27 Strategies To Deal With Diarrhea
Traveler’s Diarrhea: The Globetrotter’s Curse
Montezuma’s revenge, Delhi belly, Tiki trots. Whatever you call it, traveler’s diarrhea—the official name is turista—can dampen one’s spirits on even the best of vacations. “If you’re going to be abroad for any length of time, you’ll probably have some episodes of diarrhea,” says Stephen Bezruchka, MD, a frequent traveler. “Conceptually, it is totally preventable. In reality, it’s rare if you don’t get an occasional loose movement.”
In fact, you have a 50% chance of getting turista, even if you take the recommended precautions. The most common cause is theEscherichia colibacteria. This widespread little organism normally resides in your intestines and performs a role in digestion. But foreign versions ofE. coli—and to a foreigner, the American version is foreign—can give you diarrhea by producing a toxin that prevents your intestines from absorbing the water you ingest in the form of fluid and food. As the toxin prevents the absorption of water, you have all this extra water in there, and it’s got to come out, Bezruchka says. “The toxin doesn’t get absorbed. You don’t usually feel sick, but you might feel you have to pass some gas. Only it isn’t gas at all.”
Shigella and salmonella bacteria can also produce turista, while a smaller number of cases are caused by rotavirus and the giardia parasite. Changes in diet, fatigue, jet lag, and altitude sickness have been blamed but without sufficient proof, and up to 50% of all turista cases are unexplained. Luckily, there are ways to help your body fight turista. Here’s what doctors suggest:
- Drink water, water anywhere.When you have turista, your stools are mostly water. So why would the most important treatment be to drink plenty of the right fluids? Because dehydration, the loss of water and electrolytes, can kill. “A lot of what you take in will be pumped right back out the other end,” concedes Thomas Gossel, PhD, RPh. “But you’ll reach a point where you stabilize and begin retaining it. If you didn’t replace any fluids at all, you could become dehydrated in a day.”
- Put your bladder to the test.The yellower your urine, the more fluid you need. It should be clear or pale yellow.Use a rehydration solution.An even better way to rehydrate is to drink an ORS, also known as an over-the-counter rehydration solution. These drinks contain sugar and salt and help replace important electrolytes that are lost through diarrhea. They also help your intestines absorb water better. Over-the-counter rehydration solutions are readily available in the United States, so you can buy and take them with you. Brands include ReVital and Pedialyte.Choose a backup beverage.If you didn’t manage to pack an ORS, drink clear fruit juices or weak tea with sugar.
- Get in the pink.Pepto-Bismol, the well-known over-the-counter stomach medication, can be the traveler’s friend. It makes stools bulkier and firmer, and it kills bacteria. Don’t worry if your tongue and diarrhea turn black. It’s a natural side effect of Pepto-Bismol.
- Wine a little.No Pepto in sight? Knock back a glass of wine (red or white). One study found it worked as well or better than the pink stuff. The alcohol’s antibacterial properties killed off bacteria that cause traveler’s diarrhea within 20 to 30 minutes. But no need to overindulge—one glass is probably enough. Researchers estimate that 6 ounces of wine is all it takes to get the benefits.
- Do a little coaxing.Natural fiber-based laxatives for relieving constipation, such as Metamucil and Citrucel, also help with diarrhea. Some can absorb up to 60 times their weight in water to form a gel in the intestine. “You’re still going to expel excess water,” Gossel says, “but it won’t be so runny.” Other brands are Equalactin, FiberCon, and Konsyl.
Of course, it’s best not to have to worry about traveler’s diarrhea in the first place. Here’s how to protect yourself:
- Avoid uncooked vegetables, especially salads, fruits you can’t peel, undercooked meat, raw shellfish, ice cubes, and drinks made from impure water (the alcohol in drinks won’t kill the turista bug).
- Ask if the dishes and silverware you use have been cleaned in purified water.
- Drink only water that’s been carbonated and sealed in bottles or cans.Clean the part of the container that touches your mouth with purified water. Boiling water for 3 to 5 minutes purifies it, as does adding iodine liquid or tablets.
- Drink acidic drinks like colas and orange juice when possible.They help keep down theE. colicount, the bacteria most responsible for digestive distress.
- Drink acidophilus milk or eat yogurt before your trip.The bacterial colonies established in your digestive system before your trip and maintained during it will help you reduce the chance of a turista invasion.
Do You Need To Call A Doctor For Your Diarrhea?
Diarrhea should normally leave you only slightly worse for wear. In infants, small children, elderly people, or those already sick or dehydrated from another illness, however, acute diarrhea can be particularly severe and demands prompt medical attention. Medical help is also needed if diarrhea doesn’t subside in 1 to 2 days, if it’s accompanied by fever and severe abdominal cramps, or if it occurs with rashes, jaundice (yellowing of the skin and whites of the eyes), or extreme weakness.
If there’s blood, pus, or mucus in your stools, call your doctor. “The most immediate risk associated with acute diarrhea is dehydration,” says Clearfield. “If an individual is having a major bout of diarrhea and isn’t taking in any food or drink during that time, you’re looking at a medical emergency.”
Panel Of Advisors
Stephen Bezruchka, MD,is a senior lecturer in the School of Public Health and Community Medicine at the University of Washington in Seattle.
William Y. Chey, MD,is director of the Rochester Institute for Digestive Diseases and Sciences and a physician in Rochester, New York. He holds positions of professorship at numerous universities in China and Korea, and is a fellow of the American Gastroenterological Association.
Harris Clearfield, MD,is a professor in the department of medicine at Drexel University College of Medicine and section chief in the department of gastroenterology at Hahnemann University Hospital, both in Philadelphia.
Sheila Crowe, MD,is a professor of medicine in the division of gastroenterology and hepatology in the Digestive Health Center of Excellence at the University of Virginia in Charlottesville.
Barbara Frank, MD,is a clinical professor of medicine in the division of gastroenterology and hepatology at Drexel University College of Medicine in Philadelphia.
Thomas Gossel, PhD, RPH,is former dean of the College of Pharmacy at Ohio Northern University in ADA.
Evangeline Lausier, MD,is a clinical assistant professor of medicine at Duke Integrative Medicine in Durham, North Carolina.
David A. Lieberman, MD,is head of the division of gastroenterology at Oregon Health and Science University in Portland.
Janet Maccaro, PhD, CNC,is a holistic nutritionist in central Florida.
Lynn V. McFarland, PhD,is a medicinal chemistry adjunct associate professor and epidemiologist at the University of Washington in Seattle and coauthor ofThe Power of Probiotics.
Ann Ouyang, MD,is a professor of medicine at Pennsylvania State College of Medicine and former chief of the division of gastroenterology and hepatology at Pennsylvania State University Milton S. Hershey Medical Center in Hershey, Pennsylvania.
Gannady Raskin, MD, ND,is dean of the school of naturopathic medicine at Bastyr University in Seattle.
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