Traveler’s Diarrhea, Montezuma’s Revenge: Causes, Treatments, and Prevention

Eighty to 90 percent of traveler’s diarrhea is caused by bacteria and can be prevented with some thoughtful advance planning and travel tips.

Traveler’s diarrhea leads to frequent diarrhea three to 10 times a day, often with vomiting, abdominal cramps, bloating, and gas. This scourge, also known as “Montezuma’s revenge,” is common among travelers to Mexico and other Latin American countires, as well as to the semitropical regions of Africa, Asia, and the Middle East. Between 30 to 70 percent of people traveling to developing countries are laid low with diarrhea, depending on season and destination as well as individual susceptibility. However, some people get traveler’s diarrhea when entering the United States or other industrialized nations, or when traveling on cruise ships. You may become more exposed if your food habits or environment change.

What causes traveler’s diarrhea?

Eighty to 90 percent of traveler’s diarrhea is caused by bacteria, including certain strains of E. coli found in faeces and other germs spread by tainted food or drink, for example. It can also be brought on by parasites like Giardia lamblia and viruses like the norovirus.  Symptoms usually appear within six to 72 hours, with sudden attacks of loose watery stools, often accompanied by abdominal cramps and nausea.

What if you do nothing?

In generally healthy persons, traveler’s diarrhoea does not pose a life-threatening concern. If you drink plenty of water, you may be uncomfortable, but the condition will clear up on its own—often within two to seven days. In some cases, mild symptoms may last for weeks. However, symptoms may persist for months if a parasite like Giardia lamblia is to blame.

Home remedies for traveler’s diarrhea

  • Replace lost fluids. Your goal is to prevent dehydration, which occurs often with diarrhea because the body loses more fluids and electrolytes than it takes in. The most important self-care measure is to rehydrate yourself as soon as you can keep down fluids. Tea, flat soft drinks, sports drinks, and bottled water are all beneficial. Some travelers carry a powdered hydration mix with them—you can buy these online or in drug stores—and mix it with bottled water. You can also make your own rehydration drink by adding four teaspoons of sugar and ½ teaspoon salt to a quart of bottled water. Note: Children under age two should drink a commercial rehydration solution, which contains the correct amounts of fluid, salts, and carbohydrates to prevent dehydration.
  • Avoid coffee and alcohol. Caffeine and alcohol can increase dehydration.
  • Eat. Salted crackers are a wonderful method to start eating again since the salt helps to balance fluids if you haven’t had diarrhoea for 12 hours. Dry toast, bread, and clear soup are further options. You can add rice, baked potatoes, clear soup, chicken, applesauce, and bananas if your bowel movements become more regular and your stools take on some structure. Do not consume raw fruit or salad.
  • Self-treat with medication, if necessary. If you are otherwise healthy, it’s generally best if you give your body a chance to eliminate the germ or parasite causing the diarrhea. However, if you are in a situation where diarrhea is inconvenient, you can decrease symptoms with over-the-counter medications. Loperamide (such as Imodium) reduces the duration of diarrhea by up to 80 percent. Pepto-Bismol, which is also available in generic form, contains bismuth subsalicylate, which cuts loose stools by roughly 60%. However, bismuth subsalicylate should not be used by those who are aspirin-sensitive, have renal disease, gout, or are taking anticoagulants. neither ought to younger kids (under 12). Consult your doctor before using any anti-diarrhea drugs if you are on aspirin treatment.
  • Get a prescription for antibiotics before you travel. If you’re traveling to areas without doctors close by, ask your own doctor to write you a prescription for antibiotics, and fill it before you leave on your trip. Your doctor can give you directions as to when and how to take the antibiotic. These drugs are generally reserved for when you have fever and bloody stool.
  • If you have high fever or bloody stools on your trip, seek immediate medical attention. These symptoms could indicate a severe infection. Don’t take anti-diarrhea medicines if you have a high fever or bloody stools—the medications may make your condition worse.

