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Traveller's Diarrhoea

What is traveller’s diarrhoea?

Traveller’s diarrhoea is a strand of diarrhoea mostly experienced by travellers during the first few days following their arrival in a foreign destination. It can be caused by a number of different types of infection, with poor hygiene and contaminated food and water being the primary factors in contracting it.

Up to 60 per cent of travellers from the West develop traveller’s diarrhoea within a week of visiting a resource-poor country with lower standards for sanitation and hygiene. Around 5 million people from the UK develop traveller’s diarrhoea each year and is a very common illness for first-time travellers to certain parts of the world such as those that are more remote or less-developed economically.[1]

Traveller’s diarrhoea symptoms

As with all strands of diarrhoea, the passage of watery stools is the primary traveller’s diarrhoea symptom.

Sufferers are also likely to experience:

  • Cramps and abdominal pain
  • Fever
  • Bloating
  • A frequent, urgent need to use the toilet
  • Passage of three or more loose stools within 24 hours
  • Loss of appetite
  • Nausea and possibly vomiting
  • Dehydration

Dehydration

The World Health Organisation (WHO) classify dehydration as the most severe threat posed by diarrhoea to sufferers[3]. Diarrhoea results in a dramatic loss of water and electrolytes (specifically sodium, chloride, potassium and bicarbonate) due to the frequent passing of liquid stools, possible vomiting and sweating. If these electrolytes are not replaced then the symptoms will continue to worsen. The dehydration caused by diarrhoea can also lead to further symptoms such as drowsiness, light-headedness, muscle cramping and a rapid heartbeat.

What is diarrhoea?

Diarrhoea is a common set of symptoms signified by frequent or more often than normal loose, non-solid stools passing through your system quickly. It is important to note that frequent passing of solid stools is not diarrhoea and should be treated accordingly.

What causes diarrhoea?

There are a few potential causes of diarrhoea, but it is usually symptomatic of an infection, specifically an infected intestinal tract (Gastroenteritis).

Gastroenteritis is easily spread, and a common occurrence for people who travel to different parts of the world. It is even more likely for those who immerse themselves in the local culture, cuisine and lifestyle. Depending on the cause of the infection, diarrhoea can be short term or long term, as is the case for conditions like irritable bowel syndrome (IBS).

Most cases of diarrhoea last for a few days and can lead to a sudden, frequent need to immediately empty your bowels. Children are particularly susceptible, and it is not uncommon for children to pick it up easily. Plus, it can sometimes take a little longer for children to recover from it. Diarrhoea is one of the leading causes of malnutrition in children under five years of age. [3]

Fundamentally, this is caused and aggravated by bacteria, parasites and viral organisms. These organisms are spread through both contaminated water and food but can also be passed on from human to human if good hygiene is not practised regularly. Infection occurs most commonly where there is a lack of necessary sanitary and hygiene controls for clean and safe water for cooking, drinking and cleaning.

Below are the most common causes of gastroenteritis and, consequently, diarrhoea.

Viral

Norovirus is a very common stomach bug that is spread very easily through human contact. Often known as the “winter vomiting bug”, it often leads to diarrhoea, vomiting, aching joints and other flu-like symptoms.

Bacterial

E. coli (Escherichia coli), is a type of bacteria that is usually found in your intestines and can also be found in the gut of some animals. It is mostly harmless, but in some cases it can result in a variety of illnesses and symptoms – such as diarrhoea. Contraction of E. coli through undercooked food or contaminated water is one such example.

Campylobacter is similar to E. coli as it can be found in the gut of animals. Most commonly it is found on chicken or other forms of poultry. Infection can occur if the chicken is undercooked or contaminated.

Parasitic

Giardia is a microscopic parasite that can cause infection in your small intestine, leading to illnesses such as diarrhoea. It can be spread from one infected person to the next, by domesticated dogs and cats and also by eating contaminated food and water.

In addition, diarrhoea can be caused by lifestyle-related factors that put stress on your body and organs. Excessive caffeine consumption, drinking too much alcohol, as well as poor diet and personal hygiene can contribute towards it.

There are three types of clinical diarrhoea, all of which have different estimated recovery times. However, are all caused by the same underlying infection.

  • Acute watery diarrhoea
  • Acute bloody diarrhoea
  • Persistent diarrhoea

Diarrhoea is even more likely for those travellers who immerse themselves in the local culture, cuisine and lifestyle. Depending on the cause of the infection, diarrhoea can be short term or long term, as is the case for conditions like irritable bowel syndrome (IBS).

Where am I at greatest risk of traveller’s diarrhoea?

The underlying parasitic, viral or bacterial organisms that cause traveller’s diarrhoea such as E. coli, Salmonella and Campylobacter can be found worldwide and it is not uncommon to hear of cases being reported in the UK and across Europe [2]

That being said, the risk of developing it is still higher in some countries than others, especially if parts of those countries that you are visiting engage in inadequate hygiene and sanitation, have contaminated water supplies or improperly stored fish and meat. South East Asia, South Asia, the Middle-East, Africa and Latin America all carry a high risk of the infection for travellers, especially those from higher income countries. Eastern and Southern Europe, South Africa, Russia and parts of the Caribbean all carry significant, yet lower risk.

Street food, tap water, unwashed fruit and vegetables, shellfish and ice in drinks can all carry the infection.

