Travelers' diarrhea: what is it, causes, symptoms and treatment

Traveler's diarrhea is a bowel disorder characterized by frequent bowel movements three or more times per day. In this case, the stool is abundant, watery, and is accompanied by acute pain in the abdomen. Diarrhea itself does not pose a threat to human life. However, excessive fluid loss leads to dehydration of the body. In severe cases, death is possible.

What is traveler's diarrhea?

Traveler's diarrhea is usually described as passing watery stools 3 or more times a day, during or shortly after travel. It usually lasts from 3 to 5 days.

Traveler's diarrhea is a common but usually mild illness that is spread due to poor hygiene. Most cases of traveler's diarrhea are caused by bacteria that are passed from feces (feces) to the mouth. This usually occurs when someone does not wash their hands after using the toilet and then prepares or serves food that travelers eat.

How common is traveler's diarrhea?

You risk getting travelers' diarrhea if you travel anywhere, although the disease is most common in warm countries where sanitation and hygiene standards are poor. These are usually countries in the developing world, such as parts of Asia and Africa.

About 30-50% of people traveling from a developed country to a developing country will suffer from traveler's diarrhea.
About 8-15% of people visiting medium-risk countries such as Russia will experience traveler's diarrhea.
Less than 4% of people visiting low-risk countries such as the US or Western Europe will experience traveler's diarrhea.

Antibiotics can wait

Diarrhea can be caused by both bacteria and viruses. With bacterial infections, the symptoms of intoxication are most pronounced (fever, chills, body aches, nausea); with viral diarrhea, absorption processes are affected and severe dehydration (loss of salts and fluid) is noted.

It is not easy to figure out what exactly caused the disease - viruses or bacteria - when traveling, which is why every travel first aid kit should have a universal remedy that would cope with diarrhea of any origin, and also help restore the intestinal wall damaged by infection.

Even after apparent recovery, the intestines need time to re-regulate the processes of digestion and absorption. That is why in the treatment of diarrhea it is important not only to cope with diarrhea and vomiting, but also to restore normal digestion.

In most cases, antibiotics are not needed to treat diarrhea. Taking “fixing” drugs is also not always justified - after all, along with frequent bowel movements, the body removes the infection. Therefore, the enterosorption method can be a general treatment for the entire group of similar diseases of mild and moderate severity. It is based on the binding and removal from the gastrointestinal tract of microorganisms, toxins, antigens, chemicals and other harmful substances that cause poisoning.

There are many sorbents in pharmacies, from ordinary activated carbon in tablets to more “advanced” ones, which not only absorb and remove toxins, but also treat damaged intestinal mucosa. Since diarrhea disrupts the intestinal microflora, in addition to sorbents, probiotics (preparations containing “beneficial” bacteria) are needed.

Symptoms of traveler's diarrhea

Traveler's diarrhea is usually described as passing 3 or more loose stools in one day, during or shortly after travel. Other symptoms include:

abdominal pain or cramps;
nausea or vomiting.

Symptoms of traveler's diarrhea usually begin within two to three days of arriving at your destination. More than 90% of cases occur during the first two weeks of vacation or travel abroad. Symptoms usually go away without treatment within three to five days.

In approximately 5-10% of travelers, diarrhea may last two weeks or longer. For 1-3% of travelers, diarrhea may last longer than a month.

At-risk groups

Some people may be at greater risk of developing complications of diarrhea, such as dehydration (when the body's normal water content is reduced). Those most at risk include:

small children and infants;
elderly or frail people;
people with immunodeficiencies such as HIV and AIDS;
people with severe heart or kidney disease;
people with inflammatory bowel disease such as Crohn's disease;
people with low stomach acid, such as those taking proton pump inhibitors (PPIs), a type of medicine to treat stomach ulcers and hernias by reducing the amount of acid in the stomach.

Signs of traveler's diarrhea may be more severe in these people and should be monitored with extreme caution.

When to Seek Medical Help

If anyone (especially a child) is dehydrated, consult a doctor immediately. Signs of dehydration include:

irritability;
restlessness;
sunken eyes;
dry skin;
strong thirst.