How to prevent traveler’s diarrhea

Follow these guidelines while travelling to underdeveloped nations.

  • Find out about health precautions. The Centers for Disease Control and Prevention (CDC) travel page can supply you with information about health risks in different countries. It’s also a good idea to get advice from a doctor who specializes in travel medicine before you go, especially if you are pregnant, nursing, traveling with a small child, or have chronic health problems. Also consult with a travel medicine specialist if you’re taking a critically important business trip that would be compromised if you developed traveler’s diarrhea.
  • Take diarrhea medications with you. If you’re traveling to an out-of-the-way place, take a diarrhea treatment along. If you have any health concerns, consult your doctor, who can recommend an over-the-counter product or a prescription medication such asdiphenoxylate/atropine (brand name Lomotil).
  • Consider taking Pepto Bismol once you arrive. Many experts in travel medicine suggest taking Pepto Bismol as a preventative measure the entire while you’re travelling. It can cut the risk of traveler’s diarrhea by as much as 50 percent. But in order to be effective, the regimen must be strictly adhered to, which necessitates consuming a lot of chewable tables. Before each meal and before going to bed, chew two pills. The drug may temporary stain your tongue and stool black. (Again, if you are on aspirin therapy, talk with your physician first.)
  • Don’t rely on antibiotics or anti-diarrheal drugs other than Pepto Bismol to prevent traveler’s diarrhea. When travelling, it’s a good idea to include antibiotics and anti-diarrhea medication, as well as information on how to use them if necessary. With the exception of Pepto Bismol (see bullet above), however, taking drugs as preventative measures is generally not advised because some of them might have serious negative effects. Additionally, consuming them may deceive travellers who may normally exercise caution while selecting food and beverages.Note: Your doctor might advise you to take antibiotics before travelling if you have a health issue. Do as your doctor instructs.
  • Drink only bottled or canned beverages once you are there. Make certain that you are the one who opens the seal. Or limit yourself to hot beverages like freshly brewed coffee or tea. Beer and wine in bottles are secure. Avoid fresh juice since it can have had tap water or ice added. As well, stay away from raw milk. Stick to steaming hot tea and coffee if you’re unsure.
  • Never use tap water. Even for tooth brushing, switch to bottled or heated water. In the shower, avoid swallowing water.
  • Pass up all ice cubes. The water used to make the cubes could have been tainted, because freezing does not usually destroy microorganisms. If ice cream contains unclean water, stay away from it.
  • Don’t eat anything raw—particularly salad greens. Fruit that can be peeled and that you peel yourself is OK when it is raw. Make sure to avoid washing the fruit in tap water. Chutneys and salsa sauces should be avoided, along with any sauce or garnish created from uncooked produce. You cannot be certain that raw meat, raw eggs, raw fish or shellfish, or any dairy products have been pasteurised.
  • Stick with food served piping hot. That means avoiding buffets where the food is left standing at low temperatures, where it may have been exposed to flies carrying germs.
  • Don’t buy food from street vendors. Even when served hot, food might still be tainted.
  • Wash your hands carefully. Wash your hands with soap and water after using the restroom and before eating to stop the spread of diarrhoea and eliminate any possibility of reinfection. When there is no clean water available for washing, disinfecting alcohol wipes come in handy.

What your doctor will do

Contact a doctor if you have diarrhea that lasts more than four days without improvement, a fever of 101˚F or higher that lasts more than 24 hours, or if there is blood in your stool. A doctor also should be contacted immediately if severe diarrhea occurs in infants, elderly people, or people with heart disease.

The doctor will review all your symptoms and perhaps take a stool sample to detect the organism causing your problem. If you have frequent diarrhea and painful cramps, the doctor may prescribe medications to relieve symptoms, especially if you have serious heart disease or a weakened immune system. Treatment will stop the diarrhea in about a day, compared to two to four days without medication. Anti-diarrhea medicine can slow your body’s ability to eliminate the germ from your digestive tract, so the doctor may not recommend it if you are otherwise healthy.

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