Traveler’s diarrhea: Symptoms & how to get relief

by Sue Benzuly, RN

A bout of traveler’s diarrhea can really put a damper on your vacation.

Here, experts break down what traveler’s diarrhea is, including its causes, symptoms and treatment, so you can get back to enjoying your trip as quickly as possible.

What is traveler’s diarrhea?

Put simply, traveler’s diarrhea is frequent, loose, watery stools that occur after travel to an area with poor public hygiene. Unfortunately, it is the most common illness among travelers, according to Johns Hopkins University.

Traveler’s diarrhea causes and risk factors

Although traveler’s diarrhea could be the result of stress from traveling or a change in diet, it is usually caused by bacteria, viruses or parasites. According to the Mayo Clinic, you typically contract traveler’s diarrhea after ingesting food or water contaminated with germs from feces. People that are local to the area have often developed an immunity to the bacteria and are unaffected.

Traveler’s diarrhea symptoms

The Mayo Clinic lists the following symptoms:

• Abrupt onset of three or more loose watery stools in a day
• Urgent need to defecate
• Abdominal cramps
• Nausea
• Vomiting
• Fever

Severe symptoms indicate you should see a doctor; these include:

• Diarrhea lasting longer than two days
• Dehydration
• Severe abdominal or rectal pain
• Black or bloody stools
• Fever over 102 degrees Fahrenheit

In children, traveler’s diarrhea can cause severe dehydration in a relatively short time; call your child’s health care provider if the following symptoms are occurring:

• Persistent vomiting
• Fever over 102 degrees F
• Dry mouth, crying without tears
• Unusually sleepy, drowsy or unresponsive
• Bloody stools or severe diarrhea
• Decreased volume of urine, including fewer wet diapers in infants

How to lower the risk of traveler’s diarrhea

The U.S. Centers for Disease Control and Prevention lists the following high-risk destinations for traveler’s diarrhea:

• Asia (except Japan and South Korea)
• Middle East
• Africa
• Mexico
• Central America
• South America

When traveling to these areas, it is advised that you:

• Choose your food and drink carefully
• Drink only beverages in factory-sealed containers
• Avoid ice
• Peel or wash all fruit and vegetables
• Avoid food that has been sitting out at a buffet
• Wash your hands frequently or use hand sanitizer
• Brush your teeth with bottled water
• Avoid swimming in contaminated water

How long does traveler’s diarrhea last?

Dr. Alexander Leung noted in Travelers’ Diarrhea: A Clinical Review, “Travelers’ diarrhea is usually self-limited. If left untreated, approximately 50% of the patients are spontaneously cured in 48 hours and, in the majority of patients, the average duration of diarrhea is 4 to 5 days.”

He does add that “the clinical course tends to be more severe and prolonged in children, especially those younger than 2 years of age.”

Traveler’s diarrhea treatment

The Cleveland Clinic has several suggestions for treatments for traveler’s diarrhea:

• Bismuth subsalicylate (Pepto-Bismol) can reduce the duration or frequency of your stools, although it is not recommended for children or pregnant people.
• Antibiotics may be prescribed for severe cases or if you have a compromised immune system. Your health care provider may request a stool sample to see what organism is causing your illness, so that they can prescribe the appropriate antibiotic. The most common antibiotics used for traveler’s diarrhea are ciprofloxacin (Cipro), levofloxacin (Levaquin), azithromycin (Zmax), rifaximin (Xifaxan), metronidazole (Flagyl) and nitazoxanide (Alinia).
• Antidiarrheals such as loperamide (Imodium) or atropine diphenoxylate (Lomotil) may reduce your symptoms, but they could also prolong the infection because they slow down the motility of your gut which may allow the infectious organism to stay in your bowel longer.

If you are infected, you should:

• Hydrate frequently with low-sugar sport drinks or Pedialyte
• If you can’t tolerate solid food, then try soups or popsicles
• The BRAT diet may be helpful, which is bananas, rice, applesauce and toast
• Eat small amounts at a time
• Call your doctor for any of the severe symptoms above, or if symptoms last longer than two days

It is possible to be infected more than once while you are traveling, and therefore important to continue to use the preventive steps listed above.