Other signs that require medical attention include:

high temperature (fever) of 38°C (100.4°F) or more;
blood in stool;
difficulty retaining enough fluid due to frequent watery bowel movements or repeated vomiting;
diarrhea lasting more than three to four days;
diarrhea that continues after three days of taking antibiotics.

How do you know if a child is dehydrated?

Signs of dehydration in children:

scanty urination;
dry mouth;
dry tongue and lips;
few tears when crying;
sunken eyes;
irritability;
lack of energy (lethargy).

Symptoms of severe dehydration in children:

drowsiness;
pale skin;
cold hands or feet;
lack of urination;
rapid (but often shallow) breathing.

Severe dehydration is a critical condition and requires immediate medical attention.

Dehydration is more common:

in infants under one year of age (and especially if children are under 6 months). This is because infants do not need to lose much fluid to become critically ill;
in infants of the first year of life who were low birth weight and did not gain their expected weight;
in a breastfed child who stopped drinking breast milk during illness;
any child who doesn't drink enough when they have an intestinal infection (gastroenteritis);
any child with severe diarrhea and vomiting.

Causes of Traveler's Diarrhea

Traveler's diarrhea can be caused by:

bacterial infection (responsible for 80-85% of cases);
virus (in 10-15% of cases);
parasites (in 2-10% of cases).

Possible reasons include:

Escherichia coli (E. coli): The bacteria is primarily found in undercooked beef and unpasteurized milk.
Campylobacter: Bacteria found in raw meat and poultry, unpasteurized milk and dirty water.
Salmonella: The bacteria is found in raw meat and poultry, as well as dairy products.
Shigella: bacteria that are spread by poor hygiene and found in undercooked or raw food.
Norovirus or Rotovirus: Viruses that are transmitted between people due to poor hygiene.
Giardia intestinalis (giardia): a parasite found in contaminated water and spread by poor hygiene.
Cryptosporidium: A parasite found in contaminated food and water.
Cyclospora: a parasite that is also found in contaminated food and water.

Dangerous viruses

Of the viral pathogens of diarrhea, rotavirus is the most dangerous. The incidence is more than 140 million cases per year. According to statistics, it has a fairly severe course and can be fatal in children under 2 years of age.

Diarrhea can be caused not only by dangerous bacteria; travelers are often incapacitated by viral infections.

Most cases of the disease occur when visiting countries in Africa, Latin America, and South Asia.

The virus can survive in water for up to 20 days. It is transmitted through water, dirty hands and through close contact with a sick person. The danger of infection is that, by affecting intestinal cells, the virus leads to rapid dehydration of the body. There is no antiviral treatment. The body begins to produce antibodies to fight the virus from the third day of illness; after an infection, immunity lasts for several years.

During the course of a viral intestinal infection, it is very important to adequately combat dehydration - to replenish fluid losses.

To do this, use special rehydrating solutions for drinking (sold in the pharmacy in the form of powders). Sorbents that bind viruses in the intestinal lumen are usually effective. When the patient begins to eat, it is necessary to take enzymes, since intestinal cells damaged by the virus cannot provide complete digestion. The best prevention against rotavirus infection is vaccination. This vaccination is especially important for children. Currently, the rotavirus vaccine is included in the vaccination schedule of 28 countries. If you are going, for example, to Rio de Janeiro or Goa, get vaccinated against rotavirus.

Not only the remote corners of Asia and Africa pose a danger to travelers; good old Europe can also reward tourists with diarrhea. Several years ago, the cause of local “epidemics” on 13 cruise ships in Europe was a norovirus infection.

This type of virus is famous because outbreaks are often associated with the consumption of gourmet foods. It is also the standard and most common culprit of intestinal infections in restaurant chains and clubs.

Norovirus usually causes a mild intestinal infection lasting 1 to 3 days in adults, up to 4 to 6 days in children and older adults.

Not very dangerous to humans, norovirus is extremely stable in the external environment. Cleaning surfaces with disinfectant and alcohol solutions does not kill this virus; it can survive on a computer keyboard for weeks and thrives at low temperatures, for example, in ice cream.

