Travellers' Diarrhoea

What is diarrhoea?

Diarrhoea (or diarrhea) - is classed as loose stools that pass through your system quickly, most often caused by a bowel infection called gastroenteritis. Depending on the cause of your condition, you may find the symptoms last for a short time, or they're connected to a long-term condition such as irritable bowel syndrome. For more information on this, you can read our 'What causes diarrhoea?' section below.

Once or twice can be extremely common, however more frequent stools cause discomfort that require additional assistance in the form of self-help techniques and antibiotics. Analytically speaking, it is characterised by a passing of watery stools more than three times a day for a period of at least three days, but it may vary for each individual.

If it is more often over a course of at least a few days, and you may find yourself rushing to the toilet, this is a severe case of diarrhoea that can be significantly improved with treatment.

What is travellers' diarrhoea?

Travellers' diarrhoea is mostly experienced by travellers during the first couple of days of arriving in a foreign destination, but can still occur after you've returned from holiday. Poor hygienic conditions could be the cause and travellers who aren't hardened to the bacteria in their new environment tend to develop symptoms as a result. Most people develop diarrhoea in a foreign country through contaminated food or water.

In what parts of the world am I most at risk?

The risk of developing travellers' diarrhoea is higher in some countries than others, which can be down to poor hygiene conditions in the particular country you're visiting or poor sewerage services. For example, if you're familiar with travelling, you will know not to drink the tap water in certain countries. Areas where you are at the highest risk of catching travellers' diarrhoea are:

Although the threat isn't as pronounced, there is also a slight risk if you are travelling to Eastern Europe, Russia, Southern Africa and some parts of the Caribbean.

What causes diarrhoea?

Both adults and children are affected by the same bowel infection medically known as gastroenteritis, and this is the main cause of diarrhoea the vast percentage of the time. The cause of a bowel infection can be broken down into 3 categories:

• Bacteria – Often spread through contaminated food
• Virus – Referred to as the norovirus or rotavirus
• Parasite – Often spread through contaminated water

The most common cause of gastroenteritis is bacterial. The parasite associated with diarrhoea is known as the giardiasis, and you may experience other symptoms detailed under the 'symptoms of diarrhoea'. In terms of the virus strain of diarrhoea, it is more likely to be the norovirus. This is the most common and is also referred to as the "winter vomiting bug". Like the parasitic versions of diarrhoea, you may get other symptoms that are detailed below.

Other causes of diarrhoea include:

• Irritable Bowel Syndrome (IBS)
• Food or drink allergy
• Mood changes (anxiety or stress)
• New medication*
• Certain conditions

These causes can be classed into short-term and long-term diarrhoea. For example, short-term is more likely to be a virus form of diarrhoea and connected to gastroenteritis, whilst long-term could be a condition such as IBS or something more serious.^[1]

Short-term diarrhoea

Diarrhoea are a couple of days is very common and often linked to a bowel infection. This could be either bacterial, parasitic or viral infection. The most common bacterial diarrhoea infection is linked to E. coli, salmonella and campylobacter. All of these are most commonly classed food poisoning.

Any mood changes or food allergies can also trigger a bout of diarrhoea, and you may find alcohol – or certain alcoholic drinks – can disrupt your tummy.

Long-term diarrhoea

Some conditions can cause diarrhoea and these are more often long-term causes. For most, it will be irritable bowel syndrome (IBS) that means your stomach is much more sensitive to certain foods and drinks, or for women, your menstrual cycle can trigger this. Inflammatory bowel disease, coeliac disease, chronic pancreatitis, diverticular disease and bowel cancer can all cause diarrhoea making it important to see your doctor if you are suffering from frequent, severe and long bouts of diarrhoea.

*Medication such as antibiotics, statins, laxatives, non-steroidal anti-inflammatory drugs (NSAIDs) and selective serotonin reuptake inhibitors (SSRIs) can all cause diarrhoea – laxatives more deliberately so – which will be detailed under the side effects in the patient leaflet. For most, this is usually a temporary effect.

What are the causes of travellers' diarrhoea?

For travellers' diarrhoea, the majority of people contract the condition due to poor hygiene conditions, especially those they aren't used to. More than 80% of cases occur as a result of bacteria, while the rest are either due to a virus or a parasite. The Escherichia coli (e-coli) bacteria is the cause of illness in roughly 4 out of 10 cases, and is mostly found in undercooked beef or unpasteurised milk and faecal matter.

Symptoms of diarrhoea

The primary symptom of diarrhoea is watery stools (faeces or 'poo') that are frequent, however depending on the cause of the condition, you may be experiencing other symptoms as well.

Dehydration also has a number of symptoms that will require quick medical assistance. This includes drowsiness, lightheadedness, rapid heartbeat and muscle cramping. For more information on dehydration, head to the NHS then seek medical attention as soon as you can. Other symptoms along with diarrhoea that require assistance from your GP including blood in your stools, severe symptoms, continuous stomach ache or vomiting, inability to drink and if your poo is dark.

