Traveler's diarrhea: what is it, how to prevent it, and what to do about diarrhea abroad?

What is diarrhea, and what is traveler's diarrhea?

• Diarrhea is a loose, watery stool.
• Diarrhea is also called traveler's diarrhea.
• More flowery descriptions include: the runs, the skitters, Gippy tummy, the squits, a Delhi Belly, the Aztec Two-step, Turista, the Malta Dog, the Rangoon Runs, or Montezuma's Revenge.

What else do you experience with diarrhea?

• In addition to loose, watery stools, you also regularly experience abdominal cramps, nausea, fever, and flatulence.
• Your body tries to eliminate the germs that caused the diarrhea as quickly as possible, so the intestines don't have time to remove moisture from the stool. This makes the stool extra watery and thin, and you have to go to the bathroom several times a day.
• In severe cases, blood or mucus may appear in your stool (do not take antidiarrheal medication in this case!).
• Many travelers experience diarrhea during the first two weeks of their trip.

How do you get traveler's diarrhea?

• Traveler's diarrhea can be caused simply by a change in your environment, daily routine, a lack of stress, or simply by the tension of the new travel environment.
• A more unpleasant and dangerous cause is diarrhea caused by drinking contaminated water or eating contaminated food.
• Undercooked food often contains bacteria that cause diarrhea.

How can you prevent intestinal problems and diarrhea while traveling and backpacking?

• Preventing diarrhea starts with safe and clean food and drinks.
• Another measure is washing your hands regularly.
• Bacteria can be transferred from your hands to your mouth, for example, when peeling fruit or simply by placing your unwashed fingers too close to your mouth.
• In many cultures, it's normal to eat with your hands. If you don't wash your hands regularly and correctly, you can quickly suffer from diarrhea.
• There are countless ways to wash your hands. It's important to rub your hands together thoroughly for at least twenty seconds, and to wash your nails thoroughly as well. Use soap if available.
• Sanitizing gels are often used as a substitute for washing your hands with soap. An ideal emergency solution, but not a full-fledged substitute for soap in terms of disinfection.
• Don't dry your hands with a dirty cloth after washing.

When should you take action if you have diarrhea?

• If your diarrhea lasts longer than a few days and is accompanied by a high fever (higher than 38°C or longer than 24 hours), see a doctor.
• When diarrhea is accompanied by fever, bleeding, nausea, or vomiting, the risk of dehydration is greater, and diarrhea can become dangerous.
• For children under 2 years old, contact a doctor immediately after the first day.

What should you do if you have diarrhea?

• The greatest risk of diarrhea is dehydration. So pay close attention to your urine; if it is scanty and dark in color, you need to drink more! It's important to keep drinking plenty of fluids to prevent dehydration.
• Avoid alcohol and coffee. No special diet is necessary.
• It's helpful to follow a "light" diet on the first day. For example, tea with a little sugar, cooked rice, bottled water, or even easier, a saline solution of ORS. This is a sugar/salt solution to replace the loss of minerals and salts. Drinking ORS helps retain fluids in the body better than drinking only water, tea, or soda. It also often helps prevent diarrhea. You can dissolve a sachet of ORS in a glass of water, but if you don't have any with you, you can make your own by dissolving sugar and salt in water.
• For very young children and adults over 70, it's recommended to take ORS immediately when experiencing diarrhea.
• Tips about not eating unwashed vegetables are nice in theory, but impossible in practice. There's simply no way around it. However, you could consider sticking to a vegetarian diet as much as possible or being very selective about where and when you eat meat (and which ones!). Always have plenty of backup food with you so you can skip that dirty road restaurant.
• Diarrhea can also reduce the absorption and effectiveness of medications (including malaria pills like Malarone and Lariam) and contraceptives, so you should take this into account.

What can you do about traveler's diarrhea if you are pregnant or very young?

• It is recommended not to use antidiarrheal medication during pregnancy, for children under 2 years of age, or for diarrhea accompanied by blood or fever.
• Consult a doctor about what is necessary in your personal situation.

Can you treat diarrhea with antidiarrheal medications, and which medications help with diarrhea?

• Do you have traveler's diarrhea? This usually goes away on its own after a few days. It is also possible to stop the diarrhea symptom without addressing the underlying problem. This can be done with so-called antidiarrheal medications. Examples include medications based on loperamide or activated charcoal (such as Norit).
• Medications like Norit rarely help with diarrhea. Moreover, they are not recommended because they reduce the effectiveness of other medications (such as antimalarials and contraceptives). These also make it difficult to detect any blood in the stool.
• If you have a 10-hour bus ride ahead of you, with only two stops along the way, you can also use an antidiarrheal medication such as Loperamide (Imodium). Loperamide doesn't cure diarrhea, but it slows down bowel movements and thus reduces diarrhea.
• There are other antidiarrheal medications with stronger effects. Read the instructions carefully, because you often shouldn't take these types of medications if you also have a fever or if the condition is more serious than traveler's diarrhea.

When to prefer antidiarrheal medications containing loperamide?

• If you're traveling and have hours left on the bus, it's very wise to carry antidiarrheal medication containing loperamide with you.
• These pills slow down the process that diarrhea goes through, so your body is able to absorb more fluid from the intestines and you'll have less loose stools.
• Note: this doesn't address the cause of diarrhea! In any case, you don't have to worry about waiting for your next stop, or worse...
• If you have more time and are often near the restroom, you can take over-the-counter products based on activated charcoal. This product absorbs water, bacteria, and potential toxins, thus addressing the cause of diarrhea. Note that activated charcoal hasn't been sufficiently proven to rely solely on this.

How to choose between loperamide, activated charcoal, or tasectan for fighting diarrhea?

• Loperamide reduces diarrhea. You'll need to go to the bathroom less often. Essentially, it causes constipation, which is very useful when you're traveling for a long time and can't always go to the bathroom when necessary. Loperamide is not used as a cure and is for temporary use. The most common antidiarrheal medications contain loperamide.
• Activated charcoal is claimed to address the cause. This activated charcoal absorbs and removes toxins from your body. The effectiveness of this medication is not yet sufficiently scientifically proven to fully rely on this. It also absorbs medications and hormonal contraceptives and masks blood in stool (activated charcoal turns your stool black).
• Tasectan is a medication that is also claimed to address the underlying cause. Tasectan ensures that the intestinal wall absorbs sufficient fluid again. This prevents fluid from being removed with the stool, thus resolving the diarrhea. Tasectan can be used for very young babies. While its effectiveness has not yet been sufficiently scientifically proven, there are no known major drawbacks.

What about using activated charcoal in combination with other medications?

• When using activated charcoal, Norit or other charcoal tablets, you should be careful when taking other medications. Activated charcoal is an absorbent and can therefore also absorb substances from other medications. It is advisable to wait 2 to 4 hours before taking another medication. You also need to be extra careful with contraceptives like the pill! Activated charcoal (including Norit) also absorbs your anti-malaria pills, eliminating the desired protection!
• Note: Norit causes black stools, which can mask any blood in your diarrhea.