The prevalence of this infection is due to the mildness of the disease and the fact that stable immunity is usually not formed. A sick person does not feel so bad that he does not come to work. Thus, one sick member of the service staff, unaware of his illness, can easily infect the entire closed team. And since there is no strong immunity and norovirus is quite variable, you can get norovirus infection several times a year.

The main means to combat viral diarrhea are rehydration (replenishment of fluid losses) and the use of intestinal sorbents.

Diagnostics

Traveler's diarrhea is easily diagnosed by its symptoms. In most cases, this will not require medical attention. However, if you visit your doctor or other health care provider while abroad, they may ask you about some of the following factors:

how long does diarrhea last,
how often do you go to the toilet,
what is the consistency of the stool, for example how watery it is,
is there blood in the stool?
whether you have any other symptoms, and
where did you travel?

Stool sample

If there are other symptoms, such as blood in the stool or fever, your doctor may want to do more tests. He or she may take a stool sample from you and test it in a laboratory to find out the cause of your diarrhea.

If specific bacteria are responsible for the diarrhea, the test results can help your doctor determine which antibiotic medicine will be most effective at killing the bacteria.

How to protect yourself while traveling

Don’t forget to wash your hands thoroughly while traveling, preferably with antibacterial soap. Use bottled water for drinking and brushing your teeth.

When going on a trip, it is better to have a supply of antibacterial agents in case you encounter a bacterial intestinal infection, rehydration powders, sorbents and antipyretics. Moreover, in different countries of the world it is sometimes impossible to buy pharmaceutical products without a doctor’s prescription. If you return home and the symptoms of an intestinal infection persist, you should definitely get examined. For this purpose, our laboratory has a special test called OKI - this is a test that identifies the main pathogens of OKI (acute intestinal infections), both bacterial and viral, by analyzing stool. The result is ready within 3–4 days. Thus, based on the test results, it will be easy for the doctor to prescribe the correct treatment and identify carriers of the infection, and you will be able to protect your loved ones from infection.

Treatment of traveler's diarrhea

Symptoms of traveler's diarrhea should resolve without treatment within 3 to 5 days. The most important thing you can do is make sure you drink enough fluids.

Drink plenty of fluids

Dehydration (when the body's normal water content is greatly reduced) can be dangerous, especially for young children, older adults, or children with pre-existing medical conditions. If you have diarrhea, make sure you drink plenty of sterile (pure) water or diluted fruit juice.

Drink 2 glasses of liquid each time you have a bowel movement, and more if you are thirsty. Avoid drinking alcohol and caffeinated drinks because they will make your body more dehydrated. Take small, frequent sips and continue drinking even if you vomit.

Oral rehydration solutions

Oral rehydration solutions such as Dioralyte and Rehydron can be used by anyone who suffers from diarrhea and is at risk of dehydration. They are available in pharmacies and must be mixed with sterile water.

Oral rehydration solutions are not a treatment for diarrhea. They are used to replace salt, glucose and other important minerals that the body loses due to diarrhea.

Read the manufacturer's instructions before using oral rehydration solutions, especially if giving them to young children.

What is the usual treatment?

Diet (that is, the most gentle nutrition possible) + plenty of constant drinking (or droppers with appropriate solutions for severe vomiting and other severe conditions in which a person cannot drink).
Taking antibacterial drugs. For example, Rifaximin, Ciprofloxacin, Macmiror, Tinidazole, etc.
Taking sorbents (they are needed to remove toxins and consolidate stool). For example, Enterosgel, Smecta or Polysorb, Enterodes or Polyphepan, Filtrum, etc.
Taking saline solutions: Gastrolit or Regidron, Citroglucosalan or Gastrolit, etc., described above.
Polyenzymes without bile acids (for easy breakdown of food). For example, Pancitrate or Creon, Panzinorm N or Mikrasim, Ermital, etc.
Probiotics (note - to restore microbial balance in the gastrointestinal tract): Enterol or Probifor, Acipol or Baktisubtil, Bififormi etc.
Drugs with antidiarrheal effect: Desmol or Ventrisol, Smecta, etc.

