Most international travelers worry about it. Many international travelers are uncomfortable talking about it. More international travelers actually suffer from it than you might think. Traveler’s diarrhea (TD), is frequently referred to as Montezuma’s revenge.
You know what it is. It isn’t pleasant. You suffer from abdominal cramps and have to make frequent and urgent trips to the bathroom. More severe cases include dehydration and fever. Your fears of TD are not unfounded. The Centers for Disease Control and Prevention (CDC) estimates that 20-50% of international travelers, 10 million persons, develop diarrhea. Most people recover in 1-2 days without treatment. 90% of people recover within a week, and 98% recover within a month. But who wants to spend even one day of a vacation in a bathroom?
Can I Avoid Getting TD?
Anyone can get TD. The highest risk factor is your destination. Visitors to developing countries in Latin America, Africa, the Middle East and Asia are more likely to suffer. Young adults, people with inflammatory-bowel disease, diabetes or people taking H-2 blockers or antacids are more susceptible to TD.
Contaminated food or water is the main cause of infection. A well-prepared traveler can dramatically lower his or her risk by taking some precautions and eating and drinking wisely.
First, keep yourself clean. By washing your hands, or using sanitizing hand wipes or gel, you lower your risk of transferring nasty germs. The National Institutes of Health advises that this can help even in high-risk areas where the water is not drinkable. Just be sure to thoroughly wash and dry your hands.
If you are traveling in developing countries avoid any beverages that are not sealed. Ask to open your own water bottle so you can be sure the seal has not been broken. (Remember the scene from Slumdog Millionaire where the boys refill water bottles in a restaurant?) Do not consume drinks with ice. Stick to bottled water, soda or juice in cans or bottles, beer, or wine. If you are in a luxury hotel in a large city, odds are the water is filtered, so use your own judgment. If you won’t drink the local water, don’t use it to brush your teeth – use bottled water.
What Foods Should I Avoid?
To prevent getting TD from food, the standard recommendation is “boil it, peel it, or forget it.” Raw food may have had contact with fecal matter. Even though it may have been washed, raw fruits and vegetables, even if washed, may be contaminated if the water source is not clean. So, eat your fruit or vegetables cooked, or peel them yourself. The NIH recommends avoiding raw leafy vegetables because they are difficult to clean.
Raw or undercooked meat and seafood present risks anywhere. Use discretion when eating them. Raw or undercooked eggs can also make you sick. Salmonella poisoning occurs frequently, so you may want to pass on those soft cooked eggs or that Caesar salad.
Can I Venture out and Try the Foods the Natives Eat?
If you are careful, you can sample local foods from stands and food carts. There are some simple precautions to take. Look at the cleanliness of the food area and the server. If things look unsanitary, you may want to pass. Don’t eat food that should be hot at room temperature – you don’t know how long it has been sitting, which raises the possibility that it could be unsafe to eat. My husband got food poisoning twice in Paris, probably from eating mayonnaise based sandwiches that had been sitting under lights on a counter.
What If I Get TD?
TD generally resolves without specific treatment. Keeping yourself hydrated is important. Just be sure to drink clear liquids that are safe. If you have a moderate case of TD, you can take something like Imodium to make it easier for you to travel. The problem with Imodium is that it stops your bowels from purging what is irritating them. If you don’t need Imodium, it is better to just flush it out. Pepto Bismol is generally a better cure because it coats your digestive system to protect irritated tissues, and kills some bacteria that cause diarrhea. This is the CDC’s favorite prophylaxis for TD. If you have a high fever, or blood in your stool, contact a doctor. Sometimes an antibiotic is warranted. Do not self medicate, contact a doctor if you need further treatment.
If you can’t travel or participate in prepaid vacation activities because of TD, travel insurance can help. Depending on your policy, if a doctor must treat you, you won’t lose out on everything. You may not want to tell people that you missed out on a shore excursion because you were stuck in the bathroom, at least you may be reimbursed for it.