Traveller’s diarrhoea prevention?

If the diarrhoea infection is widespread and present in the area you’re travelling to, traveller’s diarrhoea isn’t always preventable. However, there are certain precautions you can take to reduce your risk of acquiring the infection. These include:

  • Washing your hands, especially after using the bathroom and when preparing food
  • Keeping yourself and your accommodation clean, especially the kitchen surfaces
  • Cooking meat thoroughly until it’s piping hot, and keeping raw meat separate
  • Washing utensils, including shared cutlery, crockery and towels
  • Drinking only sterilised or sealed, bottled water
  • Avoid eating raw eggs
  • Avoid fresh vegetables, salads and fruit with the skin left on unless you can ensure that they have been washed thoroughly with mineral or bottled water

Traveller’s diarrhoea prevention requires you to be acutely aware of whatever you consume while on holiday. Keep a closer eye on way your food is being prepared and where your water is coming from. Ensure that you keep electrolyte solutions such as Dioralyte with you whilst travelling.

Traveller’s diarrhoea treatment

In most cases, traveller’s diarrhoea will take anywhere between 3-5 days to pass through the system. According to a clinical review conducted by the British Medical Journal in 2008 [3], approximately 10% of cases last more than 5 days with 2% of cases reportedly lasting for up to a month.[1]

If you do develop traveller’s diarrhoea, it’s important to rest for at least two days and to stay extremely hydrated. Diarrhoea already results in a significant loss of fluids from the body, which can be made even worse by the onset of vomiting. This extreme loss of fluids can very quickly result in dehydration and, subsequently, further health problems.

If you are suffering from diarrhoea, make sure you take regular sips of water. Try to replace any water that you might lose each time you go to the bathroom, and keep a track of your water intake so that you ensure you are regular hydrating yourself.

It is also advisable to take an oral electrolyte solution such as Dioralyte (link). Oral Rehydration Solutions can be a very quick and effective way of replacing essential salts, vitamins and minerals that are lost whilst you have diarrhoea and your body is in a process of dehydration.

There are a number of home remedies for diarrhoea that have been promoted as effective solutions for diarrhoea. Many of these treatments work on the basis of balancing electrolytes in the body and tackling the issue of dehydration.

Diarrhoea tablets

Antibiotics are the most effective way to treat bacterial traveller’s diarrhoea and speed up your recovery times. Traveller’s diarrhoea medication such as Azithromycin and Ciprofloxacin kill bacteria in individuals travelling to South Asia and South East Asia, where the infection is most common.

Azithromycin

Azithromycin is an antibiotic used to treat a wide range of bacterial infections, such as traveller’s diarrhoea. It can also be used to treat pneumonia and chest infections, among others.

A typical course of Azithromycin consists of one pill (taken orally) per day, to be taken at the same time each day.

Ciprofloxacin

Ciprofloxacin is similar to Azithromycin in that it is a broad antibiotic for use in the treatment of a variety of infections. Ciprofloxacin is a member of the class of drugs known as quinolone antibiotics – inhibiting the growth of bacteria.

What can I do if my traveller’s diarrhoea symptoms aren’t improving?

It is very important to ensure that you take the basic steps highlighted in the above to ensure that you are giving yourself the best chance to recover. Please remember that dehydration is a common occurrence when suffering from any form of Diarrhoea.

Ensure that you take on enough water, salts, amino acids and sugars to match the liquids that are leaving your body as a result of the symptoms. The best way to do this is to use a solution like Dioralyte as well as isotonic drinks like Lucozade.

If your condition does not improve through holistic and natural means, you may require medical intervention in the form of antibiotics such as Azithromycin or Ciprofloxacin.

If you are abroad, contact a health professional, preferably a doctor or pharmacist so that you can present them with your symptoms.

If you have completed your course of antibiotics and are still suffering from the symptoms of traveller’s diarrhoea, contact your GP immediately.

What can I eat while I have traveller’s diarrhoea?

First and foremost, drink lots of water. A good method of ensuring you take on enough water is to take a sip from a bottle of water every 20 minutes, and to drink a full glass of water after every visit to the bathroom. You should aim to drink at least 1–2 litres of water a day.

What you can eat is largely dependent on how you feel and how your body responds to certain foods. Start out with small meals and stick to light foods like brown rice and toast to gauge how you feel. Avoid eating heavy or spicy foods like curry, and try to avoid meat until your bout of diarrhoea has passed.

As your condition improves, and your appetite returns, it is advisable to consume foods rich in electrolytes like bananas, rice, fruit juice, spinach, cheese and clear soups. Remember to keep drinking plenty of fluids throughout and after your condition has improved

Takeaway tips –

Drink: Regular sips of water, especially after using the bathroom; Isotonic drinks like Lucozade and Gatorade; electrolyte solutions such as Dioralyte;

Eat: Plain rice; plain toast; bananas; clear soups

Avoid: Meat; heavily spiced curries or stews; deep-fried or oily foods.

Sources

[1] British Medical Journal: Clinical Review – Management of Traveller’s Diarrhoea

[2] Health Protection Agency. Foreign travel-associated illness – a focus on travellers’ diarrhoea. 2010 report

[3] World Health Organisation (WHO) - Diarrhoeal Disease Factsheet; May 2nd 2017

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