Laboratory research is certainly necessary. It is imperative to have a stool culture tested for parasites.

In some cases, gastric lavage upon admission to the hospital.

Complications

The main complication of traveler's diarrhea is dehydration (when the body's normal water content is reduced). Symptoms of dehydration include:

increased thirst;
irritability;
restlessness;
sunken eyes;
dry skin, including lips;
dark, concentrated urine;
dizziness or delirium.

Seek immediate medical attention if you or someone else experiences obvious signs of dehydration.

Other medicines

If you are taking other medications, diarrhea may make them less effective. This is because the drugs will leave the body before they are absorbed and will therefore have no effect.

This may affect any medications. Be especially careful if you are taking oral contraceptive pills or the anticoagulant (blood thinner) warfarin.

If you take oral contraceptive pills and have diarrhea, they may not provide effective contraception because the pills may not have time to work before they pass into your stool. This can lead to an unplanned pregnancy.

If you are taking warfarin and have diarrhea, you may be at risk of developing blood clots inside your blood vessels. This can lead to serious complications such as deep vein thrombosis (when a blood clot forms in one of the body's deep veins) or stroke (when the blood clot cuts off the blood supply to the brain).

Long-term diarrhea

In some cases, traveler's diarrhea can last for more than a month while you are traveling abroad. If you are losing weight, consult your doctor. It may be worth changing your diet to see if this helps reduce your symptoms. You can try removing:

milk and dairy products;
fatty, fried and spicy foods;
alcohol.

Long-term diarrhea often goes away without treatment once you return home because you will no longer be exposed to the same bacteria and viruses that caused it.

In rare cases, long-term diarrhea in travelers is associated with another cause. Diarrhea could be the start of another health problem that has nothing to do with your travels.

For example, diarrhea may be a symptom of irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), which are long-term disorders that affect the digestive system.

Safe products for travelers

Purely not where they clean. Clean where there is no litter. This can also be applied to our body. Let's start with garbage, or rather, with what is absolutely forbidden when traveling.

Fruits, vegetables and herbs washed under the tap;
ice cream and dairy desserts;
fast food, food prepared on the street;
cold meat and fish dishes, raw seafood;
reheating food several times.

Accordingly, everything that is not included in this list will be safe.

Forecast

Traveler's diarrhea is usually mild, but it is unpleasant and can ruin a holiday. It often goes away without treatment, but it is important to drink plenty of fluids. In more severe cases, a short course of antibiotics may be prescribed.

Traveler's diarrhea may be more serious for people with pre-existing medical conditions, such as inflammatory bowel disease such as Crohn's disease. Very young or very old people may be at greater risk of dehydration (when the body's normal water content is reduced).

Symptoms

It is not difficult to recognize the occurrence of an intestinal disorder - traveler's diarrhea. Suddenly, after drinking previously unfamiliar water or food, a frequent urge to defecate appears. A person, in the literal sense of the word, cannot move away from the toilet.

In addition to the irresistible desire to have a bowel movement, people experience:

painful cramps in the abdomen - local or widespread;
dyspeptic manifestations – nausea, vomiting;
severe flatulence - a feeling of fullness in the abdomen, excessive gas formation;
pain and discomfort in large joints, head, sacrum;
increased sweating and weakness;
increasing fatigue, desire to sleep;
lack of appetite;
temperature rise, but insignificant - low-grade fever.

In severe cases, severe dehydration leads to confusion, coma and death. In general, the disorder lasts no more than 1–2 days and is quickly eliminated.

Preventing traveler's diarrhea

There is no effective vaccine against traveler's diarrhea. However, taking some precautions before leaving and being away can reduce the risks of it occurring.

Before you leave

If you are planning to travel internationally, check the health guidelines in the country you plan to travel to. You can contact your GP or a travel clinic.

If you have a long-term condition, such as diabetes, please consult your GP before traveling. You may be given additional advice to prevent diarrhea or prescribed preventive antibiotics.

During the journey

Follow the tips below to avoid an episode of diarrhea while traveling.

