercooked meat and prefer peelable fruit

Tip n. 4 - Carry a thermometer

I know, right? Of all the things I need to carry to travelling why should I take something I might not need? 

Well, a few reasons. As a doctor I do see quite a few people who have fallen ill. And most times they feel they had a fever or a temperature but never measured and that has caused unnecessary anxiety. The problem is we will sometimes feel hot and cold and have the shivers without having a high temperature. Without going into too much detail, that usually happens because your autonomic nervous system gets irritated by the gut problem and causes not only cramps but also this sensation that is often mistaken by fever (same as high temperature). 

So when you do get traveller's diarrhoea, having a temperature above 38 degrees Celsius (or 100 degrees Fahrenheit) could actually be a sign of severe infection while a normal temperature is much more reassuring. This means that with a normal temperature you can wait a few more days to see if things ease down while if you have a fever, you should seek further medical help. 

It is also light, cheap and reusable. 

Tip n. 5 - Treat yourself

First of all, if easy and accessible, you are probably better off speaking to a doctor or healthcare professional. In the UK you might try your GP or call 111 for initial advice. 

But let's face it, if you're reading this,  it's because you are planning to go abroad to some amazing adventure. 

The first thing you need to know is the signs of an alarming episode that definitely require medical treatment or review. High fever with blood and mucous and severe abdominal pain would most definitely indicate severe infection and you should start antibiotics if you have them but seeking a doctor is essential. 

If your symptoms are not severe then you should consider:

1 - Rehydration - This is the single most important thing about treating traveler's diarrhoea. Most complications relate ti the effects of severe dehydration caused by traveller's diarrhoea. Nevertheless if you drink only water, you are not replenish all the salts that you loose and therefore it is important to use oral rehydration salts. If you don't have any available you can prepare a solution mixing 1 litre of water, 6 level teaspoons of sugar and a half teaspoon of salt. 

2 - Anti-motility agents - Most infectious diarrhoea are caused by toxins. Therefore it is essential that those toxins are expelled from your body which is what causes diarrhoea away. So medication such as diarrhoea stopping loperamide (such as Imodium) could actually make you worse as it delays the removal of all the toxins. Medication like this can be taken when there are no signs of severity and if you REALLY need to hold your symptoms for a few hours (if travel is unavoidable or stuck in a tent due to storm). 

3 - Antibiotics - Most common antibiotic tablets to cure travellers' diarrhoea are either azithromycin or ciprofloxacin and recommended treatment lasts for 3 days usually. Please note that current guidelines do not recommend you take medication with you unless you go a risky remote exploration. So discussion at a travel clinic is essential.

Although traveller's diarrhoea is a very common problem when travelling, most people will recover well after a few days. It is still better to prevent it, as much as possible, so you can enjoy an amazing great time while travelling. 

If you want to see a video version of these tips, click here