How To Prevent Traveler’s Diarrhoea

You may have heard of the infamous “Bali/Dehli belly” or “Nile runs” from friends after their overseas travels, or have even experienced some gastrointestinal (GI) discomfort yourself when travelling. 

These terms are nicknames for “traveller’s diarrhoea” (TD) – a condition you may experience whilst traveling which is characterised by where loose bowel movements (diarrhoea) and/or some of the other below symptoms (1, 2):

• Nausea 
• Vomiting
• Abdominal cramps, bloating and/ or pain
• Fever
• Blood in the stool (faeces/poo)
• Urgent and frequent need to use the bathroom

Cases of traveller’s diarrhoea can be mild, moderate or severe depending on the symptoms that occur. 

Usually, the condition is mild and will last around 3 days. Only about 10% of people who experience TD will have symptoms for more than 1 week (1, 3). 

TD is uncomfortable and can ruin a much-anticipated holiday. Luckily, it is preventable with good preparation including advice from the online dietitians at PNW Clinic. 

What causes traveller’s diarrhoea?

Similarly to food poisoning, TD can be caused by eating or drinking something contaminated with bacteria. Escherichia coli (or E. coli) is a pretty common one you may have heard of. This is the most common way to contract TD (3,4).  

Other causes include parasites from food, animals, or viruses (2, 5, 6).

The condition occurs when travelling to places with bacteria that the traveller may not have come across before and risk is increased with poor hygiene/sanitation. If an unfamiliar bacteria is ingested, the traveller may be at higher risk of experiencing TD than someone whose body has been exposed to that particular bacteria before (1). 

This explains why many travellers from developed countries experience TD when visiting developing countries with poorer hygiene and sanitation practices than their home country. This is because more (and unfamiliar) bacteria is present and contamination of food and water is common (7). 

TD is most common for Western travellers when visiting Asia, Africa, the Middle East, and Central and South America (8). 

High risk foods 

Eating some foods in particular can put a traveller at higher risk of experiencing TD. These foods include (9,10): 

• Fresh, raw fruit and vegetables (especially peeled)
• Raw or undercooked meat and seafood
• Raw or undercooked eggs
• Raw/unpasteurised milk and milk products
• Foods serves buffet-style or ‘charcuterie’ style
• Room temperature foods, including sauces that sit on a table (like mayonnaise)
• Foods from market stalls or street vendors that are sold out in the open – Fruit juice

These foods are all at higher risk of being contaminated with bacteria like E. coli1. An online dietitian from the PNW clinic can help a traveller prevent this condition by making suggestions on ‘safe’ foods that will be available wherever the traveller is going. 

Recommendations of foods considered safe may include cooked food, bottled water, sealed or packaged foods such as canned goods and fruit that requires peeling (1, 8). 

What about water?

Drinking contaminated water is another common cause of TD. 

The PNW dietitians recommend the following to avoid contaminated water (2):

• Avoid tap water if not sure of its safety
• Boil tap water for at least 5 minutes before use, if using (this includes using tap water to wash fruit and vegetables, or rinse a toothbrush)
• Buy bottled water
• Drink carbonated bottled water if possible
• Avoid ice or drinks containing ice

Can you prevent traveller’s diarrhoea?

As well as avoiding high-risk contaminated foods and drinks, there are some immunisations, antibiotic and non-antibiotic treatments that can help prevent TD (1, 11). 

While the online dietitians at PNW Clinic can help you plan ahead to avoid eating or drinking something that is contaminated, it is best to ask your GP about the other preventative methods mentioned.

Hygiene and sanitation are also especially important in preventing TD. Washing hands with soap often, or using alcohol-based sanitiser, can prevent bacteria contaminating foods and drinks (8). 

Treatment

Treatment of TD can be similar to other types of diarrhoea, with a goal of reducing symptoms and preventing dehydration. 

Recommended treatment includes (2,11):

• Staying hydrated with safe water (bottled, or boiled if bottled is unavailable)
• Electrolyte or rehydration supplements e.g. Hydralyte
• Salty foods
• Anti-nausea medication and/or antibiotics (remember to consult with a health care professional if starting antibiotics)
• Eating small, plain meals more regularly rather than three big meals – Avoiding dairy products, ‘unsafe’ foods, alcohol and spicy foods

Summary

Traveller’s diarrhoea is a common condition for travellers when visiting places with poor sanitation and hygiene. 

It is a preventable condition, primarily through good personal hygiene and avoidance of high risk foods and beverages. 

If TD is experienced, it usually does not last more than 3-4 days and there are many treatments available to reduce symptoms and prevent dehydration.

Antibiotics may be required for more severe cases of TD, but it is important to consult with a healthcare professional before accessing any prescription medication. 

If you want more advice on how to your minimise risk of developing TD, you can book an appointment with one of our online dietitians at the PNW clinic! 

Article written by student dietitian Lilee Lunney

Reviewed by PNW dietitian Jade Wrigley