Water and Ice Precautions

You should only drink water if you are sure that it is sterile (clean).
If the water is not sterile, boil it for a few minutes or use a chemical disinfectant or reliable filter. This also applies to water used for making ice cubes, washing fruit or salad, and brushing teeth.
Avoid ice because it may have been made with unclean water or may have been touched by someone with dirty hands.
If you want a cold drink, pack ice around the glass or bottle.
Avoid drinks made with crushed ice, such as lassi (a drink common in hot countries made with crushed ice and yogurt), as the ice may be contaminated.
Bottled water is usually safe, but make sure it hasn't been opened.

Precautions when eating and drinking

Hot tea and coffee, beer and wine are usually safe.
If milk is pasteurized, it is safe. If you are not sure whether the milk is pasteurized, boil it first.
Yogurt is usually safe.
Be careful when buying cheese or ice cream. They are often made from unpasteurized milk, so they may not be safe. Buy them from large, reputable companies as they will likely be safer.
Food must be fully cooked and served hot. Once food reaches temperatures above 60°C (140°F), any bacteria inside it will usually die.
Avoid eating leftover food or food left at room temperature.
Fried rice is high risk because it's often made from bits that are lying around the kitchen, and frying doesn't sterilize everything.
Food from markets and street vendors, as well as some restaurants, should be avoided unless hot food has been hot and cold food has been refrigerated or packed with ice.
Fish and shellfish can be dangerous at certain times of the year, even if they are well cooked. Take local seafood advice, but when in doubt, avoid it.
Vegetables should only be consumed when they are thoroughly cooked.
Avoid salads unless you make them yourself, and wash everything in sterile water.
Fruits, including tomatoes, must be peeled. Avoid smoothies because the fruit may have been contaminated when making the smoothie.
If you are washing fruit for food, the water must be sterile. Smooth-skinned fruits are easier to wash. Strawberries are very difficult to peel. Avoid fruits that have split skin.

Personal hygiene

Wash your hands thoroughly before eating or handling food, and after using the toilet.
Air dry your hands or use a clean towel after washing.
Make sure all cutlery, plates, cups or glasses you use are sterile.
On expeditions or while camping, do not allow anyone to cook if they are not feeling well.
Short nails are easier to keep clean than long nails.
Bring a plastic bottle with soapy water and antiseptic wipes or hand sanitizer when away from running water.

"AiF Health" recommends

► In most foreign resorts, you cannot drink tap water, or drink cocktails with ice, which can also be made from raw water. For drinking and washing fruits, you should use only boiled or drinking mineral water.

► Outside the hotel, you should not eat dishes made from fruits and vegetables that have not undergone heat treatment.

► It is dangerous to buy food from street vendors. You should not try raw seafood, fish and meat even in a restaurant (if it is not located on the hotel premises). Be careful with ice cream and dairy products.

High-risk foods and drinks

When going on vacation to other countries, it is important to remember that some local food products can cause poisoning or introduce foreign infection. Never drink tap water while on vacation. Don't be lazy, stock up on bottled water from the store. Nowadays, there are coolers with drinking water in almost every establishment.

High risk products:

raw meat purchased at the market or from private traders;
vegetables and fruits;
seafood;
dairy products not from the store.

The question immediately arises: what can you eat and drink at resorts during your vacation, and where can you get safe products? Try to buy food and drink in large supermarkets rather than small shops. This will significantly reduce the risk of buying low-quality food.

If it is not possible to purchase drinking water, then boil tap water. Boil for at least 3-5 minutes. Only after this can it be eaten. You can also use boiled water for cooking and washing vegetables and fruits. You can eat foods that have undergone heat treatment without fear for your health.

It’s better to be on the safe side than to spend your entire vacation in your room with abdominal pain, vomiting and diarrhea. Also, caring for a sick person also deprives a loved one of a pleasant time on vacation.

In which countries can diarrhea occur?

If you travel during the hottest months of the year, there is a risk of diarrhea in almost any country. But there are countries where it is hot all year round, so the American Society for Public Health decided to identify countries with high, medium and low risk.

You are at high risk of getting diarrhea in the following countries: