Traveler'S Diarrhea

1 What is Traveler's Diarrhea?

Traveler's diarrhea is a disorder that causes loose stools and abdominal cramps. It is caused by eating food or drinking water that is contaminated.

Traveler's diarrhea is not a serious condition although it can be unpleasant. It is caused by visiting places where climate, social conditions or sanitary conditions and practices are diffent from those at home.

Being careful about eating or drinking certain foods and drinks can help to reduce the risk of traveler's diarrhea. Most cases traveler's diarrhea don't require treatment. Medications can be prescribed if diarrhea persists.

2 Symptoms

The signs and symptoms of travelers diarrhea may include:

  • Increased frequency of passing loose stools
  • An urgent need to defecate
  • Abdominal cramps
  • Nausea
  • Vomiting  
  • Fever
  • Moderate to severe dehydration
  • Bloody stools  
  • Pain in the rectum

Traveler's diarrhea usually begins abruptly during a trip or after returning from the trip. Most cases resolve within a few days without treatment.

3 Causes

Traveler's diarrhea is usaully caused by ingesting food or water that is contaminated with organisms, such as bacteria, viruses and parasites, from feces.

When these organisms enter the digestive tract they can overpower the digestive body's defense mechanisms. This leads to the development of signs and symptoms of traveler's diarrhea.

The most common cause of traveler's diasease is enterotoxigenic Escherichia Coli (ETEC) bacteria. ETEC attach to the lining of the intestines and release toxins that cause diarrhea snd abdominal cramps.

Natives are not affected because their digestive system is accustomed to the bacteria and developed immunity to them.

Stress can also cause traveler's diarrhea.

4 Treatment

Traveler's diarrhea usually resolves on itself and does not require treatment. Patients are required to take lots of fluids to prevent dehydration.

Dehydration can be treated by administering an oral rehydration salt (ORS). This solution contains water and salts in a specific proportion to replace both water and minerals lost. An ORS may also contain glucose to stimulate absorption in the intestines. ORS is availabel as a bottled product and as packets of powder thaat can be dissolved in water.

In emergency cases where ORS is not available, it can be made by mixing:

  • 1/2 teaspoon salt  
  • 1/2 teaspoon baking soda
  • 4 tablespoons of sugar
  • 1 liter of safe drinking water  

If symptoms do not improve, medications can be used to relieve symptoms.

Medications that can be used include:

  • Anti-motility agents, such as loperamide (Imodium AD) and drugs containing diphenoxylate (Lamotil, Lonox). These drugs prompt but temporary relief by reducing muscle spasms in the gastrointestinal tract. These drugs are not recommeded for children or people with fever or bloody diarrhea.
  • Bismuth subsalicylate (Pepto-Bismol), an over-the-counter medication that decreases the frequency of stools and also reduces the duration of traveler's diarrhea.
  • Antibiotics, which may be given if a person has more than four stools a day or severe symptoms, such as fever or blood, pus or mucus in the stools.

5 Prevention

Traveler's diarrhea can be prevented by:

  • Avoiding the consumption of food from street vendors.
  • Avoiding unpasturized milk and diary products, including ice cream.
  • Avoiding raw and uncooked meat, fish or shellfish.
  • Avoiding foods that have been left at room temperature for a long time.
  • Eating foods that are well cooked and served hot.
  • Sticking to fruits and vegetabkes that can be peeled by a person who is eating them, such as bananas, oranges and avocados.
  • Drinking clean water.
  • Using bottled water to brush the teeth and closing the mouth when bathing.
  • Using bottled or boiled water to mix baby formula.
  • Avoid swimming in contaminated water.
  • Using clean dishes and utensils.
  • Washing the hands frequently especially before eating.
  • Keeping children from putting things including dirty hands in their mouths.

Bismuth subsalicylate (Pepto-Bismol) can also be taken to prevent traveler's diarrhea. However, it must not be taken for more three weeks. Patients who are allergic to aspirin, pregnant women or people taking anticoagulants should not take this drug. Side effects of bismuth subsalicylate include:

6 Lifestyle and Coping

The following lifestyle tips can help to relieve the symptoms of traveler's diarrhea:

  • Avoiding caffein and diary products which may worsen symptoms or increase fluid loss.
  • Drinking canned fruit juices, weak tea, clear soup, decaffeinated soda or sport drinks to replace lost fluids and minerals.
  • Eating a diet of easy-to-eat complex carbohydrates, such as:
    • salted crackers,
    • bland cereals,
    • bananas,
    • applesauce,
    • dry toast or bread,
    • rice,
    • potatoes,
    • plain noodles after the diarrhea improves.

7 Risks and Complications

There are several risks and complications associated with traveler's diarrhea.

The risk factors for having traveler's diarrhea include:

  • Young adults
  • People with a weakened immune system
  • People with diabetes or inflammatory bowel disease
  • People who take acid blockers or antacids
  • People who travel during certain seasons in certain parts of the world. For example, the risk is highest in South Asia during the hot months just before the monsoon.

The most common complication of traveler's diarrhea is dehydration. This can be especially dangerous for children, older adults and people with a weakened immune system.

Extreme fluid loss caused by diarrhea can cause serious complications, such as

  • organ damage,
  • shock,
  • coma.

Signs and symptoms of dehydration include:

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