This article explains the symptoms of traveler’s diarrhea, how to treat it, and the best ways to prevent getting infected in the first place.

Symptoms

Symptoms of traveler’s diarrhea caused by bacteria or a virus usually appear six to 72 hours after eating or drinking something contaminated. With some types of pathogens, it may take a week or longer for stool to be affected.

Changes in your bowel habits it the main symptoms of diarrhea. At its mildest, diarrhea involves passing loose, watery stool three times a day. You may pass unformed stool 10 or more times a day in severe cases.

Other symptoms vary depending on the type of bacterial or virus you’ve been exposed to but may include:

Stomach cramps Nausea Fever Vomiting Tenesmus, feeling you need to have a bowel movement even when your bowels are empty Belching Bloating Mucous in stool

More severe cases of traveler’s diarrhea may cause bloody stools.

Traveler’s Diarrhea Causes

The most common cause of traveler’s diarrhea is probably poor hygiene (lack of cleanliness) in restaurants. You’re most at risk when dining out in areas of Asia, the Middle East, Mexico, Africa, and South and Central America.

Pathogens are usually spread via the fecal-oral route. This means someone with the bacteria or virus excretes the germs in their feces. The feces may not be safely disposed of in a sanitary setting, or the infected person may not properly wash their hands before handling food and beverages. This allows germs to be transmitted to something you put into your mouth.

This cycle of contamination is most common in areas of the world that have specific conditions:

Warmer climates that promote germ growthPoor sanitation (such as open sewage areas)Unreliable refrigerationLittle education on safe food handling.

Common Bacterial Pathogens

The most common cause of traveler’s diarrhea is bacteria, which are thought to lead to 80% to 90% of cases. These include:

Escherichia coli or E-coli Shigella Campylobacter jejuni Salmonella

Ingesting these bacterium causes gastroenteritis, which means the stomach and small intestines become inflamed. This leads to diarrhea.

Common Viral Pathogens

Viruses can also be transported via the fecal-oral route. The most common types of viruses that cause diarrhea include:

Norovirus Rotavirus Astrovirus

Viral infections of the digestive system are often referred to as stomach flu. The illness has no connection to respiratory influenza, but like the “flu,” it usually lasts a short period.

Complications

Dehydration is one of the most common complications related to any form of diarrhea. Multiple bowel movements that release a lot of fluid can cause you to have too little water in your body.

Parasites, or protozoal pathogens, can also cause diarrhea. In these instances, you’re more likely to develop symptoms one to two weeks after exposure to the pathogen.

Severe dehydration can lead to problems such as:

Fatigue and muscle weakness or pain Headache Dizziness or lightheadedness Increased heart rate and breathing Confusion Kidney Failure Death

Dysentery is a serious condition that can develop from exposure to Shigella or parasites. It usually causes bloody stool, fever, and extreme dehydration. It can be fatal if it’s left untreated. In addition to being picked up from contaminated food or water, the bacteria or parasites that cause dysentery can be passed from person to person in close contact, or you can get it by swimming in unclean water.

Treatment for Traveler’s Diarrhea

Getting sick while far from home is more than just inconvenient. The sudden onset and severity of symptoms can be frightening. Often, symptoms will last a few days and resolve on their own, but you may need to manage the condition and take medication.

Fluid Replacement

To manage dehydration, you want to concentrate on getting enough liquids even if you feel like you don’t want to put anything in your stomach.

Drinking any safe fluids can manage mild cases of traveler’s diarrhea. Since tap water may be a source of infection, you need to boil non-bottled water and let it cool before you drink it. You can also drink boiled broth or prepackaged (non-citrus) fruit juice. Sports drinks like Gatorade are good, too, but not essential.

For severe dehydration, an oral rehydration solution may be needed. These are mixes or packaged beverages that contain glucose and electrolytes such as potassium and sodium. Pedialyte is an example of an oral rehydration solution for kids.

Sweating can cause dehydration as well. Try to find a cool place out of the sun to rest while you rehydrate.

Antibiotics

Antibiotics may be used for traveler’s diarrhea caused by bacterial infections. A stool test should be done to identify which antibiotic might work best.

Quinolone antibiotics such as Cipro (ciprofloxacin) are most often used when antibiotics are needed.

A single dose of 750 milligrams (mg) for adults is the typical treatment. Children may be given 20 to 30 mg per kilogram of weight per day.

In some areas, bacteria are resistant to quinolones, which means the medication won’t help. This is especially a problem in Southeast Asia. Another antibiotic, azithromycin, may also be used in this case, although some strains are resistant to it.

Upset Stomach Medication

Pepto-Bismol can provide short-term relief of symptoms. However, it may not be effective in small doses, and high doses put you at risk for a health condition called salicylate toxicity. Additionally, Pepto-Bismol is not recommended for people younger than 18 years because there’s a risk of a condition called Reye’s syndrome.

Antidiarrheal Agents

It might seem logical to reach for an anti-diarrheal product such as Imodium (loperamide) or Lomotil (diphenoxylate). However, these products should not be used if your diarrhea is related to dysentery or if you see any signs of blood in your stools.

An antidiarrheal agent should only be taken with an antibiotic. When using an antidiarrheal for traveler’s diarrhea, it is especially important to keep yourself well-hydrated. Discontinue the product if your symptoms worsen or you still have diarrhea after two days.

Prevention

To help prevent traveler’s diarrhea:

Wash your hands with soap and water after going to the bathroom and before eating. At restaurants, only eat foods that are cooked and served hot. Drink beverages from factory-sealed bottles or containers. Don’t get ice in your drink since it may be made with contaminated water.

There is evidence that Pepto-Bismol may protect against traveler’s diarrhea. Studies have shown a protection rate of about 60%. However, not everyone should take Pepto-Bismol, including those who are pregnant or are 18 years of age and younger.

Don’t take antibiotics or antidiarrheal medicine like Pepto-Bismol as prophylaxis—that is, to prevent traveler’s diarrhea— unless it’s been recommended to you by your healthcare provider.

Summary

Bacteria and viruses can live in water and food. These pathogens (germs) are most common in areas where the climate is warm, refrigeration is unreliable, and there isn’t proper hand washing or bathroom sanitation. Infection with these pathogens (bacterial or viral) can cause traveler’s diarrhea.

Traveler’s diarrhea will often resolve on its own once the bacteria or virus is out of your system. However, you may need antibiotics. You may also need to manage symptoms by staying hydrated and using over-the-counter medications. You should contact your healthcare provider if symptoms last more than a few days.

When traveling to regions that have warm climates and relaxed hygiene practices, be sure to take steps to avoid eating or drinking anything that could have pathogens. Drink pre-packed or boiled water and ensure food is handled properly.