Although these symptoms are very uncomfortable, most people tend to feel better after two or three days. In most cases, where it's been caused by something other than bacteria, it could last for up to a month or more, however this is extremely rare.

Benefits of treating diarrhoea

For many, diarrhoea is temporary and will pass however treatment will alleviate symptoms and clear up the condition quicker. Many opt for medications such as Imodium to get rid of a short-term diarrhoea bout, and even those with long-term conditions such as IBS find this help considerably.

• Eases discomfort
• Reduced bowel movement

• Quick treatment can lead to recovery of strength and wellbeing

Getting rid of the condition quicker obviously eases discomfort and allows you to carry on with your life free from worry and lack of confidence. For those with long-term diarrhoea and are unsure of the cause, it's essential that you visit your doctor. There is absolutely no need to feel embarrassed, and it could be linked to a more serious issue.

How to treat diarrhoea

Some prefer to let the condition run its course, especially if it lasts just a few days, however the bigger percentage decide to use medication. It means the symptoms will pass more much quickly in a manageable fashion, allowing you to continue with your life; especially considering the rest of your body and mind is perfectly healthy and adept.

Antibiotics - In cases where the causes of diarrhoea are bacterial, a short course of antibiotics can be very helpful at speeding up recovery time. Antibiotic treatments kill bacteria, which reduces the amount of time it has an effect on your health.

Symptomatic relief - Treatments such as Imodium or Pepto-Bismol can help with loose bowel movements and can increase the amount of time your body has to absorb water. Medications such as Buccastem can help with symptoms like nausea and you can easily buy travellers' diarrhoea treatment online.

Keeping well hydrated - Although not strictly classed as a treatment for diarrhoea, drinking loads of water and using products to supplement your body with electrolytes can help you avoid becoming dehydrated during your illness.

Electrolytes as well as water are both important to help rehydrate your body and you should preferably try and get enough of both during and after your illness. Food and drink that can help include:

• Bananas
• Salted crisps
• Rice
• Clear soups
• Clean water
• Fruit juice
• Fizzy drinks

Electrolyte specific foods:

• Table salt
• Red meat
• Sardines
• Cheese
• Spinach and kale
• Sweet potatoes
• Potatoes

Many 'electrolyte' foods include a moderate level of salt that can help prevent and alleviate the symptoms of diarrhoea.

How to prevent diarrhoea

Diarrhoea is always completely preventable, especially if there are particular bugs going around, however there are ways you can help:

• Washing your hands – Particularly after using the bathroom and when preparing food
• Washing utensils – Keeping any shared utensils, towels and cutlery clean and limiting contact with any shared utensils
• Rest – To avoid spreading germs, rest for up to 2 days after a severe bout of diarrhoea to avoid triggering symptoms again and passing it on
• Keep clean – Not only yourself, but surfaces in the kitchen and bathroom should be cleaned with the appropriate disinfectant including handles, drawers and seats. If you have diarrhoea already, this preventing the bug spreading further
• Keeping raw meat separate – Raw meat has a higher risk of salmonella and should be kept apart from other food types
• Cooking meat properly – Whilst red meat can be near raw if stored correctly, other meats and seafood should be piping hot before eating to avoid food poisoning^[2]

If you're heading abroad, there are a couple of pointers you can use to avoid contracting travellers' diarrhoea:

• Before you leave, you can speak to your doctor or pharmacist about taking probiotic supplements. These supplements help to ensure that your intestinal flora is better able to handle the changes in bacteria associated with eating foreign food.
• You can also stock up on preventative antibiotics before you travel and always have plenty of tablets in your first aid pack.
When travelling to a high-risk destination, make sure:
• You don't drink any water if you are unsure of how clean it is. This is also applicable to ice cubes or the water you use for cleaning your teeth.
• Always purchased sealed bottled water.
• Fizzy drinks, coffee, tea, beer and wine usually tend to be safe to drink.
• It's important to keep away from food that isn't cooked or has been exposed to flies; this includes vegetables if you're unsure about its origin.
• Seafood should be avoided, even when well cooked, or get advice locally about where it is safest to eat.
• Avoid unpasteurised milk.
• Always wash your hands before eating and after you've been to the toilet.

What are the options we have to offer for diarrhoea?

HealthExpress offer the convenient Diarrhoea Travel Pack, so that you can be prepared, not only if you're heading abroad, but at home too. Useful for your first aid kit, the pack contains:

• Ciproxin (antibiotic treatment)
• Imodium
• Dioralyte (oral hydration aids)
• Buccastem

All provide symptomatic relief in cases where you are significantly uncomfortable and help to cure the condition.

Dr Hilary Jones, HealthExpress Medical Advisor

How do i deal with Travellers' diarrhoea?

Travellers' diarrhoea is extremely common, but you can limit the risk of travel discomfort and dehydration with the combination of treatments in the Travellers' Diarrhoea Pack.

Click here to find the right treatment for you